Introduction

1. General Practice Education and Training Limited (GPET), a wholly owned Commonwealth company, manages general practice^[1] training programs funded by the Australian Government.

2. GPET's major training program, Australian General Practice Training (AGPT), is the most common method of vocational training undertaken by registered medical practitioners seeking to become general practitioners (GPs).^[2] GPET's other training program, the Prevocational General Practice Placements Program (PGPPP), provides prevocational ‘work experience' in general practice to less experienced medical trainees.^[3]

General Practice Education and Training Limited

3. GPET was founded in 2001, significantly changing the way general practice vocational education and training had been organised and delivered in Australia. Until then, general practice vocational education and training had been delivered by the Royal Australian College of General Practitioners (RACGP), with Australian Government funding.

4. Important features of the vocational training model instituted by the Government was that it be run on a regional basis, be responsive to local community and health care needs, and that it foster community-based education, with teaching practices that encourage best practice and reward teaching in the community. GPET launched AGPT in 2002 and it took over responsibility for PGPPP in January 2010, to provide more efficient and integrated general practice training.

5. GPET is a Commonwealth company limited by guarantee. Its scope and operations are framed by the Company Constitution which specifies the company ‘objects' (that is, objectives or purposes) regarding general practice training, the Corporations Act 2001 (Corporations Act) and the Commonwealth Authorities and Companies Act 1997. GPET does not have specific enabling legislation.

6. The sole member of GPET is the Commonwealth, represented by the Minister for Health and Ageing. The company is governed by a board of directors which is directly accountable to the member (the Minister) for its performance in meeting the objects of the company and addressing government priorities. Consistent with the duties of directors under the Corporations Act, the Board is independent in its capacity to determine GPET's strategies and the work program required to achieve these outcomes.

7. Based in Canberra, GPET's expenses in 2009–10 totalled $106.7 million, with an average staffing level of 35 people.^[4]

Scheme design for general practice education

8. The Australian Government places a quota on the number of new general practice training places it funds through GPET each year. In broad terms, GPET's role is essentially one of managing and supporting the delivery of outsourced training within a global budget for places and funding determined by government, to meet training quality standards specified by relevant, separate authorities.^[5] GPET is not a regulator.

9. GPET receives funding from the Australian Government, represented by the Department of Health and Ageing (DoHA), under three-year Funding Agreements. GPET's role is to allocate the government-funded training places and associated funding to the organisations it contracts to deliver the education and training across Australia, and to contract-manage those training providers.

10. In early 2010, there were 17 Regional Training Providers (RTPs) throughout Australia delivering AGPT. PGPPP was also delivered by these RTPs, and some additional providers such as universities and divisions of general practice.^[6]

11. RTPs are not-for-profit organisations created to deliver education and training within a specific geographical location. RTPs deliver general practice training in local general practices using networks of GPs who are able to provide experience and support to the trainees (that is, to the GP registrars and junior doctors undertaking training).^[7]

12. Once GPET allocates training places to RTPs or other training providers, these bodies determine the placement of participants in particular geographic locations within their regions, in collaboration with relevant hospitals and general practices.

13. Trainees do not pay fees for their education and training; these costs are met from government funding. Based on 2009 figures for GPET, in broad terms, the education and training cost per GP registrar is $45 000 per year.

GPET's training programs

14. The distinctive nature and context of GPET's general practice training programs and associated administrative arrangements bear on GPET's administrative effectiveness in managing the programs. These matters are highlighted in this section as context.

Australian General Practice Training

15. AGPT is a competitive, three to four-year full-time vocational education and training program for medical graduates wanting to pursue general practice as their medical specialisation. Selections for AGPT are done by GPET and RTPs. Training of these trainees (GP registrars) is conducted within accredited medical practices and hospitals, and is supervised and assessed by experienced medical educators.^[8]

16. GPET accredits RTPs against college standards, and RTPs in turn accredit their networks of training practices against college standards. The systems of accreditation provide GPET with assurance that the education and training from training providers is in accordance with required standards.

17. As well as being a training program, AGPT has a workforce dimension because GP registrars provide primary care services while participating in AGPT. GP registrars undertaking a recognised training placement can access the GP items in the Medicare Benefits Schedule.^[9] Community access to general practice medical services is further enhanced by AGPT's requirement that GP registrars complete training placements in outer metropolitan, rural and remote areas, areas often defined as ones of medical workforce need.

