AUGUST 2013 - New Zealand Doctor

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RNZCGP Review of the delivery of general practice vocational training August 2013Option 11: Community-based pre-vocational trainingPoints for consultation1. That the College engages with MCNZ to help develop the definitions of community-based training andplacement.2. That the College (in the first year) expands the current PGGP programme to 170 placements perannum, with placements occurring in all practice settings, but promoting rural placements. If there isdemand from PGY1/2 interns, the programme should be expanded to 300 placements over the nextthree to five years.3. To achieve this, additional funds will be required from HWNZ or other sources (potentially allocatedbetween DHBs and the College), along with agreement with the DHBs for consistent employmentterms and treatment of all interns as they move into, and out of, the PGGP programme.4. The College begins discussions with HWNZ and DHBs as soon as possible to ensure implementationcan be achieved prior to the MCNZ community-based training requirements beginning.5. That interns involved in the PGGP programme be offered provisional membership to the College.6. Depending on numbers of interns entering the programme, and MCNZ’s definition of community-basedtraining, the feasibility of a generalist primary care-focused placement programme be explored.In New Zealand, PGY1 and PGY2 training is completed in a hospital without any, or minimal, inputfrom, or contact with, GPs or the College. If the College is to increase the profile of a career pathwayin general practice, more interaction is required between the College and the PGY1/2 interns.MCNZ has proposed introducing the requirement for PGY1/2 interns to complete three monthscommunity-based training. This training will not need to be completed as a single block, nor does thistraining need to be in a general practice setting. The College endorses this proposition as a focuson generalist training that can be provided in a community based setting will help upskill the PGY1/2trainees so they are more ‘fit for purpose’ on entering GPEP. The current PGGP programme isrurally-based and the College would like to preserve the value this adds to generalist training.The College currently provides a three month rural general practice-based placement programme(PGGP) for PGY2/3 interns with funding 50 PGGP placements per annum.Current numbers indicate that 350 PGY1/2 interns will complete community-based training eachyear with a number wishing to complete this in a general practice setting. However it is likely thatcommunity-based training will also be provided by up to nine other vocational scopes for exampleaccident and medical practice, palliative medicine or sexual health medicine etc.One scenario is that the programme offered by the College, that is already established and hasan excellent reputation, is positioned as the programme of choice for interns. Assuming the otherscopes have five interns/placements each, that would leave approximately 300 interns on the PGGPprogramme (see table opposite).Another scenario is that the other vocational scopes establish programmes that gain reputations ofexcellence. In this scenario, it could be assumed that the 10 vocational scopes share the internsevenly and therefore attract 35 each to their programmes. The middle ground is that the 170 interns,who are likely to choose general practice as their registered vocational scope, will join the PGGPprogramme.42
RNZCGP Review of the delivery of general practice vocational training August 2013Option 11.1 (status quo): PGGP placements retained at 50 per annumThe College would not extend its current PGGP programme and would not attempt to attract anyadditional interns to the general practice environment. This is viable if the other community-basedvocational scopes are able to provide training for an equal proportion of the PGY1/2 interns, or thatPGY1/2 interns are able to undertake their training through a variety of scopes within the DHB.Option 11.2: Expand existing PGGP programmeThe College would increase the number of PGGP placements to cater for some, or all, interns whowish to complete their community-based training in a rural practice.There are three potential challenges with the implementation of this option.1. Finding rural practices that are able to accommodate additional placements. While there may berural practices willing to take interns for a three-month placement, there is unlikely to be capacityto find between 120 and 250 additional placements per annum (over and above the current50 PGGP placements) even if there is flexibility in placement timeframes. There are currentlyapproximately 400 rural practices nationwide.2. This can be addressed by expanding the PGGP to all general practices willing to take an internfor a placement regardless of their physical location. It is possible that from this increased poolthe College could source the required placements, however this would detract from the ruralaspect of PGGP and may reduce the number of interns exposed to rural practice.3. Funding would need to be obtained for any additional placements. HWNZ provides the Collegewith funding of $30,000 per placement for the current PGGP placements and an administrationfund of $58,400 to support the 50 PGGP placements. If the number of placements increases, thenfunding for administration will also need to increase. The PGGP programme is a specialised ruralbasedprogramme and is funded as such. At the current level of funding 300 placements wouldrequire funding of more than $9,000,000 per annum, an unsustainable amount.But there is an option. Currently DHBs receive $31,000 and $18,000 per annum for PGY1 and PGY2training respectively. If this funding was directed towards community-based placements then prorated,the following funding (assuming a 50:50 split of PGY1 and PGY2) would be provided to thecommunity-based training providers.Total placements 35 170 300Funding $430,000 $2,080,000 $3,675,000Responsibility for intern salaries while they are on the programme would need to be determined.DHBs currently take inconsistent approaches to the PGGP programme. Some interns are requiredto resign from their DHB posts and reapply for their DHB positions on completion of the PGGPplacement while others are permitted by their DHB to take three months unpaid leave during theirPGGP placement.Presently interns on the programme are paid a bursary via the College. Agreement must be reachedwith all DHBs to ensure consistent employment terms. The bursary component of the PGGP fundingcould be used by the DHBs towards employee payments subject to agreement by all affected parties.IMPLEMENTATIONIf the challenges noted above can be addressed, implementation of the expanded PGGP programmecould begin, including reviewing PGGP syllabus material, in line with the MCNZ’s proposedcurriculum changes, training new practices and teachers, increasing support staff numbers and theestablishment of an e-portfolio.43
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AUGUST 2013 - New Zealand Doctor

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