Welcome to the EVGPT Rural Plan Gippsland

For enquiries relating to this plan, please contact Julieanne McLuckie, Rural Community Engagement Manager.

CEO Message

The difficulties of appropriate provisioning of primary healthcare, particularly in relation to rural and remote communities, is a world-wide problem. Within Australia we are acutely aware of the impact that inadequate healthcare provisioning has had upon many of our most exposed communities. As demand continues to dwarf supply there exists the need to look at solutions that are more efficient, are patient rather than algorithmic centred and promote integration and cooperation rather than siloed and independent approaches.

Embracing this concept, EVGPT has sought to move to a whole of region strategy. Based upon significant analysis of current and prospective regional need and in recognition of our own capacity, EVGPT has developed a Rural Plan which actively seeks to partner with other local agencies to form a collective and cooperative approach to the planning and delivery of primary healthcare services in Gippsland. For EVGPT this encompasses the sharing of our resources and our responsibility to lead and/or support healthcare initiatives implicit in a whole of region approach. 

We fully expect this document to be challenged, questioned, altered and expanded and that is to be applauded. However, its foundation, the intent to promote a collective ground-up approach whereby all local agencies are forthright in their commitment to drive sustainable and collective healthcare improvements for Gippsland must remain central and be embedded as a longitudinal mantra for all healthcare providers and facilitating organisations.

We at EVGPT look forward to working with you on this significant challenge.

Dr. Mark Rowe EdD
Chief Executive Officer

Introduction

For the last 20 years, Regional Training Providers (RTPs) and Regional Training Organisations (RTOs) have been delivering training of quality general practitioners meeting the health needs of our communities.

Since 2016, Eastern Victoria GP Training (EVGPT) have offered and delivered both the Australian General Practice Training (AGPT) general pathway and rural pathway program with now over 468 GP registrars achieving fellowship. This has included more than 128 rural pathway registrars, with 44% remaining in our rural region (MMM3 – 6) across Gippsland and surrounding areas, of which many have joined EVGPT as either Medical Educators, Training Advisors or Supervisors.

Our success to date is evident via the following:

  • Recent RACGP Accreditation Outcomes report noting EVGPT as a training organisation and the program devised, ‘is maintained and continuously improved offering tailored and personalised training and supervision’ [1] which is reflected in both national registrar and supervisor satisfaction surveys.
  • The most recent GPSA results indicated an 80% Supervisor satisfaction rate with EVGPT compared to the national average of 69%. The National Registrar Survey (2020) demonstrated for the past 5 years, EVGPT registrar satisfaction has been above the national averaged consistently. These results also demonstrated EVGPT is an RTO of choice based on reputation and we are more likely to be recommended by our registrars. More recent survey results demonstrate EVGPT registrars continue to be highly satisfied with the support, supervision, location of training and infrastructure and resources provided [2].
  • EVGPT has been successful in training places being filled. This has occurred across both pathways and for our rural pathway, 93% of places allocated since EVGPT’s inception in 2016 have been filled by rural registrars on either the ACRRM or RACGP pathway.
  • The 2020 National Registrar Survey also demonstrated that plans of registrars to stay in the region after completing the AGPT program is greater than the national average.
  • EVGPT registrars have achieved higher than the national average pass rate with RACGP exam results (AKT, KFP & OSCE) with a large percentage of ACRRM registrars passing assessments.
  • Our program and success are underpinned by our medical educators, training advisors, program support staff, our supervisors and practices who are experienced, highly skilled and engaged.
  • Many of our staff have been with EVGPT from the beginning in 2016, and a large percentage worked with previous RTOs in the region. Our strength is our organisational knowledge in the sector which is amongst the highest nationally [3].
  • EVGPT’s ability to continue to be adaptable and innovative during the COVID pandemic. Restrictions are constantly changing in a reaction to the environment providing instability and uncertainty for many as lockdowns continue to be implemented particularly in Victoria. Despite these ongoing challenges  our achievements have been significant; exceeding national average results in RACGP exams, continued  high satisfaction amongst supervisors and registrars, record numbers of doctors applying for our program for 2021 and 2022 entry,  and healthy staff retention levels. [4].

EVGPT will continue building capacity to meet both community and workforce needs across our Gippsland rural footprint and further enhance our partnership and collaboration with key relevant stakeholders. Important elements of building capacity across Gippsland will be the identification and selection of potential posts and area of coverage including service delivery, scope of practice, extension of skills, rural generalist advanced skills, accessibility, allied and specialist health access and service amenities.

With reference to the EV Engagement and Influencing Strategy, EVGPT will aspire to be more proactive in our region in the development of the pipeline for our future sustainability. We will continue to maintain and implement new initiatives and strategies with our extensive stakeholder engagement including GP Colleges, Government Health Departments, rural health services and health networks and rural clinical schools which can be leveraged to position us to achieve our objectives of addressing community need and workforce distribution in our rural region.

Shared Vision

To ensure a high standard of training continues to be delivered via our network of accredited practices, training posts and supervisors. This plan will illustrate how EVGPT will facilitate improved targeting of practice and post recruitment across our rural region. The overall objective is to expand our training network using several data sources to assess areas of need underpinned by a robust and transparent accreditation process including the following:

It is acknowledged that our rural footprint extends beyond Gippsland, including the Yarra Valley, WhittleseaHealesville and Warburton. However, the Commonwealth Government through the Department of Health towards the end of 2020 focused AGPT service provision on areas of need and therefore Gippsland was identified as a priority area, given the majority of the region is classified as a DPA (District of Priority Area). There are many elements in this plan which will be relevant and applied to our entire rural footprint, as we will remain as equally committed to supporting practices and communities in these areas. 

Snapshot

Population Overview

Gippsland covers an area of 41,556 square kilometres of south-eastern Victoria. In the 2016 census, the population of Gippsland according to the Australian Bureau of Statistics (ABS) was 271,266. Since the previous 2011 census, the population has increased by 15,548 (nearly 6%). In 2019 the Gippsland Primary Health Network (GPHN) projected the population across Gippsland to increase to 284,767 [1], however, the population was estimated to be approximately 287,000 [2]. These estimates were determined prior to the COVID pandemic.

