RACGP cautiously accepts Victorian Single Employer Model

The Victorian Government has announced its trial of a Single Employer Model (SEM) in a bid to strengthen the state’s rural and regional workforce.
 
Under the model, rural generalist (RG) registrars will have the opportunity to be employed by a single health service while undertaking primary care training placements in up to 15 SEM positions across rural and regional Victoria: at Bairnsdale Regional Health Service, Grampians Health and Mildura Base Public Hospital.
 
The announcement of Victoria’s trial SEM comes following the recent placement of 177 registrars across areas of urgent need under RACGP incentive payments, including the first registrar in Mallacoota, Victoria, since 2016.
 
RACGP Victoria Chair Dr Anita Muñoz welcomed the pilot but said there are some risks to consider.
             
‘It’s an opportunity, absolutely, to try and address workforce and we’re very pleased that governments are continuing to try things out to meet the workforce needs of areas,’ Dr Muñoz told newsGP.
 
‘But we don’t want to incorporate the problems of other programs or other bureaucracies into this, and therefore establish a program with problems that could be avoided.
 
‘We don’t want there to be general practices in particular areas that feel excluded from the workforce pool – we want there to be fair participation. That’s our big caveat.’
 
Dr Muñoz said the RACGP does not want to see those in charge of the program to ‘somehow, by default, have a control over local general practices’.
 
‘The practices need to be able to function and not have this SEM act as a bureaucracy that then dictates to practices how they function,’ she said.
 
‘So we cautiously support the trial and we’re pleased the Victorian Government has consulted with us to ask for our opinion so it can be set up in a way that’s most likely to be successful.’
 
While SEMs have a role to play as a local response to addressing prioritised areas of workforce need, to be successful, the programs need to be executed equitably and fairly, according to Dr Muñoz, who says certain considerations are needed for Victoria.
 
‘Unfortunately, Victoria does have an ongoing issue with some of the VMO [visiting medical officer] contracts … in some regional and rural hospitals they have not been fair or equitable with some GPs and practices, and it is an area that does urgently need to be addressed,’ she said.
 
‘We don’t want those hospitals to then be using some of those approaches when they’re executing the SEM in Victoria – for those problems inherent in the processes to then become part of the setup of the SEM.’
 
In 2018, recommendations were made by the National Rural Health Commission for development of a National Rural Generalist Pathway. In response, the Federal Government announced training pathways for RGs and additional training places in regional, rural and remote communities – with the SEM falling within this work.
 
Enabling RG registrars and GPs in training to be employed by a single employer for up to four years while they complete their training, SEM pilots have been rolling out across Australia, including in regional New South Wales, South Australia, and Tasmania, with plans for other states and territories to follow.
 
While the RACGP does not currently support the rollout of a national SEM, it recognises the benefits of short-term localised models, and backs recommendations in the Employee Entitlement Portability for GP Registrars report which proposes to improve registrar conditions through direct incentive and parental leave payments via the existing National Consistent Payments Framework.
 
In its position statement on SEMs, the college says this payment pathway is the most ‘expeditious, effective and efficient’ in improving conditions, and maintains relationships between registrars and practice owners while boosting the GP workforce.
 
‘SEMs may provide an avenue for addressing remuneration disparity for a targeted cohort of registrars when entering the Australian General Practice Training Program, and retention of employee entitlements during training,’ the college’s statement outlines.
 

RACGP Victoria Chair Dr Anita Muñoz says there is no ‘one-size-fits all solution’ for a national SEM rollout.

Overall, the RACGP calls for a ‘comprehensive evaluation’ of existing SEMs as the first step to design an evidence-based process for any proposed national scale-up of SEMs.
 
‘Given there is limited evidence at this time that these models are successful or scalable, their expansion should continue cautiously and not as a potential system level solution to portability of entitlements,’ it states.
 
Dr Muñoz adds that because all jurisdictions are ‘inherently different’, a national SEM response is not currently feasible.
 
‘The same goes with all of our very complex and different funding models, and if you tried to make a one-size-fits all solution out of this, you’d probably cause more harm than good,’ she said.
 
‘We do know there have been some jurisdictions where this has been a helpful strategy, and some where it hasn’t really had a huge impact on workforce solutions for areas.
 
‘So we’re cautiously observing what happens in Victoria, and a lot of that comes down to making sure the process is clear and this is not a program that is then used in a way that excludes some practices and favours others in the area.’
 
Log in below to join the conversation.

rural generalist rural registrars single employer model Victoria workforce incentives