In this article the concept of the rural academic general practice in Australia is explored. Recent Australian general practice history is described with a particular focus on education and research activity. There is a strong demand for an increase in training capacity in rural general practice to accommodate recent increases in learner numbers and to address the current rural general practice workforce shortage. There is also a need to address the dearth of general practice research. The aim of this study was to develop a rural academic general practice framework to assist practices in developing both comprehensive educational activity and a strong research focus.
General practices in Australia
General practices in Australia have traditionally arisen from small businesses focused primarily on health service delivery by general medical practitioners. Since the early 1990s, Australia has seen a steady change in the range of clinical services educational activity undertaken by general practices. This has in part been driven by the Australian Government General Practice Strategy1 and been supported by financial incentives2. There has been a move towards larger practices with an increasing range of allied health services. Practice accreditation against formal standards and compulsory vocational training for general practice has been introduced. Vocational training for general practice in Australia is an apprenticeship model largely based in private general practices. Australian General Practice Training funds vocational training of general practitioners (GPs) through a network of 17 regional training providers (RTPs) that work to the standards of the Royal Australian College of General Practice and the Australian College of Rural and Remote Medicine. As well as the opportunity to host registrars in general practice vocational training, practices can host medical students in community-based placements and interns on rotation.
While many practices in Australia now engage in teaching3, there remains a dearth of active involvement in research4. Publication rates for general practitioners in Australia are low, sitting at 2-5% of the rates achieved by their physician and surgical colleagues5. The Australian Government has endeavoured to support primary care research through the Primary Health Care Research, Evaluation Development (PHCRED) strategy established in 20006. This has largely been a top-down approach by funding universities to undertake primary health research and has not been reflected by an increase in rural primary health publication rates6.
An important but limited initiative supported by PHCRED has been the formation of practice-based networks to facilitate research activity at the level of the general practice and other primary care services7. These networks are supported by university research expertise and organisational structures8. After initially taking a top-down approach, a Victoria-based network (VicReN) has recently adopted a more bottom-up approach by undertaking a member-directed research project with community-based general practitioners as members of the research team8,9. This project has resulted in the publication of two peer-reviewed research papers with community-based general practitioners included in the authorship10,11. Elsewhere, international trends in primary care research identify significant success with practice-based research networks12-14.
In Australia, general practices tend to engage in education delivery in response to opportunities offered by universities and/or general practice training providers. Similarly, active research programs in general practice are most likely associated with university-based research initiatives14. Engagement in education and research by general practice tends to be piecemeal with disjointed funding streams and uncoordinated support. Practices are left to create their own solutions for the required structures for managing educational and research activity.
Pressure for increased training capacity by rural general practices
Currently in Australia demand is 