18. AGPT is a growing program; the government increased the number of new intake training places on several occasions from 2008 onwards in order to increase the number of GPs. Between 2004 and 2008 inclusive, the number of AGPT new intake training places funded by government was stable at 600 per year. The number rose to 675 new intake training places for the 2009 training year.^[10] The total number of GP registrars enrolled in AGPT at that time was approximately 2500.

19. AGPT is budgeted to provide 700 new intake training places in the 2010 training year, 900 new intake training places in 2011, and 1200 in 2014.

20. Up until 2010, AGPT was the only training activity that GPET managed and all GPET activity, directly or indirectly, related to that program. In 2010, GPET's funding for AGPT accounted for some 84 per cent of the total training program funding, the remainder related to PGPPP.

21. Between 2005 and 2009 inclusive, some 2058 GP registrars successfully completed AGPT and the required professional college assessments and became eligible for vocational recognition as GPs.

Indigenous Health Training

22. Training in Indigenous health (Indigenous Health Training—IHT) is a component of AGPT. The two components of GPET's IHT for GP registrars are: IHT posts whereby GP registrars undertake general practice training at Aboriginal Medical Services; and GP registrars undertaking learning activities specific to Indigenous health as part of the colleges' Aboriginal health curricula for GP registrars. A major part of the learning activities is Indigenous cultural training, to provide GP registrars with an insight into Indigenous culture as well as factors (such as demographic, economic and lifestyle factors) that affect Indigenous health.

23. All GP registrars are required to undertake IHT learning activities as provided by their RTP; however it is not a requirement that all GP registrars complete an IHT post. In 2009, six per cent of GP registrars undertook training at an Aboriginal Medical Service, up from five per cent in 2008.

Prevocational General Practice Placements Program

24. PGPPP provides prevocational trainees (called junior doctors) with the opportunity to experience the general practice environment prior to determining their area of specialty. The program offers these junior doctors voluntary, supervised and supported placements for a nominal 12 weeks in outer metropolitan, regional, rural and remote areas in accredited training environments.

25. Selections for PGPPP are made by the junior doctors' hospitals as junior doctors are in their employ. Completion of PGPPP, as a work experience program, depends on satisfactory completion of the placement.

26. From 1 January 2010, the management of PGPPP became the responsibility of GPET. GPET is budgeted to provide 380 PGPPP placements in 2010 and 910 placements in 2011.

How GPET's training programs relate to action on workforce shortage

27. Although GPET, as a Commonwealth company, has independence from some detailed government planning, operational and review processes, the Australian Government determines some key parameters for GPET, namely the number of training places and amount of funding for training and education.

28. GPET's functions also make it one of many parties with an interest in health workforce issues. Health workforce shortage problems (particularly in rural and remote locations)^[11] are matters of significance to the Australian Government, as evidenced in the Health and Ageing Portfolio Budget Statements and the Statement of Expectations issued by the Minister for Health and Ageing to GPET in 2009. Although some of GPET's specific processes in placing GP registrars in particular locations respond to these considerations, GPET has limited influence over general practice workforce matters.

Audit objective and scope

29. The objective of the audit was to assess the administrative effectiveness of GPET's management of the general practice training programs, AGPT and PGPPP, the latter being a responsibility that GPET assumed in 2010.

30. Particular emphasis was given to GPET's governance functions such as planning and performance reporting, and to its program delivery, with attention to whether the:

• planning and reporting regimes were integrated to allow GPET to monitor its progress appropriately, with alignment between the entity's overall purpose, its high-level strategies articulated at the enterprise level, and its performance information;
• delivery and review processes for AGPT and PGPPP allowed GPET to administer these programs appropriately; and
• key supporting processes (information management, communications and marketing and stakeholder engagement) suitably assisted program delivery and accountability.

31. The ANAO also examined how GPET contracted with, managed and supported regional training providers; and how well GPET managed the transition in assuming responsibility for PGPPP and the program's subsequent implementation in its very early phase.

Overall conclusion

32. General Practice Education and Training Limited (GPET) is a relatively small public sector organisation in terms of expenditure and staffing, with expenditure of $106.7 million and an average staffing level of 35 people in 2009–10. However, its responsibility for managing the delivery of general practice training and education across Australia is of growing significance. Linked to this, there are increasing expectations from government regarding GPET's contribution to addressing health workforce shortages when allocating training places for general practice registrars (GP registrars).

