CCCGPT Newsletter | October 2014

Content

A note from the CEO
A report from the Chair man
Dates for Your Diary
Supervisor Liaison Officer News
Registrar Liaison Officer News
2014 Fellowship Dinner
Registrar Training Requirements
It Department Update
There are also Unknown unknowns!
Meet our new ESO in Canberra


A note from the CEO

Sharon Flynn

sharon My words in this newsletter are brief because as undertaken I will soon be providing a second CEO bulletin update on our tendering strategy with a focus on the opportunities for people to provide input. As CEO I now live in a two tier world; the first working with BME and Wentwest to prepare for the tender process and the second working with GPET to make sure that as our contract to deliver training in 2015 novates to the Commonwealth we have sufficient certainty and protections in place to operate through to the end of 2015.

As I write this I am particularly thankful for the efforts of Supervisor Liaison Officer’s and Registrar Liaison Officer’s in keeping fingers on the pulse and highlighting communication needs. I am also in awe of my staff who have almost completed the cycle of induction of new Registrars for 2015 and placement of these doctors and all other cohorts in practices and other accredited settings. This process has shown that our Rural Generalist training program is going from strength to strength including growth in our ACRRM Registrar cohort. Thanks also to the supervisors who have given overall such positive feedback to the new practice placement process and next time we will try not to do things in school holidays. I look forward to RLO feedback as well.

We have also been really busy in the policy update space recently and I urge Registrars in particular to read updated Bullying and Harassment (here) and Grievance Handling (here) policies. If you are interested we have also updated the governance document outlining our Registrar Support System, including the flagging component of the process (here) and we will soon complete a revised Performance Assessment and Monitoring (PAMI) policy.

We live in interesting times but none of the changes unfolding now will change the fact that CCCGPT remains committed to continuing to deliver a high quality training program in 2015 and organising for a smooth transition for all concerned into 2016. If you have any questions or concerns please contact your RLO or SLO or email the feedback line. [email protected]


A report from the Chairman

Bill Coote

BILL The Federal Government has announced a major “shake-up” of the way it funds GP postgraduate training. In the May Budget it was announced that GPET, the government owned company established in 2001 that contracts with Regional Training Providers such as CCCGPT, will be wound up at the end of 2014. From 2015 its functions are to be undertaken by the Commonwealth Health Department.

The Government also announced in May that during 2015 tenders will be called for the delivery of GP postgraduate training after 2015. Indications are that the Government wants fewer providers and a more “competitive” tendering process. There are presently 17 Regional Training Providers such as CCCGPT.

The future of CCCGPT after 2015 is therefore uncertain. There are indications that minimum conditions in the Government’s “request to tender” documentation will mean that the geographic area covered by CCCGPT will of necessity become part of a larger region.

The Federal Government commenced funding of postgraduate general practice training in the early 1970s through the RACGP Family Medicine Programme (FMP). The College went on to develop an innovative, world class GP training program based firmly on the apprenticeship model. CCCGPT covers the same geographical area as the former FMP/RACGP ACT and Southern NSW region.

Formal postgraduate training remained optional until Federal Parliament passed the 1989 “vocational register” legislation and then the 1996 “provider number” legislation. These two steps effectively limited entry to general practice to those with the FRACGP (and now also the FACRRM following Australian Medical Council accreditation of ACRRM’s training in 2007).

The established RACGP training program was disrupted in 2001 when the Federal Government directed funding through GPET rather than directly through the college. Regional Training Providers (RTPS), such as CCCGPT, were fostered and funded by GPET to allow for more local oversight of training arrangements. As well, it was the Government’s hope that the new regionalised structure would be the means of enhancing GP numbers in rural areas.

It is very unlikely that CCCGPT will continue in its current form after December 2015. In response to the current uncertainty the CCCGPT Board has commenced “in principle” discussions with other RTPs about forming a combined entity able to meet conditions expected to be imposed by government as part of the 2015 tender process.

CCCGPT throughout its existence has been completely reliant on the expertise, experience and professional commitment of the network of supervising GPs and training practices established under the previous RACGP training arrangements. Any new entity providing training in the region will be similarly reliant on experienced supervisors and practices.

