Change boss for GP registrars: Report

Our trainees are telling us that...they feel lost and bereft

Te Whatu Ora should take on the employment of GP trainees, according to the report that underpins the Government’s new efforts to improve the training and make it attractive to many more doctors.

Health minister Andrew Little on 4 October announced government funding of initially $7 million a year for a package of GP training improvements and medical-student attachments to general practice.

The package was the result of negotiations with the RNZCGP, based on a report commissioned by the Ministry of Health from research firms Malatest International and Sapere. Dated May, the report, Review of the general practice education programme training funding, was published with the announcement.

Crucially, Mr Little’s media release said the package of changes would see GP trainees “paid as much as their hospital counterparts”.

Junior hospital doctors currently take a pay cut if they choose GP training, partly due to fewer work hours.

What the release doesn’t mention is the 80-page Malatest report’s recommendation that Te Whatu Ora become the employer for general practice training programme (GPEP) registrars in year 1 and possibly year 2, alongside the alignment of GPEP pay and conditions with those of hospital registrars.

“Equivalence may be most effectively achieved if GPEP registrars and registrars in other vocational training programmes have the same employer and employment contracts,” the report says. Te Whatu Ora was identified by the interviewed stakeholders as the potential employer, meaning GPEP registrar terms and conditions of employment could be negotiated directly with the funder.

About 200 doctors enter GPEP1 each year. The plan is to increase to around 300. About three-quarters of GPEP1s are employed by the college; the rest – and registrars in following years – are employed directly by practices.

RNZCGP president Samantha Murton says the college doesn’t oppose the idea of Te Whatu Ora being the employer. But, she says, the big hurdle is Te Whatu Ora would need to negotiate an employment agreement that applies at 200 practices and possibly 350, given that college-employed registrars need to rotate to different kinds of practices.

“You’re contracting with 200 different entities [at which] you have to make sure that the health and safety guidance and standards are all okay, and [which] you have to have a relationship with and also you’re the point of call for any issues that come up.

“The college runs it because we have a relationship with a lot of our practices and our teachers, and it is a natural place for it to fit.”

New Zealand Doctor Rata Aotearoa asked Te Whatu Ora for its response to the proposal it become the employer, and other issues in the report.

Emma Prestidge, interim director, primary, community and rural – national commissioning, says by email, the report has highlighted a number of areas that need to be considered.

“Te Whatu Ora is currently working with Te Aka Whai Ora to consider the Malatest recommendations and no decisions have yet been made.”

The report includes survey results from current and past GP registrars, providing insight into why they chose general practice.

The most highly rated reasons, ticked as “very important” by 63 per cent, were flexible hours and opportunity to train part time, the report says.

“Registrars compared the long rostered shifts in the hospital to the flexibility and work–life balance of general practice. Flexibility and family-friendly hours were particularly attractive to registrars who had young families or wanted to start families.”

Along with flexible and family-friendly hours comes the lower income, the report noted.

Registrar feedback about their educational experiences in GPEP1 was positive. However, most of the registrars and other stakeholders interviewed felt the educational/teaching component of GPEP2 was inadequate.

The registrars wanted more frequent peer and mentor sessions focused on case reviews. And many thought the clinical component of the exam at the end of GPEP1 should be delayed to the middle of GPEP2.

The level of support for GPEP2 and 3 registrars was described to the report’s researchers as “almost nonexistent and particularly dangerous for registrars who needed additional learning and training to pass exams”.

Dr Murton contrasts year 1 and its weekly seminars to year 2 “group meeting every six weeks”.

“Our trainees are telling us that in years 2 and 3 they feel lost and bereft, and that’s real.”

The college runs the six-weekly GPEP2 programme with the “nominal” funding provided in year 2 but there’s no funding for in-practice supervision by senior colleagues.

That only happens out of the goodwill of those colleagues.