33. When GPET was established in 2001, its focus was to set up a regionalised vocational training regime. This was to involve contracting with regional training providers (RTPs) for the delivery of quality vocational education and training for GP registrars. This vocational training was directed to GP registrars seeking to specialise as GPs, recognised with fellowship of the relevant professional colleges. As GPs they would thus be able to consult with patients unsupervised and unrestricted and to provide a Medicare rebate for the cost of medical services delivered.

34. Since its establishment, GPET has successfully administered the vocational training program, Australian General Practice Training (AGPT), and also successfully managed the transition and early implementation phases of the Prevocational General Practice Placements Program (PGPPP). Overall, GPET's delivery and review processes for both AGPT and PGPPP are sound. GPET has comprehensive administrative processes and controls underpinning AGPT delivery and review, with sound mechanisms relating to the: management and improvement of its funding agreements with the Department of Health and Ageing (DoHA) and contracts with RTPs; accreditation of training providers; allocation of training places and distribution of funding to training providers; recruitment of applicants; and selection of GP registrars.

35. As well as having sound delivery and review processes for AGPT and PGPPP, GPET pays appropriate attention to the key processes supporting its management of GP registrar training and education (namely information management, communications and marketing, and stakeholder engagement). This has been demonstrated by GPET acting in 2009 to address problems with its information management systems; using a range of communications and marketing mechanisms; and working effectively with a wide range of stakeholders. The results of successive GP registrar satisfaction surveys reflect well on GPET's attention to engaging with key stakeholders and the effectiveness of its management of general practice education and training.

36. Over time, and particularly since 2008 in the face of particular health workforce supply challenges, the government has increased its expectations of GPET. GPET's training and education activities are expected to take greater account of workforce shortages in its allocation of training places and to pay more attention to providing GP registrars with training in Indigenous health.

37. The changing expectations of GPET, including the need to balance its initial function to provide quality training with its increasing role in addressing health workforce shortage issues, had not been fully reflected in updated, clear and aligned statements of its objectives, strategies, priorities and performance information. GPET's work in 2010 to update the Constitution that had been in place since 2001, culminating in the company's sole Member, the Minister for Health and Ageing, approving GPET's Amended Constitution in December 2010^[12] , was an important step towards improving the basis for communication, governance and accountability to stakeholders.

38. With the Amended Constitution in place, there are opportunities for GPET to clarify its directions and the alignment of strategies across key corporate documents. The major benefits in having clarity of purpose and alignment of its priorities and performance expectations would include: a common language to inform external stakeholders of GPET's purpose and directions; and a shared understanding of the activities planned to deliver and report on its priorities.

39. GPET's main responsibilities lie in the management of general practice education and training; GPET has limited ability to influence overall trends in issues such as addressing workforce shortages or meeting the health needs of Indigenous Australians. However, it is important for GPET to be able to communicate its performance expectations in administering its programs and contracts with RTPs and to demonstrate clearly its particular contribution to meeting these changing expectations.

40. With these changing expectations in mind, GPET could improve its capacity to report its unique contribution to general practice education and training that helps communities facing workforce shortage. GPET could do this by improving and aligning its high-level planning and performance information and reporting processes, with better alignment between GPET's high-level statements of performance intent (especially GPET's Strategic Plan and the Health and Ageing Portfolio Budget Statements). GPET's appreciation of the state of workforce issues relevant to informing its own strategies on new and emerging workforce priorities would be improved by the company having access to additional workforce data from DoHA. DoHA has agreed with this view and advised that it has commenced processes to establish standardised reports that will be provided to GPET regularly, in line with its business needs.

Key findings by chapter

Planning and reporting (Chapter 2)

Clarity of purpose and objectives

41. Sound corporate governance for any organisation requires an appropriate planning and reporting regime. To enable an entity to monitor its progress, it is important that planning and reporting are integrated and there is alignment between the entity's overall purpose, its high-level strategies articulated at the enterprise level, and its performance information.

42. GPET's high-level guiding documents (for example the 2001 Constitution, Strategic Plan and the Health and Ageing Portfolio Budget Statements) communicated different points of emphasis for GPET's purpose and main objectives, with varying degrees of attention to education, provision of primary health care services, meeting community needs and meeting workforce shortages.

43. Until its amendment in late 2010, GPET's Constitution had not changed since GPET was first established in 2001. Aspects of GPET's Constitution, particularly in relation to the objects of the company, had become outdated, with expressions of GPET's role and coverage of operations not reflective of current approaches. For example, one of the company objects dealt with establishing the framework for vocational training, a matter overtaken by events with GPET now much more involved in maintaining or expanding the vocational training arrangements. The Constitution of 2001 also did not refer to the prevocational training responsibilities that GPET had assumed in 2010 via PGPPP. In mid-2010, GPET and DoHA commenced a review of GPET's Constitution to reflect better the current operating environment. The Amended Constitution, finalised in late 2010, deals with these matters.

