Who’s Training in Whose Training?

WP_20131128_16_12_56_ProI am not sure if everyone is aware of the potential professional crisis for specialist general practitioners if the Department of Health and Ageing decide who is providing training for general practice in 2016. That is the stated aim, presumably not with advice from experts in health care delivery.

The Department contributes public money to primary care and so can decide who has access to what rebates and other financial assistance. This is the case for all specialist training.  During the Howard government a shortage of trained specialist general practitioners developed due to a failed policy to limit health care spending by limiting numbers of doctors. The ensuing GP shortage in outer suburban, rural and remote areas led to the government opening the door for doctors to work in primary care without the qualifications from the RACGP or ACRRM.  These qualifications have been developed to distinguish specialist general practitioners; the FRACGP has never been granted without submitting for the Fellowship exam, or equivalent international qualification. If the value of the FRACGP is not recognised by the community, then value in training to achieve Fellowship is also depleted. This is the crux of the issue and has led to the profession being at a precipice.

We specialist general practitioners understand how to deliver evidence-based sustainable primary health care across the broad range of community settings found in Australia. It is our space, not one invented by governments. Innovations and responses in our profession are not determined in Canberra. We are proud professionals delivering high quality care despite the limits of Medicare. I have worked in the NT for over 20 years and understand the issues with workforce distribution; I am keen to work with anyone who wants to ensure that all Australians have adequate access to primary health care. However the proposed takeover of our training by the Department of Health is unacceptable.

Universities and other large providers will no doubt see this as an opportunity. We will see massive conflicts of interest paying dividends to various agencies to meet workforce needs, fill departmental coffers or bring money to other organisations. Our new registrars have been learning on dolls and out of textbooks for years, and it shows. They want to be able to do doctoring – not be doctors. We have more to do than ever to prepare our registrars for delivery of the services our patients’ need. We need to do better at it.

I have a 7 principle approach to success:

  • The College must determine if placements are suitable for learning specialist general practice
  • The College must determine if supervisors are suitable for training registrars seeking to become specialist general practitioners
  • Our Fellowship must be seen as the hallmark of quality primary care, the doctor with FRACGP as the go to professional to provide primary ongoing medical care and lead the primary care team
  • The College must robustly represent and support our Fellows, particularly our supervisors, and our Members who are working towards Fellowship
  • The College should work hard for all Members to gain Fellowship and all Fellows to improve their standard of practice
  • Doctors with Fellowship should be recognised and promoted as specialist general practitioners and be expected to deliver a higher standard of care
  • The College should be the custodian of knowledge relevant to our professional practice and pathways to providing new and improved services to our communities.


The RACGP needs to advocate strongly for our Fellows (especially our Supervisors) and Members seeking Fellowship while working closely with ACRRM and GPRA to ensure that our profession and quality primary health care thrive.

It is our training and those training with us should feel that we are supporting them in their endeavour.

eHealth and Clinicians

Hi Tech
Hi Tech

You may know me from my work in eHealth. I have been interested in discovery around ways for clinicians to control and develop the content specification for eHealth. It was a key role of the Royal Australian College of General Practitioners (RACGP) in the days of paper to offer quality health records for use in general practice. Technology has offered a lot to our profession, particularly in managing work flow and the movement of documents. However at current levels of eHealth provision, we have lost the ability to store information in a recoverable (or query-enabled) form in a way that meets our clinical needs. This is not unexpected and many are content enough with current software to tolerate this situation. I am not. I established Ocean Informatics with 4 GP Colleagues in 1996, ws CEO from 2004 to 2012 and now chair the Board of this clinically oriented health informatics company.


My aims have been to:

  1. Ensure that data collection specifications are managed by clinicians for specific purposes – not software developers
  2. That standardisation of clinical information enables interoperability of care environments, supporting clinical care
  3. That the infrastructure of eHealth should have no concern as to the content of the health records
  4. That there should be one logical record for every person although the information may be distributed among many systems
  5. That the infrastructure should not determine the information flows

I was a founding Co-Chair of the International HL7 EHR Technical Committee, and Co-Chair of the Standards Australia Working Group as well as the Australian delegate to the European Union’s eHealth Standards Committe (CEN TC251). My work has led to the establishment of the openEHR Foundation of which I am Chair. This international group is still evolving – this open source specification is now used in a number of European countries and Brazil. The openEHR method provides the basis for NEHTA’s Clinical Knowledge Manager.

The solutions in eHealth must involve and support clinicians. Not involvement  in some glacial consultation process once per decade (if we are lucky) but in a vibrant living evolution of clinical data specifications. I believe that our College could be the curator of such an environment.