Warrnambool GP training provider closes as college takes over

The move marked a transition - after more than 20 years - away from regionally based training centres back to the centralised Royal Australian College of General Practitioners (RACGP) and Australian College of Rural and Remote Medicine (ACRRM).

But chief executive of MCCC Greg McMeel said the move to centralise had been a long time coming.

"Basically as soon as we regionalised in 2002 they were trying to centralise it all again," Mr McMeel said.

Prior to 2002 GP training was the responsibility of the RACGP, but a federal government review found the college wasn't meeting expectations, particularly in rural areas.

"Basically they weren't producing any rural doctors. There were hardly any people training in rural regions and the college had basically ignored rural general practice," Mr McMeel said.

"The year prior to that the ACRRM started up as a breakaway group because rural doctors were so upset at the state of rural general practice. Now we have this ludicrous situation where we have two colleges running general practice."

The regional training provider for south-west Victoria and south-east South Australia was called the Greater Green Triangle (GGT). Mr McMeel said the new organisation worked directly with GP clinics throughout the region to build places for graduates to train in the country.

"When we started GGT we worked on the ground with practices to encourage them to take on GP registrars and that's how we started increasing the number of registrars," he said.

"They could have done that under the college but the RACGP didn't choose to do it. Once we established those places at rural clinics it forced graduates to come out and do their training in those areas."

But he said within a few years there was pressure to merge many of the different regional providers. In 2010 the GGT was merged with the provider in eastern Victoria, a move that puzzled Mr McMeel and his colleagues.

"The bureaucrats in Canberra thought it was going to be cheaper to merge the training centres. That didn't turn out to be the case. We got the same amount of money per registrar whether we were a small organisation or a big one," he said

"Government likes to change things so it looks like you're doing something and saving money, but it didn't save a brass razoo."

But while the mergers didn't save money, Mr McMeel said they damaged the organisation's effectiveness.

"When you're small you understand your community really well and you're able to work within that community to generate training capacity. When you're large it all becomes about developing systems so you can communicate with each other," he said.

Another merger in 2016 created MCCC, which covers two thirds of Victoria, and in 2017 the federal government announced training centres would be abolished altogether, with training responsibility to return to the colleges.

"Now it's completely centralised to the point where two colleges are managing the program, the RACGP based in East Melbourne, and the ACRRM based in Brisbane," Mr McMeel said.

"It's just nonsense that they do this sort of stuff, and in five years time there will be a decision to regionalise GP training again, that's just what will happen."

He said the government's official reason for returning training to the colleges was two-fold.

"They said they wanted it to be cheaper, but now they are pouring millions of dollars into the program for the colleges to manage, so that's gone out the window," he said.

"Then they wanted it to be profession led, but the profession doesn't exist in the college in East Melbourne, it's in the clinics in communities like Warrnambool that you or I actually go to, it's on the ground.

"So the whole argument's been driven by bureaucrats and it's completely flawed."

But while Mr McMeel didn't agree with the government's reasoning, he said there were reasons for optimism under the new college-run system in the south-west.

"There is some hope on the horizon because of Deakin finally moving their full four-year medical course out to the regions. People often find partners when they're studying and working, and if they do that while they're in a regional area they are far more likely to stay," he said.

"A lot of our staff have also moved across to the colleges, so I have some hope they'll continue to work for the regions where they live."

Mr McMeel said his biggest concern in coming years was that smaller towns would lose their only GP.

"Warrnambool is going to be able to look after itself pretty well. It's your Terangs, Portlands and so on that are really important. And once you lose the supervision you lose the training program," he said.

"We really need to be replacing our seasoned GPs with the ones coming through, otherwise the system breaks down and you end up with no GPs at all, and you never get them back."

He said that was what had recently happened in Casterton and Coleraine, which had had many registrars come through over the years, but nobody had ever stayed and now the long-term GP had decided to leave.

"Poor old Casterton and Coleraine, we'll never be able to get anyone out there now and those communities are really going to suffer."