High-level strategies and performance information and reporting

44. There is also scope for GPET to improve the consistency of how it expresses and aligns its key strategies. Analysis of GPET's high-level guiding documentation shows that if GPET were to set out more clearly and consistently its strategies and priorities, it would be better placed to determine what has to be achieved over time to realise its objectives.

45. Improved alignment across GPET's high-level guiding documents would also assist in obtaining a clear ‘line of sight' between the strategies articulated at the enterprise level, key performance indicators, and targets so that they are consistent with GPET's overall purpose. In particular, GPET's four Key Result Areas and associated performance indicators, as presented in its Strategic Plan 2010–13, do not correspond with GPET's three Major Activities and the associated performance indicators, as provided in the Health and Ageing Portfolio Budget Statements 2010–11.

46. A strategic matter for GPET, given its reliance on contracts with a relatively small number of providers delivering training services on its behalf, is how to provide assurance that it is obtaining value for money in procurement. While GPET is not required to comply with the Commonwealth Procurement Guidelines, it did use a competitive tender approach for the selection of RTPs for the 2007–09 triennium. In choosing to use direct source contracting rather than an open tender for RTPs for the 2010–12 triennium, GPET's approach to procurement and contracting with RTPs used legal advice and other processes to provide it with assurance that its intended RTP engagement processes could be ‘supported as a responsible and prudent strategy'.^[13] The longer term approach for GPET should take into consideration testing the market from time to time. GPET could use that process to provide assurance that it is obtaining value for money while also encouraging competition in the delivery of services.

Management of AGPT (Chapter 3)

Management of delivery

47. GPET's frameworks and procedures to manage AGPT program delivery include: the Funding Agreement with DoHA and the contracts with RTPs; the accreditation of training providers; the allocation of training places and the distribution of funding to training providers; and the recruitment and selection of suitable applicants for GP registrar positions.

Funding Agreements with DoHA and contracts with RTPs

48. Although containing some of the features of an appropriate framework for AGPT delivery, such as specified service objectives and deliverables and funding levels, the Funding Agreement and contracts for 2007–09 did not contain adequate performance indicators or targets by which to assess the effective delivery of the program. This position improved with the development of the Funding Agreement with DoHA and the RTP contracts for 2010–12. The new contracts with RTPs for 2010–12 provide the basis for more effective management of AGPT, as GPET is better placed to measure and assess the delivery of selected key aspects of AGPT by RTPs.

49. Aspects of GPET's operational decisions and subsequent performance measures rely on data being received from DoHA. For GPET, data from DoHA on GP servicing can highlight districts of workforce shortage, or the location of GP registrars who completed AGPT and are now practising GPs (that is, GP registrars ‘retained' in the profession, particularly in rural and remote areas). Such information on districts of workforce shortage and rates of GP retention helps inform GPET of one of the factors that contributes to its decisions on the allocation of training places to RTPs and helps GPET consider its results, in terms of adding to the supply of practising GPs, particularly in areas of need.

50. GPET's capacity to manage AGPT would be improved by GPET and DoHA reaching an understanding on GPET having access to relevant workforce data that bears on GPET's capacity to perform and assess its functions, and helps it to consider and report on emerging workforce priorities.

51. Although DoHA is not obliged to provide GPET with this data under the terms of either Funding Agreement, DoHA appreciates that access to the data would provide GPET with a broader context in which to make decisions about GP education and training. During the latter part of the audit, DoHA advised that it had commenced processes to establish standardised reports that will be provided to GPET regularly, in line with its business needs.

GPET's other procedures to manage AGPT delivery

52. GPET has comprehensive processes underpinning program delivery, with sound mechanisms relating to the: accreditation of training providers; allocation of training places and distribution of funding to training providers; and recruitment and selection of GP registrars.

Performance monitoring and reporting

53. GPET's Board and DoHA receive activity reports on AGPT, including training in Indigenous health (Indigenous Health Training—IHT). GPET also examines RTP activity to monitor comparative and absolute performance of RTPs and AGPT over time.

54. Increasing the incidence of GP registrars undertaking IHT at an Aboriginal Medical Service (that is, an IHT post) is not a straightforward objective to achieve. GPET has acted on several fronts since 2008 at the strategic and operational levels, consistent with government priorities and additional Council of Australian Governments funding, to boost the numbers of GP registrars taking IHT posts. Nonetheless, IHT continues to be an area requiring concerted attention.

