Royal Australian College of General Practitioners
|The Royal Australian College Of General Practitioners|
|Motto||Latin: Cum Scientia Caritas
("With skill, tender loving care.")
|Legal status||professional body|
|Purpose/focus||Regulation and representations of GPs|
|Headquarters||East Melbourne, Victoria|
|President||Dr Liz Marles|
- 1 About the college
- 2 History of General Practice in Australia and beyond
- 3 RACGP Awards
- 4 Arms
- 5 References
- 6 See also
- 7 External links
About the college
The Royal Australian College of General Practitioners is responsible for maintaining standards for quality clinical practice, education and training, and research in Australian general practice. The RACGP has the largest general practitioner membership of any medical organisation in Australia, with the majority of Australia's general practitioners belonging to their professional college. Over 22,000 general practitioners are members of the RACGP Continuing Professional Development Program. The RACGP National Rural Faculty, representing more than 8000 members, has the largest rural general practitioner membership of any medical organisation in Australia. The RACGP publishes Australian Family Physician, Australia's main peer-reviewed academic medical journal for general practitioners.
Membership of the Continuing Professional Development Program should not be confused with fellowship of the college. In the absence of fellowship in any of the specialty colleges, a medical practitioner will typically obtain membership of the Continuing Professional Development Program in order to satisfy medical registration requirements with AHPRA, the national medical registration body.
Additionally, membership of the college is mandatory for any medical practitioners hoping to obtain fellowship of the college via any of the training pathways; as such, membership is non-negotiable for these practitioners.
Furthermore, approximately half of the vocationally registered general practitioners in Australia consist of "grandfathered" general practitioners who obtained unrestricted access to MBS Medicare Rebates in 1997 when provider number restriction legislation was enacted by virtue of their existing access to MBS rebates. These grandfathered GPs have not undertaken GP training, and critics argue that the imposition of training on new graduates is both unfair and unconstitutional.
Provider number restriction legislation enacted in 1997 by the new coalition government prevented new graduates from accessing Medicare rebates, on the basis of "oversupply" of medical graduates, and was to be a temporary measure with a sunset clause to take effect in 2000. GP training places were also reduced to only 400 per year to help address this alleged oversupply of general practitioners.
The sunset clause was removed in 1999, making the provider number restrictions permanent, and cementing the RACGP's role as the gatekeeper for new graduates entering primary care.
Critics have argued that this is a workforce measure which limits the supply of general practitioners, and therefore reduces federal government Medicare expenditure. This critique is supported by the 1996/7 budget policy papers indicating the large savings likely to result from the provider number restrictions in the following years.
Critics have argued that the RACGP has a vested interest in limiting access to fellowship, and international medical graduates in particular have argued that they are being used as cheap medical labour while they struggle to meet the RACGPs fellowship requirements. Arguments from the RACGP of "maintaining standards" must be contrasted with the fact that half of existing general practitioners were grandfathered and have never done GP training.
In 2002 The RACGP obtained around $5 million of dollars from the then federal minister for Health, Dr Wooldridge, for their new headquarters in Canberra. Dr Wooldridge announced his retirement from government shortly thereafter and his intention to take up a consultancy at the RACGP. Critics argued that this was unseemly and improper.
International and local medical graduates with clinical experience hoping to obtain RACGP fellowship have argued that RACGP fellowship pathways are expensive, fail to properly recognise their experience, and that appeal mechanisms lack transparency and are exorbitantly priced. The appeal fee is around five times the application fee.
History of General Practice in Australia and beyond
Prior to the mid 20th century, upon graduation Australian doctors spent time in general practice. A medical career usually included completing an intern year immediately after graduation as a resident in a major teaching hospital. After a period of time in general practice, some doctors would seek specialist qualifications. Possibly reflecting the historical origins of Australia as a series of British colonies, these doctors would travel overseas, most often to the UK, to specialise and then return to establish practice.
As the Australian population grew post World War II, the public hospital system also grew demanding an increasing number of specialists. Local training program emerged and therefore the ability of a doctor to enter specialist training directly following the mandatory intern year post graduation without entering general practice. This increasing number of specialist made it increasingly difficult for general practitioners in Australia to hold and retain public hospital appointments, especially in procedural areas such as surgery or obstetrics.
This was not a uniquely Australian phenomenon. Worldwide, medical practice was shifting focus onto hospitals with the expansion of pharmaceuticals and medical and surgical interventions. In the United States, the number of doctors identifying as General Practitioners fell markedly between 1931 and 1974 from 83% to 18%. This process began as specialisation increased prior to the War. US GPs increasingly felt that health care was becoming fragmented and weakening doctor patient relationships.
