GP First A story of success
Taking a fresh look at general practice
The future of general practice
Breathing new life
into general practice
GP FIrst a story of success GP FIRST has successfully ignited the conversation about general practice as a career specialty of choice in universities and hospitals around the country. The program was designed to increase the supply of doctors entering general practice and to enhance the understanding of the integration between primary and secondary healthcare amongst medical students and junior doctors. It encompasses three key workforce programs – General Practice Student Network (GPSN), Going Places Network (GPN) and First Wave Scholarship program (FWSP). Originally launched by The Hon. Tony Abbott MP, the program has been supported by every subsequent health minister.
ABB114
/07 2
General Practice Registrars Australia
media release
The networks are managed by GPRA, the only organisation in Australia with a cohesive vertically integrated network servicing medical students, junior doctors and GP registrars, and providing the pipeline for transition into AGPT.
GP FIRST – supplying candidates for AGPT
2011
2012
11%
2013
25.6% 35%
of AGPT applicants were from GP First
of AGPT applicants were from GP First
of AGPT Acceptances were from GP First
By 2017 over 80% of all AGPT applicants will come from GP First networks.
Fastest-growing medical network in the country 6 years in a row GP FIRST MEMBERS 15,000 14,155 12,000
11,400
Developing future leaders for general practice The networks are run by a number of highly committed volunteers, and provides its members with opportunities for leadership and involvement in policy development. Since inception, these networks have produced over 120 potential GP leaders each year – that’s over 600 in total.
Value for money GP First is extremely cost-effective. For a $77 per individual investment the network reaches a target audience of 17,000 medical students and 10,000 junior doctors, offering multiple touch points through print media, online campaigns, events and scholarships. GP First depends upon its passionate, committed volunteer workforce of over 100 individuals. A highly conservative estimate of the combined contribution of these individuals is estimated at 2,500 days of work per annum, presenting a FREE work output of 20,000 hours per annum valued at over $500,000 per annum. Compared to other programs, the value for money that this program represents speaks for itself, for example, if compared with PGPPP COSTS ($m)
MARKET PENETRATION
9,000 8,164 2.1
975
6,312
6,000 4,049 3,000
2,469 192 2007
54.5 2008
2009
2010
2011
2012
14,155
2013*
*At August 2013.
GPSN started in October 2007. GPN started in 2009 as a pilot in 3 states followed by national roll-out in mid 2010.
64%
of all current medical students are members of GPSN
32%
of all prevocational doctors are GPN members
PGPPP GP FIRST
$54.5m $2.1m
PGPPP GP FIRST
975 Jr. doctors 14,155 members
PGPPP has been operational since 2007 and in 2012 only 25% who completed the placement later joined the AGPT (source: Mason Review, 2013). In comparison, in 2013 35% of acceptances in AGPT were from GP First.
GP FIRST A STORY OF SUCCESS
3
General Practice Student Network Launched in October 2007 with a funding grant from the Commonwealth via the then Health Minister The Hon. Tony Abbott MP, the network is a student-driven peer-to-peer engagement program that has created a space for the conversation about the breadth and depth of general practice.
GPSN offers direct face-to-face engagement with the student cohort
GPSN membership MEMBERS
ENGAGEMENT WITH STUDENT COHORT
12,000
7,000 10,763
10,000
5,000
8,000
4,000
6,865 5,838
4,000
3,704
1,000 1,000 0
2008
2009
2010
2011
2012
2013*
YEAR
*As of August 2013.
Strong return on investment GPRA continues to provide value for money by through financial contribution. TOTAL FUNDING ($’000) 600
13 28
500
23
510
500
2010
2011
575
25 560
400 300 200 100
32 45
7.5 36
2007
2008
GPRA FUNDING
4
2,500
2,000
121 2007
3,500
3,000
2,230
2,000
6,000 5,000
8,960
6,000
6,500
48 2009
GPET FUNDING
General Practice Registrars Australia
2012
2013
YEAR
0
2007
36 2008
EVENT ATTENDANCES
72
60 2009
2010
EVENTS HELD
85 2011
101 2012
YEAR
“From a small idea by one medical student, who wanted to ensure that every student was being provided with an opportunity to explore the possibilities of a career as a general practitioner, to the thriving network it is today, GPSN is an exceptional initiative.” Professor Michael Kidd AM
Cost allocation per member continues to reduce
Breathing new life into general practice ÆÆ GP First has been the catalyst for change around the way general practice is discussed in universities.
