AUGUST 2013 - New Zealand Doctor

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RNZCGP Review of the delivery of general practice vocational training August 2013This model works because the majority of training occurs while the registrar is a College employee,although it has its limitations such as the intensive early training leaving less time for on the jobeducation.Option 2.2: Alternative employment and educational funding modelThis model would see the College becoming the employer of GPEP registrars for the full threeyears that they are on the programme. The College would continue to place registrars in a variety ofpractices enabling ongoing focus on high needs and rural practices.The registrars would be sub-contracted to the practice in which they train. The practice would paythe College for the services provided by the registrars. The subcontract rate may be less than thetotal salary as a reflection of the teaching and supervision required by a registrar and his/her level ofexperience.As employer of the registrar, the College would have significant input into the conditions and hoursthat the registrar is required to work and could therefore protect a registrar’s learning time. This wouldallow an increase in the amount of educational delivery in GPEP Years 2 and 3 and also endorse thelearning to occur during daytime hours rather than the current evening groups that are run.The College would also be able to set the salary rates for the registrars. At present GPEP registrarsalary rates, especially in Years 2 and 3, are more than those of their hospital-based peers who arepaid based on the MECA salary scale. This option would pay GPEP registrars using MECA as aguide and in accordance with the MECA scale.As an incentive to join the programme, practices would be guaranteed a GPEP registrar, althoughthere would be no guarantee of the year of that registrar. This would enable the practice to build upa patient base to ensure income from the registrar’s service (capitation funding). Practices would beentitled to generate income from the registrar’s service and this income (less subcontract paymentsto the College) would pay the practice for time spent teaching/supervising.This model would allow the College to spread HWNZ funding over the three years of training tobetter reflect the hours of educational delivery in each year of the programme. It would rely onfunding being commensurate with other vocational scope funding over the three years of training.HWNZ would continue to pay at the same rate as currently, but less of that money would go towardsemployment as this cost would be shared by the practice.The practice would not pay much more overall than currently for GPEP Years 2 and 3 employment,but they might be working at a loss with GPEP Year 1 registrars. Therefore it would encouragepractices to have multiple levels of registrars to mitigate against this loss and therefore supportvertical integration as part of education delivery.This is similar to the model currently used in Australian regional training programmes, with moneyfrom GP education and training going to both education and employment. In the earlier part oftraining, more money goes to offset employment costs and then reduces as expertise is gained andvalue to the practice increases. The College fee is separate from registrars’ contribution to education.26
RNZCGP Review of the delivery of general practice vocational training August 2013Option 3: Start point, length of training programme and othervocational scope requirementsPoints for consultation1. To ensure MCNZ requirements are met, future registrars should be interviewed during PGY2 andattached to the GPEP programme from PGY3. There should be an option to complete the PGY3 withina DHB.2. Discussions to be held with HWNZ and DHBs to determine the feasibility and funding requirements ofa PGY3 training year being completed within DHBs.3. The length of the GPEP programme remains at 36 months, although some registrars may complete anadditional year (PGY3) in a hospital setting.4. The time spent in ‘traditional general practice’ during GPEP training remains at 18 months.5. That runs in either high needs, Māori/Pacific or rural practice are explored with the concept thatcompletion of six months in one of these runs is undertaken during training.Registrars who enter the GPEP programme do so with a range of medical training backgrounds,experience and other vocational learning.Currently registrars can start the GPEP training programme at PGY3 and go directly into generalpractice with no other vocational scope training required. Commencement of GPEP training at PGY3is often not possible as the prerequisite number of hospital runs has not been completed. Forty-twopercent of registrars do not begin GPEP training until PGY5+ often for this reason.INTERNATIONAL COMPARISONThe table below shows a comparison between the start point and length of the New Zealand GPtraining programme and other international GP programmes, as well as other New Zealand medicalprogrammes.ProgrammeStart oftrainingLength of vocational trainingNZ GP PGY3 3 years (4 years for rural hospital fellowship, reduced withrecognition of prior learning).Australia GP PGY2 3 years (4 years for rural and remote medical registrars, reducedwith recognition of prior learning).Canada GP PGY1 2 years (+1 extra year option taken by most trainees)Netherlands GP PGY3 3 yearsUK GP PGY3 3 yearsUSA GP PGY1 3-4 yearsNZ Psychiatry PGY3 5 yearsNZ Physician PGY2 6 years27
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AUGUST 2013 - New Zealand Doctor

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