COVID-19 information for GPs in training

The COVID-19 pandemic has had a huge impact on our personal and working lives in 2020, and many organisations have had to adapt quickly to the current restrictions. The RACGP is no exception.

We won’t be running another Objective Structured Clinical Exam (OSCE) in its current format. We will instead hold the Remote Clinical Exam (RCE) three times: in October 2020, March 2021, and mid-2021 before introducing a new Clinical Competency Exam (CCE) in late 2021.

Saying goodbye to the OSCE

We were forced to postpone the OSCE scheduled for May 2020 to October 2020 due to COVID-19. As the largest clinical medical exam in the southern hemisphere, the OSCE requires hundreds of candidates, examiners and support staff to gather in confined spaces, so is not feasible or safe for us to run in 2020.

As we are unable to hold a face-to-face clinical exam this year, the RACGP is using this opportunity to realise long-held plans to modernise this assessment. We have been working on this project since 2019, drawing on the expertise of advisory committees and external stakeholders. We aim to make the exam more competency based and bring it into line with contemporary assessment principles.

The Remote Clinical Exam: An online exam

The online RCE format will ensure access for those impacted by COVID-19 and enable us to deliver the clinical exam regardless of any COVID-19 restrictions.

Candidates will be examined on 12 short cases, delivered in sets of four cases over three short sessions of approximately 60–90 minutes on different days. These will be delivered via videoconference, removing the need to travel and significantly reducing time away from home and work for those in rural and remote locations. Candidates will connect with examiners over a secure link. We will work with all candidates to support them with their individual technical needs to ensure that everyone has the same opportunity to access this exam.

Candidates whose performance is deemed borderline at the completion of the 12 cases will have an (optional) additional opportunity to demonstrate their competence in a fourth and final set of four cases on a separate day. This is a new initiative, introduced for the RCE to maximise candidates’ opportunities to demonstrate competency and achieve Fellowship. The RCE is a structured, multi-station clinical exam that aims to assess general practice clinical competencies. It is important to note that although the RCE is somewhat different to the OSCE in its format, the clinical skills being tested will be the same. Any OSCE preparation that has been done so far will be valuable preparation for the RCE.

The RACGP faculties will run optional mock RCE sessions, similar to the previous mock OSCE workshops, leading up to the exam. The mock RCE sessions will be delivered remotely and the same platform and technology used for the actual RCE will be adopted for the mock RCE. This will allow candidates to test the technology and become more comfortable with being assessed remotely. Furthermore, to help with accessibility, candidates will be able to easily attend a session hosted by a faculty in another part of the country, should they choose. We will ensure there are sufficient mock RCE places nationwide to allow all enrolled candidates the option of attending a session.

What does this mean for me?

If you were expecting to sit the 2020.1 OSCE in May 2020, you will instead be able to meet your Fellowship requirements by passing the Remote Clinical Exam (RCE) in October 2020. The RCE replaces the OSCE, and is delivered entirely online. You will not need to travel to an exam centre to sit the RCE. If you pass the RCE, it will count toward your Fellowship requirements just like passing the OSCE would.

If you were expecting to sit the 2020.2 OSCE in November 2020, you will instead sit the RCE in March 2021. The RCE will run again in 2021.1, mid next year.

From 2021.2, the OSCE will be permanently replaced by the Clinical Competency Exam (CCE). From the time it is introduced, the CCE will become the final exam for everyone working toward Fellowship of the RACGP.

I’ve been preparing for the OSCE, will I be disadvantaged by this change?

The RCE is designed to test the same skills as the OSCE. While the delivery will be somewhat different, the preparation you have already done for the OSCE will be valuable. Although the changes forced upon us by COVID-19 could not have been predicted, we recognise that the change from the OSCE to the RCE is an unexpected challenge to anyone preparing to complete their Fellowship of the RACGP.

We are therefore granting some allowances to the Fellowship Exam Attempts Policy for any candidate eligible to sit either the RCE or the CCE in 2020 or 2021. For more details, see section 4, Exam Candidacy, below.

When will I be able to enrol in the clinical exams?

Enrolments for the Remote Clinical Exam (RCE) and Clinical Competency Exam (CCE) are open now, and will close 9:00 am AEST, Monday 20 July 2020.

I was enrolled in 2020.1 OSCE, what does the exam postponement mean for me?

Candidates who are currently enrolled in the May OSCE are automatically enrolled in the RCE in October 2020. Candidates who are yet to enrol, and are eligible to sit can enrol now.

I was hoping to enrol in the 2020.2 OSCE, what do the changes to the OSCE mean for me?

Candidates enrolled in the 2020.2 OSCE will undertake the RCE in early 2021, and their enrolment will be automatically rolled over.

