National Rural Health Commissioner (the Commissioner)
Emeritus Professor Paul Worley updated the Roundtable on his progress in developing a National Rural Generalist Pathway to address the shortage of medical professionals in rural, regional and remote areas. He also updated the Roundtable on the formation of the National Rural Generalist Taskforce (the Taskforce) as a key component of his strategy to deliver on his legislated functions. The Taskforce met most recently on Monday 20 August 2018 to progress a paper they are developing entitled Advice on the Development of the National Rural Generalist Pathway.
This paper will inform the next phase of policy development with Commonwealth, State and Territory governments and other stakeholder leaders.
While Professor Worley’s first priority is the development of the Pathway, he reiterated that the role will also include consultation with stakeholders to give consideration to the nursing, dental health, pharmacy, Indigenous health, and allied health needs in rural and remote Australia.
Stronger Rural Health Strategy
The Department provided the Roundtable with a presentation on the Stronger Rural Health Strategy that was announced in the 2018-19 Budget. Key elements of the Strategy were discussed, including teaching; training; recruitment; and retention of the rural health workforce.
Members of the Roundtable noted the importance of ensuring the Strategy focuses on the nursing, dental, pharmacy and allied health workforce as well as the medical workforce in rural and remote Australia, and welcomed the Workforce Incentive Program as providing substantial focus on this workforce.
Distribution Working Group (DWG)
The Roundtable was updated on the progress of the DWG and discussed the review of the District of Workforce Shortage (DWS) and the principles of the DWS system. Final advice will be provided to Government once the group holds its final meeting in December 2018.
The Department of Health reiterated the goals of the DWG, to review the geographical classification Modified Monash Model (MMM) and to review the levers designed to attract health professionals into rural areas. Since the last roundtable meeting, the DWG has met on 21 February 2018 and 8 June 2018, reviewing the appropriateness of the DWS system and considering the geographical classification systems used by the Department.
Members of the Roundtable discussed some of the barriers to attract permanent medical professionals to rural and remote areas. It was suggested that the development of a joint Federal and State policy approach to rural and remote health would help articulate the steps needed to overcome some of these challenges.
Rural Allied Health
The Roundtable explored key allied health issues in rural and remote Australia, and what elements could be considered in the development of a rural generalist allied health workforce.
The Chair of the National Rural Health Alliance spoke on behalf of their respective organisations on some of the key barriers face by the rural allied health workforce, such as professional isolation, lack of access to clinical supervision and limited opportunities to make some private practices financially viable.
Members of the Roundtable discussed initiatives that have been working well, such as telehealth models of care and supervision; the appointment of regional clinical senior positions; and the usage of generalist roles in areas that cannot attract a variety of different allied health professionals. Members also discussed the Stronger Rural Health Strategy and the components that are related to allied health.
Alcohol and other drugs – workforce implications
The Department discussed the Australian Government’s 2018-19 Budget Measure, Support for Alcohol and Drug Abuse Treatment, and roundtable members were canvassed for their views on alcohol and other drug workforce issues particular to rural areas.
The Roundtable raised a number of safety issues for health professionals delivering care to patients who were seeking treatment for alcohol and drug issues. The significant shortage of an appropriately skilled workforce and infrastructure in rural and remote areas was also highlighted by the group. The need to address the broader social, cultural and environmental determinants of health was also highlighted as important in addressing drug and alcohol issues in communities.
Drought Support Package – Mental Health Initiative
The Department welcomed the additional representatives present for this item, including Mrs Peta Rutherford, CEO, Rural Doctors Association of Australia, Ms Marita Cowie, CEO, Australian College of Rural and Remote Medicine, and Associate Professor Morton Rawlin, Chair, General Practice Mental Health Standards Collaboration.
The Roundtable discussed the impact that the drought can have on the mental health and emotional wellbeing of farmers, their children, and their community. The Department reported on mental health initiatives that provide additional support to drought affected communities including:
- The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule;
- The Better Access Telehealth initiative; and
- Delivering General Practitioner Focused Psychological Strategies via telehealth.
Members and additional representatives of the Roundtable highlighted the need to ensure General Practitioners are appropriately qualified when delivering mental health services; as well as having a good understanding of the local community need. Consideration could be given to the role of Rural Generalists with mental health expertise to deliver appropriate treatment without the need for a Mental Health Treatment Plan or referral to practitioners that are eligible to deliver services under the Medicare Better Access initiative. Some members advocated for restrictions to be placed on the delivery of mental health services via telehealth so that only GPs in Modified Monash Model (MMM) areas 4 – 7 could provide these services. Administrative considerations including telehealth definitions and item numbers were also discussed.
The Roundtable membership includes a number of peak bodies representing the rural health workforce and the National Rural Health Commissioner.
Members in attendance for the 24 August 2018 meeting were:
- Allied Health Professions Australia
- Australian College of Rural and Remote Medicine
- Australian Dental Association
- Australian Medical Association
- Australian Rural Health Education Network
- Congress of Aboriginal and Torres Strait Islander Nurses and Midwives
- Federation of Rural Australian Medical Educators
- Indigenous Allied Health Australia
- National Aboriginal and Torres Strait Islander Health Worker Association
- National Rural Health Alliance
- National Rural Health Commissioner
- National Rural Health Student Network
- Royal Australian College of General Practitioners
- Rural Doctors Association of Australia
- Rural Health Workforce Australia
- Services for Australian Rural and Remote Allied Health
- Pharmaceutical Society of Australia
- Pharmacy Guild of Australia (guest member)
- Australian Indigenous Doctors’ Association