The population in Gippsland is growing. We know this anecdotally when driving through the region, particularly South Gippsland, Bass Coast and West Gippsland with the expansion of housing and infrastructure development as an example. The impact of COVID is also contributing more recently with indicators showing a migration from urban to rural. This is evident through conversations with practices on the ground as well as businesses plus recent data from the Australian Bureau of Statistics showing a net 7445 people left the Greater Melbourne area through the September quarter of 2020, more than three in five persons moving to a regional location.

The next census completed on 10 August 2021 will further define population growth and movement.

Key health issues as identified in the Gippsland PHN Priorities 2019 – 2022 Snapshot are as follows:

Many service gaps identified in stakeholder consultations are affected by workforce limitations including: disability services, paediatric care, mental health, especially for children and young people, alcohol and other drug services and indigenous health [3].

Region Summary

EVGPT recently undertook an analysis to evaluate our current impact in the Gippsland region. This provided a breakdown of the population, median age, number of GPs per population/square km for each of the LGAs as well as outlining the workforce specialist skills shortages and variances in comparisons of patient presentations. A total of 313 GP FTE serviced Gippsland residents in  2019-2020, contributed by 631 individual GPs [4]. The EVGPT Rural Training Practice Map illustrates our Accredited and non-Accredited practices and their geographical Modified Monash Model (MMM) distribution across Gippsland.

The following table illustrates the varied socio-economic levels across Gippsland compared to both the Victorian and Australian average weekly household income.

Our internal evaluation, utilising various external data resources, raised more questions than answers with respect to the many factors that impact quality community healthcare provision. However, primary healthcare in that assessment was the consideration of supply and demand, most notably within the current environment and accentuated through increased demand spearheaded by COVID. How can service accessibility, that being accessibility in its widest sense – cost, distribution, availability, timeliness, service depth and the like be equivalent to demand? Is it acceptable for the Gippsland community to be unable to obtain an appointment with their GP of choice when they need it, or in lieu endure a two week plus wait for an appointment to become available. Based on the feedback we have received from the communitylack of access and inadequate provision remain of paramount importance.   

Aboriginal Health

EVGPT is committed to supporting Aboriginal Health in Gippsland and supports the National Cultural Mentor-Cultural Educator Network.

Professor Marlene Drysdale, EVGPT Senior Aboriginal Health Educator & Advisor, is the Chair of the National Aboriginal and Torres Strait Islander Cultural Educators and Mentors Network. Members of the network all work in Regional Training Organisations and have some responsibility for Aboriginal and Torres Strait Island health. Marlene highlights the importance of the network and the valuable collaboration that occurs, not only within the network, but amongst the wider medical educator staff also.

The Aboriginal Health team’s overarching remit is to work with all cohorts across EVGPT – registrars, supervisors, practice staff, medical educators, staff, and Board Directors – to create a culturally inclusive organisation committed to Reconciliation in Australia and Close the Gap.

We currently have training agreements with ACCHS with two out of four accredited practices located in Gippsland. The Aboriginal Health Team, via an extensive Engagement Strategy, continue to work with potential new practices who have received NACCHO Accreditation.

Professor Marlene Drysdale, EVGPT senior Aboriginal Health Educator & Advisor, talks about EVGPT’s contribution to Aboriginal Health.

Dr Shane Robbins, EVGPT Supervisor, discusses the contribution EVGPT registrars make to our communities.

Community Engagement

EVGPT is committed to understanding community need.

Our connection with Gippsland communities, stakeholder engagement, research, policy formation, innovative education programs and evaluation activities, will enable us to keep abreast of the health service needs and in particular, gaps in service delivery versus demand to maintain a voice and be a contributor to primary health care provision [5].

Dr Elisabeth Wearne, EVGPT Deputy Director of Education and Training (Rural Pathways), talks with Ms Jane Anderson, Latrobe Health Advocate about what community need is and how important it is to listen to the community’s voice. 

EVGPT continues to collaborate with our Gippsland partners and stakeholders, such as:

Through our EV Engagement and Influencing Strategy we strive to continually improve relationships to further strengthen our position to positively impact upon our rural footprint. We share the common vision of all our stakeholders across Gippsland to support and contribute to having the right care, in the right place, at the right time. The goal of EVGPT is to contribute to this vision through meeting our KPIs in filling rural GP training places and placing registrars in our highly dedicated and committed training practice network across the Gippsland region meeting community need and the training, educational and social needs of the registrar.

[1] Gippsland PHN Community Snapshot Fact Sheet July 2019
[2] Victorian Government, Department of Health and Human Services, 2018.
[3] ‘Meeting the Medical Workforce Needs in Gippsland’, Report prepared for the VRGP by Gippsland PHN, June 2021.
[4] ‘Meeting the Medical Workforce Needs in Gippsland’, Report prepared for the VRGP by Gippsland PHN, June 2021.
[5] RACGP Training Organisation Accreditation Submission November, 2020

Resourcing

Strategic Appointments

EVGPT restructured our key educational roles with an emphasis on delivering increased support and focus on rural general practice pathways in Eastern Victoria. The appointment of Dr Elisabeth Wearne to the newly created role of Deputy Director of Medical Education and Training (Rural Pathways) is central in supporting our vision to build viable pathways into general practice and to strengthen opportunities for GPs who in turn will serve our rural communities.

Throughout our rural training region, we work collaboratively with health services, training hubs and PHNs in meeting our communities’ health needs and providing a skilled and trained workforce to do so. Dr Elisabeth Wearne is very well placed with her experience and knowledge, and with her connections in the region to take this vision forward.

Dr Wearne has been working with us for many years as a Supervisor and Medical Educator, and in fact completed her GP training in the region.