I have successfully passed one exam but not the others as yet. Will my exam pass validity period be extended?

Exam results are being extended to compensate any member who would miss an attempt at the OSCE due to the exam postponements. This means if you were eligible to sit the OSCE in 2020.1 or 2020.2, but your exam results will expire before the rescheduled exam day, you will be given an extension.

Extensions will not be given to members who were not eligible to sit the clinical exams, or whose results were already valid for the new exam dates.

How will the delays impact the 6 attempt policy for Exams?

The rescheduling of the 2020.1 and 2020.2 exams to later dates will have no impact on the three year, six attempt exam limit (the Fellowship Exam Attempts Policy). Because the exams are keeping the same label, the 2020.1 RCE will still be treated as part of the 20.1 semester, even though it's falling in the second half of the year. Same for the 20.2 RCE, even though it's falling in 2021. The exam delays themselves do not negatively impact your maximum Fellowship exam attempts. However, candidates eligible to sit the RCE or CCE in 2020 or 2021 will be granted an additional semester in their candidacy, bringing the new total to seven semesters over 3.5 years (plus approved suspensions and leave).

What other affordances are being made for affected exam candidates?

In addition to extensions of results for doctors affected by delays, the RACGP is also granting an additional semester of exam candidacy to all candidates eligible to sit either the RCE or CCE in 2020 or 2021. This means instead of being able to sit exams in up to six semesters over three years (plus approved suspensions and leave), candidates eligible for the RCE or CCE in 2020 or 2021 will now be able to sit exams in up to seven semesters over 3.5 years (plus approved suspensions and leave). You can choose to use this additional semester to attempt the exam, and still have the same number of attempts remaining should you be unsuccessful, or, you can choose not to attempt the exam in this additional semester and take the extra time to study and prepare for the new assessment format.

My existing exam results from 2017 expire in December 2020, will I still get to sit the clinical assessment in 2021?

Because the exams are keeping the same label the clinical assessment in 2021 will still be treated as part of the 20.2 semester, even though it's falling next year. You will therefore not be disadvantaged with regards to expiry of your existing exam results by the exam delays and will still be able to sit the rescheduled exam even if it falls outside of this.

My AKT and/or KFP results will expire before the rescheduled Remote Clinical Exam in October, will I need to repeat those exams?

Exams are linked to exam semesters, not dates. The October RCE is now part of the 2020.1 cycle so the postponement will have no effect if you sit on the new date.

Will I be refunded for exam prep workshops and mock exams or have the dates been postponed?

Exam preparation workshops and mock OSCEs will be refunded in full. New activities including a mock RCE will run across the country, and be accessible for all RCE candidates. Further information will be available in due course.

Payment in full is required 20 working days prior to the relevant exam, does that mean my assessment fee is due 20 days prior to 23 October?

Yes. Full payment for the RCE will be due by 5:00 pm AEST Friday 25 September 2020.

Can I get a refund for my exam enrolment?

If you wish to withdraw from an enrolled exam your refund will be issued under the normal process.

What options are available if I am having trouble paying for the exam?

If you are experiencing financial hardship, you can request a payment plan for the KFP or AKT by filling out the special consideration form. You will be given a manual enrolment form and sent an invoice to make payments in instalments.

When will my exam fees be due?

Payment in full is required for exams 20 working days prior to the relevant exam. This refers to the rescheduled dates and not the original dates.

My registration is conditional on achieving fellowship, how will the exams being postponed affect me?

On 30 March 2020, the Medical Board of Australia announced it will not refuse to renew an IMG’s registration or refuse to re-register an IMG solely because they have not been able to sit an AMC or college examination or assessment.

This applies to IMGs who were scheduled to sit an examination or be assessed from March 2020, and specifically includes the RACGP's AKT & KFP.

For full details please see the Medical Board website.

PEP COVID term

COVID social distancing restrictions have had an extraordinary impact on the way we work in General Practice, and therefore, the ability of PEP Participants to effectively complete PEP requirements and Training Organisations (TOs) to deliver the PEP. The PEP term impacted upon thus far is Term 2 2020 (April to June).. In response, the RACGP has introduced the PEP COVID Term (1 July to 30 September 2020) (“Program Pause”) to be offered to any current PEP participants regardless of their length on the program to enable PEP Participants and TOs additional time to work towards program requirements.

Who is eligible to apply for a PEP COVID Term Extension?

PEP Participants who identify any of the following issues (listed in Table 1 below) that have impacted upon their program, are eligible for a PEP COVID Term Extension.