“There are 57 different varieties of specialist to diagnose and treat 57 different varieties of disease but no physician to take care of the patient."
Development of professional colleges
In 1950, an Australian Graduate, Dr Joseph Collings, conducted a review of general practice in the UK. This 30 page report was published in the Lancet in 1950.
“There are no real standards for general practice. What a doctor does and how he does it depends entirely on his own conscience” Dr Collings, 1950.
Dr Collings’ report was scathing and generated immediate and heated interest. It was undoubtably a key event in the definition of general practice as a "speciality."
He identified that general practice has no academic underpinning, no evidence upon which to base practice and no consistency of practice. The report did not pull punches. He described rural practice is “an anachronism”, suburban practice is a “casualty-clearing” service and Inner city practice is “at best… very unsatisfactory and at worst a positive source of public danger.”
There is a direct link between the public criticism of general practice and the move to create a College. Dr Rose and Dr Hunt in the BMJ 1950 write:
“There is a College of Physicians, a College of Surgeons, a College of Obstetricians and Gynaecologists, a College of Nursing, a College of Midwives and a college of Veterinary Surgeons, all of them Royal Colleges; there is a College of Speech Therapists and a College of Physical Education, but there is no college or academic body to represent primarily the interests of the largest group of medical personnel in this country – the 20,000 general practitioners.” 
Interestingly, there was opposition in the UK to the creation of a College by the existing three Medical Colleges – Colleges of Surgeons, Physicians and Obstetricians and Gynaecologists – who held the belief that general practice should be a joint faculty of general practice linked to the existing Colleges. However, put into perspective, in the same document Hunt describes the two original British Colleges sought to stop the creation of the College of Obstetricians and Gynaecologists via legal action in 1929.
The development of the Australian College of General Practitioners
The British College of General Practitioners was formed in 1953 with many Australian doctors amongst the founding members including the RACGP’s first president Dr William Connelly. Dr Connelly, again reflecting the origins of Australia as a series of British colonies, established a New South Wales faculty of the BCGP. This was followed by the creation of other state based faculties of the British College of General Practitioners in Queensland, Western Australia, Tasmania, Victoria and South Australia over the next 5 years.
In keeping with the process for creating Medical Colleges under the British system, a group of Australian General Practitioners met in 1957 at the first Annual Scientific Convention in Sydney to declare an intention to form the Australian College of General Practitioners (ACGP) which was formally founded in 1958. This new College joined the state based faculties. State based faculties remain a key part of the modern day function of the RACGP.
Recognition of general practice as a medical specialty
In modern Australia, General Practice is listed by the AMC as a medical specialty and the RACGP as the specialist college responsible for assessment, as endorsed by the Medical Board of Australia inaugurated in 2010. Yet, on further examination of how general practice is considered across the nation, some of the now-defunct State-based Medical Practitioners’ Boards such as Victoria, Queensland and South Australia, did not consider general practice a medical specialty and general practice qualifications, such as the Fellowship of the Royal Australian College of General Practitioners (FRACGP) were not registrable qualifications. The practical implication of the nationalisation of medical registration on the status of General Practice as a medical specialty may be unclear.
The oddity of general practice in Australia is a lingering and arguably outdated perception that the decision to practise as a GP has low or no standing and status. Comments heard by many GPs including; ‘You are just a GP’ or ‘What do you intend on specialising in?’ reflect something of the community understanding of the General Practitioner.
This is not without precedent. The history of the General Practitioner shows that GPs in early Australia through to GPs in mid and late 20th century, ‘defaulted’ into general practice having disliked surgical or physician training or having failed exit exams too often.
Also, while Australian General Practitioners were part of the creation of the Royal College of General Practitioners and instrumental in highlighting the need for professional and practice standards, Australia was one of the last developed countries to recognise general practice as a specialty. It was 1978 before the National Specialist Qualification Advisory Committee (the predecessor to the Australian Medical Council) recognised general practice as a specialty. In contrast, The United Kingdom had a powerful case for recognition by the late 1960s, and the United States recognised general practice in 1969.