55. Once the AGPT and GPET objectives are more clearly defined, GPET's capacity to monitor AGPT activity and assess performance would be enhanced by it:

• continuing to develop its performance indicators relating to the overall success of the program;
• determining the information required against these performance indicators; and
• formulating measurable targets for these performance indicators.

56. Like many public sector entities, GPET operates within constraints over which it has limited or little control—funding amounts, training place numbers, levels of GP retention and their location on qualification. However, GPET's management of AGPT would be enhanced by it seeking to provide greater explanation, and drawing conclusions as to the success or otherwise of the overall AGPT program against its strategic aims and targets.

Management of PGPPP (Chapter 4)

57. In January 2010, GPET assumed responsibility for PGPPP. GPET managed the PGPPP preparation and handover well. For example, GPET entered into contracts appropriately with the colleges and DoHA to support its handover and the relevant operational processes. It also commissioned a study to identify and map the operations the colleges used and to appreciate the key management issues requiring consideration.

58. To manage the transition, GPET worked with the colleges to arrange and finalise the 2010 placements and undertook appropriate funding processes. Stakeholders who offered comment during the audit fieldwork were supportive of the work that GPET undertook in the preparation, handover and transition phases evident at that time.

59. The review of GPET's internal documentation and Board processes indicate that GPET also had an appropriate focus on future reform of the program and future challenges.

Supporting processes (Chapter 5)

60. GPET pays appropriate attention to key processes supporting its management of GP registrar training and education activities (namely information management, communications and marketing and stakeholder engagement).

61. The way GPET conducts its information management activities continues to be important, particularly in its operations with RTPs. GPET sought to address significant problems in the functionality and reliability of key parts of its information management systems, deciding in the latter part of 2009 to replace two core IT systems and to redesign its approach to managing IT. GPET and RTPs also agreed in 2009 on a minimum data set to be provided to GPET on a routine basis. This tool is essential to GPET's ongoing monitoring of its general practice training programs and reporting to key stakeholders.

62. GPET sets out its approaches to communication in a structured way in its Marketing and Communication Strategy 2009–11. Consistent with its Marketing and Communications Strategy, GPET uses a range of activities and devices for communication and marketing. GPET evaluates its marketing and communication methods and acts on these evaluations.

63. Stakeholder engagement is particularly important for GPET to secure its broad goals of improving the overall system of medical education and training for junior doctors and GP registrars. GPET works effectively with a wide range of stakeholders. The nature, timing and scope of these interactions reflect the circumstances. GPET and RTPs have worked together to manage differences and maintain effective working relationships.

64. In considering the achievement of its goals, including work with stakeholders, GPET can take some reassurance from the results of its annual GP registrar satisfaction surveys. Successive survey results reflect well on GPET's attention to engaging with key stakeholders and indeed the effectiveness of its activities managing general practice education and training.

Recommendations

65. The ANAO made two recommendations directed at strengthening GPET's management. They involved GPET:

• articulating its purpose, objectives, strategies and associated performance indicators consistently in its high-level corporate guidance material and plans; and
• arranging with the Department of Health and Ageing to obtain general practitioner workforce information to assist it to consider and report on new and emerging workforce priorities.

Summary of GPET response and Department of Health and Ageing comment

66. GPET provided the following response to the audit report:

The Australian Government has made significant investments in general practice education and training over recent years, with entry places in the AGPT program rising from 600 in 2008 to 1200 in 2014. Placements in the PGPPP have increased from 380 in 2010 to 975 in 2012. This growth in general practice training is an important component of the Government's health reform and workforce strategies. As noted by the ANAO, GPET has successfully established and administered the AGPT program and successfully managed the transition and early implementation of the PGPPP.

Throughout its short history GPET has applied the highest standards of corporate governance. GPET's strategic and business planning has successfully supported the establishment of a network of regional training providers, the implementation of a regionalised approach to general practice training, and the subsequent expansion of the AGPT program and the PGPPP.

GPET's high level corporate guidance materials and plans have reflected the strategic priorities of the Company at each stage during the transition from the establishment and start-up phase of the training programs through the consolidation of the regional training provider network and on to the current growth phase.

The changes to the Company Constitution in 2010 have provided the basis for a clear alignment between the Company's objects, its strategic planning, and the key performance outcomes set out in the Health and Ageing Portfolio Budget Statements, in the current context of an unprecedented growth phase in general practice training.