Table 1 – Issues that qualify for a PEP COVID Term

Category	Description
1. Practice or Personal	Difficulty for participants in completing the assessable tasks in the learning units due to: altered patient demographics, presentations and patient volumes which impact upon contextualisation of knowledge; and/or Telehealth (limited examinations and procedures); and/or personal circumstances – social stressors, e.g. family ill health, other social need and/or home-schooling requirements.
2. Multisource Feedback	Likely delays due to changes in patient and colleague recruitment.
3. Education Activities	Inability of TOs to provide face-to-face education activities and WBA as planned although alternatives should be sought wherever possible.
4. Employment	Employment instability in current employment, or the inability to commence in a new practice due to a reduction in patient volumes.
5. Assistance Terms	Inability to participate in recommended PEP Assistance Terms due to loss of income and/or change in patient demographic profiles and consultation modalities.

What are the new PEP COVID Term Guidelines?

1. An initial three-month program extension – this would benefit participants who are mid-program, due to complete, or commencing.
2. An option to extend the term to a total of six months, if required (but a further Extension Term at the completion of the program will not be granted).
3. The PEP Provider Number can continue to be used during the extension even if for minimal working hours.
4. The three-month extension is in addition to the maximum program time.
5. Portal and Learning Management Systems access remain active during the extension.
6. There is no requirement for TOs to provide additional WBA during this period (but outstanding WBA should be attempted where possible).

What’s the impact on program fees to the PEP Participant?

There is no additional funding to the TO for the ‘pause’ and no additional fee charged to the PEP Participant.

Other considerations

• PEP Participants who are due to complete mid-year with the aim of enrolling in the 2020.2 exams will still be eligible for the extension and able to enrol in the assessment cycle as the 2020.2 exams are now delayed by >3 months.
• Change in Circumstances notifications are still required if PEP Participants change their practice location and/or are seeking a new practice location during the time of extension. This also includes requests for leave. For PEP participants, leave provisions are determined by their employment contract. Program length will not be affected.

How can participants apply?

The form for participants to apply for the COVID term can be found under the existing Change in Circumstances link on the PEP portal. This can be accessed under the ‘my account’ icon on the top right corner of the screen.

Cancellation of PEPEA

Due to the COVID restrictions, the RACGP was required to cancel the April 2020 PEPEA. This had an impact on applicants who were aiming at starting the program in July 2020. We apologise for the inconvenience and acknowledge how this might have impacted on your plans to progress on the program. The RACGP has now arranged for PEP applicants to sit an online version of the PEPEA starting from July 2020. Candidates can opt to sit the assessment in their home, workplace, or any location that meets the requirements. If you paid for the April 2020 PEPEA, you are not required to pay again. More information can be found under the PEPEA section of the PEP website.

DoH extension of provider numbers

Provider Nos. - The Department of Health (DoH) has extended 3GA Provider Nos for approved programs (see DoH website for list), including PEP provider Nos., for six months. This extension does not automatically extend allocated PEP education time. i.e. if you are completing PEP in the next six months and require additional time, you must extend your program time under the processes below. This extension will be applied at the end of the educational time in the program and has no impact on other PEP extensions.

Program Time – if an extension in Program time is required, this must be applied for under the Covid Term application (if eligible) or Practice Experience Program – Standard Stream Leave and Extensions Policy.

I am a PEP participant and I need more time to fulfil my WBA requirements. What are my options?

We understand that social distancing restrictions have had an extraordinary impact on the way GPs work, and that this has likely affected your ability to complete your Practice Experience Program (PEP) requirements. The RACGP is offering all PEP participants (who commenced the PEP prior to July 2020) a PEP COVID term extension.

I need time off work because I have respiratory infection symptoms OR have been tested for COVID-19 and need to self-isolate OR have been confirmed to have COVID-19 and need to self isolate.

AGPT registrars are entitled to 5 days of paid sick leave and 2 weeks of paid annual leave (or full time equivalent) per six month term under the NTCER. It is important to know that the 5 days of paid sick leave per six months is available to both full time and part time registrars. Under the NTCER you do not need to wait to accrue sick leave and are entitled to an advance of 38 hours paid personal leave for each 6 month term upon commencement of the term. If you are working with the same employer for a full 12 months then you can negotiate to have the full advance of 76 hours paid personal leave allowable for the full 12 months upon commencement to help cover any period of sick leave required for COVID-19 reasons. Any leave above and beyond this, is at the discretion of the employer.

If you have run out of sick leave and annual leave (or alternatively are not wanting to use annual leave for this reason) then you will be eligible to access category 1 leave. Whilst category 1 leave does not contribute to training time it will not add to your training time caps. Please liaise with your training post and RTO to arrange any leave and complete any necessary leave forms.

