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Addressing the issue of GP supply and distribution is opening up new considerations for the training our all junior doctors, writes Dr Paul Myhill.

07062017-Consultant-training-junior-doctorsThe modelling indicated that a ‘siloed’ approach, in which junior doctors complete all rotations…would not facilitate efficiency of training, nor provide the breadth and depth of training necessary for enough junior doctors to achieve readiness for GP training.

GPs play an essential role in the provision of health care in WA, however, WA’s access to primary care is lower than the national average and it has one of the lowest rates of bulk-billing in Australia. Growth in WA’s general practice workforce is lower than that of non-primary care specialities.

Evidence suggests a number of factors are impacting on the availability of primary care and GP workforce supply in WA – a shortfall which is projected to increase to 2025:

·                     The inequitable distribution of the GP workforce within and between metropolitan, outer metropolitan, rural and remote locations which manifests in supply deficits or super-saturation.

·                     An ageing GP workforce with a significant volume approaching retirement. In 2015, 11% of primary care full-time equivalents (FTE) in WA were provided by GPs over the age of 65.

·                     A significant disparity in the ratio between GP headcount and FTE/Full-time service equivalents (FSE), which is anticipated to increase as the older cohort retires and given younger GPs are more likely to work part-time.

·                     A fall in average GP hours worked indicating a need to train a minimum of 2.1 GPs for 1 FSE in clinical practice. (see above)

·                     Currently WA is graduating insufficient GP trainees to meet maintenance-model requirements. Training readiness prior to selection and attrition in training are priority areas that need to be addressed.

·                     The level of retention of WA GP trainees in the WA workforce requires further investigation.

Australia’s comprehensive provision of primary care may be at risk without workforce development strategies to ensure a sufficient supply of GPs with the appropriate scope of practice to meet future demand in all locations.

GP workforce planning must ameliorate the impact of increasing part-time work and improve exposure to general practice in prevocational years. Changing population and medical demographics (e.g. gender balance), and the lifestyle choices of the emerging specialist population are other variables that must be considered, as significantly more GPs will be required to achieve the same level of FSE than in the past.

Pressure on rural GPs

Evidence suggests that rural and remote GPs work longer hours and provide more FSE than their metropolitan counterparts, and 59 towns in WA are solo GP towns. Given the dependence of these and other rural and remote locations on GP services, WA can ill afford a reduction in the scope of practice of its GPs.

WA has relied on international recruitment to fill primary care supply gaps. As the number of Australian-trained junior doctors increases, there will need to be a transition to greater self-sufficiency. However, despite strategies to improve the number of WA vocational trainees achieving GP fellowship, including reform in prevocational training and increasing prevocational and vocational training capacity, interstate and/or overseas recruitment will need to continue in the short-to-medium term to meet shortfalls in some locations.

GP training is the largest vocational training pathway and, in 2016, 49% of all training registrars in WA were undertaking Australian General Practice Training (AGPT) with WAGPET.

GP trainees complete their prevocational training, hospital year and advanced skills training in WA hospitals.

While further delineation of GP training readiness is required, the WA Department of Health has undertaken modelling to identify WA’s capacity to provide junior doctors with exposure to the prevocational specialty rotations (PGY2+), identified by WAGPET as optimal for vocational GP training.

Where JMOs are missing out

The modelling identified that four of the key specialities – paediatrics, obstetrics and gynaecology, psychiatry and geriatrics – have limited prevocational training capacity, particularly given competing specialty demands.

While these specialty rotations are pinch points in junior doctor training, by taking a system-wide strategic approach, those junior doctors with an interest in GP training can still be provided with the prevocational rotations, skills and experience necessary to achieve GP Recognition of Prior Learning (RPL).

There were 12 generalist prevocational exposure programs (models) explored, which would equip between 100 and 160 junior doctors with the broad range of skills and experience required to achieve RPL for vocational GP training. The modelling indicated that a ‘siloed’ approach, in which junior doctors complete all rotations within their employing Health Service Provider (HSP) network, would not facilitate efficiency of training, nor provide the breadth and depth of training necessary for enough junior doctors to achieve readiness for GP training. This is an issue facing other specialties.

The recommended achievable model, which will be explored further, including HSPs, is a networked matrix of rotations. This appears to be increasingly necessary to optimise WA’s training capacity to accommodate the increase in medical graduate numbers and progress junior doctors efficiently and cost-effectively to vocational training.

The modelling undertaken for general practice is the start of a system-wide mapping of speciality requirements to balance training and workforce needs in WA and align supply and demand for all 49 medical specialties.

By Dr Paul Myhill

References on request

ED: Dr Paul Myhill is Medical Adviser on Medical Workforce in the Office of the WA Chief Medical Officer

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