The CCCGPT Board’s aim in seeking to adapt to the new environment being developed by the Government is to ensure that the years of experience and expertise are incorporated into and appropriately recognised in whatever training format does emerge from the proposed changes.

Dr Bill Coote Chair CCCGPT


Dates for your Diary

10 October – RACGP KFP Results
14 October – Annual Dinner 14/15 October – ISSH Release (GPT1&2)
16 October – Supervisor workshop evening
16/17 October – SENSWACT 2 day Release including counselling skills
18 October – GP Supervisor Professional Development day
Read More…


Supervisor Liaison Officer News

140906_0445

Report on GPSLON meeting in Brisbane on 02.09.14

At this meeting, Mr Glenn McMahon from GPET spoke to us and assured us that GPET was working closely with the Department Of Health and Aging on the transfer of responsibilities to DOHA. We talked to some representatives who were working in the relevant section of DOHA. They took on board all our concerns and assured us that they saw the importance of the maintenance of the quality of GP training and the need for the Colleges to continue to set standards for general practice training., They also said that they were cognisant of the need to maintain some degree of stability to keep general practice supervisors in the program. Nevertheless, they also acknowledged their subservience to their political masters.

So, for example, while GPET has asked for a further 1 year extension to the contracts for RTPs so that the tender doesn’t coincide with the start of the registrar year in 2015, the Minister had clearly indicated that he wanted to stick with the current timetable. The public servants from DOHA also said that while funding was guaranteed for the 1500 general practice registrar places for the foreseeable future, the Minister was keen to explore other ways of funding further expansion of the GP registrar program. In the Budget of 2014, the Government had announced that it will “work to further expand the number of GP training places by …..developing innovative approaches to allow employers to contribute more to the development of their future workforce.” The AMA, after their meeting with the Minister had said that “the Government appears to be resting all its faith in the marketplace to provide a training solution – this is a recipe for chaos.”

What this signals to me is that the Federal Govt may look kindly at programs where GP registrars and /or practices fund the training themselves. I have grave fears about what this might mean for the quality of the general practice training for these self-funded places in particular, the huge potential for conflict of interest in these arrangements. A compromise in the quality of general practice training will lead to a decline in the quality of general practice in this country. We need to watch the Federal Govt’s proposals closely and if necessary, take action to tell the public we serve of our concerns.

Dr Tuck Meng Soo


Registrar Liaison Officer News

A very successful Induction day was held in Sydney on 30 August for the incoming cohort of new GP Registrars joining CCCGPT for 2015. Introductions were made to the CEO and other key staff members, followed by a description of the structure of the organisation, recent changes in the training environment, training requirements, the new practice-matching process, and financial policies.
Belinda Allen and Kristin McMahon attended as RLO representatives, and discussed: the CCCGPT catchment region; the experience of being a GP Registrar; practical tips; introduction to the RLO’s and our role in provision of information, support, liaison and advocacy; and there was plenty of opportunity to talk one-on-one with Registrars to answer direct questions. There were workshops also for hospital-based and GP-placement based Registrars, RACGP, ACCRM, and rural generalist/ARST pathways. The day was very well received and the new cohort’s seem enthusiastic about commencing their training next year.
With Induction completed the focus for RLO’s across CCCGPT since the last Newsletter has been in lobbying, forward planning and the ongoing support of our GPR colleagues.
RLO’s continue to lobby decision makers to restore the PGPPP program. The withdrawal of the program removes an opportunity for junior medical doctors to be exposed to general practice during their hospital training time and drastically reduces the number of intern places across Australia. In the CCCGPT footprint alone the FTE equivalent of twenty hospital training places have been axed. Planning is underway to seek feedback from GPR’s on the Practice Matching Process for 2015.1 and for RLO’s to be involved in meeting and greeting incoming GPR’s (2015 cohort) during early face-to-face training days.
Given the volatile climate in Australian GP training, existing GPR’s are being encouraged by RLO’s to sit their exams and assessments as soon as possible so that they can be supported through the process in the current CCCGPT framework.
RLO’s are also watching with interest the take-up of training places in the Rural Generalist Training Programme for 2015.