Can GP trainees in self-isolation continue to work through teleconsulting?

For AGPT registrars, approval is required from the trainee’s RTO.

What happens if a supervisor has to take time off from work due to COVID19 related issues?

If an AGPT supervisor self-isolates, the supervisor or practice should inform the relevant RTO as soon as possible and ensure that any registrars under their supervision continue to receive the required supervision. If the practice has not done this then please speak with your practice or contact your RTO directly.

I am on the rural stream but had planned to move to a metro area post fellowship, can I still go?

You will need to remain on the rural stream until you have completed your Fellowship.

I am really confused about the practice diversity requirements. Can you please explain what will happen if I can’t move practices?

The aim of the requirement is to ensure that you have a diverse general practice training experience with exposure to a broad range of presentations, populations and patient demographics. Additionally, you should ideally be exposed to a variety of supervisors as well as different practice management systems. If you can’t move practice as a result of the COVID-19 pandemic then your training organisation can work with you to find alternative ways to demonstrate that you have met these requirements. This could be by doing a visit to another practice and writing a reflective essay on how the business model and practice systems were different to what you have already experienced, and what you have learned from this. Any alternatives need to be prospectively discussed and approved by your training organisation. This guidance document might be useful if you are looking for more information.

What will the RACGP recognise as training if I do different work during the COVID-19 pandemic?

We acknowledge that training placements may change for registrars due to several factors and many of which could be out of the registrar's control. Registrars may be asked to work in fever clinics or in essential services in the hospital. The RACGP has been working with RTOs to provide clear guidance about what can be recognised for training time. We acknowledge that there is a need to find flexible solutions to your situations whilst balancing the need to ensure that you progress to fellowship standards.

If you are facing a change in your circumstances to your currently approved training placement then we encourage you to make contact with your training organisation as soon as possible to discuss the suitability of different work for counting towards training. It is important to note that any contractual arrangements with your current training practice do need to be met. It is important also that any desired placement options have adequate supervision commensurate with your level of training.

If you are enrolled in the FARGP and your ARST is being impacted then this can be discussed with your training organisation and the Rural Censor. The same comments about needing suitable supervision apply for the FARGP.

Your training organisation will be able to work with you to minimise the disruption to training as much as possible.

What happens if I end up a couple of training weeks short of exam eligibility because I needed to take time off during COVID-19? Can I still sit my exams as planned?

To be eligible to sit your exams as an AGPT registrar you need to have completed 2 years of training including all of GPT1 and GPT2. As an RVTS registrar you need to have completed 12 months of GP terms. As a special COVID-19 related allowance, if you are slightly short of this because of COVID-19 related disruptions to your training, you will be allowed to enrol in and sit your exams, as long as your RTO or RVTS agree that you are ready to sit.

The special policy provision is:

Where a registrar's completion of term date:

1. is delayed as a result of previously approved COVID-related allowances which have not been counted as training; and
2. falls within 28 calendar days beyond the scheduled date of the AKT;
   an exemption will be granted to allow the registrar to sit the examination, if supported by the registrar's Regional Training Organisation.

Previously approved COVID-19 related allowances include additional sick or carer's leave taken as category 1 leave, or where category 2 leave is taken for COVID-19-related reasons during the COVID-19 pandemic.

The date I am due to complete my training requirements is going to be delayed because of COVID-19? What can be done about this?

We appreciate that some registrars will end up completing their training requirements later than anticipated due to COVID-19 disruptions including COVID-19 related leave, training time extensions and exam postponements.

While delays to completion of training dates will be unavoidable for many, the RACGP and TOs will work with you to minimise the impact of these delays, while maintaining the integrity and standards of the training program.

If you take additional COVID-19 related leave and have special consideration needs for the expedition of Fellowship, we may be able to facilitate this.

The special policy provision is:

Where a registrar’s completion of training date:

1. is delayed as a result of previously approved COVID-related allowances which have not been counted as training; and has
2. special consideration needs for provider number related or employment issues; 
   then sign-off of completion of training can be up to 28 calendar days early, at the discretion of the RACGP.​
   ​

Previously approved COVID-19 related allowances include additional sick or carer's leave taken as category 1 leave, or where category 2 leave is taken for COVID-19-related reasons during the COVID-19 pandemic;

How does the AGPT Program COVID-19 Support Policy 2020 apply to training impacts?

On the 15^th May, 2020 the AGPT Program COVID-19 Support Policy 2020 was announced. This policy has been devised jointly with Department of Health with feedback from major stakeholders in order to support registrars enrolled in the AGPT program during the COVID-19 pandemic. The below FAQs help to understand some of the implications of this policy and how it may be relevant to you.

