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From the Chair...

"Wisdom is knowing what to do next. Skill is knowing how to do it. Virtue is doing it."

Thomas Jefferson’s definition of wisdom or “sagacity” (hopefully this word has you thinking of a sage who has guided you along your personal journey) highlights the need to combine knowledge and experience, knowing and doing.
In Inuit tradition, developing wisdom is the aim of teaching; and a person is wise when they can discern what needs to be done and do it successfully without being told to do so.

This month’s newsletter includes an article showcasing the sagacity of GPSA’s Deputy Chair, Dr Frank Maldari, whose insights have been fundamental to the GPSA Board throughout and prior to my term as a Director: please take a few minutes to enjoy this read. As an experienced GP, supervisor and mentor, Frank has supported peers and GPs-in-training in many ways – including through his role as SLO – and I for one am most grateful for his guidance and support.

The past month has again been a flurry of activities, with ongoing focus on bringing to our members and the sector a revised NTCER which is future-focused, sustainable, and updated with contemporaneous legislative requirements. We have been working through this extensive process with GPRA with the goal of having the new version of the NTCER Agreement ready for the 2025.1 placement processes. An immense amount of work has gone into this endeavour, and I would like to thank every GPSA member who has contributed to the review process via the survey, working parties and our negotiation party.

Another focus which created an extra bit of work for Carla and me was the College Presidential elections. We had a great time interviewing all of the candidates for RACGP and ACRRM to give our members a bit more insight into their views on the role of supervisors and practice-based GP training, and I am genuinely excited about the future for both GP specialty Colleges given the passion we uncovered. I would of course like to take this opportunity to extend my congratulations to Dr Michael Wright on his election to RACGP President, and Dr Rod Martin on his election to ACRRM President. I look forward to working and actively collaborating with both of these experienced GPs. This serves as a reminder that the election season for our sector is not yet over, with other representative roles for organisations coming up soon, and GPSA’s AGM and Board election at the end of November.

The GPSA education team continue to provide education support to our members and the most recent webinars that were of particular interest for me were around two integral parts of training that have been retained into current times – providing feedback and how to make the most of ECT visits. The former was also of interest as I had seen Dr Davies present her RACGP Future Leaders project at the GP22 conference, in the session where I too had been a contributor and was keen to learn more. The latter was designed to help integrate the roles of both supervisor and ECT visitor that I personally find very rewarding. I hope you were able to attend and if not, they remain accessible on GPSA’s YouTube channel.

I continue to support additional collaboration with other GP-focussed education and research partners to continue to bring you education and learning opportunities which keep your knowledge up to date and allow you to best share your wisdom with the trainees you support in your learning practices.

The most recent wisdom on learning I have seen is quite that highest form of learning in unlearning. We have seen some robust discussions and conversations around use of innovative technology including generative AI in our practices and certainly initial feedback looks positive in terms of improving quality of interaction with our patients and managing cognitive and administrative burden in our daily tasks. While the RACGP has published its guidance to all its members in this regard, we will be seeking further clarification on how this might specifically translate into the training context. In the meantime, I would recommend utilising a combination of an appraisal of your expertise with a generative AI tool, your trainee’s foundational competency in consultation skills, their willingness to use AI, the value they may ascribe to it, and then assessing its safety through discussion with them: as we would in many similar situations in our clinical practice in terms of shared decision making. For some of us, it is an opportunity to evaluate our learning skills as much as our teaching and supervision skills until more guidance becomes available. Patient and registrar safety remains paramount.

The GPSA team and I are looking forward to the last quarter of this year as we will be present at and contributing at many of the conferences where we are expecting to see a lot of our members – AAPM, RMA, Prevocational Forum, GP24, AIDA (PriDOC). I am always keen to meet you and hear from you via any platform or channel you feel is accessible for you. Every conversation and interaction allows me to better advocate and represent your needs and those of the roles and responsibilities we fulfill as GP supervisors and practice managers in training sites.

I will end with a quote from another family favourite and a wise sage for sure, Albus Dumbledore, Harry Potter and the Chamber of Secrets:

“It is not our abilities that show what we truly are… it is our choices.”

Dr Srishti Dutta
Chair

Return to September newsletter

Date reviewed: 30 August 2024

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Chair Reports - 2024

GPSA’s Chair, Dr Srishti Dutta, is actively involved in the stakeholder engagement and broad advocacy work GPSA is engaged in on behalf of the GPSA community.

Her monthly Chair Reports include updates on a range of topics discussed at the many tables at which GPSA now has a seat. Below you can access all of the Chair Reports for 2024 to date, including one penned by Deputy Chair, Dr Frank Maldari, in January:

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Date reviewed: 29 August 2024

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From the Chair...

“There is no absolute truth”… or is there?

The human brain that remains curious for longer learns more, and discovers more. It knows that wicked problems need more than simple solutions or potential magic bullets. It struggles with contradictions and paradoxes.  And it rejects antinomies.
Antinomy: a real or apparent mutual incompatibility of two notions, a contradiction in our own knowledge system, within our reason itself. Not being aware or being unable to acknowledge these antinomies can generate false understanding and contradicting theories.

In the current environment, critical thinking and wisdom are more important than ever.