Dr Elisabeth Wearne, Deputy Director of Medical Education and Training (Rural Pathways), talks about her appointment in 2020. This role builds on our strong history of GP Education in Gippsland and encompasses both medical education team leadership, and positive and productive engagement with regional, state and national partners.

Another key appointment was Julieanne McLuckie as the Rural Community Engagement Manager.  This role build’s on Julieanne’s previous role as the Rural Medical Workforce Manager with EVGPT to manage and contribute to a range of key organisational and program related projects predominantly focusing on engagement, partnerships, development and management of EVGPT operations with various agencies, professional networks, the local community and current and future training post needs.

Our Manager Rural Pathway Training, Val Treneman assists the Director of Medical Education and Training and Deputy Director of Medical Education and Training (Rural Pathways) in coordinating the GP registrar education and training program across EVGPT’s entire rural footprint managing a team of staff who are responsible for providing support to: (i) Participating practices, including supervisors, registrars and practice managers, and: (ii) The EVGPT medical education team.

This is an integral role and is supported by a highly skilled program support team, the majority whom have been with EVGPT since its inception and with previous RTOs and have a wealth of experience, knowledge and skills.

Importantly the strategy is championed by our Board and Senior Management Team providing a whole of organisation approach to the Gippsland Rural Plan. 

EVGPT’s Rural Team

Our success in filling 93% of rural pathway training places allocated since our inception to date is because of our highly skilled and experienced team based out of our Churchill office and across Gippsland. Many of our staff have been with EVGPT since we commenced operations in 2016 and with previous RTOs in the region. 

EVGPT Rural Resourcing

EVGPT’s rural footprint across Gippsland encompasses 58% of general practices which are accredited training practices, including branch practices throughout the region. Click on the buttons below to view the EVGPT Accredited Practices or the EVGPT Accredited and Non-Accredited Practices.

EVGPT supports registrars on both the ACRRM and RACGP rural pathway, accredited training practices and health facilities with a complete wrap-around service delivery model across the Gippsland rural footprint. Our activities also include non AGPT initiatives which will contribute to the retention of GPs post-Fellowship and a sustainable pipeline.

Achievements

What we currently do…

One of our biggest strengths is our Training Practice and Supervisor cohort – GP Training is a collective effort and we acknowledge that the practices, supervisors and registrars have played a significant role in making the program the success it is to date. The contribution of our practices, training posts and supervisors over the years and our relationship with them as an RTO is the enduring bedrock of any apprenticeship training program. This was highlighted in the recent RACGP Accreditation Report stating:

Extensive stakeholder engagement is in place. Stakeholder engagement in the Gippsland region provides an exciting opportunity to have a real pipeline oversite of registrars and workforce planning measure’ [1]

This is demonstrated through EVGPT’s commitment to existing initiatives/programs such as the following:

Training Places

Our program recruitment has been highly successful and we have continually filled the majority of our allocation of training places since 2016. The below table illustrates our success to date, noting that overall EVGPT has achieved a 93.0% of total places filled across both the ACRRM and RACGP rural pathway in our rural footprint. 

Rural GP Pipeline

Our rural pipeline is supported by collaborative programs supported by the Commonwealth Department of Health, Department of Health Victoria, training practices, regional health services, Gippsland Training Hub, Victorian Rural Generalist Program (VRGP) and PMCV and aimed at medical students and junior doctors.

EVGPT established a GP Pipeline Working Group of key senior staff including:

  • CEO
  • DMET
  • DDMET (Rural Pathways)
  • Communications and Marketing Manager
  • Manager Rural Pathway Training
  • Rural Community Engagement Manager

This group, meet fortnightly to keep abreast of local contextual information to strategically plan engagement activities with hospital and key stakeholders.

The Gippsland Students Medical Network is an initiative EVGPT has supported since commencing in 2016 with a focus on supporting Gippsland secondary school students who have a strong desire to pursue a career in medicine. EVGPT have coordinated and supported partnerships with Monash Rural Health, the Gippsland Training Hub and WILDFIRE providing a number of information sessions over the years as well as assistance with mentoring, work experience and preparation for the former UMAT examination. EVGPT continues today to provide advice and guidance as part of our ‘grow our own’ initiative and collaborates with key partners to promote the GP training rural pathway in Gippsland.

EVGPT annually sponsor various medical student activities undertaken by both Monash University and University Melbourne and General Practice Student Network’s (Monash University) promoting rural general practice.

RACGP & ACRRM

EVGPT continue to collaboratively work with both Colleges for the common purpose of delivering the AGPT program for registrars. EVGPT have maintained accreditation and more recently were acknowledged by the RACGP in the ‘Accreditation Outcomes Report’ who stated:

EVGPT as a training organisation and the program devised, ‘is maintained and continuously improved offering tailored and personalised training and supervision’. [1]

Our success is because of our staff across our entire footprint! In our rural office located in Churchill, staff under the leadership of Val Treneman, Manager Rural Pathway Training have gone above and beyond what is required, particularly during the last 18 months to take on additional activities to support both Colleges as a result of the impact of COVID, most notably:

  • Our staff have proven to be versatile, innovative, adaptable and committed to supporting our registrars. Due to the current environment and restrictions they have taken on additional activities at the request of both Colleges, which has resulted in a workload that has been above and beyond their normal job requirements. In particular, our Registrar Support Officer, Leanne Renshaw and Practice and Supervisor Support Officer, Belinda Giles together with the unwavering support from other staff members in the Churchill office have provided their expertise to both Colleges to assist in delivering the following:
    • KFP, RCEs, AKTs and will assist with the upcoming CCEs for the RACGP
    • Invigilated MCQs and CGT (and advanced skills discipline) STaMPS for ACRRM

Our delivery of the AGPT program during the current pandemic and ever-changing restrictions has continued uninterrupted as a result of our staff:

