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A guide to Managing Practice Diversity


1. Introduction

The requirements for Fellowship includes the provision  that registrars have exposure to at least two different supervisors and two different management systems in addition to the requirement of exposure to diverse patient populations. 

While the requirement emphasises diversity of experience over number of practices, the expectation is that registrars will meet this requirement by training in a variety of diverse practices, unless it is challenging for them to do so. The experience of diversity in different practices should be sustained for a period of time sufficient to broaden the registrar’s learning experience. 

In any location where there are challenges to registrars being placed in two dissimilar practices, the RTO must ensure that training provides access to sufficient diversity of experience with regards to patient presentations and demographics, supervision, and practice management systems. This is particularly relevant to rural locations where the opportunity to work in multiple diverse practices may be limited either through absence of access to other practices or potential impact on service provision. 

Training providers must ensure sufficient practice capacity for registrars to be able to choose to work in at least two different general practice placements during their training and pressure should not be applied to registrars to remain in one practice (or a group of similar practices) should they wish to move between training terms. 

This document outlines the processes by which Training Organisations may meet the RACGP’s Vocational Training Pathway practice diversity requirement:

  1. when accrediting practices; and
  2. when considering how to support registrars in meeting the practice diversity requirement when there are challenges to training in diverse practices.


2. Definitions

Branch practice For the purposes of this document, this is defined as practices which are owned by the same entity. This includes outreach clinics, corporate clinics and traditional branch practices.

Part time 14.5-hour minimum working week, over a minimum of two days per week, of which a minimum of 10.5 hours must be in face-to-face, rostered, patient consultation time undertaking general practice activities. Work periods of less than three consecutive hours, or of less than one month in any one practice, will not be considered.

* Note – All practices (including branch practices) require a unique provider number.


3. Guidance for RTOs when accrediting practices

As part of the Training Organisations accreditation process of practices owned by the same entity, a diversity assessment must be made, commenting on supervision arrangements, practice management systems and patient populations between the various practice branches. 

3.1 Branch practices with shared populations, records, supervisors and a shifting workforce

  1. These branch practices should be treated as one clinic for the purposes of the diversity requirement, even where registrars require different provider numbers for each practice location.
  2. The branch practices do not require separate accreditation as training posts but the registrar must be adequately supported (for example, with sufficient supervision) while working at any branch.
  3. Registrars may move freely between the practices, with working hours in each practice to be negotiated between each registrar and the practices.
  4. The RACGP’s part time minimum requirements (14.5 hours per week over two days) will not apply to individual sites but to the practice as a whole.


3.2 Branch practices – other than those with shared populations, records, supervisors and a fluid workforce.

Such clinics have a varying degree of diversity. In accrediting these types of practices, the RTO can choose from the following options:

  1. Consider the practice as a single practice with two or more locations. If this option is selected, the stipulations of clause 3.1 apply.
  2. Considered as separate practices.

The Training Organisation will assess the application and determine whether the practice is:

  1. Diverse (sufficient diversity in all three diversity components – supervision, patient population and practice management):
    1. The practices may be regarded as separate practices.
    2. Registrars may complete all diversity training requirements across  the various branch practices, sequentially or concurrently.
    3. Registrars must work to at least the minimum part time in each location (and therefore may not work at more than two locations at any given time).
    4. Practices require separate accreditation as training posts.
  2. Not sufficiently diverse (sufficient diversity in two out of three diversity components – supervision, patient population and practice management):The practices may be treated as diverse but registrars must undertake some additional activities relating to the component lacking in diversity if none of their training time is spent in an unrelated separate practice.
    1. Additional activities undertaken require Training Organisation approval in advance. Examples of activities to meet the practice management diversity requirement include Completing relevant practice management modules (e.g. modules from the RACGP’s GP management toolkit) and organised visits to practices owned by other entities and a subsequent report on identified criteria. Further case-by-case guidance on appropriate additional activities can be sought from the relevant RACGP state censor if needed.
    2. Registrars must work to at least the minimum part time in each location (and therefore may not work at more than two locations at any given time).
    3. Practices require separate accreditation as training posts.
  3. Not diverse (sufficient diversity in none or one of the three diversity components – supervision, patient population and practice management): The practices are to be considered as a single practice. The stipulations of clause 3.1 apply. 

3.3 Reporting
Training Organisations are responsible for the development of systems to document the manner in which registrars are meeting the diversity requirement.


4. Guidance for RTO support for registrars in meeting the requirements.

RTOs can develop guidance in line with RACGP policy that outlines how diversity requirements are met during training. Registrars will need to meet any additional RTO requirements.

In certain circumstances there may be significant challenges to meeting the diversity requirement by training in different practices. This is mostly relevant to training in rural locations where ongoing service provision could be interrupted by the departure of a registrar or through limited practice availability. In those instances the registrar can be supported to meet the diversity requirements through undertaking additional activities.

Additional activities undertaken require RTO approval in advance. Further case-by-case guidance on appropriate additional activities can be sought from the relevant RACGP state censor if needed. Any prospectively approved variation to the training requirements must be submitted to the relevant Censor at the completion of training.


5. Reporting

RTOs are responsible for the development of systems to document the manner in which registrars are meeting the diversity requirement.


6.  References

Vocational Training Pathway Requirements for Fellowship Policy

Standards for General Practice Training

Completion of Training Worksheet