e aware that the practice hosts a learner. The supervisor's interest in teaching is often the motivator for the practice's involvement in education. The practice receives a small amount of educational income. Resources required to support several learners and a strong culture of education (more than one supervisor, physical space for learners and administrative support) are often the barriers for these practices moving towards the consolidating and established academic status. There may be the concern that hosting more learners will erode the financial viability of the practice. To encourage an emerging practice to take the next step in increasing their engagement in education, support for infrastructure and training supervisors is critical. Also there needs to be clear financial value in making education a stronger focus. This value needs to be well articulated.
Consolidating practices are likely to have been involved in education for some time and to hold learning to be a significant priority within the practice culture. Patients within these practices are well aware of the presence of learners and generally expect and accept learner involvement in consultations. Consolidating practices have multiple supervisors who are involved in teaching and who value the presence of students, interns and registrars. As teaching is a developed activity in these practices, educational payments form an important component of the practice's business revenue. Dedicated administrative support for education is present. While research is appreciated, there is minimal engagement. For advancement of research activity, a clear route needs to be articulated for developing research skills with mentoring and role models. Research networks are essential to supporting research activity development in the practice. There also needs to be a good business case for practices to engage in research.
In an established practice, service, education and research are viewed as equal priorities. Strong relationships with educational and research institutions (universities and regional training providers) are present. As with the consolidated practices, resources (patient population, physical infrastructure, supervision and educational administration) are sufficient to host multiple learners at varying stages of their training. Also, processes for curriculum development, orientation and teaching are well established. Supervisors are likely to hold formal educational qualifications. There is administrative support for both the educational and the research activities. These practices conduct research either independently or in close partnership with academics from outside institutions. Personnel within the practice are familiar with research paradigms and processes, ethics approval and scholarly writing. Research grants together with education payments and grants are significant funding streams for the practice.
This model has two particular strengths. First, this is a holistic model that places service, education and research together as integrated activities for the mature academic rural general practice. In this way, each activity supports the other activities. Second, this is a bottom-up model putting the individual general practice at the centre rather than on the periphery. Putting the individual general practice at the centre gives a capacity for genuine ownership of academic activity by general practices. This focus is likely to engender research agenda setting and ownership by general practices14 and integration of research into clinical services31 and educational activity in the community setting.
It is acknowledged that the model suggests that engagement in education precedes engagement in research. This is consistent with the historical reality of the recent steep increase in the engagement of general practices in education while engagement in research has remained low5. The present study's sample of general practices and subsequent model was based on engagement in education. It would be valuable to test the framework on a sample based on engagement 