Royal Australian College of General Practitioners

The Royal Australian College of General Practitioners is the professional body for general practitioners in Australia.

About the college

The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia, with the majority of Australia's general practitioners belonging to their professional college. Over 22,000 general practitioners are members of the RACGP Continuing Professional Development Program. The RACGP National Rural Faculty, representing more than 8000 members, has the largest rural general practitioner membership of any medical organisation in Australia. The RACGP publishes Australian Family Physician, Australia's main peer-reviewed academic medical journal for general practitioners.

Membership of the Continuing Professional Development Program should not be confused with fellowship of the college. In the absence of fellowship in any of the specialty colleges, a medical practitioner will typically obtain membership of the Continuing Professional Development Program in order to satisfy medical registration requirements with AHPRA, the national medical registration body.

Additionally, membership of the college is mandatory for any medical practitioners hoping to obtain fellowship of the college via any of the training pathways; as such, membership is non-negotiable for these practitioners.

Furthermore, approximately half of the vocationally registered general practitioners in Australia consist of "grandfathered" general practitioners who obtained unrestricted access to MBS Medicare Rebates in 1997 when provider number restriction legislation was enacted by virtue of their existing access to MBS rebates. These grandfathered GPs have not undertaken GP training, and critics argue that the imposition of training on new graduates is both unfair and unconstitutional.

Provider number restriction legislation enacted in 1997 by the new coalition government prevented new graduates from accessing Medicare rebates, on the basis of "oversupply" of medical graduates, and was to be a temporary measure with a sunset clause to take effect in 2000. GP training places were also reduced to only 400 per year to help address this alleged oversupply of general practitioners.

The sunset clause was removed in 1999, making the provider number restrictions permanent, and cementing the RACGP's role as the gatekeeper for new graduates entering primary care.

Critics have argued that this is a workforce measure which limits the supply of general practitioners, and therefore reduces federal government Medicare expenditure. This critique is supported by the 1996/7 budget policy papers indicating the large savings likely to result from the provider number restrictions in the following years.

Critics have argued that the RACGP has a vested interest in limiting access to fellowship, and international medical graduates in particular have argued that they are being used as cheap medical labour while they struggle to meet the RACGPs fellowship requirements. Arguments from the RACGP of "maintaining standards" must be contrasted with the fact that half of existing general practitioners were grandfathered and have never done GP training.

In 2002 The RACGP obtained around $5 million of dollars from the then federal minister for Health, Dr Wooldridge, for their new headquarters in Canberra. Dr Wooldridge announced his retirement from government shortly thereafter and his intention to take up a consultancy at the RACGP. Critics argued that this was unseemly and improper.

International and local medical graduates with clinical experience hoping to obtain RACGP fellowship have argued that RACGP fellowship pathways are expensive, fail to properly recognise their experience, and that appeal mechanisms lack transparency and are exorbitantly priced. The appeal fee is around five times the application fee.

History of General Practice in Australia and beyond

Prior to the mid 20th century, upon graduation Australian doctors spent time in general practice. A medical career usually included completing an intern year immediately after graduation as a resident in a major teaching hospital. After a period of time in general practice, some doctors would seek specialist qualifications. Possibly reflecting the historical origins of Australia as a series of British colonies, these doctors would travel overseas, most often to the UK, to specialise and then return to establish practice.

As the Australian population grew post World War II, the public hospital system also grew demanding an increasing number of specialists. Local training program emerged and therefore the ability of a doctor to enter specialist training directly following the mandatory intern year post graduation without entering general practice. This increasing number of specialist made it increasingly difficult for general practitioners in Australia to hold and retain public hospital appointments, especially in procedural areas such as surgery or obstetrics.

This was not a uniquely Australian phenomenon. Worldwide, medical practice was shifting focus onto hospitals with the expansion of pharmaceuticals and medical and surgical interventions. In the United States, the number of doctors identifying as General Practitioners fell markedly between 1931 and 1974 from 83% to 18%. This process began as specialisation increased prior to the War. US GPs increasingly felt that health care was becoming fragmented and weakening doctor patient relationships.

“There are 57 different varieties of specialist to diagnose and treat 57 different varieties of disease but no physician to take care of the patient."

Development of professional colleges

In 1950, an Australian Graduate, Dr Joseph Collings, conducted a review of general practice in the UK. This 30-page report was published in the Lancet in 1950.

“There are no real standards for general practice. What a doctor does and how he does it depends entirely on his own conscience” Dr Collings, 1950.

Dr Collings’ report was scathing and generated immediate and heated interest. It was undoubtably a key event in the definition of general practice as a "speciality."

He identified that general practice has no academic underpinning, no evidence upon which to base practice and no consistency of practice. The report did not pull punches. He described rural practice is “an anachronism”, suburban practice is a “casualty-clearing” service and Inner city practice is “at best… very unsatisfactory and at worst a positive source of public danger.”

There is a direct link between the public criticism of general practice and the move to create a College. Dr Rose and Dr Hunt in the BMJ 1950 write:

“There is a College of Physicians, a College of Surgeons, a College of Obstetricians and Gynaecologists, a College of Nursing, a College of Midwives and a college of Veterinary Surgeons, all of them Royal Colleges; there is a College of Speech Therapists and a College of Physical Education, but there is no college or academic body to represent primarily the interests of the largest group of medical personnel in this country â€" the 20,000 general practitioners.”

