AUGUST 2013 - New Zealand Doctor

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RNZCGP Review of the delivery of general practice vocational training August 2013In relation to the minimum time requirement in general practice, New Zealand general practiceregistrars are required to undertake at least 18 months, although many spend the majority of theirthree years in general practice. The exceptions are those registrars who want to achieve dualfellowship in rural hospital medicine and general practice and who are on the rural hospital medicineprogramme concurrently. For several international programmes, one year is compulsory and othertime is optional.PROGRAMME STARTThe review has identified two options available to the College regarding when to accept trainees ontothe GPEP programme.Option 3.1: Status quoThis option would see a continuation of the status quo. Registrars would be interviewed for theprogramme at a time in their career when they had determined they wished to enter general practiceand had completed the required prerequisite number of hospital runs. This is possible from PGY3,but would be likely to continue to attract registrars at PGY5+.Option 3.2: Encourage engagement with the programme from PGY3A PGY2 applicant could apply and be provisionally accepted subject to the completion of specifichospital runs. This would fit with the desire in the sector to have registrars assigned to trainingprogrammes earlier.The registrar would commence the programme in PGY3. However, there would be an option for thisPGY3 year to be completed in the DHB (under DHB employment), including six months of othervocational scope training and related educational activities. Educational activities could be providedfor the other six months by the GPEP supervisor for four hours per week.Although the future GPEP registrar might have less time in clinical medicine prior to coming into GPtraining, there appears to be little support amongst the profession to increase the length of trainingbecause of this.Implementation of this option would involve discussions with DHBs to ensure they were comfortablewith GPEP trainees remaining in their employment for the PGY3 year, and also willing to facilitate therequired other vocational scope training and educational activities.HWNZ would also need to agree that funding would be available for both DHB-based employmentand College-provided education for a hospital-based PGY3.Over the three year training programme, registrars are required to spend six months in anothervocational scope and 18 months in ‘traditional general practice’. The registrars have some flexibilityregarding where they practice for the remaining twelve months although the majority of registrarsspend this time in general practice.The majority of GPEP registrars spend more than 24 months in general practice. However, making24 months in general practice a requirement for the GPEP programme would restrict the ruralhospital medicine and AMPA/CUCP programmes, therefore the required time spent in ‘traditionalgeneral practice’ should remain at 18 months.28
RNZCGP Review of the delivery of general practice vocational training August 2013Option 4: Registrar placementsPoints for consultation1. That the current model of registrar placement allocation is retained, and continues to focus on promotingrural and high need practices placements to registrars.2. Investigate sponsorship options for rural or high needs placements, either for the registrar or the practiceor both.3. Continue to provide training in all regions, while exploring ways of funding ongoing training in thoseareas that have small numbers of registrars in any given year.4. Investigate the feasibility of establishing and providing virtual learning clusters, to supplement, augmentor potentially replace, registrar learning in high cost locations.At present, registrars are allocated to accredited teaching practices on the basis of their learningneeds and the region that they request on their application form. This does have the potential ofcreating a regional imbalance if many registrars request to go to the same regions, especially largeurban centres. However this may be overcome by using the following four principles:• The current model of registrar placement allocation is retained, continuing to focus on promotingrural and high need practices placements to registrars.• Sponsorship options for rural or high needs placements, either for the registrar or the practice orboth, are investigated.• The College continues to provide training in all regions, while exploring ways of funding ongoingtraining in those areas that have small numbers of registrars in any given year.• The College investigates the feasibility of establishing and providing virtual learning clusters, tosupplement, augment or potentially replace, registrar learning in high cost locations.One of the biggest challenges facing general practice is the need for GPs in all regions of NewZealand, both urban and rural. This issue is further complicated by the ageing population of currentGPs, particularly in rural areas.There is anecdotal evidence that a GP registrar trained in a particular physical location will, oncetrained, remain in that location. This is supported by College research which shows there is a strongconnection between where registrars complete their GP training and where they practice after that.Research undertaken by the College in the course of this project is outlined in the following graphwhich shows that approximately two-thirds of registrars were in the same location four years aftercompleting their GPEP examinations.29
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AUGUST 2013 - New Zealand Doctor

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