Royal Australian College of General Practitioners

The Royal Australian College Of General Practitioners is the professional body for General Practitioners in Australia.

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 5000 members, has the largest rural general practitioner membership of any medical organisation in Australia.

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. [Bollen M Saltman D, "A history of general practice","general practice in Australia" (2000): Commonwealth of Australia.]

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 to 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. [cite web| title = History of Family Medicine| publisher = American Academy of Family Physicians| url = http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf| accessdate = 2007-09-24 ]

“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." [cite web| title = History of Family Medicine| publisher = American Academy of Family Physicians| url = http://www.aafpfoundation.org/PreBuilt/foundation_dennisresearch.pdf| accessdate = 2007-09-24 ]

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. [Collings J, General Practice in England Today: a reconnaissance. Lancet 1950;i:555-85.]

“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. [Collings J, General Practice in England Today: a reconnaissance. Lancet 1950;i:555-85.]

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. [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)]

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.” [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)]

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.” [Rose, F, Hunt J, College of General Practice. BMJ 1951;ii;908]

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. [Hunt J, A history of the Royal College of General Practitioners. 1983. Churchill London.] 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.

The Objectives of the Australian College of General Practitioners

This College established the following objectives:

* To promote a scientific approach to problems of disease at the level of the individual and the family;
* To promote the prevention of disease and guard the nation’s health and the welfare of the community by every means available to the general practitioner;
* To foster and maintain high standards of general practice;
* To encourage and assist young men and women in preparing for, qualifying in and establishing themselves in general practice;
* To stimulate postgraduate education of general practitioners by providing facilities applicable to general practice; and
* To conduct clinical research into conditions most frequently seen and appropriately studied in general practice. [Australian College of General Practitioners. Articles and Regulations, 1958 Australia]

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. [cite web| title = Specialist Practice and Relevant Assessing College| publisher = Australian Medical Council|url = http://www.amc.org.au/table1.asp| accessdate = 2007-09-28] Yet, on further examination of how general practice is considered across the nation, some State-based Medical Practitioners’ Boards such as Victoria, Queensland and South Australia, do not consider general practice a medical specialty and general practice qualifications, such as the Fellowship of the Royal Australian College of General Practitioners (FRACGP) are not registrable qualifications.

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. [Bollen M Saltman D, "A history of general practice","general practice in Australia" (2000): Commonwealth of Australia.]

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. ['NSQAC Regulations', National Specialist Qualification Advisory Committee, 1978, Australia.] In contrast, The United Kingdom had a powerful case for recognition by the late 1960s, and the United States recognised general practice in 1969. [cite web| title = History of the College| publisher = Royal College of General Practitioners|url = http://www.rcgp.org.uk/services__contacts/history_heritage__archives/history__chronology/history_essay.aspx | accessdate = 2007-09-28] [cite web| title = History of the Specialty| publisher = Nicholas J Piscano, The American Board of Family Medicine|url = https://www.theabfm.org/about/history.aspx | accessdate = 2007-09-28]

trengthening 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. [cite web| title = RACGP Home Page and website| publisher = Royal Australian College of General Practitioners|url = http://www.racgp.org.au | accessdate = 2007-09-28] 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. [Karmel P. Report of the Committee on Medical Schools to the Australian Universities Commission. Expansion of Medical Education. Canberra: AGPS, 1973.] The RACGP sought strongly but unsuccessfully that this committee accept general practice into the universities.

Today, general practice is listed or has been added along side community medicine, highlighting the shift since the early 1970s (eg Department of General Practice and Community Medicine Monash University) [cite web| title = Department of General Practice and Community Medicine| publisher = Monash University|url = http://www.med.monash.edu.au/general-practice/contacts.html| accessdate = 2007-09-28]

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. [Kamien M, A patience of professors. The Foundation Professor of Community Practice in Australia. 1974-2003 MJA 2003;179(1):10-14cite web|title = A patience of professors. The Foundation Professor of Community Practice in Australia| publisher = Medical Journal of Australia| url = http://www.mja.com.au/public/issues/179_01_070703/kam10051_fm.html| accessdate = 2007-09-28]

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 [Kamien M, A patience of professors. The Foundation Professor of Community Practice in Australia. 1974-2003 MJA 2003;179(1):10-14cite web|title = A patience of professors. The Foundation Professor of Community Practice in Australia| publisher = Medical Journal of Australia| url = http://www.mja.com.au/public/issues/179_01_070703/kam10051_fm.html| accessdate = 2007-09-28]

Notably, many did not hold general practice qualifications either from Australia or international.

General Practice Textbooks

The definitive point in Australian General Practice came with the textbook General Practice. [ Murtagh J, John Murtagh's General Practice. Now in 4th Edition 2007. First published in 1994. McGraw Hill Australia ISBN 9780074717790]

John Murtagh was a science teacher in rural Victoria who return to study Medicine at the first intake of Monash University. John Murtagh has along academic association through Monash University becoming the first Professor of General Practice (Neil Carson was Professor of Community Medicine). He remains with teaching positions at Monash University as Professor in General Practice, University of Notre Dame as Adjunct Clinical Professor and Melbourne University as Professorial Fellow.