Where can I find the policy?

A copy of this policy can be downloaded here.

How long is the policy effective for?

The policy came into effect on 15 May 2020 and will be periodically reviewed as the COVID-19 pandemic unfolds. Registrars will be able to request support under the policy whilst they continue to be affected by COVID-19.

The policy is active from 15 May 2020. Can the provisions be retrospectively applied where needed?

Yes, RTOs and the RACGP are able to backdate support for registrars under the policy as they see fit. The policy does not specify a particular date to which the supports can be backdated; such will be determined on a case-by-case basis.

The policy is time limited. When are the review and end dates?

There are no currently scheduled review or end dates for the AGPT COVID-19 Support Policy. The Department of Health, in collaboration with the GP Colleges, will review the policy when deemed necessary based on any stakeholder feedback received, and as the socio-legal environment changes in response to the pandemic, to ensure that the policy continues to support registrars as intended.

Where do I send my application for support under the AGPT COVID-19 Support Policy?

Applications for leave, extensions of training time, transfers between RTOs and training regions, and exceptions to training time obligations go to your RTO at first instance. Please talk to your RTO for further information.

Applications for pathway transfers, and exceptions to training location obligations go to the RACGP via email to AGPTadmin@racgp.org.au.

Who within the RACGP may I contact if I have further questions about this policy?

Please email Julie-Anne Pho, Senior Policy Advisor, at julieanne.pho@racgp.org.au.

COVID-19 Extensions of Training Time:

My clinical practice has narrowed in scope and I am no longer undertaking the full scope of general practice. What options do I have available to me?

RACGP acknowledges that a broad scope of practice is important for GPs in training in order to ensure you progress to fellowship standards. COVID-19 may have impacted scope of practice if a registrar has needed to change duties, change roles or had a reduction in patient numbers or variety of presentations. If you are concerned that your scope of practice has significantly narrowed as a result of COVID-19 then it is important that you contact your RTO as soon as possible to discuss your options. A decision around the impact of narrowed scope on training will need to look at the full picture of your training progression to date including training stage, assessment status, supervisor input and ECT visit feedback. If you and your RTO decide that your training progression is significantly impacted by the reduced scope then under the AGPT COVID-19 Support Policy you will be eligible for COVID-19 extension of training time.

What will happen if I run out of training time as a result of the exams being postponed or not being ready to sit exams?

Registrars unable to undertake their exams directly due to COVID-19, either due to the exams being postponed or the registrar being unable to prepare for them, will be eligible for a COVID-19 extension of training time. Please contact your RTO to discuss.

How long will a COVID-19 extension of training time last?

Up to 6 calendar months can be approved by your RTO with further extensions beyond the initial six months needing RACGP approval.

What evidence do I need to provide to support my request for a COVID-19 extension of training?

There is no application pro forma, but the standard AGPT forms may be used if desired. Supporting documentation confirming that the request is required due to the impact of COVID-19 will be required. Registrars are encouraged to discuss specific documentation requirements with their RTO and the RACGP.

How will a COVID-19 extension of training time impact my training time cap?

It is important to know that an extension of training time under this policy will not count towards training time caps.

If I am granted an extension of training time under this policy, will I remain eligible for a Medicare provider number?

Yes, you will be able to continue to work during an extension of training time and have access to your Medicare provider number.

What will happen if I obtain a COVID-19 extension of training but then I feel my training experience during this time was in fact sufficient to progress my training?

Typically, any work done during a COVID-19 extension of training time will not count towards active training. However, it may be possible to retrospectively count this towards training if relevant evidence and supporting documentation can be provided to show that there was in fact sufficiently broad enough scope of practice. This is the first time that this retrospective clause has been included and gives flexibility to individual situations where circumstances may change after the initial approval is given. Relevant evidence and supporting documentation may include patient logs, review of numbers and types of presentations and supervisor feedback.

What is the difference between applying for a COVID-19 extension of training time, standard extension of training time, and extension of training time for assessment purposes in non-extenuating circumstances?

If your training progression is affected by COVID-19 (eg because the Fellowship exams have been postponed until after you have run out of training time) your best option is to apply for a COVID-19 extension. A COVID-19 extension will not count towards your training time cap or allowances for standard extensions of training time.

If your training progression is not directly affected by COVID-19, you should instead apply for a standard extension of training time in line with the AGPT Program Extension of Training Time Policy 2020. If you have already utilised all of your extension allowances, you may apply for an extension of training time for assessment purposes in non-extenuating circumstances in line with the same policy.

I am an AGPT registrar who has completed all of my training time but has to wait for the postponed exams. Will I still need to be employed under the NTCER and what will the implications be on my remuneration of having to extend my training?