The fundamental truth of our current primary care system and apprenticeship model is that, regardless of the funding models we do or don’t apply, without supervisors’ contributions it would all disintegrate. Irrespective whether the learner is a medical student, post graduate doctor or GP-in-training, the one constant is the experienced senior GP who offers their expertise to provide individualised guidance, teaching, mentorship and support - this supervisor in turn being supported by a team that helps create and sustain the training site as a quality learning environment.

The supervisor is the one constant across learner levels, standards and outcomes; yet it is the supervisor who has to adapt and change the most to meet the learner’s needs, and the training provider’s requirements, with every individual placement.

The last year or so has seen increased training numbers. While this may have been greater in rural areas and across certain pathways, we know that access to and sustainability of future workforce goes beyond just vocational training to supporting the pipelines leading to general practice and rural generalism. Yet again there is an expectation not only from our profession and peers but also our funders that we, supervisors and training sites, continue to volunteer considerable resources to scaffolding medical students and prevocational trainees. This comes at a time when the sustainability of general practice remains a challenge, as evidenced by the increasing number of practices closing around the country. Although an integral part of every learner’s needs, clinical supervision continues to be unremunerated. Thus a role that comes with clinical accountability and potential reputational risk for any practice or training site, a role that is central to the perpetuation of our profession, remains altruistically-powered (less by choice than need) for the overwhelming majority.

The Board and team of GPSA are all too aware of the challenges and responsibilities our members face. We remain committed to being responsive to your needs and supporting you in all possible ways. This year again our research team has been working tirelessly on the development of systems and structures that best empower supervision teams through evidence-backed innovation.  The education team continues to develop more webinars and resources to help you deliver educational supervision with excellence at its heart. In addition to Scenario – our first mobile app – along with its corresponding learner-facing app, ScenarioEd, this team now brings you Consultation! The Board Game, which had a successful international launch in Wellington at this year’s general practice conference celebrating the RNZCGP’s 50th anniversary.

Like you, we are largely unfunded for what we do: all of which is for you, our members. We are unique in our provision of open access resources, and we remain committed to continuing to share our content for free for the benefit of the broader community, and equally committed to keeping membership free for all Australians involved in GP training. Shoring up the sustainability of GPSA so we can continue to deliver the calibre of support you deserve is naturally one of our key priorities; your purchase of our apps and game will help ensure GPSA can continue to represent and support you into the future.

Our future focus also extends to exploring sponsorships and partnering opportunities with organisations who share our values. This last is part of our goal of ensuring any emerging areas of clinical practice and learner perceived needs can be addressed with confidence by our valued members.

How we work on your behalf in terms of our stakeholder engagement and advocacy efforts takes numerous forms. While some of this advocacy occurs behind closed doors and over many conversations across a variety of settings, our goal is singular: to ensure that your interests do not get buried under other pressing priorities and demands placed on this sector. I want to assure you that your priorities continue to be prosecuted even when some of the issues highlighted earlier in the year have still not been announced as resolved. This is quite frankly because we have either met with relative deafness from sector partners pursuing their own political agendas or encountered unexpected environmental changes requiring additional time to navigate.

The GPSA team and I have invested more than 4 months establishing our member priorities for the NTCER review and the future of GP training via the national annual survey, the NTCER survey, the NTCER working groups, networking events, conferences, the Community platform and the many one-on-one conversations we have had. I remain confident that we have heard from across the full and diverse membership of GPSA, and am grateful that so many of you have been keen to offer solution-focussed and innovative ways to tackle the problems we face. We will continue to raise these insights with other member organisations, training providers and our funders. In addition, we remain involved in other discussions including the various SEM trials occurring across the country, always determined to ensure inclusion of the supervisor voice. We continue to support the SLO Advisory Council too, under the able leadership of its Co-Chairs – Drs Sue Harrison, Tim Chappell and Candice Baker -, facilitating their conversations with both colleges on topics such as dual accreditation of supervisor PD, improved communication, access to regional supervision teams, and proactive measures to support an optimum training experience.

As we start to gear up for the next round of placements in the AGPT space, we encourage training sites to continue to offer as much as is viable by way of both financial and non-financial supports. The NTCER is a minimum set of national terms and conditions, which a great many of you have indicated you already surpass in varying degrees to show the value you place on your future colleagues and potential practice partners. Through the ongoing NTCER review process, we have learnt about the wide range of ways practices offer meaningful support for their trainees over and above the required minimum, including additional exam practice sessions run by volunteer GPs, and personal finance training and assistance delivered by our phenomenal practice managers in their own time. This confirms my belief that the values that drive GP supervision remain enshrined and safe, capable of weathering any pressures or changes to the external environment. I salute your commitment and resilience.

As the Chair of the GPSA Board, I understand that we may all be facing up to the same storm, but we are not all in the same boat. Our role as a membership organisation is to support the entire fleet, including looking after the smallest and the biggest ships through a lens of equity, so each can do their best and sail together. We represent otherwise unassociated individuals and businesses, and do so with humility and respect for all each of you offer to ensure quality health outcomes through high quality training.

This time I leave you to ponder over one of my favourite movie quotes, from of all things the Disney animation ‘Bambi’:

“Life is all about perspective” (not just perception).

Dr Srishti Dutta
Chair

Return to August newsletter

Date reviewed: 30 August 2024

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From the Chair...

Change is the only constant... Or is it?

It was almost 15 years ago when, at the orientation day of a vocational training scheme not unlike the AGPT, a speech delivered by the Director – who was himself a GP – doused the enthusiasm of a room full of largely female trainees with two messages of doom:

  • that we would be impacted by medical (specifically GP) unemployment, and
  • that most of the women in that room would have at least one pregnancy during training… and that he expected to be informed about it as soon as it occurred.

I can’t attest to the accuracy for the rest of the registrars who heard those words, but for at least for one person in that room those predictions were entirely incorrect. Hence I find myself here still: a GP unwilling to blithely accept all the negative predictions about our profession and the future GP workforce currently swirling around us.

While I may accept change is the only constant and adaptability a skill that we undervalue, I remain optimistic that GP supervisors and our trainees have plenty to contribute to the delivery of quality primary healthcare for our communities in the years to come. Change doesn’t always come in the forms we expect, nor is it always unwelcome; it is in fact an opportunity for us to make what is good even better.

The past month has seen me in many gatherings, with many opportunities to meet and engage with members, partners and stakeholders. The topics of discussion have ranged from the single employer model to the NTCER review, use of AI, medical education tips and peer support to name a few. There is wide acceptance of the inevitability of changes to come, however there is also a desire to hold on to things that matter to us: the collaborative nature of GP supervisors and medical educators, the ability to pass on business skills and help grow new practices, and most of all having fun while we do the things we each do best. This last was clearly demonstrated at the GPME conference on the Gold Coast, where GPSA’s Drs Simon Morgan and Jess Wrigley launched our newest education tool “Consultation!” – a fun, educational and at times frustrating board game that uncannily mimics a day in practice as the players navigate patient presentations and brain teasing challenges while racing each other to the tea room before all the cupcakes are gone! If you want to know more, please have a look at (link) and other learning resources on our website and in your mobile app store designed around the philosophy Justin Coleman refers to as “edutainment”: making GP training more enjoyable.

At the tail end of June, GPSA brought together your on-the-ground College representatives, the Supervisor Liaison Officers (SLOs), for the annual face-to-face meeting of the SLO Advisory Council. This meeting took place across 2 half-days in Brisbane, and included a really productive session with key members of each College’s leadership team including both RACGP President (and former GPSA Chair) Dr Nicole Higgins and ACRRM President Dr Dan Halliday. Another first, driven by GPSA’s MoU with GPRA, the second day started with a joint meeting of the two advisory councils representing the key participants in vocational training: the RACGP, ACRRM and RVTS SLOs and their registrar counterparts, the RLOs. This was a highly engaged, interactive session that spoke to the passion, commitment and alignment of both the two Advisory Council members as well as the two independent peaks committed to supporting them, and in turn you.

The next month will bring for these peaks further engagement as we enter into negotiations regarding the revision of the NTCER. GPSA will also continue to participate in broader training and supervision conversations such as the facilitation of higher quality supervision for pre-fellowship PGY1 and PGY2 trainees in community general practice, supporting practices and supervisors in the next AGPT placement process, and seeking clarity from the Colleges about timing of Semester 2 out-of-practice education so that practices can take back some control over their ability to plan and minimise the impact on their patients’ access to registrars. We encourage you to contact us and your SLOs with any concerns or issues that you might have to ensure your needs are voiced in our discussions with our sector partners and Commonwealth.

Until next time, I leave you with words that come from another of my favourite motion pictures (that’s “movies” for you younger folk):

“Change isn’t always bad. It’s just different.” – Chani (from “Dune”) 

Hopefully this reminds us that change, while often uncomfortable, really can lead to positive outcomes.

Dr Srishti Dutta
Chair

Return to July newsletter

Date reviewed: 30 August 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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Out and about – May 2024

Living out of a suitcase through May!

May for our CEO started with a pleasant if lengthy drive to the South Australian Riverlands for the National SEM Conference, where she had the opportunity to speak with supervisors and practice owners participating in the SEM developed for the Renmark and Berri communities.

What struck her most was the value of co-design in these place-based solutions. The essential ingredients might be summarised as flexibility, mutual respect, and a willingness to investigate and respond proactively to the needs of all stakeholders – trainees, supervisors, practices, state-run health services and the community members they serve. SEM is definitely not a one-size-fits-all concept, and has limited application based on geographical and demographic context; but for certain rural locations in which GPs juggle their workload across both hospital and practice settings, it offers a means to improve and perpetuate equitable primary health care options for the community.

On her trip home from Berri, Carla was invited to attend a GP Supervisor Networking Dinner in Swan Hill. Hosted by Murray PHN, this fun night at One28 Doors gave an enthusiastic group of supervisors the chance to discuss what they most enjoy about their supervision role, and their concerns about retaining registrars in regional and rural locations.

The next road trip followed shortly after the first, seeing Carla head to another very pretty town that should by rights be teeming with GPs! This year’s Rural Doctors Association of Victoria (RDAV) Conference was held in Mildura, where a lot of the discussions were again around retaining junior doctors to the end of and following their vocational training.

The Hon. Anne Webster, Federal Member for Mallee and Shadow Assistant Minister for Regional Health – coincidentally the wife of possibly the best known Mildura GP in living history, recently-retired Dr Phillip Webster – spoke passionately about this issue at the conference dinner where she witnessed the presentation of the RDAV Lifetime Membership Award to Dr Sue Harrison OAM… by none other than Sue’s daughter, Emergency Department Clinical Lead at Swan Hill District Health, Dr Emily Harrison (FACRRM).

Closing out the month, Carla travelled to Cairns for the RACGP Practice Owners Conference with GPSA COO Leonie Chamberlain and Chair Dr Srishti Dutta. In addition to all that Srishti covered in the June Chair Report, GPSA held a lively networking night for practice managers; Leonie visited the Wuchopperen Health Service managed by the lovely Susanne Raistrick; the GPSA booth was never empty; and Srishti, Carla and other sector partners were in constant networking mode. What you can’t tell from the conference photos is just how busy the GPSA team was talking with practice owners and supervisors about the NTCER, and hearing about the many innovations our members have developed to maintain and expand their team’s focus on a high quality learning culture. Truly inspirational.

Return to E-Newsletter

Date reviewed: 31 May 2024

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From the Chair...

Change not necessarily the only constant!

April 2024 has been a month of many significant days, extremes of celebration and tragedy, but there is one I would like to highlight in particular.

ANZAC Day is an opportunity to reflect on a great many things: sacrifice, courage, security, commitment, loss, solidarity, trauma… all having a lasting impact equally on loved ones and the community at large as on those who have contributed to our armed forces. GPSA is proud to support our peers who currently serve, those who have served, those who supervise ADF registrars, and those who care for our veterans and their families.

With Autumn in full gear now, May seems to be shaping up as a month of action for all of us in the supervision environment. Some of you will be completing mid-term reports for your registrars, others getting ready for the next round of placements, and hopefully we’re all keeping up with our professional development requirements too.

In my many travels and roles as a GP, I am repeatedly engaged in discussions about GPSA activities. This feedback from a supervisor peer who attended a webinar presented by Dr Simon Morgan and Dr Tim Chappell shows the impact our ongoing educational delivery has on our members:

“Thank you both for a very engaging seminar! I watched it because I am a supervisor but benefitted from it as a GP. Tim, you had me at “dementor” and “chocolate”….! I absolutely love my job and listening to what you shared, Tim, it articulated the “why”. It was just good to hear again about the importance of being a good listener, being in your patient’s corner, not giving up on them…. and smiling! As is the case in many places, there is a high demand for services (where I work) and a long wait time and I have wondered if I should be more “matter of fact” and a more efficient problem solver so as to be able to see more patients. But I think that one would then miss out on those nuggets of history that come forth with time, and also the meaningful doctor-patient relationships that we can have in our line of work.”

And these words from a registrar who had reached out in a time of difficulty shows the benefit of what GSPA’s focus on the “how” of supervision ultimately has on our trainees:

“I am at a new practice now – it is amazing what a difference a supportive supervisor can make. Feeling settled and now actually can start to learn.”

It is when we receive such feedback that I know our impact as supervisors goes well beyond supervision, and GPSA’s impact as the supervision peak truly is vital for the future of general practice.

GP training will continue to change, as will general practice. As part of this community of practice, we will have to evolve and keep up with the world around us, yet we can do so in the knowledge that the GSPA values shaped by the “why” and the “how” of supervision will remain a constant on which you can rely.

The other thing you can depend on is GPSA’s commitment to representing you faithfully in our stakeholder engagement, the future direction we are advocating for on your behalf, and in the priorities you share for the current review of the National Terms and Conditions for the Employment of Registrars (NTCER).

If you haven’t already done so, please take some time out to complete our National Survey for 2024. This is not an idle exercise. This really is your opportunity to influence future policy around a range of things including workforce, remuneration and recognition of supervision. The information we obtain from this survey helps us share the real issues at the coalface with policy makers and funders, emphasising what needs to change and what needs to stay the same. While this is of course the long term benefit, there’s a short-term one too! Completing “ENGAGE 2024 – Building a better future together” counts towards your CPD (RP) as an added bonus. This survey is open to everyone involved in GP training – supervisors, GPs, practice managers, practice nurses, and others who support learners in general practice.

For anyone who has been involved in registrar employment – terms, conditions, or contract oversight -, now is the time to help us maximise the opportunity to update this legally valid employment instrument. The inevitability of change applies in this area of GP training too, with other employment models being explored under the Single Employer Model pilots, but the NTCER remains relevant to the bulk of GPs-in-training, and we need your contribution to ensure its robustness and utility is maintained and possibly broadened to non-traditional contexts (i.e. beyond the employment of AGPT registrars). We’ve come up with a variety of ways for you to tell us what’s important, which key areas you would like addressed to ensure the next version of the NTCER is fit for purpose into the future. Let us know your views via the NTCER survey and/or by joining one of our member workshops or via email.

So until next month…

May the force be with you!

Dr Srishti Dutta
Chair

May 2024

Date reviewed: 30 August 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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“We really are building the future of general practice”
Dr Candice Baker, GP Supervisor and GPSA Board Director

Candice obtained fellowship as an Australian General Practitioner in 2015, then as a Canadian Family Physician in 2019. She has worked at a training practice in regional Victoria for 10 years.

This is where the seeds of passion for medical education were sown through supervision of medical students and registrars before becoming an accredited supervisor early in 2022.

How have you arrived at your GPSA role?
“I have a desire to contribute within general practice supervision, to try to ignite some change, and help support the profession.

