Project updates

Latest updates on the GP training review will be provided here.

6 March 2012

Changes to the General Practice Education Programme (GPEP)

Health Workforce New Zealand (HWNZ) has been working with the Royal New Zealand College of General Practitioners (the College) and the Medical Council of New Zealand (MCNZ) on changes to the general practice education programme (GPEP).

Details about the planned changes and how they will be implemented are now being finalised.  This update outlines what will be happening over the next few months.

As signalled in earlier communications, the changes are intended to build on the best aspects of existing general practice education and are expected to bring benefit to doctors, patients and communities.

From this year, GP vocational training will commence in December each year, aligning it with other medical specialists’ training and the timing of DHB registrar rotations.

Funding for Registrars

Most first year (GPEP1) registrars are currently funded by HWNZ via a tax-exempt bursary for the duration of two twenty-one week general practice attachments. During the subsequent two years of training (GPEP2), registrars are remunerated directly by the practices in which they work.

The College and HWNZ agree that GPEP1 registrars should enjoy the same benefits as registrars in other scopes who are employed by DHBs. The intention is that registrars entering GPEP1 at the end of this year should be employed by DHBs for twelve months under similar terms and conditions as other registrars. Discussions have begun with employers and other stakeholders to develop a suitable arrangement.

It is also intended that during the subsequent two years of their training registrars will be required to have some supervised training under other vocational scopes (to an equivalent of six months’ full-time employment) linked to their personal learning needs and interests. The training might be in community or institutional settings and could be spread over time, or in formal attachments/runs.

All GP registrars and vocationally registered GPs will have the opportunity to begin enhanced training in an area of interest which can be completed following the attainment of Fellowship. Work is underway to develop the framework for an advanced competency for mental health and addictions in collaboration with the Royal Australian and New Zealand College of Psychiatrists. Further modules will be prioritised and developed with the relevant medical colleges according to interest and need. 

Regional training hubs

In future, general practice training will be supported by the regional training hubs, which will co-ordinate DHB placements and provide links with other vocational training and CPD activities. The College will place registrars in practices that will meet the learning needs of the trainee and are approved by the College. The expectation is that general practice training will occur in practices that meet the College standard, Aiming for Excellence.

The College is developing a revised curriculum which will be submitted to the Medical Council for approval by mid-2012. The new curriculum will take into account emerging models of care, such as integrated family health centres, while also addressing the education and training needs of general practitioners working in a range of settings. Recognition of relevant and valid past experience, either overseas or in NZ, will be factored into the new curriculum.

The College will also implement a revised assessment process from 2013, which will include the PRIMEX clinical examination, part of which may move into the second year of training. A formal academic component will be introduced which will be completed during GPEP2 , with a range of options as to how this can be done.

The changes to general practice education are an important part of wider changes across the New Zealand health system, with the focus being on increasing workforce flexibility to ensure the current and future health needs of all communities can be met. We believe these arrangements will encourage more doctors to enter GP training as well as supporting greater integration of training across institutional and community settings.

More details about the implementation of changes to GPEP training can be found on our Implementation FAQs webpage.

29 July 2011

A summary of feedback received on the discussion paper as well as further information on the proposal '4.3.3 Training in Hospital (or DHB) Environments' has been published and is available to view on the discussion paper and feedback page.

11 May 2011

The Royal New Zealand College of General Practitioners, Health Workforce New Zealand and the Medical Council of New Zealand have published proposals for a new model of GP training for implementation starting in 2012

To read the full document and to find out how to have your say click here.

28 April 2011

The review of GP training is now reaching the stage where proposals for the future will be put to the sector for discussion. We encourage your input into that process.

We expect the full discussion document to be published mid-May and will seek as many opportunities as possible to have face-to-face dialogue with GPs, GP registrars and other doctors in training. We will provide mechanisms for online feedback via a dedicated web portal.

The RNZCGP, HWNZ and MCNZ believe the proposals that will be outlined will build on the strengths of the existing GP education programme, while introducing new opportunities and support that will benefit both current and future GPs and GP registrars.

Clear themes about the direction the review should take emerged early on in the process which began last May, and from the first meeting of the reference group established to inform the review, we had a strong platform to build on.

The themes that will be reflected in next month’s discussion document include:

• Ensuring that the first stage of vocational training continues to be centred on practice in GP settings.
  