  • Our staff have adapted seamlessly to working remotely from home, learning very quickly new systems and technology, staying connected (one of EVGPT’s values) to ensure program delivery and support continues as ‘business as usual’ for registrars and practices.
  • The impact of COVID and working remotely increased demand for administrative support from Program Support staff to host events outside their normal working hours and remit which is testament to their commitment.
  • Our staff worked extremely hard to go online and adapt the Workshop programs so they could be delivered remotely by the Education team so that registrars were not disadvantaged by the impact of restrictions. Our Workshop Administrator, Lisa Kassell, worked tirelessly in resourcing and managing the logistics of moving to remote formats in a relatively short timeframe. Our Workshop team were innovative and also worked tirelessly to adapt the educational program to online ensuring the educational support of registrars continued, uninterrupted. This was no different for our Supervisor PD Program.
  • ECTVs moved to videoconferencing that required an enormous effort into adapting systems, rescheduling of visits and provide guidelines to support registrars, practices and supervisors undertaking these visits. In addition, our Supervisor PD team offered additional workshops to support supervisors in managing ECTVs remotely.

Selection Interviews
Our Rural team’s ability to move traditional face to face selection interviews for 2021 and again for the 2022 to a remote format for all has been exceptional! Our Manager Rural Pathway Training, Val Treneman, and her team have worked tirelessly in developing and coordinating the logistics and managing the selection and interview process remotely. From holding these interviews over two days in 2021, to refining the process further and utilising their skills, knowledge and experience, to recently successfully running 40 interviews in an online hub environment in one day for the 2022 program is to be commended.

The expertise EVGPT staff have developed is second to none and their effort and commitment to ensuring ‘the show will go on’ has been outstanding in what remains a challenging and uncertain environment. This effort and commitment have been no different in our Hawthorn office and overall is a testament to the culture and values all EVGPT staff embrace and embody.

 

[1]  RACGP, ‘Training Organisation Accreditation Outcomes Report, Eastern Victoria GP Training ‘, March 2021
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Rural Junior Doctor Training Innovation Fund

Since 2018, EVGPT is the only RTO to have been funded by the Department of Health to co-ordinate GP rotations for Interns in the Gippsland Rural Intern Training Program and PGY2 prevocational junior doctors employed by Latrobe Regional Hospital. These GP rotations are hosted by a number of highly experienced and supportive EVGPT accredited training practices across Gippsland. This program has filled a gap since PGPPP (Prevocational General Practice Placement Program) ceased in 2016 to expose prevocational junior doctors to rural general practice in a positive and supportive environment which is widely documented as a successful strategy to attract prevocational junior doctors into GP training.

This program is vertically integrated within our practices. This enables training from medical student – Intern/PGY2 – registrar – GP Specialist. Our success to date with this program has been exceptional as  demonstrated by the feedback received from our junior doctors and practices. A number of junior doctors have since remained in Gippsland and pursued AGPT either via RACGP or the ACRRM pathway.

It was a great rotation with excellent education. In particular, the fact I was able to ‘run’ my own consults with the security of a supervising consultant was not only beneficial to my clinical learning, but also my ability to interact with patients as a ‘doctor’ rather than the medical student. I’d strongly recommend all interns do a GP rotation, especially one with the opportunities present in rural Victoria. The GP rotation conducted in 4th year medical school does not paint General Practice in the same light as a fully immersive internship rotation, and I do believe more people would be likely to take up General Practice if they were fortunate enough to be exposed to it early-on in the intern setting.” (Intern, 2019)

Within our jurisdiction, in partnership with LRH, all GP rotations offered within the RJDTIF program to GRIT interns are accredited by the Postgraduate Medical Council of Victoria (PMCV). 

Rural Generalist Pathway

EVGPT and their legacy RTO, Southern GP Training (SGPT), have provided a case management approach to support registrars that have chosen to undertake both extended and advanced skills with more than 40 registrars undertaking training skills posts since our inception. EVGPT have a dedicated Senior Medical Educator supported by ACRRM and FARGP Medical Educators and the Rural Community Engagement Manager to assist registrars on both the RACGP/FARGP and ACRRM pathways.

With the establishment of the Victorian Rural Generalist Program (VRGP) in 2020, EVGPT have aligned and supported the integration of activities and worked closely with the VRGP to improve access, support and retention of rural generalists across our Gippsland region. EVGPT works together with the VRGP team and closely with the Gippsland RG Coordinator, providing resources and timely information to registrars as well as support the VRGP Advanced Skills computer match process for posts as managed by the Postgraduate Medical Council Victoria (PMCV).  

The Deputy Director of Medical Education and Training (Rural Pathways) is a representative on the VRGP State-wide Reference Committee.

Development of Training Posts Relevant to Community Need

EVGPT continue to evaluate our impact on the community and service demand versus service delivery ensuring there is sufficient capacity of training posts available for registrars where they are needed. In partnership with the Gippsland Health Services and the Victorian Rural Generalist Program we have continued to establish, develop and accredit additional posts to meet community need. The development of this work has been due to the highly skilled medical educator staff within EVGPT, our effective engagement with relevant stakeholders and a strong desire to ensure we align community need for educational and training delivery to registrars. More recently these posts have included:

– Adult Internal Medicine (12 month Advanced Skills)
– Palliative Care (12 month Advanced Skills)
– Mental Health (12 month Advanced Skills)
– Additional Emergency Medicine posts (6 month Extended Skills and 12 month Advanced Skills)

Aboriginal Health Posts in Gippsland

EVGPT have staff who identify as Aboriginal and are employed as Advisors, Educators and Mentors. They contribute to all aspects of Aboriginal Health training across multiple cohort groups at EVGPT. Our staff have been the cornerstone of EVGPT’s ability to embed a remote supervision program that enables registrars to undertake training at posts where there are no accredited GPs on site. This is particularly relevant at Aboriginal and Torres Strait Islander Health Services (ACCHS) including Gippsland and East Gippsland Aboriginal Co-operative (Bairnsdale) and Ramahyuck District Aboriginal Co-operative (Morwell) with which we have training agreements in place. Off-site supervision arrangements are developed in correspondence with, and approved by the RACGP. Careful planning of these placements prior to registrar commencement ensures that registrars have timely access to support and assistance where required. The remote supervision model for ACCHS placements at EVGPT has enabled an increase in FTE service provision in these settings since 2016.

