Equity in general practice training in Aotearoa New Zealand: a national descriptive study of rurality and socioeconomic deprivation in GPEP1 placements (2016–2025)

Introduction Rural Aotearoa New Zealand (NZ) experiences poorer health outcomes than urban areas, driven by the unequal distribution of the social determinants of health and persistent workforce shortages. Postgraduate rural exposure predicts future rural practice. Accordingly, the Royal New Zealand College of General Practitioners (RNZCGP) aims to place GP registrars in rural and high-needs practices. Aim This study aims to describe the distribution of first-year general practice (GPEP1) registrar placements by rurality and socioeconomic deprivation. Methods De-identified data from 1896 registrars completing 3792 placements between 2016 and 2025 were analysed. Rurality and socioeconomic deprivation were classified using the Geographic Classification for Health (GCH) and the NZ Index of Deprivation (NZDep), respectively. Descriptive statistics evaluated placement distribution over time. Results Overall, 17.4% of placements occurred in rural practices, and 74% of registrars completed no rural placement during GPEP1 training. Rural placement proportions remained stable over time and were slightly below the rural proportion of the total NZ population. In contrast, placements were concentrated in areas of high socioeconomic deprivation: approximately 58% occurred in NZDep deciles 8–10 areas, home to 30% of the population. Across the study period, 81.3% of registrars completed at least one placement in either a rural or high-deprivation practice. Discussion Most registrars met programme objectives through placements in high-deprivation communities, although rural exposure remained below population share. Expanding rural training has the potential to improve equitable workforce distribution and access to primary care in underserved rural NZ, particularly as GPEP1 employment transitions to Health New Zealand from 2027.