“That desire has been born out of the environment that I trained in and therefore the same sort of environment that I want to create and promote in terms of general practice supervision. It stems back to when I did my training and that amazing environment, surrounded by my supervisors, and a culture of teaching and learning: where everyone was a teacher and a learner at the same time. I identified with these colleagues, and they were pivotal in shaping my desire to follow their lead.

“I identified with these colleagues, and they were pivotal in shaping my desire to follow their lead”

“With regards to my role on the GPSA Board specifically, I think that’s probably a combination of my love of teaching with a hint of opportunity and a whole lot of luck – falling into things at the right time and the right place. Dr Madhu Tamilarasan, a GP Supervisor and former GPSA Director and friend, motivated me to engage actively with GPSA. Despite my hesitation about my suitability for the Board, Madhu encouraged me to throw my hat in the ring. She was a great inspiration to me.”

How have your various roles prepared you for your work with GPSA?
“The training environment I experienced enabled me to get involved in education in various forms. As a 2nd year registrar, I was involved in supervising medical students and I was also a Registrar Medical educator (RME) with my Victorian RTO.

“I also work for Monash University School of Rural Health and assist in the running of their general practice program for their Year 4 students. These roles were quite complementary to general practice supervision and allowed me to understand the breadth of supervision, and in fact, what it means to be a supervisor.

“And I’m currently a Supervisor Liaison Officer (SLO) which is a complementary role to everything in terms of advocating and works nicely with my GPSA Board role.
“It all seems to be a very natural progression for me, and I have just gone where the path has taken me.”

Do you see opportunities for GPSA’s education products internationally?
“I think there are opportunities for GPSA to expand to specific international markets where the core knowledge is the same throughout. For example, in looking at Canada where I spent some time during Covid, there were no major differences to Australia in terms of primary health care.

“In terms of SCENARIO, GPSA’s phone application, I think it’s really helpful and could be applied in other health care settings. Particularly for new supervisors, who maybe just haven’t quite figured out exactly how they want to structure their teaching sessions, or whether they’re stuck for what to cover at a particular stage in their learner’s journey.

“This application offers a form of convenience and a certain spontaneity that can be helpful. SCENARIO can flush out streams of deficiencies or things that maybe the learner needs to focus a bit more on. For example, was their respiratory knowledge as good as their cardiology knowledge; are they not as good at communication versus legal concepts.

“I think there is huge potential for growth within different areas of specialization, whether that’s obstetrics or emergency. I can see it being used much more widely and I’ve certainly found it useful and a fun thing to add to our teaching sessions with my registrars.”

What challenges are presently of greatest concern in the realm of supervision for our members that you’re aware of?
“I have three issues when I speak to supervisors that are top of mind:

  1. The sustainability of supervision – in the sense of the current apprenticeship model in general practice and what that looks like into the future.
  2. Appreciation of supervision is a big concern and, in particular, how supervisors are viewed In the wider scheme of things. With the transition of GP training back to the colleges, I think that has led to some under appreciation and undervaluing of the supervisors on the ground. There has been lots of new work and new assessments being introduced with limited consultation on the ground about how that would work in practice.
  3. Thirdly, remuneration is always a hot topic. I think we’re all aware that GP supervisors give way more than what most people would at the hourly rate they get paid. There seems to be this constant idea that supervisors can just do more, and that’s okay. Can we create a sustainable, high quality general practitioner at the end of training, if we don’t nourish the people that are nourishing them? We wouldn’t expect to have a bountiful garden full of vegetables if we didn’t actually take care of the soil. I think supervisors are the soil that helps grow our future workforce.”
  “I think supervisors are the soil that helps grow our future workforce.”
 

What solutions do you see that we offer to our members? What are we doing to help?
“GPSA is striving to lead from the front. I think our presence is more visible and the organisation is more prominent compared to perhaps 3-5 years ago.

“I believe we’re doing a great job advocating for those at the coalface and that’s partly because the Board of Directors are supervisors – we are the people we represent. We’ve got a firsthand idea of what it’s like to be on the ground and doing supervision work. That puts us in an excellent position to be able to advocate for change and be heard. We are very good at listening to our members and making sure that we sort of get a seat at every table to talk about issues that are important to general practice supervision.

“I firmly believe you can’t effect change if you’re not actually involved in the conversation. From that perspective, it’s been a successful couple of years in terms of having a seat at each table and being able to do that.”

Message to fellow supervisors
“My main message to fellow supervisors is that we value you. A while ago I was told by a colleague at Monash, “we really value what you do”. I suddenly thought, no one’s ever really said that to me. As supervisors, we really don’t get told that we are valued for what we do. Now I make a concerted effort when I catch up with my local supervisors to tell them that we really value having them as part of the team. And if there’s anything that we can do to make life a bit easier for them, then tell us. Acknowledging their indispensable role in general practice training is crucial. Without supervision and the dedicated work of supervisors on the ground, training simply wouldn’t be possible. We really are building the future of general practice and GPs in Australia.

“We really are building the future of general practice and GPs in Australia.”

“Additionally, I really feel strongly about finding a way to further engage practices that are committed to education and training at a high level of quality. It’s important we come up with a set of standards for supervision that allow us to ensure that we are putting supervisors and registrars into supported practices, and that we know that trainees are going to get a good training experience. The GPCLE tool has a huge role to play in this work. It sets the standard of supervision and whether we’re meeting that bar as training organizations or training practices. This is an important focus over the next couple of years.”

