Placing house officers within general practice is achieving the desired goal of encouraging junior doctors to become GPs, a Ko Awatea report has found.
The Ko Awatea Final Evaluation Report for House Officer Placements in Primary Care was designed to assess the benefit of placing house officers (typically post graduate year twos) in general practice for three-month attachments.
House officers reported that they felt more confident in making clinical decisions as a result of working in primary care. It also gave them an opportunity to understand patients’ experiences of and journey through the healthcare system that they miss by only spending attachments in secondary care settings.
House officer attachments within Airport Oaks, Mangere Family Doctors, Eastside and Turuki Health Centre were examined for the report, using a mixed methods approach comprising surveys, interviews and focus groups with house offices and practice staff.
Deputy chief medical officer Dr David Hughes, who commissioned the report, explains the Medical Council of New Zealand requires that by 2020 all newly graduating doctors have attachments in community settings such as general practice within their first two years of practice.
Counties Manukau Health is one of the first DHBs to attach house officers into general practice with Manukau Family Doctors beginning attachments in 2009, Dr Hughes says.
Similar initiatives have existed in the UK and Australia since the mid-2000s, he adds.
In New Zealand, the number of trainee doctors becoming GPs is not meeting the demand caused by population growth. The situation is even more pronounced in Counties Manukau where there are only 54 FTE GPs per 100,000 of the population, compared the national average of 97 GPs per 100,000 of the population.
It is hoped the attachments will help to address this, Dr Hughes says, noting: “Similar schemes in Australia and the UK since the mid-2000s have shown a real increase in people moving into general practice training.”
Report authors state: “Overall, all of those involved are very supportive of the attachments and are passionate about being involved. Of significant importance, as a result of the attachments the house officers are gaining an understanding and appreciation for primary care, with the majority going on to apply for the GP training programme.”
Patients attended by house officers at these practices reported being happy with the care they received from house officers and house officers noted their confidence increased with the autonomy of working in a general practice.
Duties carried out by house officers during their attachments included triage, seeing walk-in patients, follow ups and recalls, smoking cessation, wound review, palliative care, home visits and ordering tests.
One house officer summed up the attached as “a great opportunity to really talk to patients, take the time to listen to people’s problems, and see patients as people.”
The attachments also helped to counter the sometimes negative perceptions among hospital doctors that GPs send all their patients to hospital. Said one house officer; “This is not the case, the practices do not send everyone to hospital…it was good to be able to see things from the GP perspective.”
However, the report also uncovered a number of challenges with the programme, including a lack of consistent training standards across the attachments. The authors recommend better definition of training standards and expected outcomes, and that the attachments be aligned with the registrar training programme in terms of funding, noting the significant investment GPs currently face when preparing for house officers.
In 2016 the programme is to be expanded to include community health providers and primary care practices in the Auckland Region and Northland.