COST ALLOCATION ($ per member) 350
ÆÆ For the first time in Australian history there is a genuine conversation about general practice in medical schools.
313
300
ÆÆ The program has shifted the perceptions of an entire generation, and started a conversation about the real world of general practice.
250 200 150
ÆÆ Energised by a passionate volunteer student workforce dedicated to promoting general practice and creating strong mentoring and professional relationships between medical students, junior doctors, GP registrars and GPs, the program is:
130 100
87
73
63
50
51
0 2007
2008
2009
2010
2011
2012
2013
YEAR
–– raising the profile of regional and rural general practice –– developed and maintained a strong active presence at every medical school campus across Australia.
“GPs are critical to our health system. Establishing mentoring between registrars and medical students should promote the discipline in the same way that a good clinical placement in general practice does.” The Hon. Tony Abbott MP
GP FIRST A STORY OF SUCCESS
5
First Wave Scholarship Program
“My placement reinforced the many positive aspects of general practice, such as the variety of clinical practice and the ability to pursue a special interest in an area of medicine at the same time.”
First Wave Scholarship Program (FWSP) is designed to offer early positive exposure to general practice, enabling students to better understand where general practice sits in the context of the healthcare system and holistic patient care.
Second year medical student, UWA
This program was funded entirely by GPRA for 2009 and 2010 and then gained support from the minister’s office and from DoHA. The program was formally funded via GPET.
Strong growth in scholarships NUMBER OF SCHOLARSHIPS
PARTICIPATING UNIVERSITIES & RTPS (%)
150
100 %
120
100
95
80
121
75
70
102 90
63
65
2009–10
2010–11
60
70
70
2011–12
2012–13
73 60
40 52
30
20
24
2008–09
15
2009–10
2010–11
2011–12
2012–13
2008–09
YEAR
Scholarship funding TOTAL FUNDING ($’000) 55
600 500
72.85
510
72
400
375 300
242*
300
2009–10
2010–11
200 116 100
2008–09 GPRA FUNDING
GPET FUNDING
2011–12
2012–3
YEAR
*2009-10 70% of the cost was supported by RTPs.
GPRA continues to substantially support this program through other externally sourced funding.
6
General Practice Registrars Australia
15
PARTICIPATING UNI %
PARTICIPATING RTPS %
YEAR
“Through First Wave I experienced the sense of community of rural medicine, which has influenced my decision to chose rural medicine.”
Average cost per scholarship continues to reduce
First year medical student, University of Melbourne
AVERAGE COST PER SCHOLARSHIP ($) 6,000 5,000
Conversion to AGPT
5,287* 4,833
4,735
4,653
Despite the fact that the program is still young, we are already able to show significant conversion.
4,340
4,000 3,000 2,000
Total students completed in 2008–10
76
Total who have graduated as of 2012
35
Have applied into GP training 1,000
9
Are intending to apply in 2014
2
Are still undecided but considering 2008–09
2009–10
2010–11
2011–12
10
2012–3
YEAR *2010–11 involved additional setup costs as the program moved mainstream.
Economies of scale for this program are achieved when running > 80 scholarships per annum
Program impact This program has a long lead time to conversion. Students undertake the scholarship in first or second year of study. Participant surveys reveal that this program has significant impact on career decisions.
Over 92% say this was extremely useful in assisting them with their future career choice. Over 77% say they are more likely to consider GP as a career after completing this scholarship.
This presents a conversion of 31% with another 28% still considering. These conversion rates are expected to further increase as the quality of the program and selection processes have improved over the years. In comparison, only 25% of PGPPP applicants in 2012 went on to apply into AGPT (source:Mason Review, 2013).
The average cost of one First Wave Scholarship is LESS than one FTE week of PGPPP. There is a substantially higher conversion rate at a fraction of the cost, providing great value for money. GPRA is certain that this conversion can be translated to rural and aboriginal health settings with appropriate adjustment of the program.
Strong stakeholder support ÆÆ 100% of departments of general practice within the universities actively support this scholarship program. ÆÆ Over 70% of RTPs actively support and participate in this program. They are building direct links with their future applicants. ÆÆ The program encourages registrars to become medical educators and supervisors by taking on medical students. ÆÆ This is now regarded as a highly prestigious scholarship and students now aspire to be First Wave Scholars. ÆÆ The program changes students perceptions of the nature of general practice and begs the question, “Are you good enough to be a First Wave Scholar?” One in three miss out and the process is highly competitive.