Date reviewed: 24 April 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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From the Chair...

Celebrating & Reflecting

March was certainly a month for celebrations and reflection – Harmony Day, International Women’s Day, Holi, St Patricks Day, Ramadan, World Compliment Day, International Day of Happiness, Lent and Easter….

Following the first meeting of the General Practice Training Advisory Committee (GPTAC) in Canberra at the tail end of the month, I can now share yet another reason for GPSA members to reflect and celebrate: the release of the AGPT Program National Report on the 2023 National Registrar Survey | Australian Government Department of Health and Aged Care.
For me, the key messages in this report reiterate the vital role the people at the coalface of GP training played in the successful transition to college-led training – and continue to play as the lifeblood of high quality primary care for the Australian community.

The satisfaction of registrars with our members has remained consistently high from 2017 to 2023. Indeed, the analysis by the Australian Council for Educational Research (ACER) of over 1000 open-ended responses in the 2023 survey shows that more than 92% of registrars attributed the best aspects of their training experience to:

  • their current workplace or practice;
  • supervisor and mentor support; and
  • the diversity of patient presentations.

This feedback reinforces the value of GPSA’s commitment to facilitating a supportive and well-structured clinical learning environment for tomorrow’s GP workforce – through our ever-expanding repository of educational resources, our virtual community of practice, the GPCLE quality improvement tool we are currently refining, our upcoming biennial review of the National Terms & Conditions for the Employment of Registrars (NTCER), and even the Memorandum of Understanding (MoU) recently signed between GPSA and our sister peak GPRA.

In all the many tables at which GPSA has a seat now, it is a true pleasure to highlight the role supervisors, practice managers and other members of training practices play in the success that we as a profession can claim today and into the future. My job as GPSA Chair is largely focused on advocating for you in your supervision of medical learners and trainees across the educational spectrum. I continually speak to both GP specialty colleges regarding topics our members flag as priorities, such as dual recognition of supervisor professional development and similar efficiencies to ensure minimisation of red tape and maximisation of well-being. To get this right though, we are reliant on your engagement and input.

To this end, you will soon receive an invitation to participate in the GPSA national survey – newly and aptly branded “ENGAGE”. I cannot stress strongly enough the importance of the information you provide through this data collection opportunity: the more you contribute to GPSA research such as this survey, the greater an investment we can make in your future growth and sustainability.

We will soon be launching into the NTCER review – which again is completely reliant on your input to ensure we represent your needs faithfully in this process. The NTCER remains a tool that provides protections for both training practices and registrars, and this year we are looking to enhance it and expand its application to non-traditional contexts such as vocational training pathways outside the AGPT. No doubt you have ideas about improvements at both a big picture and granular level, and we sincerely want to hear about these! Please submit your expression of interest here if you would like to be involved in workshopping the NTCER for 2025-26 with us.

Looking forward to working with you on the key activities lined up for April. Until then, as Yoda would say, “Pass on what you have learned”!

Dr Srishti Dutta
Chair

Return to April newsletter

Date reviewed: 30 August 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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Why get involved with GPSA? “Having lots of skin in the game,” says this high-flying GP

Dr Kate Manderson is a name associated broadly with Australian general practice and GP supervision yes, but also with aerospace medicine, corporate and clinical governance, advocacy and – above all else – family and community.

On the eve of the transition of GP training to the GP specialty Colleges, this experienced GP and practice principal decided it was time to contribute her vast skills and experience to ensuring quality and passion remained at the heart of clinical supervision for future GPs in-training.

So it was that this ADF-trained health professional, businesswoman, Principal Medical Officer of CASA, Senior Aviation Medical Officer of the  Royal Australian Navy, Graduate of the AICD, Medical Educator and past President and Chair of the Australasian Society of Aerospace Medicine (ASAM) came to be elected onto the Board of GPSA in October 2022.

Kate recently talked with our Communications Manager, Pauline Ingham, about her burning desire to get a better deal for Australian GP supervisors.

What do you think has brought you here to this role on the GPSA Board?

“After 25 years as a GP I have been inside the GP system for a long time and gained a lot of valuable experience.

“Like a lot of GPs, I have a lot of ‘skin in the game’, having worked as a GP, a Medical Educator and a Supervisor.

“I understand how it works, how it could be improved, and have seen some challenging times.”

Why GPSA?

“At a time when I couldn’t contribute to GP training at the coalface, I still wanted to contribute meaningfully.

“I saw the opportunity to use my experience and skills in clinical leadership and governance through the role on the GPSA Board… as a way to help our system, our supervisors and our trainees on a broader scale.”

She notes that she was encouraged and supported by colleagues who said, “Kate you can do this!” – and she decided the time was right.

“My experience in governance, company directorships and leadership came into play. Having an understanding of the importance of operating a viable and strong business, combined with my supervision experiences, enabled me to put myself forward and make a contribution to GPSA."

How have your various roles prepared you for your work with GPSA?

“My first role as a GP registrar prepared me by going through the system. I was privileged to train in Tasmania and on the whole had fabulous education, mentoring and training, working with pioneers and leaders who are still involved today. I learned from people who showed me how great it could be.