You will still need to employed as a registrar until you Fellow. The NTCER stipulates minimum remuneration rates. You can negotiate higher rates with your practice.

COVID-19 Transfers

As a result of COVID-19, I need to move interstate or to a different region. What options do I have available to me in regards to my training on the AGPT Program?

Under the COVID-19 Support Policy you may be eligible for a transfer between RTOs and / or training region as long as the reason for your transfer is due to the impacts of COVID-19. It is important that if you feel you may need to move RTOs or training regions that you talk to your RTO as soon as possible. You will need to provide supporting documentation to your RTO for them to support your application.

In what circumstances could I apply for a COVID-19 transfer between RTOs?

Registrars are encouraged to apply for a COVID-19 transfer between RTOs if they believe the transfer is required due to the impacts of COVID-19. Examples include:

• The registrar would like to be closer to an immediate family member who has contracted COVID-19 or is particularly isolated due to social restrictions relating to COVID-19;
• The registrar’s immediate family is under particular pressure due to social restrictions relating to COVID-19, they do not have an adequate support network in their current location, and they would like to be closer to their family and friends; and
• There is an identified need for COVID-19 first responders within the requested RTO’s training region and the registrar would like to assist the local communities there.

How difficult will it be to change RTOs?

Requests for transfer between RTOs require the support of both your current RTO and the requested RTO. Your request should be approved if you are able to prove to both RTOs via supporting documentation or evidence that the transfer is required due to the impacts of COVID-19.

The AGPT COVID-19 Support Policy states that transfers will be valid until the end of 2020. What happens if my situation changes in that time and I need to stay?

If a further transfer is required because you are still affected by COVID-19, you may submit a request for a further transfer to your RTO (for transfers between RTOs and training regions) or to the RACGP (for transfers between pathways). If you need to stay in the location to which you have transferred for reasons unrelated to COVID-19, you may submit a request for transfer in line with the AGPT Program Transfer Policy 2020. This will be considered by your RTO (for transfers between RTOs and training regions) or by the RACGP (for transfers between pathways).

I am currently on a temporary transfer between training regions. Given that the Fellowship exams have been postponed anyway, am I able to stay in my current location for a while longer?

Please discuss your options with your RTO. With your RTO’s support, the RACGP may grant an extension to your temporary transfer under the COVID-19 Support Policy if the reason for your transfer extension is a result of COVID-19. If the transfer is not strictly required due to the impacts of COVID-19, you may still request a transfer in line with the AGPT Program Transfer Policy 2020.

Training time obligations 

Am I able to change from full time to part time training as a result of COVID-19?

The RACGP acknowledges that there are many reasons that a registrar may wish to change their full-time equivalent training status as a result of COVID-19. Under the COVID-19 Support Policy, this will be approved if supported by your RTO. If possible, please apply in writing to your RTO at least five business days before you propose to commence training at less than 1.0 FTE. If dropping to part time training you will still need to comply with the RACGP’s minimum part time requirements. This includes a minimum 14.5 hour working week over a minimum of two days per week, of which a minimum of 10.5 hours must be in rostered, patient consultation time undertaking general practice activities.

The policy states that I need RTO approval first before changing to part time, but my practice has asked me to change to part time effective immediately. What happens now?

Where possible, registrars are asked to seek RTO approval to change their training time obligations at least five business days before they propose to, or are required to change to part time. We accept that this is not always possible. Registrars are urged to seek RTO approval as soon as possible, and accepted changes to your training time obligations may be applied retrospectively.

Right of appeal

 
What happens if my RTO denies my request for COVID-19 support?

If your RTO rejects your request (ie because it is found that your request is not in direct relation to COVID-19), you may alternatively apply for support via the standard suite of AGPT Program Policies, ie:

• AGPT Program Extension of Training Time Policy 2020;
• AGPT Program Leave Policy 2020;
• AGPT Program Training Obligations Policy 2020;
• AGPT Program Transfer Policy 2020.

Registrars are encouraged to first seek alternative support as per the above. There is also an option for appeal to the RACGP in line with the AGPT Program Appeals Policy 2020. The registrar must first exhaust all internal appeal and dispute resolution mechanisms with their RTO. For further information, please contact the RACGP at AGPTadmin@racgp.org.au.

What happens if a registrar misses an RTO education and training activity?

We are committed to ensuring that registrars are not unfairly disadvantaged by changes to education and training activities and that there are appropriate options available where traditional delivery formats are not feasible. Registrars are required to log 125 hours of education with their RTO over their training time as a requirement of Fellowship. Many of the RTOs have made the decision to stop face to face education activities but are offering non face to face options instead. This will still count towards your education requirement hours. RTOs are working on contingency plans for those workshops or activities that cannot be delivered in a non face to face manner.

