SA Single Employer Model (SEM)

The Single Employer Model (known as SEM) is a Commonwealth initiative that allows Rural Generalists and General Practice trainees to be employed by a single employer for up to four years whilst they complete their training.

Under the single employer model, regional LHNs would be responsible for employing the trainee for the duration of their training under the SA Health Salaried Medical Officers Enterprise Agreement. 

For the periods that the trainee spends in general practice, there would be defined agreement between the General Practice and the regional LHN – in most cases a Memorandum of Administrative Agreement (MoAA). 

Usually state government employees are not eligible to bill Medicare, due to rules outlined in Section 19(2) of the Health Insurance Act 1973. As part of the Commonwealth SEM trial, a Section 19(2) exemption is granted for the practice that allows General Practice trainees in that practice to bill Medicare whilst in the practice doing their GP training terms. The revenue earned from the Medicare billing is split between the General Practice to ensure all overheads are covered, and the LHN to offset the trainee’s salary. 

The SA SEM trial will be available in the following SA Health regional LHNs:

• Barossa Hills Fleurieu Local Health Network
• Eyre and Far North Local Health Network
• Flinders and Upper North Local Health Network
• Limestone Coast Local Health Network
• Yorke and Northern Local Health Network

The Riverland Mallee Coorong Local Health Network has it’s own stand alone SEM Trial that commenced in 2022 through the Riverland Academy of Clinical Excellence.

The RACE SEM trial will be available across the Riverland Mallee Coorong Local Health Network.

The other regional local health networks covering Barossa Hills Fleurieu, Eyre and Far North, Flinders and Upper North, Limestone Coast and Yorke and Northern are covered by the SA SEM trial.

A Health Insurance Act 1973 subsection 19(2) Direction is required to support the employment of registrars where the LHN acts as the single employer for the duration of training, by allowing the GP/RG trainee to bill Medicare for their work in private agreed GP practices.  

Trials where the LHN acts as the single employer cannot commence until a MoU is established and a subsection 19(2) Direction is issued for the nominated sites and/or number of sites. 

A MoU is negotiated between the Commonwealth and respective LHN. The MoU sets out the roles and responsibilities of the member parties and expectations to foster co-operation and facilitate operational arrangements. The MoU also details the numbers of registrars permitted, the sites and service provision under the trials. 

Under the SA SEM Trial any registrar that is on a GP training program with an endpoint of Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) or Fellowship of the Royal Australian College of General Practitioners (FRACGP) or Fellowship of the Royal Australian College of General Practitioners – Rural Generalists (FRACGP-RG) are eligible to participate in SEM.

This includes GP/RG trainees in an eligible training pathway (GPT, ACRRM, RACGP, RVTS, RGTS) at PGY3 level and above to claim MBS items for services while undertaking general practice rotations. 

Under the RACE SEM trial -TBA

The s19(2) exemption is granted to the specific GP practice(s) where trainees will undertake their training under SEM. The Commonwealth will grant the 19(2) exemptions to the sites nominated in the approved proposal, and subsequent MoU established between the LHN, the Department of Health and Wellbeing (DHW) and the Department of Health and Aged Care (DoHAC).  

The LHN will enter into a Memorandum of Administrative Agreement (MAA) with the practice for the SEM training place.  Trainees participating in SEM can then move between the approved sites and bill MBS under the s19(2) exemption in agreeance with the Commonwealth direction. 

The s19(2) exemption is not granted to an individual.  

Both rural and metropolitan GP trainees generally need to leave public sector employment during their required training periods in private general practice. This results in them losing their entitlements and in particular, limited access to extended leave including parental leave.

However, under the Single Employer Model, Rural Generalist and GP trainees can have the same employer for the duration of their training. This means they’ll retain their employment entitlements which accrue over time, including sick leave and parental leave. 

A single employer model is therefore recognised as a potentially useful tool in attracting future rural GP and Rural Generalist trainees. It’s intended outcome is to give trainees certainty about location, income and working conditions such as work hours, on-call obligations, and leave entitlements including long service and maternity leave. 

No. The model doesn’t replace current employment models for Rural Generalist and GP trainees; it’s in addition to existing options. A SEM should be optional for GPs in training and will be set up as an opt in. Rural registrars will have a choice. 

There are two SEM trials in South Australia:

• The Riverland Academy of Clinical Excellence (RACE) in the Riverland Mallee Coorong Local Health Network (LHN) has shown very positive results in attracting and retaining rural trainees. It began in December 2022 offering multiple-year contracts to junior doctors. 
• The SA SEM trial commencing in January 2025 covers five regional local health networks – Barossa Hills Fleurieu, Eyre and Far North, Flinders and Upper North, Limestone Coast and Yorke and Northern.

