As many readers of Partyline will be aware, I was appointed to the role of National Rural Health Commissioner in October 2017 through an Act of Federal Parliament that received bipartisan support from both major parties. The Commissioner’s role is independent, and its establishment was the culmination of rural and remote stakeholder advocacy over many years.
In my first year as Commissioner I was tasked with developing a pathway to make medical services more accessible for regional, rural and remote communities. Specifically, I was asked to consider the role of Rural Generalists. This is a term that had gained greater currency in recent years and there were multiple definitions of what a Rural Generalist actually does. In response to this, one of my first tasks, as requested by the Minister responsible for rural health, Senator Bridget McKenzie, was to establish a definition of the Rural Generalist role that was acceptable to rural and remote communities, practitioners and education and training institutions.
The definition that was presented to the Minister and the Rural Health Roundtable in February 2018 is:
“A Rural Generalist is a medical practitioner who is trained to meet the specific current and future healthcare needs of Australian rural and remote communities, in a sustainable and cost-effective way by providing both comprehensive general practice and emergency care and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.”
This definition, part of the Collingrove Agreement between the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine, provides us with a commonly agreed language and understanding of what we mean when we explore the potential benefits of Rural Generalism, what skills practitioners need and how a training pathway might work. It also places the needs of the community very firmly at the centre.
Many communities outside large regional centres cannot sustain a large specialist workforce. This means that patients often have to travel to access services, causing disruption and loss of income. Rural Generalists can fill this gap by providing a mixture of general practice and emergency services along with an additional skill such as obstetrics, palliative care, internal medicine, and many others, depending on the needs of the community.
My next task was to develop a pathway for Rural Generalists to undertake the majority of their training rurally. So much of medical training in the past has been designed for metropolitan populations and so opportunities to study and train in rural areas have been limited. The majority of trainees are forced to relocate to urban locations to complete their vocational training and returning to a rural or regional area becomes more and more challenging. Rural and remote communities and those who wish to work in them deserve a better solution!