2014 Fellowship Dinner

Congratulations to all the 2014 Fellowed Registrars

Fellowship

See Photographs here

Speech for Fellowship dinner

by Professor Kirsty Douglas

Distinguished guests, graduating fellows, colleagues and friends; I too would like to acknowledge the Ngunnawal people on whose land we are dining together tonight. I pay my respects to their elders past, present and future and I want to express my gratitude for the acceptance, friendship, and teaching that has been afforded to me by our local indigenous community. I have learnt from them much about resilience, passion, persistence, humor and friendship as well as the sweet satisfaction of a well-­‐placed swear word -­‐ and I thank them for all of that.

When Michelle asked me to speak tonight I was genuinely delighted as I do believe that the awarding of the fellowship is a major achievement that should be celebrated with a little pomp and ceremony however I also found myself nervous -­‐ I wanted to mark the occasion properly – to give some reflective words of wisdom and guidance – it seems like the Proper Professorly thing to do and I am trying very hard in my new role to act as a Proper Professor should.

So as any self-­‐respecting academic does I decided to do a little research. I spent an evening on the web and found that my role was to be both “Hilarious and inspiring” – well that sounds easy! I listened to many of the “300 of the best commencement speeches ever” from the likes of Barak Obama, Gloria Steinham, JFK, Aaron Sorkin, Mother Theresa and JK Rowling and finished feeling truly intimated! But my evening was not wasted and I did glean some pearls of wisdom. And I have synthesised for your edification the 13 most commonly used themes in great commencement speeches.

  • 13. Be kind -­‐ (an oldy but a goody)
  • 12. YOLO You Only Live Once -­‐ (this rose very quickly to popularity in the mid 2000’s but is just as quickly going out of fashion again)
  • 11. Make Art -­‐ (very popular particularly amongst the US liberal arts colleges and a apparently according to Yoko ono Art is Love)
  • 10. Balance (statistically I am highly like to choose this theme because I am a woman and although only 27% of the 300 best ever commencement speeches thus far have been made by a woman almost of them include the balance theme)
  • 9. Dream -­‐ (pretty self-­‐explanatory)
  • 8. Remember history -­‐ (which is really like saying don’t dream too much and was extremely popular but has declined in popularity since the 1990’s)
  • 7. Embrace Failure -­‐ (rapidly becoming popular -­‐ particularly post 1990’s)
  • 6. Work hard -­‐ no explanation required
  • 5. Fight for equality -­‐
  • 4. Don’t give up
  • 3. Listen to your inner voice
  • 2. Tips – (This is incredibly popular and is essentially a jumble of personal advice ranging from “wear sunscreen”, “don’t do drugs -­‐ I did and it didn’t turn out well” -­‐ What worked for me was breast augmentation but it might not work for you. But my personal favorite of these was “join a club that meets once a month – that produces the same happiness gain as doubling your income”).
  • 1. Change the world -­‐ equally common from Presidents of the US to authors and film stars

That isn’t a bad start for giving a few tips to live your life by– I seriously considered reading them out and then stopping there but somehow that seemed like copping out – and I really don’t like copping out.

So lets get back to General Practice and to you because tonight really is all about you –

My warmest and most heartfelt congratulations for what you have achieved and the milestone you have reached. Tonight marks the end of a very significant period of your life dominated by exams, degrees and study – you are now officially qualified –Well done. Except for you Janine -­‐ you still have to tick off that MPH! – It has taken much of your last 15-­‐18 years of your life and I know for some the journey has also required starting from scratch in a new country and new culture. You have all made enormous commitments to get here as have your family and people around you.

So please look around, take a deep breath and enjoy a moment’s stillness to fill yourself with quiet appreciation for what you have achieved and the relationships that have enable you to get here.

….

So welcome formally into the Fellowship of general practice -­‐ it is a pleasure to have you join us. I have been at it for 20 years and find being a GP is a wonderful job and I truly believe the most intellectually challenging and emotionally satisfying of all the myriad of medical options you could have chosen from.