67. GPET agreed with the two recommendations in this report. GPET's responses to each of the recommendations are shown in the body of the report following the relevant recommendation. GPET's full response to the audit is included at Appendix 1 of the report.

68. The ANAO provided DoHA with the opportunity to comment on the report, recognising DoHA's important role regarding policy matters for general practice training and its particular responsibilities regarding the Funding Agreement. The Secretary of DoHA commented that:

It is pleasing to note that overall, the outcome of the review is positive and the recommendations provide constructive suggestions which the Department and GPET are already working to address. I appreciate that the report acknowledges the Department's agreement to commence processes to establish standardised reports that will satisfy GPET's business requirements.

Footnotes

^[1] General practice is the first point of contact for the majority of people seeking health care. General practice training broadly follows an apprenticeship model, with the ‘trainee' undertaking structured education as well as supervised practical (clinical) training over the course of their learning time.

^[2] General practice is a medical specialisation for medical practitioners, recognised by fellowship of the relevant professional colleges. The relevant professional colleges are the Royal Australian College of General Practitioners (RACGP) and the Australian College of Rural and Remote Medicine (ACRRM). Fellowship requires successful completion of college assessment processes. Fellowship of the relevant professional colleges is a mandatory requirement to become a qualified GP, able to consult with patients unsupervised and unrestricted, and provide a Medicare rebate to those patients for the cost of medical services delivered. The structured vocational training managed by GPET is one way that medical practitioners seeking to become GPs work to gain the skills and knowledge required for vocational recognition as GPs. Based on Medicare claims data, there were 25 726 vocationally recognised GPs and other medical practitioners billing Medicare in Australia in 2008–09. Medicare is Australia's universal health insurance scheme, providing free or subsidised treatment by medical practitioners.

^[3] That is, graduates from medical school who are still undertaking their intern training in hospitals to become registered medical practitioners.

^[4] GPET's revenue in 2009–10 totalled $124.8 million, of which the majority was revenue from government ($118.6 million in 2009–10). GPET did not receive fees. In 2010–11, GPET's revenue from government is expected to increase to $150.4 million and average staffing is expected to increase to 38 people. In addition to general practice policy and promotion functions, GPET's program delivery activities broadly involve selecting and accrediting training providers, allocating training places to training providers, attracting and selecting trainees, and managing funding and provider contracts. See Appendix 3 for GPET's organisational structure.

^[5] GPET manages general practice training and education. It is not responsible for the registration of doctors; this is a function of the medical boards in the states and territories. Nor is GPET responsible for the assessment of international medical graduates who may wish to practise in Australia; this is one of the functions of the Australian Medical Council. Regarding the setting of training quality standards, training quality standards for AGPT are set by the professional colleges. The training quality standards for PGPPP are set by the Post Graduate Medical Education Councils in each state and territory in respect of interns and by the professional colleges in respect of junior doctors who have completed their intern year.

^[6] Divisions of general practice are professionally led and regionally based voluntary associations of GPs that seek to provide professional support for GPs and to coordinate and improve local primary care services.

^[7] A GP registrar is a registered medical practitioner taking vocational training in the speciality of general practice (undertaking AGPT). A junior doctor is a medical graduate still undertaking medical training as an intern in the hospital system. The junior doctor may participate, as part of their formal hospital intern training, in a placement in a general practice situation, via PGPPP. This general practice placement complements the junior doctor's other intern training in fields such as accident and emergency, obstetrics, gynaecology or surgery, which are based in the hospital.

^[8] AGPT is successfully completed when the GP registrar meets the requirements for fellowship set by the professional colleges (for example, completion of relevant training, assessments and examinations).

^[9] The Medicare payments attached to services provided by GP registrars in training are part of the Australian Government's broader financial support for general practice training. These payments fall within the financial responsibilities of Medicare Australia, rather than GPET.

^[10] A training year broadly corresponds to a calendar year, commencing in January of one year and finishing in January of the next.

^[11] Media coverage in 2009 and 2010 highlighted factors bearing on the availability of GPs, particularly shortages of GPs in rural and remote areas (as well as some metropolitan areas). Coverage highlighted calls for additional government-funded GP training positions, especially for rural GPs.

^[12] Among other things, the Amended Constitution updated GPET's stated functions and objectives, with changes reflecting its altered functions since its establishment, including gaining responsibility for PGPPP in 2010.

^[13] This expression was used in the legal advice to GPET, October 2008.