esa making it work presentation

© 2014 Grant Thornton Australia Ltd. All rights reserved.

Making it Work: Sustainable Solutions for

Rural and Remote Service Delivery in

Australia

Dr Abby Kamalakanthan

Manager – Operational Advisory


What rural & remote Australia looks like

68% - major cities

20% - inner regional

9% - outer regional

3% - remote & very remote



Peace

Contact with nature

Open space

Strong family values

Reduced traffic

Sense of community

More relaxed lifestyle


Rural & regional contribution to the Qld economy

Rural & regional

communities

contribute over $13.7

billion per annum in

agricultural production

88% of jobs in

agriculture & 53% of

jobs in food

processing industries

are regionally based

Tourism in regional

Qld generates more

than $8.5 billion (58%)

for the Qld economy

Mining in rural &

regional areas

contributed more than

$2 billion in royalties


Where it all began

PhD Thesis (2010) - An Economic Analysis of the Supply of General Practitioners

in the Rural and Urban Areas of Australia

2007

2011

BRW

Magazine!


Revisiting key findings from PhD study (2005-2010)

• Australia had a supply shortage of doctors & GPs

in the rural & remote areas

• Due to the absence of benchmark ratios for hospitals

and specialists, it was difficult to judge the precise

situation in rural hospitals

• Because the regional and remote sections of Australia

cover a vast geographical area, it was difficult to

ascertain that rural communities were adequately

serviced. This increased the travelling times of

patients & made transport necessary to access

medical services

• Rural and remote areas had a higher proportion of

elderly people than urban areas, & their health was

generally poorer than that of older people living in

metropolitan areas


Revisiting key findings from PhD study (2005-2010)

• Given the amount of travel involved,

rural GPs treated less patients than

urban GPs

• Rural GPs spent a large portion of

their time in hospital work.

• Rural GPs were more likely to suffer

from stress caused by longer

working hours

• Women were less likely to work in

rural areas than men

• Overall, rural Australians had

poorer access to medical services

than their urban counterparts &

higher levels of disease risk

factors & illness, which led to

death rates 1.7 times higher than

those in major cities


Recommendations from PhD study (2005-2010)

Need to develop

work solutions

aimed at

reducing the

workload of rural

GPs, in order to

prevent high

levels of stress

and burn out

Cut the level of

responsibility of

rural GPs which

would allow them

to work longer

hours without

burning out. This

may in turn help to

decrease the rate

of turnover in the

rural areas

Female GPs in the

rural areas should

be provided with

adequate non-

financial support

which enables

them to work part-

time, but still make

a genuine

contribution to the

profession


The situation now


The challenges are many


Sustainable solutions – Contestable primary health model

• Flying in (or driving in) doctors

from a larger rural hub per a

roster offers greater access to

highly specialised care for rural

and remote communities

• These visiting services need to be

supported by a core group of

primary health care providers that

are based in the community

• These services will ideally be

funded and operated by private

providers (including mining

companies) or in a public-private

partnership model that ensures

sustainability and continuity of care

in the long run

• The conventional model of

primary health care comprises

a permanent, dedicated doctor

service in all areas of Australia

• This model has managed to

remain in most rural and

remote areas due to the

employment of overseas-

trained doctors

• The focus is still on increasing

the number of stand-alone

doctors in rural and remote

areas, despite continuous

difficulties with recruitment and

retention

1


Sustainable solutions – Agile multi-disciplinary practice

• Introducing multi-disciplinary,

community owned (community

controlled in the Aboriginal Health

area) practices, that incorporate

telehealth, to rural areas will enable

more local ‘ownership’ of the problem

of retaining and incentivising GPs

through community involvement in

reducing isolation

• These practices could operate under

a hub and spoke model where

remote spoke services are supported

by larger rural hub services

• Rural practices also require business

support to run sustainable

businesses

• Various financial incentives are

currently in place to entice

primary health care workers to

remain in rural and remote

positions, however, providing this

type of incentive alone may not be

a holistic solution, as lifestyle is

the main driving factor in these

areas, not money

• More tailored and innovative

solutions need to be found to

address the problems of

loneliness, and professional and

social isolation, which are causes

of mental health issues for both

the community and primary health

care workers

2


Sustainable solutions – Integrated model of care

• New rural and remote primary

health care model should

leverage off the strengths of rural

communities and promote greater

transparency and stronger

collaboration between local

governments, doctors, Allied

Health Workers, NPs, PAs and

Aboriginal Health Workers

• Medicare funding is needed to

make the employment of NPs and

PAs worthwhile, to enable them to

provide after hours care, and to

reduce GP resistance to

alternative types of primary health

care professionals

• Practice Nurses and Nurse

Practitioners (NPs) are currently

operating in the rural and remote

areas of various states, including

Queensland and WA, where there

is an uneven distribution of doctors.

NPs are endorsed to function

autonomously and collaboratively in

an advanced and extended clinical

role

• Small scale trials for Physician

Assistants (PAs) to work under the

supervision of GPs have recently

been conducted in Queensland

• NPs and PAs have the potential to

assist in the provision of after hours

care services

3


Sustainable solutions – More rural internships

• While the creation of rural and

remote medical schools is

important for attracting students

to rural and remote areas, more

internship places need to also

be created in rural hospitals so

students can continue their

postgraduate training in these

areas

• This is particularly important for

retaining graduating doctors

who are originally from rural or

remote communities, and are

more likely to remain in the

areas where they grew up

• Despite the stigma attached to

rural schooling, the Australian

Government has made a

concerted effort in recent years

to not only increase the overall

medical school intake, but to also

promote rural and remote

medical training, and establish a

number of rural and remote

medical schools

• The introduction of bonded

medical school places, which

was designed to retain students

in rural and remote areas post-

graduation, has been ineffective

due to the option to ‘buy out’ of

the scheme

4


Sustainable solutions – More responsive telehealth

• Improving Internet access and the

number of telehealth access points

will make telehealth a more

seamless and attractive treatment

option, with the ultimate goal being

home-based care which is

available 24/7

• MBS item numbers need to be

made available for GP patient

consultations where patients have

to travel a long distance to see a

GP

• The shipping of pharmaceuticals

has the potential to extend the

telehealth value chain even further

• Although telehealth services have

been available in rural and remote

areas for the past decade, a

number of access and equity

barriers have prevented their

uptake. These include:

o IT infrastructure

o Equipment

o tele-literacy

o Accessibility

o payment methodology

o preference for the traditional

approach of ‘in-person’ care

• MBS item numbers are not

available for GP patient

consultations; they are only

available for GP Specialist

consultations

5


Challenges & solutions for rural education

• Maintaining viable services in an increasingly competitive landscape is a

significant problem in rural and remote communities

• Catering for the needs of the Indigenous population

• Keeping the community involved in local decision-making while providing

a strong formal governance structure

• Encouraging collaboration with key local agencies & networks

• Attracting & retaining a qualified workforce

• Adopting an integrated service model


Challenges & solutions for aged care in the future

Growth per annum in LGAs by age bracket, 2008-2012


Challenges & solutions for aged care in the future

• Maintaining viable services in an increasingly competitive landscape is a

significant problem in rural and remote communities

• Changes in future income levels and affordability are difficult to predict

• Escalating regulatory requirements which can impact on ongoing service

delivery

• Encouraging collaboration with key local agencies and networks

• Attracting and retaining a qualified workforce

• Adopting an integrated service model


Thank you! Questions?

Contact details:

0413 953 643

[email protected]

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