Any mandatory activities missed are expected to be made up for in a manner that is at the discretion of the RTO. Given the extenuating circumstances, alternative ‘make-up’ activities may be offered. We encourage you to discuss this with your RTO.

My RTO has cancelled ECT visits, how will this affect my training requirements?

The RACGP has provided guidance to RTOs on the delivery of ECT visits where the traditional format of a face to face ECT visit is unable to go ahead. You can find this guidance here with examples of acceptable alternatives. Please discuss with your RTO to find out what format they will be adopting.

My contract  with my current practice is due to expire. What options do I have available to me?

Once your contract at a practice expires, the practice has no contractual obligation to continue your employment as a registrar. In saying this your practice may be open to signing a new contract and you should discuss this with your practice as soon as possible. Your RTO may support you staying at the practice if the practice is able to extend your contract, otherwise your RTO will work with you to find a suitable alternative training post.

How do leave provisions apply to leave required for COVID-19?

When considering leave options we encourage all GPiT to have a look at the following resources:

• Individual contract with your workplace
• National Terms and Conditions for the Employment of Registrars (available on GPRA website)
• Fair Work Australia website – there is a specific resource entitled “Coronavirus and Australian Workplace Laws”

We have provided some common situations below.

I need time off work because I have respiratory infection symptoms OR have been tested for COVID-19 and need to self-isolate OR have been confirmed to have COVID-19 and need to self isolate

If symptoms are mild and you are well enough you may be able to perform teleconsultations from home and not require leave. Please see the below section on teleconsultations for more information.

In all of these situations, your reason for leave qualifies for sick leave.

My family member is sick with COVID19 and I need to care for them

Under the NTCER sick leave encompasses both personal leave and carers leave. The same answers to the question above will therefore apply.

I need time off work because I have been advised I need to self-quarantine as I am a close contact of a confirmed case or have recently returned from overseas

If you need to take time off work for self-quarantine reasons but are well in yourself then you may be able to undertake teleconsultations off site and not need any leave. Please see the section on teleconsultations below.

The Fair Work Act does not have specific rules in this situation. If you are not able to organise work from home arrangements with your practice then you need to negotiate with your employer the type of leave you are eligible for in this situation. This may include working from home, taking sick leave or taking annual leave.

As per above, if you have run out of sick leave and annual leave (or alternatively are not wanting to use annual leave for this reason) then you will be eligible to access category 1 leave. Whilst category 1 leave does not contribute to training time it will not add to your training time caps. Please liaise with your training post and RTO to arrange any leave and complete any necessary leave forms.

I need time off work because I (or a direct family member that I care for eg a child) have an underlying medical condition that puts me at increased risk of complications from COVID19 and I have been advised that I shouldn’t go to work as I need to minimise my risk of exposure

All GPiT are encouraged to discuss safe working conditions with their employer. If you fall into this category then it may be appropriate for your practice to put certain safeguards in place to reduce any potential exposure eg adequate triaging of patients, ensuring PPE, working from home arrangements or converting to teleconsultations onsite. We encourage you to discuss these options with your employer in the first instance and if a reasonable outcome can be achieved then no further action needs to be taken.

If you are unable to negotiate safe working conditions with your employer then you can apply for category 1 leave through your RTO with supporting documentation. We are aware that this situation could continue for an extended period of time and we do not want GPiT adversely impacted from either a remuneration or training time perspective. If on category 1 leave you are able to work in other roles (please see working on category 1 leave) and you may be able to negotiate a change of training placement that would enable a safer working option. We encourage you to discuss this option with your RTO as it will be dependent on your stage of training and placement options available.

Can GP trainees work while on category 1 leave?

We understand the financial strain that may result from needing time off work for COVID19 reasons especially if this time is an extended period. We are supportive of GPiT being able to work whilst on category 1 leave for this reason. Work that is consistent with the reason for category 1 leave is permissible with RTO approval and appropriate documentation. Any work undertaken while in isolation for COVID-19 reasons should not compromise that isolation.

Can GP trainees undertake teleconsultations?

With the escalating infection rates in Australia it is expected that a significant proportion of GP COVID-19 related advice and management for patients will be provided remotely through teleconsultation either by telephone or by videoconferencing. Some of this may be done remote to the site of the clinician’s main clinical practice, particularly if the clinician is under self-isolation but still able to consult. Trainees may be asked to contribute to the provision of teleconsultations. This may include when they are in self-isolation. The RACGP considers teleconsultations during the COVID-19 health crisis an appropriate clinical activity for GP trainees, provided that supervision arrangements commensurate with the normal supervision requirements are in place.