Any practice (MMM2-7) that has accreditation through Australian College of Rural and Remote Medicine and/or Royal Australian College of General Practitioners for GP training, a willing supervisor participant and a willing Registrar participant can participate in SEM. Preference will be given to remote/rural areas and those serving vulnerable populations.

SEM placement opportunities will be advertised at participating regional LHN locations throughout the year. The employing regional LHN, in consultation with the GP training colleges, GP practices will manage your rotations to make sure you meet your training requirements. You will complete GP training in ACRRM and RACGP accredited practices participating in the SA SEM trial.

You may have the opportunity to rotate to other rural local health districts to undertake advanced skills training.

All Registrar billings are collected by the medical centre hosting the Registrar. On a quarterly basis, there will be a financial reconciliation process between the regional LHN and the medical centre where 50% of the Registrar billings will be kept by the Practice and 50% provided to the regional LHN.

Yes, participation in the SEM is optional and trainees can leave at any time (on agreement with the practice if part way through a rotation). Hybrid and part-time arrangements may also be considered i.e. employed part-time with the primary care clinic and part-time under SEM through the LHN.

GP training and accreditation is run by the Colleges; there will be no changes in the training and education of general practice selection, and trainee progression remains with the GP supervisors and Colleges; there will be no additional requirements. Registrars that don’t progress will be managed the same way as they are currently.

The intention is that all participants will be as financially supported as they are now or will see an improvement in their financial support for GP training, of that equal of other trainee doctors. 

The scheme has been designed so that practices are not financially disadvantaged and that General Practice Registrars participating in the program will have terms and conditions of employment at least consistent with their peers in the State Service; individuals will need to determine if they will be better off on the scheme or as a private contractor.

No, your billings will be split between the regional LHN and your Practice, with each party receiving 50%. If you choose to be a participant of the SEM, you will receive a salary and other entitlements such as annual and sick leave; the 50% of your billings that will be paid to the regional LHN will be used towards your salary. We expect that the regional LHN will run at a loss throughout the pilot, as it is being run to see if it is a sustainable model to be used in the future, to ensure rural GP’s have the same access to salaries as their hospital-based peers. 

We currently believe that your billings on the SEM should not affect your tax, however, as this is a pilot, we cannot guarantee this and would highly recommend discussing further with your own tax accountant and/or financial advisor. We will be asking your Practice to share your billing details at least every 3 months, which is usually a common practise regardless, to assist Registrars with their billings.

Yes, you can access salary packaging as you are still a SAH employee.

Registrars employed through SA SEM will be employed under the SA Health Salaried Medical Officers Enterprise Agreement.

Full-time employment for Registrars (MP5-13) is 40 hours per week or 80-hours per fortnight. Your contract will be provided to you in the hours you are contracted to work, not 1.0 FTE definitions. Annual/Sick/PD leave will be pro-rata, however, full-time allowances are 5 weeks annual, 4 weeks sick, and 2 weeks PD leave (per year, for 1.0FTE). Your available leave balances can be found by logging in to the Employee Self Service (ESS). 

If you have a regular on call commitment, then the on-call roster will determine the on-call allowance. Where on call is variable, it will be additional ‘as worked, as per timesheets’. For example, the on-call roster was prepared for 4 weeks, and the Registrar is on call for 1 of the 4 weeks (or 7 out of 28 days) that is a 1:4 on-call roster and therefore the Registrar is paid a 10% On-call Allowance (10% of fulltime base rate, regardless of contracted hours).

There are two options for maintaining additional skills while working in the community: 

One option is to work parttime in your area of additional skill and parttime in community general practice and this can be incorporated into a Single Employer Model Contract, for example, 60 hours of community general practice and 20 hours of emergency medicine. 

A second option is to work in community general practice and undertake casual shifts in your additional skill.
Please note you cannot be provided a contract that is more than 1 full time equivalent or 80 rostered hours per fortnight. For people seeking to undertake casual shifts to maintain additional skills on top of full-time general practice, the additional hours worked would be recorded on your timesheet and paid as overtime. Monitoring of these hours would be required to ensure safe work hours and sufficient rest periods are maintained. 

A call back is an unplanned event and paid as the following: 

An employee who is called back to duty outside if rostered hours of work will be paid a minimum payment of 3 hours at double-time. 

A call back that extends longer than the 3-hour minimum will be paid at double-time and calculated on hours worked to the nearest half hour. 

If further call backs occur within the 3-hour period, no additional payment will be made until the previous minimum payment expires and then payment will be made at the call back rate for each hour worked. 

The duration of call back will include actual travel time to and from the hospital to a maximum of 15 minutes each way. 

If you are a part-time Registrar and work an additional shift, then this is simply paid as an additional shift, including any appropriate plenty rates if applicable. 

If you are a full-time Registrar and work an additional planned shift, this will be treated as excess time and paid as such. Excess time is calculated per each pay period. All work performed in addition to Ordinary (full-time) hours will be paid as penalties, please refer below.

If you work an extra shift or are called back and this did not allow a sufficient break between shifts, then whilst you are not required at work, you will still be paid for the rostered shift. If you could not be released from the shift or part of the shift, then penalties (as below) are applied. 

Penalties are as follows: 

125% (time and one quarter) for the first 4 hours per fortnight, unless the excess hours are worked on a Saturday or Sunday, in which case the loading will be paid at 150% (time and a half). 

200% (double time) beyond 4 hours. 

250% (double time and a half) for time worked on a Holiday(s) with Pay. 

Will I need to complete a timesheet for each practise/hospital I work in? 

If your hours are regular each fortnight across all workplaces and do not change, this can be set up as auto-pay, so you will not be required to complete timesheets, unless in exceptional circumstances such as working casual shifts. 

If your hours are not regular, a timesheet will need to be completed unless otherwise advised; the timesheet will need to clearly identify which setting you are working in, at that time, if you work across more than one setting, for example, community general practice, District Hospital inpatient, and emergency medicine. 

This will depend on your previous experience: 

An Accredited Registrar is classified as a Medical Practitioner Level 5-9 

First year Registrars will be MP Level 5 

Fifth year Registrars will be MP Level 9 

The current award only allows progression to MP Level 10-11 on successful completion of all fellowship exams and within one year of obtaining a specialist fellowship. 

An existing MP5 will remain an MP5, an existing MP7 will remain an MP7 etc and will increment to the next level on the completion of 12 months at the current level. 

If you are coming from interstate, your classification will depend on how many years you have worked as a Registrar and appointed to the appropriate level. 

Wherever possible the SEM pilot aims to place operational decisions with the Practice and Registrar in their work setting, you will be required to provide evidence of your Practices’ approval of any leave requests. As long as there is adequate leave accrued, the leave request will then be approved by the delegated staff member in your region and ensure the correct information is received by payroll. 

The program will support periods of Leave With Out Pay (LWOP) to further their training where it cannot be undertaken in South Australia (or public system) or if exposure to another worksite is beneficial for career development; enabling LWOP or a secondment for a fixed term employee ensures accrued benefits are retained, which is also an incentive to return to the role.

The registrar could access up to 12 months LWOP to do Private GP work as this could be considered development. 

The state service would not support LWOP for a holiday; the employee would need to access accrued for this purpose; if LWOP was needed for health reasons, then this would be treated as Sick Leave Without Pay once accrued sick leave exhausted. 

LWOP could also be utilised if the Registrar is on the SEM, has a GP Practice lined up to complete their placement, but the Practice is not listed on the 19(2) exemption, this would allow the registrar to retain their leave entitlements and return when the practise list is updated. 

This SA SEM trial covers five of the six regional local health networks, so moving to another Practice within and between each region is possible subject to available positions. Moving to the RACE SEM would be subject to negotiation and available positions. The Practice would also need to be listed on the current 19(2) direction. South Australia has been granted up to eighty available 19(2) exemptions from the start of the 2024 training year for the duration of the trial period. 

Please note, Aboriginal Community Controlled Health Organisations that have their own 19(2) directions and exemptions do not need to be listed on the SEM 19(2) direction separately. Doctors participating in SEM can also be employed under the SEM pilot at these Practices if they agree to participate. 

Relocation allowances for interstate or intrastate Registrars may be considered, you would need to meet eligibility and require approval from relevant delegates.

Long Service Leave can be transferred, if the length of time between public service employment is less than 3 months. All other leave entitlements will not transfer. 

Registrars are covered by the State Service indemnity, it is also recommended that they have their own personal medical indemnity in addition to the State Service indemnity. 

Trainees are not considered to be undertaking a business activity because of participation in the SEM initiative and accordingly, do not require an ABN or register for GST. If undertaking work outside the SEM, then they will need to seek their own legal and financial advice. 

Currently lateral entry is permitted, this is subject to change and may not be a future feature. 

GP trainees will be supervised by a GP at your practice who is an accredited supervisor for the ACRRM or RACGP training program, or both. The GP trainees’ duties will be the same as those of other GP trainees. 

Yes. When trainees participating in the SEM trial undertake a GP practice rotation, they will be supervised by a GP at your practice who is an accredited supervisor for the ACRRM and/or RACGP training program. 

GP supervisors will receive supervision payments under the National Consistent Payments Framework for AGPT registrars as is the same for other AGPT registrars. The Department of Health and Aged Care has advised that both Colleges have been notified that exemptions will be provided under the NCP Framework for those practices and supervisors who: 

• are involved in the RGSEP trials and 
• providing GP training to AGPT registrars, as part of the College supported GP training program. 

If a trainee is not AGPT, for example, ACRRM independent pathway, Supervisors don’t receive payments for practice supervision.