You are lucky because a great day in general practice is hard to beat – we get to meaningfully interact with other human beings, to hear deeply personal stories, we have the privilege of sharing knowledge, the pleasure of performing practical procedures and we surprisingly often get to make a small difference one human being at a time.

As GP’s we have enormous autonomy but also get to work as part of a team. We still have the ability to work almost anywhere in Australia with the sort of job security that most of the rest of the world dream of. We are incredibly privileged in very many ways.

Not all days are great – some feel more routine and occasionally you really do feel devalued by the system, overwhelmed by the need, and just plain fed up. That is when you need to step back and take the long term view. Get rid of your watch, ignore the waiting room and just immerse yourself in the next two consultations -­‐there is still enormous satisfaction to be had in a simple job well done, an opportunity for prevention taken and effective human to human interaction. But as my old man would say even a bad day probably stacks up alright against the poor sod plucking and gutting chicken carcasses on the Steggles production line.

I suspect that you will find as I have that there are patients that you care for and will never forget -­‐ a few of I remember are because I felt proud of making an obscure diagnosis or sad about missing it but the majority of the most memorable ones are the patients that have taught me -­‐ I have been awed by fierce determination, shared a laugh with many at unpredictable occasions, I have learnt from my patients extraordinary pragmatism, have been touched by the tenderness and love of families, humbled by the gratitude for little kindnesses, surprised by the sheer joy taken in life and stunned by people’s ability to keep on keeping on despite enormous challenges. After 20 years I remain in awe of and endlessly fascinated by human beings.

I said before that GP is the most intellectually challenging and emotionally satisfying if you do it properly -­‐ Please, no matter what you do in the future – make sure you strive to do it properly. For all of us that will mean slightly different things but never give up trying, Be driven by your interest in helping others and your understanding human nature and the human body. Persist at trying to do your best and keep evolving as a clinician and a doctor. Prof Michael Kidd once said – as clinicians we get the patients we deserve. If you want to maximise your earnings by doing lots of simple stuff superficially then you will have patients that expect no more than a script or a certificate and trust you little. If you are striving to do what is best in complex consultation your patients will trust you with more and you will find greater satisfaction.

So what do the next couple of decades hold for you? You will no doubt further hone your clinical skills and learn to trust your inner instincts about patients more, some of you will change focus and potentially even move away from clinical general practice -­‐ One of the joys of our generalist training is that we can evolve it in many ways. I know that some of you are already teaching, I hope some will join us in research and others will contribute to policy. One to one clinical encounters are really draining -­‐ for sustainability combine it with other areas of medical practice and you will maintain your passion longer.

I do believe that one of the really significant challenges for you is to understand how GP fits into the rest of the health care system. The vast majority of our clinical work is one on one but understanding how the whole system works and being able to effectively work with and influence the rest of the system is utterly vital for our patients and for our profession. Too many specialists, policy makers and politicians have poor understandings of the contribution of general practice to the Australian health care system. Really the acute care system should be seen as a costly boil of the backside of the primary health care system instead of the pinnacle of health care achievements. I believe we are in part to blame for this erroneous impression because as a profession we have not been good enough at articulating and measuring the value of what we do or making sure that the rest of the world understands the contributions we make. The world we live in will increasingly discount what it cannot measure and place a value on -­‐ we have to get better at measuring the value of continuity of care of therapeutic relationships and how we can keep people out of hospital. I urge you to help us develop that understanding and then proudly, lay claim to our contribution. I hope that I never ever, ever hear you say the words “I am just a GP”

We GPs work in the bio-­‐psycho-­‐social model and through our training have a good understanding of the social determinants of health. Let this influence your daily patient contacts but don’t forget also to look outside of the consulting room. I believe that as doctors with excellent generalist knowledge and highly trained communication skills we have an obligation to try to influence the broader aspects of society that directly influence health. We have a duty to comment on and influence many issues of social justice because there is clear incontrovertible evidence that it makes a difference to our patients and to our society’s health.