EVGPT is supporting the Cultural Safety Project which will further strengthen our support of registrars with the delivery of a Cultural Competency Framework and Cultural Awareness Training Module.

Rural Generalist State-Wide Workshop Program

EVGPT (and via their legacy RTO, SGPT), have been coordinating a highly successful and regarded Victorian State-wide Workshop Program for all trainees undertaking GP Obstetrics (GPO) and GP Anaesthethics (GPA) since 2013. These Workshops including a Pre-Exam Workshop for GPA trainees have been held at various locations throughout Victoria including Warragul, Ballarat, Colac, Bendigo and Wangaratta. Although these Workshops have had to move to virtual online delivery, this has created the opportunity to have guest speakers from not only across Australia but also internationally providing their expertise, skills, experience and knowledge to the trainees. In 2021, EVGPT supported the extension of this Workshop program to include Rural Generalist GP trainees undertaking Paediatrics and Emergency Medicine and are supporting the transition of the program to the VRGP, of what has developed into a world class program supported by a highly skilled and experienced Faculty team across Victoria.

Practice Recruitment

EVGPT has currently undergone a restructure within Practice Support and Accreditation to better inform and improve practice identification, recruitment, selection and accreditation of new training practices and health services posts. EVGPT have invested to support our rural footprint with the appointment of the Rural Community Engagement Manager. A key aspect of this position is to analyse data, provide strategic advice in consultation with other key senior EVGPT staff to inform and improve EVGPT’s engagement directions and performance, particularly in relation to rural stakeholder liaison and training post recruitment.

Within our rural office, our Manager Rural Pathway Training has led a project to develop a dynamic online ‘tool’ for registrars and future applicants to view and search for accredited practices with information relevant for them. This is intended to assist registrars and future applicants to make informed choices about potential training destinations that will meet their needs as well as that of the practice and the community.

 

We encourage you to visit our Training Post Profile site.

Monash Rural Health

We continue the collaboration to augment the vertical linkages within the rural medical training pipeline, provide students with access to a network of clinical mentors and facilitate engagement with the health service community. EVGPT both seeks and provides enhanced opportunities for research in best-practice clinical education. This relationship was further strengthened with the appointment of Neil Spike, Director of Medical Education and Training as an Adjunct Professor within the School.

Professor Neil Spike outlines vertical linkages within the rural medical training pipeline.

Marketing of Rural GP Training

Our Marketing and Communications team have worked tirelessly across our entire footprint and in particular have given our rural region priority with a number of key projects undertaken to align strategies with the challenges of rural GP shortages. EVGPT has invested to promote Gippsland as a training region of choice and also showcased a number of our practices and registrar experiences across the region as part of the #Opportunity Gippsland campaign and more recently Opportunity Gippsland – a rural solution. Our rural office works closely to support and contribute providing local knowledge and guidance to ensure all marketing activities are relevant and meet operational objectives.

EVGPT, through social media, webinars, media releases and involvement in relevant events (such as the AMA Medical Career’s Expo, Monash and University of Melbourne Student events just to name a few) are highly visible and aim to complement the work done on a national level through provision of local, targeted activities.

EVGPT have collaborated with a number of partners including MCCC GP Training and Rural Doctors Association Victoria as part of the #Destination Rural Campaign in 2019 across Victoria.

View the #DestinationRuralVictoria Video Playlist

Our Marketing and Communications Manager meets regularly with both Colleges individually and as part of the Regional Training Organisation Network Marketing Sub-committee which provides an opportunity for all RTO marketers to have regular contact and foster a collaborative approach to marketing and communications.

EVGPT is proud to also participate in the Sponsorship of University of Melbourne and Monash University Awards and support various events at both universities.

Workforce Distribution

Our recent internal impact evaluation confirmed a total of 58% of Gippsland practices have been recruited and accredited by EVGPT since its inception. We have achieved a geographical spread of accredited practices throughout Gippsland from Tooradin through to Mallacoota.

Our comprehensive analysis of primary healthcare needs of the Gippsland community raises more questions than answers. While the number of GPs per 1000 people is similar to urban LGAs (between 1 and 1.5 per 1000), the land size and spread of smaller communities within each LGA across Gippsland  significantly differs compared with urban settings. While GP workforce numbers may look reassuring on paper, anecdotally we know that problems with access to primary healthcare services when people need it persists.

The analysis demonstrated that although in general, most LGAs have specialised and allied health services provided (such as; Anaesethetics, Cardiology, Diagnostic Radiology, General Surgery, Medical Oncology, Obstetrics, Ophthalmology and Psychiatry) there are persisting problems with access. An example of this is mental health. The data clearly shows high levels of mental health presentations in all Gippsland LGAs – service is not keeping up with demand. An analysis of clinical skills needed was aligned to those key health issues as identified by the GPHN. It also raised questions regarding access showing comparable levels of GP attendance in most areas but also higher levels of lower urgency ED presentations (except during A/H).

We have identified that most practices in Gippsland are in DPAs (Distribution Priority Areas), and although these practices are geographically spread throughout Gippsland, we identified there is a need to recruit more training practices in MMM3 and MMM5. Moving forward, this is where the focus of practice recruitment will be in 2021/2022 and EVGPT will actively facilitate improved targeting and expansion in these areas.

Workforce distribution remains a priority nationally and is a key focus for EVGPT as part of our Engagement and Influencing strategy. We will continue to undertake robust research and evaluation activities to inform workforce requirements and solutions. We will continue to review our contribution to primary health care in our entire rural footprint utilising several population health data resources such as HeaDS UPP to improve accuracy of general practice workforce and geographical distribution.