GP FIRST A STORY OF SUCCESS
7
Going Places Network “As an international medical graduate I felt very confused by what steps I had to take to practice as a GP in Australia. My GP Ambassador was available to help answer my questions and point me in the right direction.”
The Going Places Network (GPN) is a peer-to-peer network of GP Ambassadors based in 65% of teaching hospitals around Australia. The network provides ongoing exposure, support and information about opportunities in GP through the hospital years. Piloted in three states under the name “GP Compass”, the program was officially launched in 2009 and has been hugely successful with strong support from both DoHa and the Minister’s office. The GPN is now firmly embedded in the hospital landscape and will become the fastest-growing network in the next 3 years.
Junior doctor, Townsville
Member growth EVENTS
MEMBERS 3,500
3,392
200
3,000
171
TBC
150
2,500
2,440 120
2,000 100 1,500 1,299 1,000
50
500 71 2007
239 2008
345 2009
474
2010
2011
2012
2013*
0
0
2007
2008
10
12
2009
2010
2011
2012
2013
*At August 2013.
This is still a young program and, whilst gaining substantial traction and recognition, it has not yet attained maturity. As GPSN members graduate and become members of GPN, this network is set to double in size over the next 3 years.
GPN operates in 65% of teaching hospitals in the country, with an ability to expand to 100%, subject to funding. The GPN will expand over the next few years to provide an engagement platform with over 80% of all junior doctors in the country and is an excellent peer-driven network, offering a one-on-one engagement in an environment that has historically been very difficult to penetrate. Gradual investment in this initiative will ensure that GP remains front of mind when people are making their career choices.
8
General Practice Registrars Australia
Introducing general practice into hospitals ÆÆ The existence of GPN gives GP educators access to teach in the hospital system. ÆÆ GPN puts general practice firmly on the hospital educational programs. ÆÆ facilitates linkages between the RTPs and the hospital system. ÆÆ GPN is the only national network in the hospital system with a focus on general practice.
GP FIRST Future Direction RIGHT PEOPLE. RIGHT SKILLS. RIGHT LOCATIONS. RIGHT COSTS. The Health Workforce 2025 report and the Mason Review highlight the issue that whilst we may have enough doctors by 2025, they are going to be in the wrong locations and with the wrong skills. GP First is the only vertically integrated program that has the capacity, focus and ability to reach and influence the next generation of doctors coming through. Within the context of GP training, the current oversupply of applicants is a short-term situation. The training program is expected to expand to 1,800 over the next 4 years. To fill this with quality AMG applicants we need over 2,500 candidate applications per annum. This will require almost 70% of the graduating cohort of 3,600 graduates to apply into GP training. GP First, through its already strong networks, will have a critical ongoing part to play in this supply if it is to be consistently sustained. In addition to promoting general practice, we envisage that this program will expand to address other key areas of workforce maldistribution.
New Focus for GP FIRST GP First will expand beyond simply promoting careers in general practice and will bring a new focus to include targeted initiatives around Aboriginal and Torres Strait Islander health, promotion of the rural and remote workforce and support for IMG/OTDs. It will also look to maximise the opportunities for engagement between GPSN and GPN members in these expanding areas.
Future plans PROMOTE GP CAREERS
POSITIVE EXPOSURE TO ABORIGINAL HEALTH POSITIVE EXPOSURE TO RURAL HEALTH
SUPPORT FOR IMG’S
Aboriginal and Torres Strait Islander health The GP FIRST program currently includes over 14,000 members, some of which are aboriginal and non-aboriginal individuals. As such, GPRA has created a framework to deliver targeted outcomes in this space and build on existing initiatives such as the Indigenous GP registrar network currently funded by GPET. The key objectives will be to ÆÆ increase the supply of and support for Aboriginal and Torres Strait Islander doctors
Cultural awareness Information and links to local Community Cultural mentors Close the Gap Campaign Reconciliation Action Plans Collaboration plans Cultural safety training
direct Positive exposure Indigenous First Wave scholarships Publications and online information Events and speakers Campaigns Cultural safety training online ÆÆ encourage non-Aboriginal doctors to work in Aboriginal and Torres Strait Islander health
Pastoral care Vertical integration of indigenous networks – IGPSN, IGPN and IGPRN Cross linkages with AIDA and NACCHO IGPRN chair and RLO network support
Mentoring Links with AIDA and RACGP Support from Close the Gap subcommittee GPRMEN and GPRSNET and RLOs Exam support
GP FIRST A STORY OF SUCCESS
9
GP FIRST Future Direction continued
Rural and remote health Through a change of emphasis across the various elements of the GP First program, there will be increased opportunities for early, positive exposure to rural and remote communities. The review of the programs has indicated that building a targeted exposure to rural opportunities across the medical student and junior doctor market segments is not too onerous. Key mechanisms to build this into the program include:
The framework below outlines the broad promotional components of the program. These activities are likely to have only a small budgetary impact since some are already incorporated. New items such as regional coordination and quarantining scholarships for rural locations will have some additional costs but these will also improve the overall quality of the GP FIRST program.