“My placement experience varied after that – some practices gave little support; however, it was still the early days of training, and often I was on my own. Some practices straddled the line between good and bad: offering great mentoring and supervision, but less structured education.

“So I had the opportunity to experience lots of different perspectives as a trainee as to what supervision looked like, could look like, and what it  actually should look like.”

How did that view of supervision you had as a trainee change when you started supervising?

“When I moved into the role as a Supervisor and had the opportunity to be on the other side of the table, I instantly realised how hard it can be to be a supervisor!

“I was so determined that there really is no excuse for being a poor supervisor, but the actual experience of doing the job for more than a decade, and having more than 50 trainees over the years, has led me to realise it’s not that simple at all.

“Supervisors deal with registrars of varying needs, and this requires a flexible system that can be very difficult to achieve.”

As a practice owner, what do you see as the challenges facing educating and training the next generation of GPs?

“I see two big challenges or barriers – adequate funding and adequate recognition.

“You want to be altruistic and you want to help somebody – vulnerable people and vulnerable communities – and you want to spend lots of time with patients. And that is beautiful, but you can’t do that if the practice closes because you can’t pay the wages.

“Let’s start with money, and we must talk about that. If your business goes bankrupt you can’t help anyone. It's a fundamental part of what I teach trainees, they have to understand the business of general practice."

So let’s talk about the money!

“It can seem unpleasant to raise, but thinking that money isn’t important is part of the reason we have ended up in this current situation.

“It is important – and there are some key barriers we need to address.

“To start with, the funding model of general practice is fit-for-purpose for 1975, but it is not fit-for-purpose for 2025, 2035, 2045… It hasn’t been fit-for-purpose for a very long time because everything has changed around us, just not this funding model. That is the biggest barrier.

“We are not funded as supervisors, and until that changes we will not have consistency in the quality of training placements… Which means appropriate funding is needed urgently for supervisors and training practices as well as the trainee.

“There is a vast difference between the funding for hospital-based supervisors with payment built into their contracts, and how GP supervisors do it: GP supervisors take a pay cut to teach!”

Any other barriers you’d like knocked down?

“The culture of general practice.

“The idea of #justagp – ‘Are you a specialist or just a GP?’ – is problematic.

“We need something much more powerful in recognition of the specialty of general practice.”

“I believe we must bring back the PGPPP so that everybody gets a turn in general practice – so they understand what it’s about.

“I also strongly believe that we need a name change, because everyone uses ‘GP’ whether they should or shouldn’t.”

“We need to identify our unique skill set, it’s got to be marketed, again back to the finances... We pay equivalently, we recognise the specialty equivalently, and everyone understands what the specialty does."

What challenges are presently of greatest concern in the realm of supervision for our members?

“My sense is that the biggest concern is ‘who’s going to take over when I am done?’

“We have members who are passionate, dedicated and committed in that role. And they are altruistic, self sacrificing, they are doing it without any money, without any recognition, because they want to and they think it’s important.

“Part of it is they are there for the future of the profession, part of it is they are there for the future of their practice. They are thinking, ‘If I am not supervising, we can’t get trainees; if we can’t get trainees, we can’t get succession planning and workforce’ and so on.

“I am living that experience right now. I am not currently supervising registrars in my practice so this equates to empty consulting rooms in my practice.

“People might say if we can’t get registrars then why not get Fellows. That is proving almost impossible in the current climate.” 

We need more women in supervision. How would you encourage women to pursue roles as supervisors? 

“Firstly, GPSA’s current Women in Supervision research is important because if it doesn’t get measured it doesn’t get fixed.

“Data is key and can be used strategically. Commonwealth Departments respond well to data, and politicians respond to real life stories. So you have to tackle any issues with submissions and data.

“With regards encouraging more women into supervision, I’ve already said that supervision is altruistic – you give of your time and your money. Women already have less money and less time, and we are asking them to have even less money and even less time. We have to fix that!

“Another factor is that historically women carry the greater burden of child care. If we have more, better, financially accessible child care for women in primary care, women would do more in primary care.

“If GPSA found a way to subsidise women volunteering to supervise with a cleaner? We’d be inundated! Essentially, childcare and financial recognition are the two things I think will get more women into supervision.”

“If we can adequately remunerate or financially recognise supervision overall, then this will no longer be yet another cut to women who are already being cut by the financial disparity we continue to endure. This would benefit everyone - not just women of course, but it would proportionately benefit women even more.”

What would you like to say to Australia’s supervisors?

“My message to Australian supervisors is to hang in there!

“You are special, you are doing amazing things. GPSA understands this and we’ve got your back. We’re going to do everything we can to make it better for you, so please hang in there while we do that.

“I’d also like to send a message to our trainees, our early Fellows and our new supervisors, and that is to please show up, please don’t expect everyone else to do it. It is a champion team, so show up, be brave, put yourselves out there.

“I urge you to support the industry leaders who are saying GPs have to charge privately and we have to charge our worth to make it so that we can afford to supervise in practices. Be brave, be there, show up and take it on!

“I am taken back to my time in the Navy when the mantra in an emergency or attack was to never leave the ship – the three step approach was ‘Fight, Move, Float’ and ‘we do not abandon ship!’

“So I say to my colleagues: we value you, we need you, don’t abandon the ship!”