Strengthening general practice
The standing of general practice within academic faculties of universities and professionally has undergone a marked increase in recent decades. The RACGP has been a key driver of this shift. The development and consolidation of training programs, standards for training, standards for practice, curriculum of general practice and various evidence based guidelines and publications have occurred internally within the College. Outside of the College there are a few important events:
Academic general practice
Demonstrating again the slow shift towards recognition, Australia was late in accepting that general practice should be taught or regarded as a discipline in its own right. The Whitlam government’s Karmel committee into ‘Expansion of Medical Education in Australia’ compromised with departments of ‘community medicine’ – a confusing anachronism that persisted for many years in Australia’s tertiary institutions. The RACGP sought strongly but unsuccessfully that this committee accept general practice into the universities.
Today, general practice is listed or has been added alongside community medicine, highlighting the shift since the early 1970s (e.g. Department of General Practice and Community Medicine Monash University)
Nine foundation professors of ‘Community Practice’ were appointed between 1974 and 1976. Again Australia lagged behind the US and the UK who appointed their first professors and Chairs of general practice and family medicine in 1967 and 1963 respectively.
The Foundation professors were:
- Charles Bridges Webb MD FRACGP, Sydney University. Professor of Community Medicine
- Max Kamien MD FRACP, MRCP, FRACGP, DPM, DCH University of Western Australia. Professor of General Practice
- Professor Neil Edwin Carson FRACGP FRACP Professor of Community Medicine Monash University
- Jean Norella Lickliss MD MRACP, FRCP BMedSc DTM&H Professor of Community Medicine University of Tasmania
- Timothy George Murrell MD FRACGP DTM&H CLJ Professor of Community Medicine
- Anthony James Radford FRCP MRCP FRACP MFCM SM DTM&H Professor of Primary Health care Flinders University
- James Geoffrey Ryan BSc FRACGP Professor of community practice University of Queensland
- Ian William Webster MD FRACP Professor of Community Medicine University of New South Wales
- Ross Wharton Webster FRACGP MRACP Professor of Community Health University of Melbourne
Notably, many did not hold general practice qualifications either from Australia or international.
|Life Fellow of the RACGP||Date of award|
|William Arnold Connelly||20 February 1981|
|H Stuart Patterson||18 September 1985|
|Colin Warden Anderson||2 September 1987|
|Herbert Ewan Hamilton Ferguson||2 September 1987|
|Harvard Northcroft Merrington||8 September 1988|
|John Goulburn Radford||8 September 1988|
|Rollo Greenless||28 September 1989|
|Bernard Selwyn Alderson||24 September 1992|
|William Desmond Jackson||15 September 1994|
|John Charles Bampton||16 October 1996|
|David Sunter Muecke||16 October 1996|
|William Francis Glastonbury||30 September 1997|
|David Game||15 October 1998|
|Edgar John Hamilton North||26 October 1999|
|Richard Geeves||8 October 2003|
|Wesley Fabb||8 October 2003|
|Peter Doyle||8 October 2003|
|Charles Bridges-Webb||30 September 2004|
|Neil Carson||30 September 2004|
|Max Kamien||30 September 2004|
|Jack Marshal||30 September 2004|
|James Colquhoun||30 September 2004|
|Clive Oswald Auricht||29 September 2005|
|Mary Deidre Mahoney||29 September 2005|
|John Alfred Stevens||29 September 2005|
|Alan (Eric) Fisher||5 October 2006|
|Richard (Dick) Gutch||5 October 2006|
|Bruce Roberts||5 October 2006|
|Elizabeth Jane||5 October 2006|
|Honorary Fellow of the RACGP||Date of award|
|Lord Hunt of Fawley||20 March 1959|
|Ian Grant||20 March 1959|
|William Pickles||20 March 1959|
|The Honourable Donald Alastair Cameron||19 October 1962|
|Sir Theodore Fox||19 October 1962|
|Robert John Francis Homfrey Pinsent||24 October 1963|
|Henry Edward Martyn Williams||24 October 1963|
|William Victor Marcus Coppleson||24 October 1963|
|The Right Honourable Sir Robert Gordon Menzies||9 October 1964|
|Sir Lorimer Fenton Dods||22 October 1965|
|Carroll L Witten||29 May 1966|
|James T McCollough||29 May 1966|
|Sir Norman Nock||11 October 1967|
|Sir Thoman Moore Greenway||1 July 1968|
