“I believe the Government’s focus is now on saving money rather than delivering excellence” - Dr Chris Mitchell
The federal government’s decision to appoint a Sydney-based organization, GP Synergy, to manage all GP registrar training in NSW, including the Northern Rivers, has disappointed a number of Northern Rivers GPs, although they realise the decision cannot be reversed.
Many of these concerned GPs believe the tender was awarded on the basis of outright cost rather than the ratio of service quality to running costs - in short, that it was little more than a ‘Canberra cost cutting exercise’, as one put it.
Among the concerned doctors is long-time local Chris Mitchell who says his practice will not take further registrars after 1 January 2016 when the new contract comes into operation.
The decision to change the GP training provider arrangements was announced in the federal budget 2014-15. Details released this April included a national map that consolidated the number of training regions from 19 to 11. In NSW, regions were reduced from six to three. The Northern Rivers, indeed, the whole North Coast, fits into ‘North Eastern NSW’.
In October, Sydney-based GP Synergy was announced as the successful tenderer to deliver GP training in each of the three new training regions in NSW & ACT – North Eastern NSW, Lower Eastern NSW and Western NSW.
Of the 1,580 training places for next year, 520 are in NSW. As one of the nine new national organisations, GP Synergy will be in charge of almost one third of Australia’s GP Training.
North Eastern NSW will be the biggest training region with an intake of 265 registrars, about 17 per cent of the nation’s GP Registrars.
Consequently, there is a real risk that NSW and particularly the North Coast region will have a much lower ratio of GP Training support staff and Medical Educators per head than anywhere else in Australia.
North Coast GP Training (NCGPT), which has managed registrar placements for the past 13 years, also tendered as part of a consortium with two other regional training providers but was unsuccessful.
The new contract starts from 1 January 2016, with pre-existing arrangements likely to be carried over on a novated basis until June 2016.
Dr Mitchell, a board member of Northern Rivers GP Network, publisher of GP Speak, is one of the doctors who feels that cost factors alone lie behind the tender decision.
He said the reason for choosing GP Synergy over the consortium that included NCGPT had little to do with quality, as NCGPT has a proven track record and has regularly won excellence awards.
“At this stage there is no detailed understanding of what has been agreed to under the tender, just that the total dollars are considerably reduced,” Dr Mitchell said.
‘We don’t yet know what will be delivered on line, what will be delivered face to face, or what current training elements will or will not be provided in the future.”
What is clear is that all 39 staff of NCGPT will be made redundant by year’s end, with GP Synergy “going to market” to appoint future staff to its local office, likely to be in Ballina or Lismore.
In his latest - and almost last - newsletter, NCGPT CEO John Langill wrote, “As you can imagine, it has been a bitter disappointment for all of the staff here at NCGPT who have given so much of their time, energy and passion over many years into creating an outstanding training program for our registrars, supervisors and training practices.
“We were looking forward to helping create a new training organisation that would reflect the values that NCGPT have embedded in our program and our approach to attracting and training outstanding GPs for our region’s communities. Sadly, it doesn’t look like we will get that opportunity.”
Dr Mitchell holds concerns about GP Synergy’s governance structure, doubting it is “fit for its new purpose, which is training for all of NSW… While NCGPTs members were local GP Registrars and Supervisors, GP Synergy’s members are corporate, rather than individuals, their members including a number of Sydney Divisions, Networks of General Practice and Primary Health Networks,” he said.
Dr Mitchell added that medical educators across Australia regard the NCGPT training team, led by Drs Christine Ahern along with Associates Directors of Training, Genevieve Yates and Peter Silberberg, and Senior Medical Educator, Hilton Koppe, as highly successful.
“NCGPT has had some remarkable achievement since its inception. It delivered high quality training and attracted excellent registrars to the area.
“It had very high rural retention rates for new Fellows. It broke the cycle of short term Sydney rotations and won many awards for excellence for both staff and registrars. NCGPT delivered a truly regional and responsive training program.
“We have seen first hand what excellent regionally focused GP training looks and feels like, NCGPT has set a very high bar for GP Synergy to reach for.
"With the Medical Benefits Schedule (MBS) review seemingly focussed on reducing GP rebates, and the MBS freeze slowly turning up the pressures, we all face challenges maintaining the viability of our practices. Attracting excellent graduates to a career in General Practice may well get harder and harder."
Saying he has been passionate about General Practice and GP education for many years, taking his first registrar in 1994, he feels there are “deep challenges ahead for our profession. I believe without a significant change in Government funding and priorities we may well have seen the best days of GP training.”
GP Synergy has developed a set of FAQs for registrars, supervisors and stakeholders to assist them during the transition process. These will be added to as the organisation participates in stakeholder forums and additional questions come to light.