  Feedback consistently reflected positive views about GPEP1, including the benefits of immersion in general practice and the support and supervision available. The proposals will include making better use of resources across the entirety of GP training and ensuring the necessary infrastructure and support is in place.
• Introducing options for building specific specialist skills and competencies based on professional interests and community need.
  
  The proposals include development of optional advanced competency modules which would be open to both registrars and Fellows. The first modules in mental health and addictions and care of the elderly are currently being scoped in conjunction with the Royal Australian and New Zealand College of Psychiatrists and the Royal Australasian College of Physicians.
• Moving towards greater equity between GP and DHB employed registrar terms and conditions.
  
  The review recognised the potential for the GPEP1 bursary system to be a disincentive to doctors entering general practice, and the importance of moving towards equivalence with other medical registrars. From 2012, the GPEP1 bursary will be enhanced so that financial disincentives are reduced, while work continues in the longer term towards equivalence in employment and remuneration.
• Supporting greater exposure of GP trainees to some hospital-based practice (and vice versa, introducing more community-based training for hospital-based trainees).
  
  The proposals will consider how hospital placements can be integrated to the GP training programme.
• Maintaining the current three year duration of GPEP.
  
  Consideration of overseas general practice training programmes and feedback from the profession has confirmed that 36 months is an appropriate timeframe to complete training, with the necessary quality assurance and assessment processes in place.

While outside of the scope of the project, there has been consistent feedback on the need to introduce greater exposure to general practice in undergraduate years, and at PGY1 and PGY2, and this is something that the review partners will continue to explore separately.

We hope that as many of you as possible will take the opportunity to have your say on the proposals when they are published next month. If there are any meetings or events which you would like members of the review team to attend or if you have any queries or feedback in the meantime, please e-mail medicalworkforce@healthworkforce.govt.nz or rnzcgp@rnzcgp.org.nz or mcnz@mcnz.org.nz.

25 March 201

HWNZ, in conjunction with the RNZCGP and MCNZ expect to release a discussion document in May 2011 setting out proposed changes to general practice training.

Over the next few weeks work will continue on planning for the development of an enhanced bursary for registrars in GPEP1, and on scoping of the first advanced competency module, which are being proposed as optional enhancements to core generalist training.

Full update available here (PDF, 125.23KB).

28 February 2011

Comment has been elicited from a range of sources including the Reference Group, discussions with a range of stakeholders and feedback provided via HWNZ and RNZCGP websites. Consistent themes that will form the basis of recommendations for a revised programme include:

• acknowledging the need to strengthen aspects of GP training in order to have a workforce capable of contributing to new models of healthcare delivery including:
  - more care delivered in community settings;
  - more inter-disciplinary workin;
  - changes in the role of the doctor; and
  - greater integration of services delivered in community and institutional settings.
• valuing the existing community and patient focussed basis of general practice;
• ensuring the first stage of vocational training continues to be centred on practice in GP settings;
• building formal mechanisms for GPs (trainees and Fellows) to develop and maintain advanced competencies in areas of their choosing;
• supporting greater exposure of GP trainees to some hospital-based practice (and vice versa, hospital-based trainees to have exposure to community-based training);
• ensuring that PGY 1 and 2 doctors have greater exposure to general practice;
• moving towards greater equity between GP and DHB employed registrar terms and conditions;
• supporting better use of resources across the entirety of GP training (ie current GPEP1 and GPEP2) and ensuring the requisite infrastructure and support is in place;
• ensuring that GPEP has a high degree of flexibility to meet the needs of individual trainees and specific communities; and
• considering a more formal academic aspect to GP training.

Work is already proceeding on developing an advanced competency module for mental health/psychiatry (in collaboration with the RANZCP). A module for care of the elderly will be developed this year in conjunction with the RACP.

We are now developing a discussion paper on wider changes to GPEP which will go out to the sector later this year. The timing is not yet confirmed but is likely to be around April/May.

The paper will reflect our discussions to date in the form of a proposed concept/model. Subject to feedback from the wider sector and subsequent decisions by the RNZCGP, HWNZ and the MCNZ more detailed work on design and implementation will follow.

In respect to the employment and remuneration of GPEP1 registrars - work is underway on augmenting the existing bursary model (for 2012) so that it is as close as possible to conditions of other registrars. Work continues on the medium term objective which is achieving equivalence across all registrars regardless of the setting in which they are training.

We will continue to keep you updated on progress. Comments and queries in the interim should be sent to medicalworkforce@healthworkforce.govt.nz.