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12 Dec 2016

Last month, Assistant Minister for Rural Health Dr David Gillespie chaired a Roundtable of Rural Health Stakeholders.

I was privileged to be in the company of about 20 leaders in rural health. Our friends from the Rural Doctors Association of Australia, Australian College of Rural and Remote Medicine, the Royal Australian College of General Practitioners and the Australian Indigenous Doctors’ Association were there, as well as representatives from nursing, midwifery, allied health, dentistry, medical education and students. We were all from rural Australia and all passionate about the need to discuss the challenges of providing rural primary health care.

Dr Gillespie clearly was listening to us all. The proof of this was that he paraphrased what was said in his own words and from his perspective. An idea sounds new when another person takes the thought and views it from a different angle.

This was a true roundtable, where attendees were questioned around the table. I was glad to see that women made up half the roundtable, and there were three Indigenous representatives.

Rural Health Commissioner

The Rural Health Commissioner will not be announced until there is a legislated position created.

This is to ensure the Commissioner will be at arms-length from the Government and able to provide politically unbiased recommendations. So we won’t find out who will be leading the Commission until the autumn sitting of Parliament.

The attributes of the commissioner?

The adjectives flew around the table: knowledgeable about the industry; impartial; reasonable; articulate; ability to work in alignment with a multidisciplinary caregivers; a change agent; a worker; an educator; a hero for the rural patient. Someone said this person sounds absolutely awe-inspiring.

The job of the commissioner?

The wish list was huge: dental program, midwifery support, podiatry in all areas of the Outback, physiotherapy, tackling Indigenous suicide, mental health issues, liaising with the public, address the social determinants of health. Nurses expressed a wish to increase the scope of practice, to prescribe.

The focus the job?

The focus should first be the rural generalist pathway. Focus on “doability”. Focus on things that are working, and build on them.

Dr Gillespie summarised by saying the Rural Commissioner cannot be a fairy godmother - He or she could not deliver the whole wish list, and would struggle to do all the work hoped for given that  the pie was not big enough.

Rural generalist pathway

It was agreed that the Queensland pathway, although the most mature and established, will not work for all regions. Suggestions included the need to teach “rural clinical courage”, described as the ability to be alone, rural and competent. Stakeholders begged that the pathway be flexible in terms of entry, exit, and mobility between private clinics and public hospitals, including the freedom to be educated in the cities. It was agreed that the end of the pathway should be with either of the colleges.

It was pointed out there is a need to make the program a national one, with consistent remuneration, expectations and standards. Also that it should not be a “tack on” to the end of medical training, but rather permeating throughout training. To that end, rural candidates should be identified even before the start of training.

Dr Gillespie made it clear that not all the funding could come from the Federal Government, and that the States needed to contribute. The possible participation of private corporations was also discussed.

Since the pathway is to train only doctors, the allied health and non-medical participants expressed a wish that their fields also had a rural generalist pathway.

Other initiatives

The roundtable also discussed Health Care Homes and workforce retention.

I was disappointed that we did not discuss recent changes to the PIP program which, among other things, will see the end of the Indigenous Health Initiative PIP - a disaster for those of us working in Aboriginal medical services.

My one victory at this meeting was advocating for a longer meeting next time. Those attending came from all parts of rural Australia, and four hours of discussion was just not enough.

The next roundtable is set for April next year.


Published: 12 Dec 2016