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. The common passage of a medical career comprised of most doctors completing an intern year immediately post 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 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.

"“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
This led to the creation of the American Academy of General Practice (later Family Physicians) in 1947.

Similarly, in the UK, the increasing specialisation and cost of healthcare, saw the introduction of the National Health Service (NHS), designed to have GPs act as the ‘gatekeepers’ providing primary care to all patients registered on their ‘list’ and referring as appropriate to gain access to specialist care and other benefits under the UK’s socialised heath system. The UK experience is notably through the contribution and involvement of many influential and effective Australians in defining the problems of general practice and the need for a professional and academic basis to the craft group.

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.

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.

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. 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.

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 along side community medicine, highlighting the shift since the early 1970s (eg 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.

General Practice Textbooks
The definitive point in Australian General Practice came with John Murtagh's General Practice.

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. , offering a wide range of services to Members, registrars and all health professionals working in Aboriginal and Torres Strait Islander Community Controlled Health Services. "'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.

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

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