ÆÆ targeted regional collaboration with existing initiatives such as rural clubs, rural clinical schools , workforce agencies, training providers etc. ÆÆ realigning core activities of both networks to introduce an element of rural exposure. ÆÆ shifting focus of communication and marketing channels to ensure rural exposure.
10
medical students
JUNIOR DOCTORS
Promote rural opportunities via web, enews, publications and campaigns
Promote rural opportunities via web, enews, publications and campaigns
Partnership with rural clinical schools and rural clubs
Peer support network for rural community placement program
At least one event per annum with strong rural focus
Network events to feature rural opportunities
First Wave Scholarships to expand in rural and indigenous areas
IMG support network and targeted information resources
General Practice Registrars Australia
“Being a member of the Going Places Network has given me the opportunity to explore the world of general practice before committing myself to the training program by networking with GPs in my area and other junior doctors with similar interests. Without the Going Places Network I would probably still be in limbo as to my future training direction.” AGPT applicant 2013 Key features of GP First into the future The future direction of GP First is broken up into three broad areas: 1. Strengthening existing initiatives (green) 2. Modifying scope of existing initiatives to better target resources (orange) 3. New initiatives (red)
for medical students exec & council
support to directions to local clubs
national campaigns & communications
subcommittees: rural, close the gap, policy, community
Ambassador Program
peer-to-peer activity
organise oncampus promotion, distribution of collateral
access to universities & link to gp departments
student club acitivities
one career event
one aboriginal health event
one rural event (partner with rural clubs)
fw scholarships
three per university (100 total)
1st–4th-year students
50% rural ra3 plus locations
indigenous fw scholarships
one per uni growing to three per uni
3rd- and 4th-year students
targeted exposure to aboriginal health
igpsn network
collaboration with aida & university departments
mentoring program for aboriginal med students
support to get through medical school
cultural training
identify mentor for each club
connection to local community
publications & other targeted content
Key Green – existing programs Orange – enhancements to programs Red – new opportunites
GP FIRST A STORY OF SUCCESS
11
GP FIRST Future Direction continued “This program fills a critical gap by providing targeted advice related to general practice to junior doctors at a key time in their life when they are at the cusp of making the final choice.”
for Junior doctors
Junior doctor, RPA
Ambassador Program
peer-to-peer activity
access to hospital systems
distribute collateral & messages for gpsn, gpet & rtps
create state ambassador role to support other ambassadors
events
hospitality orientations / teaching sessions
career information events
agpt selection info webinars
clinical skills (rural/aboriginal focus)
PGppp support
promotion & information resources
agpt selection info webinars
peer support network for participants
pastoral care
img network
targeted information resources
link to otdnet
mentoring & peer support
promote rural & aboriginal health
igpn network
targeted support to apply into agpt
pastoral care & link to igpsn & igprn
link to other non-aboriginal mentors
cultural training
publications & other targeted resources
links to local community
Key Green – existing programs Orange – enhancements to programs Red – new opportunites
12
General Practice Registrars Australia
pastoral care
Š2013 GPRA. All rights are reserved. All materials contained in this publication are protected by Australian copyright law and may not be reproduced, distributed, transmitted, displayed, published or broadcast without the prior permission of General Practice Registrars Australia Ltd (GPRA) or in the case of third party material, the owner of that content. No part of this publication may be produced without prior permission and full acknowledgement of the source: Going Places magazine, a publication of General Practice Registrars Australia. All efforts have been made to ensure that material presented in this publication was correct at the time of printing and is published in good faith.
GP First A story of success PUBLISHED BY General Practice Registrars Australia Ltd ABN 60 108 076 704 Issn 2201-7356 Level 4, 517 Flinders Lane Melbourne VIC 3001 T 1300 131 198 F 03 9629 8896 E enquiries@gpra.org.au W gpra.org.au