He was associate medical editor of the "Australian Family Physician" (the RACGP peer reviewed journal) in 1980, editor in 1986 and held that position until 1995. He began the popular CHECK (Continuous Home Evaluation of Clinical Knowledge), he also held the position of Executive Director of Training at the RACGP at the turn of the 21st century. The RACGP library is named after John Murtagh. [cite web| title = The Royal Australian College of General Practitioners launches the RACGP John Murtagh Library. Media Release: 1st of December 2005|url = http://www.racgp.org.au/media2005/8216| accessdate = 2007-09-27] , offering a wide range of services to Members, registrars and all health professionals working in Aboriginal and Torres Strait Islander Community Controlled Health Services. [cite web| title = RACGP Library| url = http://www.racgp.org.au/library| accessdate = 2007-09-28]

'To add a library to a house is to give that house a soul' - Professor Michael Kidd, RACGP President 2002-2006 quoting Cicero 1st December 2005

His companion publication "Practice Tips" was named as the British Medical Association's Best Primary Care Book Award in 2005. He received a Member of the Order of Australia for service to medicine, in particular, medical education, research and publishing.

RACGP Council

Past Presidents of the RACGP

Honorary Fellows of the Royal Australian College of General Practitioners

Honorary Members of the Royal Australian College of General Practitioners

Rose-Hunt Award

tanding Strong Together: Aboriginal and Torres Strait Islander Health Award

Occasional orators

*First Annual General Meeting 1958-1959Ian Dingwall Grant
*Second Annual General Meeting 1959Joseph Silver Collings
*Third Annual General Meeting 1960Kenneth Macd Foster
*Fourth Annual General Meeting 1961Gilbert S McDonald
*Fifth Annual General Meeting 1962Sir Theodore Fox
*Sixth Annual General Meeting 1963William Victor Johnston
*Seventh Annual General Meeting 1964Sir Clive Hamilton Fitts
*Eighth Annual General Meeting 1965Trevor Corey Beard
*Ninth Annual General Meeting 1966Carroll Lewis Witten
*Tenth Annual General Meeting 1967Bruce Toomba Mayes
*Eleventh Annual General Meeting 1968Richard Roderick Andrew
*Twelfth Annual General Meeting 1969Geoffrey Malcolm Badger
*Sixteenth Annual General Meeting 1973HRH Prince Philip, The Duke of Edinburgh [RACGP Annual Report 2006-2007]

William Arnold Connelly orators

*Thirteenth Annual General Meeting 1970Sir Kenneth Beeson Noad
*Fourteenth Annual General Meeting 1971Professor Eric Galton Saint
*Fifteenth Annual General Meeting 1972Prakash Chand Bhatla
*Seventeenth Annual General Meeting 1974Sir Mark Oliphant
*Eighteenth Annual General Meeting 1975Geoffrey C Bolton
*Nineteenth Annual General Meeting 1976David C Jackson
*Twentieth Annual General Meeting 1977Sir Stanley Burbury
*Twenty-First Annual General Meeting 1978 Sir Edward Hughes
*Twenty-Second Annual General Meeting 1979Senator Peter Baume
*Twenty-Third Annual General Meeting 1980Justice Kemeri Murray
*Twenty-Fourth Annual General Meeting 1981 Professor David Maddison
*Twenty-Fifth Annual General Meeting 1982 Stuart Patterson
*Twenty-Sixth Annual General Meeting 1983Sir Ninian Stephen
*Twenty-Seventh Annual General Meeting 1984 The Most Reverend Dr Peter Carnley
*Twenty-Eighth Annual General Meeting 1985Associate Professor Byan Gandevia
*Twenty-Ninth Annual General Meeting 1986Ms Katherine West
*Thirtieth Annual General Meeting 1987Professor Stephen Leeder
*Thirty-First Annual General Meeting 1988 Professor Ralph Doherty
*Thirty-Second Annual General Meeting 1989not held
*Thirty-Third Annual General Meeting 1990Dr Keith Bolden
*Thirty-Fourth Annual General Meeting 1991Professor Max Charlesworth
*Thirty-Fifth Annual General Meeting 1992The Most Reverend Dr Keith Rayner
*Thirty-Sixth Annual General Meeting 1993Dr William Faulding Scammell CBE
*Thirty-Seventh Annual General Meeting 1994Professor Richard Smallwood
*Thirty-Eighth Annual General Meeting 1995Associate Professor David Bennett
*Thirty-Ninth Annual General Meeting 1996Dr Reg L Perkin
*Fortieth Annual General Meeting 1997Dr John Stevens
*Forty-First Annual General Meeting 1998Emeritus Profesor Neil Carson
*Forty-Second Annual General Meeting 1999Dr David A Game
*Forty-Third Annual General Meeting 2000Professor Dame Lesley Southgate DBE
*Forty-Forth Annual General Meeting 2001Professor W Bruce Connolly
*Forty-Fifth Annual General Meeting 2002Professor Judith Belle Brown
*Forty-Sixth Annual General Meeting 2003 Professor Wesley Fabb AM
*Forty-Seventh Annual General Meeting 2004Professor Max Kamien AM
*Forty-Eighth Annual General Meeting 2005 Dr Ngaire Brown
*Forty-Ninth Annual General Meeting 2006Professor Ian Frazer [RACGP Annual Report 2006-2007]

ee also

*Australian Medical Association

External links

* [http://www.racgp.org.au/ The Royal Australian College of General Practitioners]
* [http://www.racgp.org.au/history History of The RACGP]

References