|Bruce Toomba Mayes||10 October 1968|
|Douglas Gordon||10 October 1968|
|George Ian Watson||2 September 1972|
|James Lester Grobe||2 September 1972|
|Claude Howard Murphy||2 September 1972|
|Ronald Diarmid MacDiarmid||2 September 1972|
|Donald Ingram Rice||2 September 1972|
|Prakash Chand Bhatla||2 September 1972|
|Bratham Ramaswarmy Sreenivasan||26 November 1972|
|Prince Philip, Duke of Edinburgh||24 January 1973|
|Wong Heck Sing||25 August 1975|
|Sir Keith Stephen Jones||15 October 1975|
|Selwyn Carson||25 October 1978|
|James Rupert Magarey||25 October 1978|
|David Clements Jackson||18 October 1982|
|John George H Refshauge||11 October 1984|
|Yvonne Sinclair||19 April 1986|
|Reginald Lewis Perkin||2 September 1987|
|Bertram Herries Young||2 September 1987|
|Victor William Michael Drury||8 September 1988|
|Barry Betham Grimmond||8 September 1988|
|Thomas Smith Reeva||8 September 1988|
|Edward Bassett||28 September 1989|
|Robert Edward McKeown||28 September 1989|
|Ronnie Woh Mun Yeun||28 September 1989|
|Raymond George Ross Moon||28 September 1990|
|Peter Erne Baume||26 September 1991|
|Manacadu Kumar Rajakumer||24 September 1992|
|Peter George Flemming||6 October 1993|
|Frank Fry||15 September 1994|
|John Derek Richardson||15 September 1994|
|Peter CY Lee||15 September 1994|
|Neil Blewett||15 September 1994|
|Trevor Corey Beard||28 September 1995|
|Patrick Augustus Simon Edmonds||16 October 1996|
|Sir Gustav Nossal||15 October 1998|
|Goh Lee Gan||8 October 2003|
|Theres (Tessa) Turnbull||8 October 2003|
|W Bruce Connelly||8 October 2003|
|Michael Boland||30 September 2004|
|Stephen Foo||30 September 2004|
|Nat Yuen||30 September 2004|
|Fiona Stanley||30 September 2004|
|Ngaire Joy Brown||29 September 2005|
|Donald Kwok Tung Li||29 September 2005|
|Ruby Binti Adbul Majeed||29 September 2005|
|Helen Wilhelmina Rodenberg||29 September 2005|
|Bruce Louis Walsh sparks||29 September 2005|
|Geoffrey Henry James Vause||29 September 2005|
|Ian Frazer||5 October 2006|
|William Glasson||5 October 2006|
|Alfred W T Loh||5 October 2006|
|Roger Neighbour||5 October 2006|
|Daniel Mahendran Thuraiappah||5 October 2006|
- "Meet the President". Your RACGP - 55th Council. RACGP. Retrieved 9 May 2013.
- Bollen M Saltman D, "A history of general practice", general practice in Australia (2000): Commonwealth of Australia.
- "History of Family Medicine" (PDF). American Academy of Family Physicians. Retrieved 2007-09-24.
- Collings J, General Practice in England Today: a reconnaissance. Lancet 1950;i:555-85.
- Petchey R, Colling report on General Practice in England in 1950: unrecognised, pioneering piece of British social research? BMJ 1995;311:40–42 (1 July)
- Rose, F, Hunt J, College of General Practice. BMJ 1951;ii;908
- Hunt J, A history of the Royal College of General Practitioners. 1983. Churchill London.
- "Specialist Practice and Relevant Assessing College". Australian Medical Council. Archived from the original on 2007-09-01. Retrieved 2007-09-28.
- 'NSQAC Regulations', National Specialist Qualification Advisory Committee, 1978, Australia.
- "History of the College". Royal College of General Practitioners. Retrieved 2007-09-28.
- "History of the Specialty". Nicholas J Piscano, The American Board of Family Medicine. Retrieved 2007-09-28.
- "RACGP Home Page and website". Royal Australian College of General Practitioners. Retrieved 2007-09-28.
- Karmel P. Report of the Committee on Medical Schools to the Australian Universities Commission. Expansion of Medical Education. Canberra: AGPS, 1973.
- "Department of General Practice and Community Medicine". Monash University. Retrieved 2007-09-28.
- Kamien M, A patience of professors. The Foundation Professor of Community Practice in Australia. 1974–2003 MJA 2003;179(1):10–14"A patience of professors. The Foundation Professor of Community Practice in Australia". Medical Journal of Australia. Retrieved 2007-09-28.
- RACGP Annual Report 2006-2007
- "The College crest". RACGP College history. Royal Australian College of General Practitioners. Retrieved 9 May 2013.
- Australian Medical Association
- Infection control
- Occupational safety and health
- Inquiry process into registration and accreditation processes for international medical graduates
- Accreditation process for International Medical Graduates