So please as you move forward in your career be willing to comment on policies that threaten to adversely affect the health of our most vulnerable -­‐ chose one dear to your heart, do your homework and get involved. Currently there a frightening number that you could choose from, express concern -­‐ or outrage at the physical and mental harm our country is imposing on young children who seek asylum, know understand and explain the health risks of climate change to your local member of parliament, write a letter explaining the risks of compulsory co-­‐payment to preventative health in this country. If you don’t feel comfortable doing it yourself then join an organisation that meets once a month that will do it for you -­‐ According to a least one famous person it will give you the same happiness gain as doubling your income.

Whatever you do, never forget that you are now part of one of the most privileged professions in the most privileged areas of the most privileged country in the world. With all that privilege comes with responsibility to play it forward.

I guess I’ve covered off work hard, fight for equality, change the world, don’t give up. I will not deny by gender duties -­‐ it’s time to talk about balance.

So please remember in the next few years that what is good for your patients is good for yourself and your family. It is fantastic to be passionate about work but you owe the same concentration and emotional commitment to your personal life. When you leave work -­‐ leave it behind. Take a walk in the sunshine, cook a meal with a mate and take joy in little things. Don’t be afraid of taking risks with your professional journey to spend time with your friends and family -­‐ it will work out in the long run and often in surprisingly good ways. And, as a friend who works in palliative care says -­‐ I have heard a lot of people say a lot of things as they are facing up to death but never have I heard them say “I wish I spent more time at the office”

So I am finishing up now and you will all get main course very soon.

I am delighted for you, I hope you next 20 years are as fulfilling, challenging and enjoyable as my last 20 have been. My advice to you is to practice medicine at the fullest of your capabilities, strive always for excellence in medical knowledge and technical care, but don’t underestimate the importance of listening, always remain willing to learn from your patients and never, ever underestimate the power of simple kindness to your patients, to your colleagues to your family and to yourself.

Good luck and enjoy the ride.


Registrar training requirements – Reminder

Recognition of Prior Learning (RPL)

Please note if you are intending to sit your exams in 2015.1, your Recognition of Prior Learning application needs to be submitted by 31st October at the latest, in order to allow sufficient time for processing.

AGPT Registrar Placement Application Forms and Provider Numbers for 2015.1

Please note that AGPT Registrar Placement Application Forms for 2015.1 together with information on how to apply for a Medicare Provider Number were sent out by email on Friday 10th October. The AGPT Registrar Placement Application Form needs to be completed electronically, signed by both you and your 2015.1 supervisor and returned to [email protected] by the end of October 2014 at the latest. CCCGPT will process the AGPT Registrar Placement Application Form and send it to GPET. Once GPET have approved they will forward to Medicare to verify you are a Registrar on the AGPT program and therefore eligible for a provider number. Your Medicare Provider Number application must be submitted by the end of November 2014 at the latest. However, do not submit your Medicare Provider Number Application to Medicare until you have been advised by CCCGPT that GPET have verified your training status with Medicare. It is your Responsibility to ensure you have your provider number (and prescriber number) ready for the commencement of term on the 2nd February 2014.

GPSTART

This is a kind reminder to ensure that you have completed your GPStart modules via the online learning system.

Completion of Training (fellowship) application (COT)

For those of you who are nearing the end of your training, email correspondence was sent recently to remind you to submit your COT application. You can submit your application one month prior to your actual completion of training date and following successful exam results. This will allow sufficient time for processing.

For all enquires relating to training please email
[email protected]
One of our Program Managers, Kellie Kembrey or Fran Trench will respond within 3 working days.


IT Department Update

TES_Tablet

Website Updates

The ‘Common Tasks’ button is a new addition to the Public Website, which lists the different common tasks that may need to be completed during your training time, such as updating your contact details, viewing assessments, or reviewing your training progress). By clicking on these tasks, you will be taken directly to the area that allows you to do so.

For example, as a Registrar you can click ‘Enter Teaching Logs’, you will automatically be taken to the GPRime2 OTAC page to enter those details. Or, as a Supervisor you can click ‘Assess your Registrars – Complete Formative Assessment Form’ to be taken straight to the Training Evidence System (TES) to complete the form.


If you have any issues completing these tasks, you can click on the Systems Help button on the home page of website to review Tutorials, Video Guides, and access Support from the CCCGPT IT Team.