Gippsland PHN

EVGPT is actively engaged with our local Gippsland Primary Healthcare Network (GPHN) and have established a good working relationship. We have a number of staff who are affiliated and collaborate with the GPHN. In addition, EVGPT and GPHN signed an MOU which was established in relation to data sharing and workforce planning. This will enable both organisations to further inform workforce planning and retention initiatives with the common purpose of having the right doctor in the right place at the right time across Gippsland.

Latrobe Health Advocate

We have a strong and fruitful partnership with the Latrobe Health Advocate (LHA). EVGPT has worked with Jane Anderson and the LHA team since its inception focusing on Latrobe and surrounding communities. By coming together and contributing each organisation’s expertise, we have been able to achieve good outcomes for our communities.

In particular, as part of LHA’s recent “Improving access to services in Latrobe” project, EVGPT is the lead agency with regards to improving training and accreditation pathways for doctors in Latrobe.

GPRA

EVGPT continues to collaborates with, and supports GPRA initiatives marketing general practice to junior doctors including:
  • Being one of the few RTOs involved in the “Future GP network” pilot program, with Dr Damian Hannon, rural registrar, being the inaugural EVGPT GP Ambassador.
  • Ongoing involvement with the “Future GP network
  • Annual support of GPRA and GPSN publications GP First
  • Regular contributors to GPRA and GPSN e-newsletters

We support Registrar Liaison Officers in both rural and metro regions to attend GPRA national conferences/meetings, and ensure registrars, particularly those new to the program are familiar with GPRA and their support.

GPSA

EVGPT continues to work collaboratively with GPSA highlighting and promoting their resources and incorporating them into our supervisor professional development program. Our CEO meets regularly with the GPSA CEO and we have a medical educator whom is also a Board member of GPSA providing reports and updates quarterly to EVGPT’s Regional Interest Advisory Group (RIAG). Our working relationship enhances our ability to ensure both Supervisors and Practice Managers have access to timely information and are supported with advice and guidance as required. GPSA are regular presenters at EVGPT’s Practice Managers meetings.

Accreditation

A recent restructure of the Practice Support and Accreditation portfolio within EVGPT will enhance and further strengthen our robust and transparent processes into the future to accredit and reaccredit practices with systems in place to address issues as they arise.

Our Accreditation Panel oversees all accreditation who meet bi-monthly and regularly evaluate accreditation related issues and processes. Membership of the Accreditation Panel includes the CEO,  DMET, DDMETs, Accreditation Coordinator, SLOs, RLOs, PSSOs and Program Managers (General Pathway and Rural Pathway) to ensure defensibility of decision making and broad stakeholder perspectives and input.

We have recently established the Practice Support and Development Portfolio led by the Co-ordinator, Dr Niroshe Amarasekera and Medical Educator, Dr Susan Barnett, both of whom will be supported by a number of SLOs and Supervisor Advisors. The goal of this portfolio and the team is to resource and support the training environment in practices for registrars. It is focused on all staff and the environment for a good registrar experience.

The expression of interest and development of new training posts has been separated with a dedicated team established in our Rural Office including the DDMET Rural Pathway, Rural Community Engagement Manager and Practice and Supervisor Support Officer working in partnership with the newly established Practice Support and Development portfolio. Our renewed ‘Expression Of Interest’ (EOI) process will include an emphasis on strengthening relationships with non-accredited practices and facilitating support for those practices wishing to obtain accreditation subject to meeting specific requirements as outlined in the newly developed ‘Practice Recruitment Overview’ information sheet in addition to the EOI form – Becoming a Training Practice with EVGPT.

[1] Training Organisation Accreditation Outcomes Report, EVGPT, March 2021, RACGP.

Challenges

The landscape in general practice training has been a continual moving and changing environment since the reduction of RTO numbers in 2016, and now with the impending transition of AGPT to the RACGP and ACRRM in 2023.  

The current political environment is presenting significant risks and challenges. Currently the transition of AGPT to RACGP and ACRRM and the attendant uncertainty of planned priorities plus their timeline for implementation remains unclear. EVGPT is committed and will continue to work with all stakeholders involved to mitigate the impact on current registrars, training practices and staff involved in delivery training until the expiration of our existing contract.

Attraction, retention and workforce distribution

The issue of attraction, retention and workforce distribution in rural and regional areas remains a challenge not only in EVGPT’s footprint but nationally. The recent work of the Latrobe Health Advocate has highlighted through community consultation that the problem is not a shortage of GPs, it is a maldistribution of GPs. It has been suggested that there may be enough doctors in Latrobe per person, but there are not enough doctors per problem [1].

The recent release of the Melbourne Institute – Health Sector Report has raised the question, ‘Not enough GPs, too many non-GP Specialists?’ This report highlighted a higher number of doctors in training and non-GP specialists are beginning to spill over into rural areas. More doctors are working outside of major metropolitan areas. Growth in the number of doctors outside major metropolitan areas outstrips the growth inside these areas for all doctors except for GPs. This is despite decades of policy targeted to persuade more GPs to go rural; the differences in remuneration between GPs and non-GP specialists remains as illustrated in the below graph.

A higher proportion of junior doctors are continuing to choose non-GP specialty training, as the number of specialists grows faster than the number of GPs. Over the past 20 years, there have been no explicit policies designed to alter specialty choices. More GP training places do not alter doctors’ preferences or the relative attractiveness of general practice [2].

Rural Generalism

EVGPT welcomes the rise of ‘Rural Generalism’ as defined by the Collingrove Agreement [3]. A Rural Generalist is a medical practitioner who is trained to meet the specific current and future health care needs of Australian and rural and remote communities in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.

There remain gaps in the pipeline and availability of an end-to-end training pathways, particularly in South Gippsland and Bass Coast, and future employment opportunities in the nominated procedural skills set post-Fellowship [4].

EVGPT continues to support the establishment and implementation of the Victorian Rural Generalist Program (VRGP) and work closely to ensure advanced procedural skills training opportunities are available to rural GP registrars that meet both their training needs and the needs of the rural community. However, as noted in the 2019 AMA Rural Health Issues Survey [5], the utilisation of procedural skills is becoming increasingly difficult, in large part driven by the closure or downgrading of rural hospitals. Unless procedural GPs can be assured of a suitable caseload, deskilling becomes a significant problem.