What are the supervision requirements for telehealth consultations?

Teleconsultations by GP trainees require supervision that is commensurate with normal supervision requirements. For teleconsultations, equivalence to onsite availability is considered the availability of the supervisor to be dialled into the registrar’s teleconsultation. Most teleconsultations platforms have the capacity for a third person to be dialled in.

Are there additional requirements for remotely delivered teleconsultations by GP trainees?

If a GP trainee is conducting teleconsultations off-site, the GP trainee’s practice is responsible for ensuring that systems are in place for protecting patient privacy and for ensuring that the off-site worksite has the required workplace support, supervision (if required) and occupational safety provisions. Trainee engagement with remote supervision models (for AGPT and RVTS) requires agreement by the trainee who has the option to refuse. The RACGP expects all trainees to feel comfortable and well supported with any model used for remote supervision.
Training posts who wish to engage AGPT registrars in remotely delivered teleconsultations need to secure approval from their regional training organisation (RTO). RTOs are required to have a documented process for approving, managing and monitoring remotely delivered teleconsultations by registrars that is consistent with the guidelines detailed above. RTOs do not require prospective approval by RACGP for their chosen model to achieve this.

Can GP trainees in self-isolation continue to work through teleconsulting?

If the GP trainee is medically well enough, they may continue to work by teleconsulting as long as the above guidelines are adhered to.

What happens if a supervisor has to take time off from work due to COVID19 related issues?

All registrars continuing to train are required to receive supervision to the current standards with supervision for telephone and telehealth consulting detailed above. Supervision may be provided by an alternative Fellowed GP at the practice. Alternatively, if the supervisor is well enough to provide off-site supervision then this may also be an option depending on the registrar’s stage of training and competency. Any model that involves remote supervision needs the agreement of the registrar involved. The RACGP expects all trainees to feel comfortable and well supported with any model used for remote supervision.

Telehealth and supervision: A guide for GPs in training and their supervisors

RACGP has published a Guide to providing telephone and video consultations in general practice which is accompanied by a resource Telephone and video consultation in general practice: Flowcharts

Medcast has a webinar – Integrating eMH into COVID-19 Telehealth Consultations

GPRA has a webinar – Telehealth consults for GP Trainees

JCU GP has made its telehealth resources for GP training open access. The resources include an excellent guide, supervision plan template and links to articles and webinars.

The Medical Board of Australia has Guidelines for Technology-based patient consultations. Further information about the guidelines is available here.

I am worried that I won’t be able to submit my RPL application by the end of term. What do I do?

There is a 3-month COVID-19 extension for RPL submission. This applies to Registrars who commenced in GPT1 in 2020.1, for whom it would be expected that applications for RPL would be submitted by the end of the 2020.1 term. Other registrars currently due to submit their RPL application and impacted by the COVID-19 pandemic may have an extension approved on a case by case basis by the relevant Censor. Please make sure that you keep in touch with your medical educator and training organisation if you have any concerns.

I am going to start in a GP term in 2020.2 but my BLS course was done 2 years ago as part of an ALS. There are no courses available. What do I do now?

ALS and BLS requirements are:

1. A Basic Life Support (BLS) course completed within the 12 months prior to commencing General Practice Term 1 (GPT1) that meets the requirements detailed in RACGP's Basic Life Support and Advanced Life Support Guidance Document.
2. A Basic Life Support (BLS) course completed within the 12 months prior to applying for Fellowship that meets the requirements detailed in RACGP's Basic Life Support and Advanced Life Support Guidance Document.
3. Training in advanced life support (ALS) completed within the four years prior to apply for Fellowship that meets the requirements in RACGP's Basic Life Support and Advanced Life Support Guidance Document.

ALS certificates will be accepted as evidence of BLS if the course includes basic life support including assessment in CPR.

While BLS certificates are normally valid for three years and ALS certificates for four years, the CPR component is only valid for 12 months. However, given the difficulty of getting ALS/BLS courses during COVID-19, If you have a current BLS or ALS (including CPR) certificate then your RTO will be able to support your start in a general practice term.

Fellowship applications with incomplete ALS and BLS requirements will be managed likewise.

If your certificate/s are out of date then the situation is more complicated and that is where your training organisation and the Faculty Censor will need to work with you individually.

The RACGP acknowledges that COVID-19 has brought unprecedented challenges for our GPs in training both in their training as well as their personal lives and that this has the ability to impact their wellbeing significantly. In recognition of this the RACGP has put together a GPiT Support COVID19 Response Group to help support the wellbeing of all GPs in training during this time. Further information and resources can be found here.