Urgent GP training makeover

The way GPs work and train is in for a major shake-up.

Over the coming year and a half, GP training and practice is targeted for change, with a view to providing better career options for medical graduates signing up to general practice and ultimately ensuring the future of the GP workforce.

A new GP training scheme is to be up and running by 1 January 2012.

General practice is the most significant area of reform for Health Workforce New Zealand (HWNZ), the body set up to deal to workforce issues, HWNZ executive chair Des Gorman told delegates at this month's GP CME 2010 conference in Rotorua.

To meet the needs of an ageing workforce and population, and spiralling healthcare costs, Professor Gorman says around a third of graduate medical students need to be choosing general practice. Currently, only 10 to 15 per cent of graduates say they will.

Professor Gorman has just written to all, New Zealand GPs to solicit their views. "We want to know how general practice and primary care should be configured in 2020 and, quite frankly, it's up for grabs."

At GP CME 2010, Professor Gorman held break-out workshops to encourage GPs to put forward their ideas on what they would like to be doing in 10 years' time, on what the ideal patient journey might look like. He says he anticipates GPs will need to be working in consultant-type roles in future, using their unique skills of differential diagnosis to diagnose patients and plan their care.

With demand for healthcare expected to more than double in 10 years, GPs would do more of the tasks currently offered by hospital specialists. Practice nurses would also up-skill and some of the duties relinquished by GPs, and nurses could be covered by practice assistants.

As Professor Gorman sees it, there are "three burning platforms" prompting a need to revamp the training programme.

•    The current training scheme is having financial difficulties.
•    It is not appealing enough - only 108 of 155 training places were taken up this year, and only half of GPEP1 students go on to GPEP2.
•    And around 600-700 doctors who are working as GPs are not vocationally registered.

The college acknowledges the shortcomings of its training scheme.
RNZCGP vice-president Tony Townsend, who attended Professor Gorman's sessions at GP CME, says the college has been calling for more funding for GPEP2 for some time.

Funding issues have meant, while GPEP1 is world-class, the standard falls off at GPEP2, with the college unable to afford the training registrars are asking for, Dr Townsend says.

An issue with Professor Gorman's suggestion vocational registration should be  mandatory is that rural general practice relies heavily on overseas-trained locums, he says.

The idea of GPs doing more hospital work is also a good one - with appropriate training. GPs currently have difficulty getting their patients treated in hospitals and would like to help out, Dr Townsend says.

He commends the way Professor Gorman is making a genuine effort to seek and listen to GPs ideas. However, specialists will need to be consulted too as they will be involved in making the changes, Dr Townsend warns.

The NZMA is cautious in its response. NZMA chair Pete Foley believes there's a lot more work to be done across the health sector to discuss the changes Professor Gorman is proposing and to get wide agreement on what is needed.

The NZMA questions whether new roles, such as practice assistants, are needed, or whether the current workforce could be trained differently to work in enhanced roles, Dr Foley says. Certainly doctors have become too narrowly focused, he adds.

In order to generate more discussion among doctors, the NZMA is holding a seminar on "the role of the doctor" in November.

More immediately, HWNZ is forming a reference group, including trainers, registrars and current educators, with a view to meeting in mid-July to finalise plans from then to 1 January 2012.

Auckland professor of general practice and chair of Counties Manukau DHB Gregor Coster has been appointed project lead for the training review. Public health physician William Rainger is project manager.

Have your say on how GPs could be working in 2020 in a New Zealand Doctor discussion forum called the "Crikey Blogs"