Interestingly, there was opposition in the UK to the creation of a College by the existing three Medical Colleges â€" Colleges of Surgeons, Physicians and Obstetricians and Gynaecologists â€" who held the belief that general practice should be a joint faculty of general practice linked to the existing Colleges. However, put into perspective, in the same document Hunt describes the two original British Colleges sought to stop the creation of the College of Obstetricians and Gynaecologists via legal action in 1929.

The development of the Australian College of General Practitioners

The British College of General Practitioners was formed in 1953 with many Australian doctors amongst the founding members including the RACGP’s first president Dr William Conolly, again reflecting the origins of Australia as a series of British colonies, established a New South Wales faculty of the BCGP. This was followed by the creation of other state based faculties of the British College of General Practitioners in Queensland, Western Australia, Tasmania, Victoria and South Australia over the next 5 years.

In keeping with the process for creating Medical Colleges under the British system, a group of Australian General Practitioners met in 1957 at the first Annual Scientific Convention in Sydney to declare an intention to form the Australian College of General Practitioners (ACGP) which was formally founded in 1958. This new College joined the state based faculties. State based faculties remain a key part of the modern day function of the RACGP.

Recognition of general practice as a medical specialty

In modern Australia, General Practice is listed by the AMC as a medical specialty and the RACGP as the specialist college responsible for assessment, as endorsed by the Medical Board of Australia inaugurated in 2010. Yet, on further examination of how general practice is considered across the nation, some of the now-defunct State-based Medical Practitioners’ Boards such as Victoria, Queensland and South Australia, did not consider general practice a medical specialty and general practice qualifications, such as the Fellowship of the Royal Australian College of General Practitioners (FRACGP) were not registrable qualifications. The practical implication of the nationalisation of medical registration on the status of General Practice as a medical specialty may be unclear.

The oddity of general practice in Australia is a lingering and arguably outdated perception that the decision to practise as a GP has low or no standing and status. Comments heard by many GPs including; ‘You are just a GP’ or ‘What do you intend on specialising in?’ reflect something of the community understanding of the General Practitioner.

This is not without precedent. The history of the General Practitioner shows that GPs in early Australia through to GPs in mid and late 20th century, ‘defaulted’ into general practice having disliked surgical or physician training or having failed exit exams too often.

Also, while Australian General Practitioners were part of the creation of the Royal College of General Practitioners and instrumental in highlighting the need for professional and practice standards, Australia was one of the last developed countries to recognise general practice as a specialty. It was 1978 before the National Specialist Qualification Advisory Committee (the predecessor to the Australian Medical Council) recognised general practice as a specialty. In contrast, The United Kingdom had a powerful case for recognition by the late 1960s, and the United States recognised general practice in 1969.

Strengthening general practice

The standing of general practice within academic faculties of universities and professionally has undergone a marked increase in recent decades. The RACGP has been a key driver of this shift. The development and consolidation of training programs, standards for training, standards for practice, curriculum of general practice and various evidence based guidelines and publications have occurred internally within the College. Outside of the College there are a few important events:

Academic general practice

Demonstrating again the slow shift towards recognition, Australia was late in accepting that general practice should be taught or regarded as a discipline in its own right. The Whitlam government’s Karmel committee into ‘Expansion of Medical Education in Australia’ compromised with departments of ‘community medicine’ â€" a confusing anachronism that persisted for many years in Australia’s tertiary institutions. The RACGP sought strongly but unsuccessfully that this committee accept general practice into the universities.

Today, general practice is listed or has been added alongside community medicine, highlighting the shift since the early 1970s (e.g. Department of General Practice and Community Medicine Monash University)

Nine foundation professors of ‘Community Practice’ were appointed between 1974 and 1976. Again Australia lagged behind the US and the UK who appointed their first professors and Chairs of general practice and family medicine in 1967 and 1963 respectively.

The Foundation professors were:

• Charles Bridges Webb MD FRACGP, Sydney University. Professor of Community Medicine

• Max Kamien MD FRACP, MRCP, FRACGP, DPM, DCH University of Western Australia. Professor of General Practice

• Professor Neil Edwin Carson FRACGP FRACP Professor of Community Medicine Monash University

• Jean Norella Lickliss MD MRACP, FRCP BMedSc DTM&H Professor of Community Medicine University of Tasmania

• Timothy George Murrell MD FRACGP DTM&H CLJ Professor of Community Medicine

• Anthony James Radford FRCP MRCP FRACP MFCM SM DTM&H Professor of Primary Health care Flinders University

• James Geoffrey Ryan BSc FRACGP Professor of community practice University of Queensland

• Ian William Webster MD FRACP Professor of Community Medicine University of New South Wales

• Ross Wharton Webster FRACGP MRACP Professor of Community Health University of Melbourne

Notably, many did not hold general practice qualifications either from Australia or international.

RACGP Awards

Life Fellows

Honorary Fellows

Arms

See also

• Australian Medical Association
• Infection control
• Occupational safety and health
• Inquiry process into registration and accreditation processes for international medical graduates
• Accreditation process for International Medical Graduates

References

External links

• The Royal Australian College of General Practitioners
• History of The RACGP
• RACGP online education
• ClinED

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