EVGPT want, like all stakeholders, end-to-end training that ultimately offers doctors the opportunity to live, train and work in a rural area. It is important that in the smaller health services/communities, those that fellow as ‘Rural Generalists’ have access to well-supported positions where their skills can be maintained and meet community need post-Fellowship. Across Gippsland, the workforce mix varies with some of the larger health services moving towards a specialist-led workforce model. Whilst all health services are willing to train, longer-term employment opportunities for our future rural generalists at this point in time beyond training may be limited [6].

Environmental Pressures

Gippsland has been challenged as a region particularly during the past 18 months with the extensive and damaging fires across East Gippsland followed by the impact of COVID and more recently in mid 2021, floods. This has placed significant pressure on all services including our general practices that have been at the frontline of this pandemic. Nearly 18 months on, the stress and workload particularly now supporting the vaccine rollout is consuming much of their time with the need to be constantly dealing with change and most importantly meeting community needs. The feedback EVGPT is receiving from those at the coalface is these factors general practices face daily are limiting their scope to absorb any other activities outside of their number one priority, patient care. Subsequently, there is a potential risk that the pressure and complexity of training AGPT registrars and expanding more training places across the Gippsland region may be challenging, particularly with the impending change in the landscape of the delivery of GP training – it may be just another change that might not be readily digested by rural practices.

Opportunities

‘In the middle of difficulty, lies opportunity’ (Albert Einstein)

EVGPT recognises that GP training, service to our communities and support to our training practices is our established purpose and, as such, we commit to sharing our expertise to enable continued success.

EVGPT has become an increasing, although somewhat understated, voice and contributor of primary health care provision. Currently, we are the single point of education delivery of AGPT and have been for nearly 20 years. Although the political and overall environment of AGPT delivery is in a period of significant change, continued AGPT success is aligned to establishing new relationships between training practices and new training providers which EVGPT will continue to do in earnest.

The transition of  College-led delivery of AGPT presents the opportunity to widen the prospect of changed delivery arrangements including that of merged entities and new agencies. We recognise the need to increase our focus on on-going evaluation and the use of evidence to identify our strengths and areas of required improvement.

To meet the objective of expanding our training practice network we aim to utilise multiple sources of data which will enable triangulation of information to understand particularly the locally contextualised information available and make decisions to ensure our Operational objective (2020-2023) of recruiting and developing training placements that meet quality, workforce distribution and community need requirements across our rural region is reached.

COVID has forced our communities to think differently about the way we live, work [1] and impact our environment. Out of lockdown in many parts, particularly Victoria during 2020/21, has emerged a telecommuting society – virtual meetings, virtual workshops and virtual education delivery have become the norm! It has been reported that the pandemic is putting regional and rural towns back on the map. Speaking to several practice managers and stakeholders in various parts of Gippsland, in particular Bass Coast, South Gippsland and Baw Baw LGAs, population growth is occurring rapidly in our rural footprint.

This opportunity may present a change in the perception of urban versus rural – that there are opportunities that exist for the health professional community and their families here in Gippsland. It is therefore timely for EVGPT to continue to promote the liveability and diversity of living in Gippsland. We will work with our partners and stakeholders to spotlight the region as an amazing place to train, live and work.

EVGPT developed the #OpportunityGippsland marketing campaign in February 2020. The campaign comprised a series of practice profiles showcasing GP Training in Eastern Victoria. More video profiles were added in May 2021.

EVGPT is pleased that we have been able to support the Gippsland community through this campaign and believe it was a key factor that supported high applicant numbers for the 2021 and 2022 AGPT program with EVGPT.

View the #OpportunityGippsland playlist here.

[1] https://www.gphn.org.au/wp-content/uploads/2021/04/Pandemics-and-disasters-the-value-of-integrated-care_FA.pdf

Action Plan

At the heart of our rural plan is EVGPT’s commitment to being part of the rural solution. The building of our partnerships with relevant local, state and national stakeholders to influence, target and implement initiatives in our rural region will be a core element. Most importantly listening to the community voice, our registrars, practices and supervisors with regards to their needs will be vital. Ultimately EVGPT’s goal for the rural region is to provide a clear plan which is sustainable, adaptable and measured to ensure service delivery will meet demand.

Aim

Our aim is to increase practice capacity across EVGPT’s rural footprint, addressing geographical and workforce distribution underpinned by a robust and transparent recruitment process. The plan will be centred around core themes to ensure alignment, engagement and collaboration with stakeholders who are invested and committed to the training pipeline, recruitment into rural general practice and retention of doctors equipped with the right skills, at the right time and in the right place to meet current and future community needs.

Timeline

EVGPT is providing a ‘future directions’ plan, remaining committed to delivering the AGPT program and associated activities to the same high standards of excellence we have always strived towards and will do so until the end of our stewardship. 

Objectives

Key Operational Objectives (2020- Jan 2023) that will underpin the Rural Plan are:

  • Develop and implement recruitment, marketing and selection strategies that attract high quality and engaged applicants.
  • Recruit and develop training placements that meet quality, workforce distribution and community need requirements.
  • Streamline record management systems and program administrative processes.
  • Embed research and evidence-based decision-making across the organisation.
  • Increase support with a focus on actions to improve culturally relevant Aboriginal and Torres Strait Islander health outcomes.
  • Build partnerships with relevant local, state and national stakeholders to better influence, target and implement relevant health policies and initiatives.
  • Advocate for change to healthcare provision to support community equity and distribution of training posts.
  • Promote and support retention processes for Fellowed registrars and service agencies particularly in areas of workforce priority areas.
  • Take a pro-active role in the development of a sustainable pre-vocational GP pipeline.