Date reviewed: 28 March 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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From the Deputy Chair...

The 'Santa Delusion' and reading the fine print

What an interesting year we have had with the transition to College-led training. This has gone remarkably smoothly at the coalface – with only a few hiccups along the way, probably fewer than expected – which has a lot to do with the resilience of GPs and practice teams.

I would like to express from all at GPSA the enormous admiration we have for GP supervisors and training practices across the country. Given GPSA’s membership consists of more than 7,000 supervisors and 3,000+ honorary members, you represent arguably the largest unrecognised charitable organisation in Australia.

The peak representatives of GP supervision – the Supervisor Liaison Officers (SLOs) – met in Sydney on 8th December 2023. SLOs from all states and the NT participated in this Advisory Council meeting, representing RACGP (AGPT and FSP), ACRRM (AGPT, IP and RGTS) and RVTS. The passion and commitment to GP training was readily palpable and augurs well for the future of GP training if supervisors are appropriately supported. The main issues facing GP Training were discussed in an open and frank meeting with Georgina Van de Water representing RACGP as well as ACRRM’s President Dr Dan Halliday and General Manager of Education Services, Kyra Moss. The key issues identified by SLOs were clearly presented so that there was no question about what was important to GP training and the desired outcomes.

All SLOs were on the same page: we have significant headwinds in GP training, and future health workforce is dependent upon these being clearly addressed to avoid further negative impact to the already perilous state in which we find general practice currently.

The main issues addressed in no particular order were: supervisor support and professional development, bi-College collaboration and interface, registrar caps, Single Employer Model (SEM), the importance of data to drive progress, placement processes , and , specifically for RACGP, the new EASL requirements.

Supervisor professional development (SPD) – which has simultaneously experienced a significant reduction in support and a progressive increase in requirements – runs along the same lines as GP continuing professional development (CPD)… increasing requirements of a profession in a dire situation. The unintended consequences of reduced participation and loss of quality supervisors are readily apparent. There is only so much supervisors can give, and the tank is running on empty.

Placement process and registrar caps – a challenge for everyone but probably more so for registrars with many horror tales out there about practices receiving either unmanageable numbers of applications… or none; and registrars and practices having 1 week to arrange interviews and finalise offers. It is a mixed story across the country, NSW has obviously had the most experience of this process, and it seems to have become a game of ignore the rules or risk not retaining a registrar. Anecdotally, it seems to have failed on the two key metrics of placement in best quality training practices or highest area of need.

SEM – the devil is in the detail. This seems to be a very hot issue with state Health Ministers across the country champing at the bit to get a piece of the action. Terms like “cost neutrality” and “control” of primary care workforce carry a sense of foreboding and beg the questions: who is paying the piper? who is missing out? It cannot be cost neutral when an extra layer of bureaucracy is installed without extra funding. Fortunately, we had some reports from members and SLOs on the nature of contracts being proposed in NSW which really reinforced the view that the devil is in the detail. Please, read the fine print.

RACGP’s Early Assessment for Safety and Learning (EASL) – dramatic increase in demand put on supervisors for a payment of… $Zero. There was reassurance that we do not necessarily need to review every consultation for the full 4 weeks and can make a determination earlier, but no funding for those who do require closer monitoring. I must confess that I am a strong supporter of the concept and many supervisors do undertake this process both as educational and risk management for the practice. Indeed, studies undertaken by Drs Simon Morgan and Gerard Ingham do highlight the number of errors early term GP registrars make, many minor but still a significant number of serious errors. Ideally, in my humble opinion, we should be funded to review all consultations for the first three months of a GPT1 registrar term with time set aside for face-to-face discussion, random case analysis, etc. This would greatly improve competency and patient outcomes especially in the areas of rational investigation and prescribing practices. I would argue that if we did the study and looked at the data it would end up surprisingly cost-effective across the wider health system.

Data is vital in our field, and I think the 2021 GPEx report to which GPSA contributed, “The financial costs and revenue associated with teaching and supervision in general practice”, should be on the Christmas Reading List for all Health Ministers, RACGP and ACRRM Boards.

Speaking of Christmas, I do believe in Santa Claus. I wrote him a letter before Christmas, and to my surprise I actually received the requested gift. I asked that, as GP supervision was fundamentally a charitable service, we should be given DGR status and tax exemption from the ATO. To my surprise, in my stocking on Christmas Day was a letter from the ATO confirming that all payments for GP supervision would become tax free and the repayment would be backdated for 20 years and to please find a refund cheque enclosed!! Then I read the fine print… you have never received any payment whatsoever for supervising GP trainees so enjoy your tax-free status on $Zero income!

I would be happy to pay tax on any income from supervision, which I would argue should come through an MBS item number for every phone call and patient review I (and all supervisors) undertake for our registrars.

GPSA is listening and batting strongly on all these issues for training practices and supervisors; I would ask that you all be forthright and vocal about any perceived challenges and instances of neglect in GP training through the year ahead. Your contribution is not only vital to your patients and communities today, but to the health of all Australians going forward.

Wishing you all a very Happy New Year.

Frank Maldari

Return to January newsletter

Date reviewed: 30 August 2024

Please note that while reasonable care is taken to provide accurate information at the time of creation, we frequently update content and links as needed. If you identify any inconsistencies or broken links, please let us know by email.

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