Practices
FOCUSING ON THE PRACTICE-REGISTRAR RELATIONSHIP
Over the years, many GPSA members have reported difficulties with registrars who regard their time in the practice as an inconvenience – being more focused on their formal education than on their role as an employee and valued member of an established practice team from whom they have the opportunity to learn the majority of the GP’s tradecraft.
GPSA continuously advocates for the support of sector stakeholders to eliminate this common issue, and the historical undervaluing of the vital role of supervisors and training practices from which it stems. Recognising the importance of the practice-registrar relationship, GPRA agreed to highlight “mutual respect and open communication” as central tenets of the NTCER Agreement as part of the 2024 NTCER Review. The key word here is “mutual“!
Managing expectations is key to both a productive placement experience and a conflict-free employment relationship; but what many of us forget is how crucial it is to ensure all parties – registrar, supervisor, practice manager or principal – have openly communicated what they expect of one another from the outset.
Other than ADF registrars and GPs-in-Training seconded to the practice under other forms of Single Employment Model (SEM), registrars have a dual function as trainees and employees. Likewise the practice has a dual function in facilitating learning and meeting the obligations of an employer; and, on top of this, it is the supervisor and practice team who hold all the power when it comes to instilling passion for family medicine in the next generation of GPs and RGs… Balancing these requirements is different for each placement, for each individual. Focusing on a positive practice-registrar relationship is a great starting point.
BUILDING TRUST AND CONNECTION THROUGH HIGH-QUALITY TRAINING
The supervision of learners at all levels is a whole-of-practice endeavour.
A high-quality training experience fosters trust and connection, significantly increasing the likelihood that trainees will remain with or return to the practice after completing their fellowship.
Registrars who feel valued and well-supported during their placement often attribute this to the relationships they build with everyone in the practice. This includes their main supervisor, practice owner, reception team, nurses, non-supervising clinicians, and of course, their patients.
Central to this supportive environment is the practice manager. The practice manager’s role is crucial in setting expectations, enhancing the registrar’s understanding of the business of general practice, and building trust through open and transparent communication.
NEGOTIATING THE REGISTRAR'S EMPLOYMENT CONTRACT
Win/win must be the only goal when a practice and registrar enters into an employment relationship.
In certain regions more than others, practices face steep competition for registrars.
Some GPSA members feel it is unfair that the minimum terms and conditions established in the NTCER are not followed by all practices as a rule rather than a guideline; however, even in the public health system, junior doctors commonly negotiate above-Award remuneration packages. And it is widely publicised that registrars drop a significant amount of guaranteed income in the transition from hospital to GP training, with far less published about the earning capacity of the GP registrar under the NTCER base-plus-billings remuneration structure.
Explaining registrar earnings is entirely the role of the training practice and supervisor, so make sure you have some real-life examples at hand during your interviews!
Practices should not be pressured into offering financial terms that are unsustainable. The interview process offers an opportunity to help your prospective registrar understand that every business is different and that the training experience they are being offered at a practice may be more valuable than increased financial outcomes offered elsewhere.
REGISTRARS KNOW THEIR WORTH... DO TRAINING PRACTICES AND SUPERVISORS KNOW THEIRS?
Going into any form of recruitment armed with a strong sense of worth is incredibly important for the practice, regardless whether the prospective employee is a registrar or a receptionist.
When recruiting a registrar as part of the Colleges’ placement processes, this is even more crucial, and often involves hitting re-set for a supervisor and practice team who may have had a bad experience with even just one aspect of their relationship with a previous trainee. Start afresh, with an open practice discussion to determine both what you are all happy to contribute to and what you all want to get out of a training placement – acknowledging that the owner-supervisor of old is now in the minority, making the argument that supervision is rewarded by the opportunity to secure future workforce generally lacking in relevance for today’s supervision team.
During the recruitment process, practices are faced with all manner of demands from potential employees such as:
- higher base rates than the NTCER
- an increase in the minimum percentage or calculation frequency of billings / receipts
- additional entitlements such as paid study leave
- rosters adapted to the registrar’s needs, e.g. full-time hours across a 4-day week
Be ready for these demands, and make sure you can quantify the value of a good registrar for your patients and colleagues so you can weigh up how far above the minimum terms you can justify paying before even committing to the placement process. Just as this value may be less about money than job satisfaction for GPs who enjoy supervising or patient access to a doctor with new skills or interests, negotiating the practice’s value with the registrar does not need to be purely financial in nature. Indeed, practices must not be pressured into offering financial terms that are unsustainable. Registrars accustomed to a fairly standardised employment context in public health may need help understanding that every business is different, and that the training experience they are being offered at your practice may be more valuable than increased financial outcomes offered elsewhere.
- What is your practice’s point of difference? Do you see a wide range of presentations to help the registrar address their learning needs? Or a unique patient cohort that the registrar might not have the chance to work with elsewhere?
- Do you have a special culture to entice an applicant – e.g. social activities that include family members, or maybe weekly team meetings that focus on learning new clinical and administrative skills?
- Do you use specific systems to help the GPs maximise their patient billings? Does your practice manager dedicate a set number of hours to teaching registrars business skills / run regular sessions to improve the earnings of all the GPs consulting in the practice?
- Does the supervision team include a number of diverse GPs with a range of special interests and a passion for teaching?
Above all else, make sure you feel comfortable that the registrar you are trying to recruit would be a good “fit” for your practice team and your patients.
PRIORITISING BUSINESS SUSTAINABILITY
Prioritising business sustainability is essential. Pursuing profitability is a fundamental responsibility for all businesses. Ensuring consistent profitability and maintaining solvency are crucial for long-term success and stability.
As registrar wages are largely funded through the fee-for-service model, training practice sustainability relies on the registrar being supported to manage adequate patient numbers to cover their wages and associated on-costs.
Priority 1
Priority 2
Priority 3
Date reviewed: 18 September 2024