We have done a significant amount of work to ensure that 58% of Gippsland practices are accredited and that those practices are geographically distributed throughout Gippsland. However, moving forward we have identified that our future recruitment endeavours for 2022 will need to be focused on practices located in the MMM3 and MMM5 regions and particularly within designated DPA (Distribution Priority Areas) in those regions.

We will build on our strengths as outlined and the initiatives and programs already underway with the intention of further enhancing these through robust and transparent processes and systems.  

Key themes

Our rural ‘Future Directions’ plan will be based on a hub and spoke model focusing on the following key themes:

Engagement

  • Continue to support practices and promote opportunities which exist within our Gippsland rural training region with key marketing and communication activities.  
  • Maintain the newly established ‘Training Post Profile’ tool which will provide registrars the opportunity to make a more informed choice when considering our accredited training practices and for practices to promote their specific attributes.   
  • Our most valuable asset, our staff, many of whom have been with EVGPT and the legacy RTOs in our rural office are highly skilled, engaged and experienced and will continue to be committed to supporting and providing a case management approach for our registrars, practices and supervisors.   
  • We will continue to collaborate and partner with our stakeholders as the ‘rural solution’ needs to be a collective one and will require multiple organisations working together towards common goals.  
  • We will continue to engage with the Department of Health, RACGP and ACRRM to best enable a smooth transition of the AGPT program to the Colleges to minimise the impact on registrars, practices and supervisors. 
  • In the best interest of both RACGP and ACRRM and all EVGPT staff, we will continue to engage and advocate for a timely transition of staff to ensure employment opportunities are provided and the Colleges take on our highly skilled, committed and engaged workforce at all levels of the organisation to meet the resource requirements of delivering the AGPT beyond January 2023. 

Community and Workforce Need

  • As we are geographically situated in Gippsland, we will ensure the emphasis on engagement and integrating activities with our stakeholders at a local and regional level continues to be relevant and effective in advocating for more ‘rural GPs’ and ‘Rural Generalists’ that live, work and train in Gippsland. 
  • Increase targeting and recruitment of practices in areas of workforce distribution and community need.  
  • Increase and align Training Practice capacity against the number of incoming registrars, existing registrars and practice needs according to their stage of training. 
  • Improve targeting of practices through a robust and defensible recruitment, selection and accreditation process of new practices underpinned by relevant data from various sources.   
  • Alignment of pre-match eligibility of potential new training practices. Priority of practices within areas of workforce need/DPA location will be given. 
  • Embed research and evidence-based decision making across the organisation. 

Rural Pipeline

  • EVGPT will continue to provide support and advice to Gippsland Secondary School students who have a strong interest and desire to pursue a career in medicine. 
  • Increase opportunities for vertical integration within EVGPT’s network of accredited practices for medical students, junior doctors and registrars. 
  • Continue to deliver opportunities for junior prevocational doctors to experience and be exposed to the general practice environment through the Rural Junior Doctor Training Innovation program (RJDTIF). 
  • EVGPT will support and contribute to initiatives that will enhance opportunities that will provide an accessible pipeline in Gippsland from medical student through to GP Fellowship.  
  • EVGPT will continue supporting activities and initiatives of the Victoria Rural Generalist Program (VRGP). 
  • Collaborate, share perspectives and experience with ACRRM, RACGP and the VRGP with regards to rural pathway training and rural generalism. 
  • Ensure new and existing rural generalist registrars as well lateral entry rural generalist registrars have access to Gippsland Advanced Skills posts. 
  • Contribute to the governance and support of the VRGP objectives and outcomes. 
  • Contribute to the ‘rural solution’ with common goals amongst all stakeholders to increase the rural generalists and rural general practitioner workforce across the Gippsland region. 
  • Ensure registrars who have an interest in extended skills as part of GP training have access to posts and are offered where there is community need. 

Workforce Retention

  • Collaboratively design support strategies to retain GP registrars in Gippsland.  
  • Support and ensure retention of Supervisors across Gippsland to meet registrar training needs. 
  • Enhance and promote the liveability, innovation and diversity of Gippsland as a place to live, train and work with our stakeholders. 
  • Continue to support stakeholders to promote resources and programs that will assist with registrars’ to relocate to Gippsland. 
  • Promote and support retention processes for Fellowed registrars and service agencies particularly in areas of workforce priority areas. 

These themes are inherently all connected to addressing and promoting the liveability, diversity and innovation across our Gippsland region. We have the ultimate longterm goal of seeing the Gippsland community having access to the right doctor, in the right place, at the right time.  

Our legacy in our rural footprint will be the impact EVGPT has had. The ability to fill a total of 93% of training places to date in our rural pathway since our inception in 2016, and the ongoing dedication and commitment of our highly skilled and experienced staff, practices and supervisors is a testament to this.  

Our stakeholder engagement is demonstrated in these video interviews highlighting our joint goals, our response to community needs, and our ongoing work to date. Hover over the headings to watch the supporting video. 

Hub and Spoke Model

More Information

For further enquiries or if you wish to receive a full version of EVGPT’s Rural Action Plan, please contact Julieanne McLuckie, Rural Community Engagement Manager.

Acknowledgements

We would like to acknowledge the time, effort and commitment of all our rural staff, medical educators, training advisors, supervisors, practices and practice managers and their contribution to this plan, in particular EVGPT’s Rural Pipeline Group: 

  • Dr Mark Rowe, CEO 
  • Professor Neil Spike AM, Director of Medical Education and Training 
  • Dr Elisabeth Wearne, Deputy Director of Medical Education and Training (Rural Pathways)
  • Ms Pauline Ingham, Communications and Marketing Manager
  • Ms Val Treneman, Manager Rural Pathway Training 
  • Ms Julieanne McLuckie, Rural Community Engagement Manager 

Thank you to our Research and Evaluation Team for their skills and expertise. 

Special mention to the Communications and Marketing team, comprising of Pauline Ingham and Kirsten Hailes, in the design, layout and functionality of developing this into a digital plan that can continually be adapted to the ever-changing environment around us all!