Contact Details

We would like to remind everyone that CCCGPT uses GPRime2 stored contact details as our first point of contact, including your phone number and email address.
We ask that all Supervisors, Medical Educators, Practice Managers, and Registrars update their contact details in GPRime2 when any change occurs. Soon, we will be emailing all Supervisor and Practice Managers to make sure their details have been updated in GPRime2, along with an instruction guide-through.
If you have any issues or questions about updating your contact details, please do not hesitate to contact us on 02 6923 5400 or
[email protected]
Please note: No information entered into GPRime2 is available to anyone outside of the CCCGPT Community. In the contact details section of GPRime2, each contact has a ‘Public’ or ‘Private’ option. We recommend mobile numbers and email addresses are marked as Public, as only Staff members and your assigned Supervisor and Medical Educator can see this information. If you mark these private, Staff members will not be able to see these details and you risk missing out on important information from CCCGPT.


There are also unknown unknowns!

Newsletter1

Dr. Mark Sands

Ever had a registrar who could do things you couldn’t? Young doctors leave the hospitals with many skills which are very useful in general practice. You might have an ex general surgeon who had some plastics training or a former gynaecologist who can do cervical sampling. My practice often lets the patient know that the new doctor is ‘just out of the hospital and very up to date.’

We had an interesting supervisor workshop at The Boathouse On The Lake a few weeks ago. The main theme of the afternoon session was the medico legal issues of supervision. Many discussions were had about how to aid our registrars in their training and where we stand if things aren’t going so well.

To go back to our scenarios above (which have both occurred in real life) the important rule to remember is that you must be able to perform the procedure if you are going to allow your registrar to carry it out in your practice. They should also double check with their own medical insurer to make sure they are covered. Special dispensation can be made but training must be provided to any assistants. This rule does not cover VMO work which has separate accreditation and cover through the public hospital.

The most important role of the supervisor, in my opinion, is also to ensure the registrar gains knowledge about their own ‘blind spots’. Donald Rumsfeld is frequently quoted (in relation to weapons of mass destruction)

‘Reports that say that something hasn’t happened are always interesting to me, because as we know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns -­‐-­‐ the ones we don’t know we don’t know. And if one looks throughout the history of our country and other free countries, it is the latter category that tend to be the difficult ones.’

How do we work out our registrars (and our own) blind spots? Discussions ran around the table but some suggestions were by doing random case review during teaching times. Keeping an eye on the pathology ordered can be enlightening; I have found some registrars go straight for the ANCA and ENA screen as a first line test. Make sure you sit in with your registrar for a few patients or arrange to do some videoing of consults; anyone with a smartphone has a good enough camera (consent forms are on ccctraining.org). Check their learning plan regularly and lastly look at their referral patterns, also look at your own sometime! Make sure you give honest and constructive feedback.

To end remember to ensure all your registrars know how and when to contact you when they need you, I always worry about the registrar who doesn’t ask enough questions; if they get intotrouble and said you were unapproachable or unavailable you could get drawn into a legal minefield…


Meet our new ESO in Canberra

ESO

Liline Hewett

My name is Liline Hewett. I am the new Education Support Officer (ESO) in the Canberra office. I am enjoying my role at Coast City Country General Practice Training. I am grateful for the support that I have received from CCCGPT staff in helping get me up to speed. While I know there is much more to learn, it’s nice to know that there are many who are willing to help. A bit about me:

  • My first name is pronounced ‘Lee-lee-ne’ and the name is of Niue Island origin; I am of Niue Isnand and Aitutaki, Cook Islands (two small Pacific nations) heritage.
  • I was born and raised in Auckland, New Zealand (if we’ve spoken on the phone, you may have picked up on the accent).
  • I am the proud mother of a happy and silly three year old boy.
  • I have a Business degree in Human Resource Management specialising in Learning & Development.
  • I also have experience working in the Healthcare industry having previously worked at the Auckland Distrtict Health Board as the Learning & Development Administrator.

I look forward to working with you all. If you need to contact me, please email [email protected] or call me on 02 6248 5010.