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
abby.kamalakanthan@au.gt.com

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