Communique - Rural and Remote Health Stakeholder Roundtable,
20 September 2019

The Minister for Regional Services, Decentralisation and Local Government, the Hon Mark Coulton MP, chaired the eighth Rural Health Stakeholder Roundtable.

Page last updated: 08 January 2020

The Minister for Regional Services, Decentralisation and Local Government, the Hon Mark Coulton MP, chaired the eighth Rural Health Stakeholder Roundtable.

Agenda Items

  • Minister Coulton Introduction
  • Work of the National Rural Health Commissioner
  • National Rural Generalist Pathway
  • Distribution Advisory Group update
  • Update on health workforce measures

Introduction

Minister Coulton welcomed members to the Roundtable and sought feedback on their priorities for rural health. Members outlined a number of priorities, including recruitment of medical doctors into rural communities; building multidisciplinary models of care; ensuring reliable quality care is provided; improving allied health data collection; using technology to connect rural communities with urban centres; having adequate rural training pathways for medical and allied health professionals; and promoting a positive perception of working in rural and remote Australia.

National Rural Health Commissioner

The Commissioner updated the Roundtable on his current work preparing advice on improving the access, quality and distribution of allied health services in rural, regional and remote Australia. Deliverables include a literature review, discussion paper and final advice paper containing recommendations to the Minister.

The Commissioner discussed the high-level draft recommendations, including:

  • establishing a Commonwealth Chief Allied Health Officer;
  • improving allied health data;
  • establishing allied health networks using pooled funding;
  • expanding the Aboriginal and Torres Strait Islander allied health workforce; and
  • increasing undergraduate and postgraduate allied health training opportunities in rural and remote settings.
Members provided feedback on the draft recommendations and discussed the need to take action on allied health reform. The group discussed the importance of equitable governance arrangements if funding was to be pooled. There was also discussion about allied health professionals being leaders at management level if networks were created containing both medical and allied health staff.

The challenges of commencing allied health pilot programs or trials was discussed, such as the lengthy time it can take and short term nature.

National Rural Generalist Pathway

The Department provided an update on implementation of the National Rural Generalist Pathway that was announced in the 2019-20 Budget. This includes funding of $62.2m for:

  • Establishment of coordination units, which will improve workforce supply by coordinating the training pipeline for rural generalists.
  • An expansion of the Rural Junior Doctor Training Innovation Fund to increase retention of medical staff through early exposure to rural training.
  • Seeking recognition of Rural Generalist Medicine as a specialised field within the specialty of General Practice through the Medical Board of Australia.
It was confirmed that the States and the Northern Territory would be eligible to seek funding for Coordination Unit grants, as they are best placed to manage the intersection between hospital and primary care settings. The GP Colleges provided an update on the progress they have made in relation to seeking specialist recognition of Rural Generalist Medicine. A general discussion followed regarding scope of practice for rural generalists, and how accreditation of additional skills (eg obstetrics, anaesthetics) fits with other specialist college requirements.

The members discussed how the rural generalist concept applies to the allied health workforce. Allied health rural generalists have an extended scope of practice within their professions, based on community need and accredited by their professional bodies. The group discussed existing pathways for Allied Health Rural Generalists and their role providing team-based care in rural communities.

The Department updated the Roundtable on a workshop held on 19 September 2019 to discuss barriers and explore solutions around single employer models for rural generalist training. More than 30 stakeholders attended, comprising representatives from the Australian Medical Association, GP training organisations, state governments, Rural Workforce Agencies, Local Health Districts and GP accreditation bodies. As a result, options will be prepared for Ministerial consideration.

Distribution Advisory Group

It was reported that the Distribution Working Group (DWG) concluded at the end of 2018 and was replaced with a Distribution Advisory Group, which will review the DWS speciality layers and other medical professions.

The Department provided an update on the DWG, which in 2018 focussed on reviewing the District of Workforce Shortage (DWS) system for General Practitioners (GPs); as well as updating the Modified Monash Model geographic classification system.

It was discussed that on 1 July 2019, the District Priority Area (DPA) system replaced the DWS system for GPs and Bonded Medical Students. The benefits include:

  • the DPA uses GP Catchments, which provide a more accurate picture of where patients access their services; and
  • the DPA takes into account a range of factors including the demographics (gender/age) and socio-economic status of patients living in a catchment area.
Members raised the need to provide support to rural hospital administrators, to help understand any new changes to classification systems.

Update on health workforce measures

National Medical Workforce Strategy

The Roundtable was updated on the development of a National Medical Workforce Strategy (NMWS), which aims to identify achievable, practical actions to build a sustainable,
highly-trained medical workforce. The parameters of the NMWS have been agreed at state
and federal level through the Council of Australian Governments (COAG).

The first phase of this work has been to develop a Scoping Framework to inform development of the NMWS. The Scoping Framework outlines priority workforce issues and discusses opportunities to develop solutions.

The second phase of this work has commenced and is focussed on exploring and developing practical actions to address the issues as part of a long term plan.

Stronger Rural Health Strategy

The Department discussed progress on the $550m Stronger Rural Health Strategy, which gives doctors more opportunities to train and practice in rural and remote Australia, and gives nurses and allied health professionals a greater role in the delivery of multidisciplinary, team based models of primary health care.

The More Doctors for Rural Australia Program (MDRAP) was discussed, which replaces several other general practice workforce programs and includes a $20 million support package to provide supervision and education support for participating doctors.

The Department also reported on a new MBS item structure for GPs, which was introduced on 1 July 2018 to encourage all primary care doctors to qualify as specialist GPs.

Members discussed the importance of supervision for all rural doctors and trainees, and how variable it is across settings. The Department outlined a planned project to review GP supervision arrangements across the full range of Government funded programs to examine the practical operation of the arrangements, any perverse incentives and/or duplication that exists between programs, and whether they are meeting their objective of supporting and incentivising quality supervisory activity. This project will inform future policy discussions in relation to GP supervisor arrangements.

The importance of adequate allied health supervision was also discussed. Currently, a barrier exists in enabling this in private settings that rely on fee for service models.

Roundtable Membership

The Roundtable is chaired by the minister responsible for rural health. Membership includes a number of peak bodies representing the rural health workforce and the National Rural Health Commissioner.

Members in attendance for the 20 September 2019 meeting were:

  • Allied Health Professions Australia
  • Australian College of Rural and Remote Medicine
  • Australian Indigenous Doctors’ Association
  • Australian Medical Association
  • Australian Rural Health Education Network
  • 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
Guest:

  • Pharmacy Guild of Australia
Apology: