Program
A PDF version of the program is now available here:
Keynote speakers

Lara Fuller
Associate Professor Lara Fuller, MBBS (Hons), FRACGP, GCME, AMusA, is Director of Rural Medical Education and the Rural Community Clinical School at Deakin University, Victoria. As an academic general practitioner, her teaching and research interests are in curriculum design for rural medical education, learning in longitudinal integrated clerkships, rural clinical training pathways and rural workforce outcomes. She is an active member of the Federation of Rural Australian Medical Educators (AusFRAME) and the International Consortium of Longitudinal Integrated Clerkships (CLIC).
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Margaret Garde
In 1985 Margaret Garde arrived in Portland, Victoria, to join her partner, now husband. Being the only female GP, and the youngest by at least 10 years, brought with it a sense of professional isolation.
The disciplines in which she worked included family planning, occupational health, Aboriginal health, public health, forensic medicine, adolescent health and mental health. Now she has a strong interest in teaching and supporting students and doctors who wish to live and work in a rural location, with a strong emphasis on giving them the preparation they need to feel confident and secure.
Thus followed the hosting of a string of medical students, John Flynn Scholars, and cousins, children of friends or anyone else who was remotely interested in medicine as a career.
As is now well recognised, none of these wonderful people returned to Portland to work.
In 2012 the opportunity to work in Portland’s GP SuperClinic presented and, together with this, the ability to host Deakin University students from a rural background who reside in Portland for their 12-month placement.
This, together with a visit from Paul Worley, the then National Rural Health Commissioner, provided the inspiration for our longitudinal rural vocational experience.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Christine Giles
Chris Giles is a senior executive with considerable experience leading and managing regional, rural and remote health services.
Chris has a strong clinical background as a nurse then midwife, which has proven very valuable in her recent executive roles. These executive roles include working in healthcare organisations in Western Australia, Victoria and Queensland.
Most recently, Chris has worked as the Chief Executive Officer of Portland District Health in south-west Victoria. Prior to this she spent three years living in the Torres Strait, working as a District CEO for Queensland Health.
Chris has a passion for finding solutions to wicked problems, often challenging the normal by finding innovative solutions to improve health service access and quality for rural and remote communities. Some of these solutions include extending scope of practice for clinicians, training cohorts of nurse practitioners and using technology such videoconferencing and electronic health records to overcome distance.
As a sideline, Chris is on the Board of the local catchment management authority, keen to ensure land and water resources are managed to ensure future generations can enjoy them as we do.
Portland District Health services a community of almost 20,000 people. Compared to the rest of Victoria, Portland has greater socioeconomic disadvantage, a higher proportion of people of Indigenous status, and higher rates of hypertension, smoking, alcohol consumption, obesity and psychological distress.
The hospital has 69 registered inpatient beds with a 24-hour, seven-days-a-week Urgent Care Centre (UCC). The UCC is deemed one of the busiest in Victoria, per population.
On 14 June 2018, Professor Paul Worley, the then National Rural Health Commissioner, visited Portland. Portland’s shortage of general practitioners (now critical) was a familiar issue confronting him.
As a result of this visit, Portland decided to ‘grow its own’ rural workforce using the already existing infrastructure, beginning with longitudinal medical student training and ending with advanced skills training posts, eventually producing rural generalist general practitioners to meet the needs of the community.
With the hospital adversely affected, with limited access to International Medical Graduate Hospital Medical Officers due to the COVID-19 pandemic, the timing was opportune.
The outcome of this process is an innovative and collaborative rural generalist pathway with the achieved steps as follows:
- Novel longitudinal internship program. In 2021, interns commenced working for six months in ‘medicine’ and six months in ‘surgery’, but each week begins with a day in the UCC and finishes with a day in general practice. The intern may see a patient in UCC with a FACEM on Monday, follow up care in the general ward Tuesday to Thursday with a physician or surgeon and review or admit patients in general practice with their GP supervisor on Friday.
- PMCV accreditation for a Rural Generalist Year 2 stream. The program comprises a six-month blended community paediatric and obstetric experience, with placements within the hospital, general practice and Aboriginal Medical Service, followed by six months in UCC with support to enrol in ACEM Emergency Certificate and Anaesthetic experience in a JCCA-approved training position.
- Advanced skills training posts in anaesthetics and paediatrics accredited and in emergency currently under development. Partnerships established with Barwon Health and Western Health and South West Healthcare.
- The development of posts that facilitate rural generalist consolidation for each of the above disciplines
The significant beneficiaries of this integrated approach to rural generalist pathways will be the Portland community.

Stan Grant
Stan Grant is the International Affairs Editor for the Australian Broadcasting Corporation (ABC), a multi-award-winning current affairs host, an author and an adventurer.
Well known for having brought the former Prime Minister Malcolm Turnbull to tears when interviewed about Indigenous affairs on The Point, Stan’s keynotes are insightful, engaging, always professional and, at times, controversial.
Stan’s Aboriginal heritage has shaped his dynamic, resilient personality. Born in Griffith in south-west New South Wales (NSW) in 1963, Stan Grant’s mother is from the Kamilaroi people and his father is of the Wiradjuri.
Stan spent most of his childhood on the road living in small towns and Aboriginal communities across outback NSW. His father was an itinerant saw-miller who worked when and where he could. Stan moved so often he attended 12 different schools before he was in his teens.
The early travelling gave Stan a love of adventure and stories. He grew up listening to the tales of his grandfather and uncles and aunts. Despite poverty and an early sporadic education, the security of his family and the larger Aboriginal community gave him a strong platform for life.
After attending university, Stan won a cadetship with the Macquarie Radio Network, launching a career in journalism that has spanned more than 30 years and more than 70 countries. In that time Stan has travelled the world covering the major stories of our time from the release of Nelson Mandela, the troubles in Northern Ireland, the death of Princess Diana, war in Iraq, the second Palestinian intifada, the war on terror, the South Asia tsunami, the Pakistan earthquake and the rise of China.
Stan has hosted major news and current affairs programs on Australian commercial and public television. He has been a political correspondent for the ABC, a Europe correspondent for the Seven Network based in London and a senior international correspondent for the international broadcaster CNN based in Hong Kong and Beijing.
Returning to Australia in 2013, Stan continued to cover international events for Sky News Australia and reignited his passion for telling the stories of his own Indigenous people. He has worked as the Indigenous editor for The Guardian Australia, managing editor for National Indigenous Television and international editor for Sky News. In 2016 Stan was appointed as special adviser to the then Prime Minister Malcolm Turnbull on Indigenous constitutional recognition.
Stan has won many major awards including an Australian TV Logie, a Columbia University Du-Pont Award (the broadcast equivalent of the Pulitzer Prize) and the prestigious United States Peabody Award. He is a four-time winner of the highly prized Asia TV Awards including reporter of the year.
Stan has written The Tears of Strangers and Talking To My Country (Harper Collins), and has published numerous articles and opinion pieces for The Sydney Morning Herald and The Australian.
Stan Grant is passionate about justice and humanity. His years of international reporting have given him a deep understanding of how the world works. He is deeply immersed in the politics and history of Asia and the Middle East. He can link the importance of leadership and the impact of history and, above all, believes in the power and resilience of people.
Stan is married to ABC Sports broadcaster, Tracey Holmes, and has four children. He lives in Sydney.
Booked through: Celebrity Speakers www.celebrityspeakers.com.au

Mark Howden
Professor Mark Howden is Director of the Institute for Climate, Energy and Disaster Solutions at The Australian National University.
He is also an Honorary Professor at Melbourne University, a Vice Chair of the Intergovernmental Panel on Climate Change (IPCC) and the Chair of the ACT Climate Change Council. He was on the US Federal Advisory Committee for the Third National Climate Assessment, was a member of the Australian National Climate Science Advisory Committee and contributes to several major national and international science and policy advisory bodies.
Mark has worked on climate variability, climate change, innovation and adoption issues for over 30 years, in partnership with many industry, community and policy groups via both research and science-policy roles. Issues he has addressed include agriculture and food security, the natural resource base, ecosystems and biodiversity, energy, water and urban systems.
Mark has over 420 publications of different types. He helped develop both the national and international greenhouse gas inventories that are a fundamental part of the Paris Agreement and has assessed sustainable ways to reduce emissions. He has been a major contributor to the IPCC since 1991, with roles in the Second, Third, Fourth, Fifth and now Sixth Assessment Reports, sharing the 2007 Nobel Peace Prize with other IPCC participants and Al Gore.

Gabrielle O'Kane
Gabrielle O’Kane is Chief Executive Officer of the National Rural Health Alliance, the peak body for rural health in Australia. She is an Adjunct Associate Professor with the University of Canberra and Charles Sturt University. Gabrielle has extensive experience in the private and public health sector, which has contributed to her deep understanding of the need for collaborative partnerships to support the rural health workforce and achieve positive health outcomes for rural communities. She promotes solutions to the Australian Government to address the needs of rural communities and health professionals, through her position on many pertinent steering groups and committees.

Roland Sapsford
The Climate and Health Alliance’s new Chief Executive Officer, Roland Sapsford, has been working to respond to the challenge of climate change and the task of reducing emissions through public policy and activism for much of his professional life.
This work has ranged from being involved in New Zealand’s first study of the impacts of carbon taxes and work on energy efficiency and home insulation policy, through to getting solar panels installed on a local community centre and campaigning against major road projects.
Roland once completed four years of a medical degree and was a senior manager in public health for five years. He has also studied economics and systems ecology to postgraduate level, and has a strong commitment to Indigenous rights.

Rabia Siddique
Rabia Siddique is a history-making humanitarian, best-selling author and multi-award-winning international keynote speaker. She is a sought after transformational coach and mentor and speaks English, French, Spanish and Arabic.
Current work
Rabia’s powerful and engaging presentations on leadership, resilience, equality and diversity draw on her personal story of strength, courage and forgiveness, in addition to her legal, military and psychology training. Surviving a hostage crisis in Iraq, Rabia garnered global attention for making the British military accountable for silencing her about her ordeal and role as a military lawyer in releasing captured Special Forces soldiers. Standing up for justice in the face of public ridicule, Rabia’s brave action in suing the British Government for sexism and racism became a catalyst for policy change to ensure a fairer workplace for women and cultural minorities in the British military.
Rabia is an expert commentator, regularly appearing in newspapers and magazines, and on television, radio and online media in Australia and around the globe, including The Guardian, 60 Minutes and ABC television.
With her best-selling memoir Equal Justice also the focus of a feature film, she is now writing her second book.
Rabia is an Ambassador for 100 Women, Angelhands, Esther Foundation, Inner Ninja (mental health support) and Ishar (multicultural health service). She is a Board Member of the International Foundation of Non-Violence, Museum of Freedom and Tolerance, Wesley College and Calan Williams Racing.
Previous experience
Law: Rabia’s extensive career as a criminal, terrorism, war crimes and human rights lawyer has taken her to Europe, the Middle East, South America, South East Asia and Australia.
Military: Her military career includes serving as a British Army officer in England, Northern Ireland and the Middle East. Rabia was one of England’s first Armed Forces Employment Law Officers – a role which took her to Royal Military Academy Sandhurst where she ran equality and diversity training. Among her charges was Prince William, the Duke of Cambridge.

Keith Suter
Dr Keith Suter is considered one of Australia’s most influential global futurists and media commentators in national and foreign affairs. He has also held many strategic leadership roles. Dr Suter is an experienced, professional and awarded presenter renowned for explaining complex global and business issues in a way his audiences can digest and understand. He is in demand as an MC and conference facilitator. Keith’s tailored keynotes, workshops and facilitated sessions are entertaining, highly compelling and always captivating.
In 2019 Keith was proudly appointed as a Member (AM) of the Order of Australia (General Division), for significant service to international relations and to the Uniting Church in Australia.
Previous experience
Academic expert: Dr Keith Suter has achieved three doctorates. The first of these was about the international law of guerrilla warfare (University of Sydney), the second about the social and economic consequences of the arms race (Deakin University) and a third doctorate on scenario planning (University of Sydney).
Leadership roles: He has been appointed to many prestigious roles throughout his career, including Chairperson of the International Commission of Jurists (NSW), Director of Studies at the International Law Association (Australian Branch) and Managing Director of the Global Directions think tank. After 25 years, Keith recently retired from the role of Chairperson of the International Humanitarian Law Committee of the Australian Red Cross (NSW).
Global recognition: He has also been a member of the prestigious Club of Rome since 1993. The Club is ‘an informal association of independent leading personalities from politics, business and science, men and women who are long-term thinkers interested in contributing in a systemic, interdisciplinary and holistic manner to a better world. The Club of Rome members share a common concern for the future of humanity and the planet.’ The club has only 100 members, with Mikhail Gorbachev among them.
Keith is a Life Member of the United Nations Association of Australia in recognition of his service. At various times from 1978 to 1999, he served as the National President of the organisation and took on the roles of WA and NSW State President.
Strategic roles: Keith was the President of the Centre for Peace and Conflict Studies (1991–98) at the University of Sydney, and was a consultant on social policy with the Wesley Mission for 17 years. In addition, he served as a consultant for a number of other organisations with a focus on local and international issues. He is also an active member of the Australian Institute of Company Directors.
Media roles: He frequently appears on radio and television discussing politics and international affairs. He has been, for many years, the foreign affairs editor on Channel 7’s Sunrise program.
Renowned author: Among Keith’s many books are All about Terrorism: Everything you were afraid to ask, as well as Global Order and Global Disorder: Globalization and the Nation-State and 50 Things You Want to Know About World Issues … But Were Too Afraid to Ask.

Susan Wearne
Susan Wearne is a general practitioner (GP) and senior adviser to the Australian Government Department of Health and Aged Care regarding rural health and health professional education. She trained at Southampton University in England and completed general practice training in Northamptonshire and back home in Cheshire. She owned a practice in York, England, and worked at the Aboriginal Medical Service in Alice Springs and for the Royal Flying Doctor Service at Ayers Rock Medical Centre. She has extra qualifications in child health, women’s health, family planning, primary health care and medical education and now works as a GP in Canberra.
Susan is a Clinical Associate Professor at Australian National University and has published over 40 peer-reviewed articles on general practice and medical education. The fourth edition of her textbook Clinical Cases for General Practice Exams was published in 2019. She held educational leadership positions in the Northern Territory before taking on national roles for the Royal Australian College of General Practitioners and General Practice Education and Training. She works in the Health Workforce Division which manages general practice training and other programs that promote Australians’ access to qualified health professionals. She was medical lead for the soon to be released Australian National Medical Workforce Strategy.
Susan’s husband, Tim Henderson, is the eye surgeon at Alice Springs Hospital. Their daughter and her family live in England and their son works in Adelaide. Between flights home to Alice, Susan swims, makes clothes and enjoys the scenery on the lake as she learns to row.

Justin Yeung
Justin is a consultant emergency physician by training. He has had a number of leadership positions in WA Health – director roles in emergency medicine (Royal Perth Hospital, Albany Health Campus and WA Country Health Service) and medical services (Great Southern region of Western Australia). He is currently Medical Director of the WA Country Health Service Command Centre, which incorporates a number of 24/7 clinical streams in acute telehealth – emergency, inpatient medicine, mental health, obstetrics and midwifery, palliative care and acute patient transfer coordination. Justin splits his time between Perth and Albany, and still maintains clinical exposure working in the Emergency Telehealth Service and locums in regional Western Australia. To add some spice to the year, Justin has started postgraduate studies in health care leadership. He’s also an oft-stung beekeeper.
From humble beginnings as a limited-hours, weekend-only, single-doctor emergency consultation service for a handful of small country hospitals in Western Australia (WA), the WA Country Health Service Command Centre is approaching a 10-year milestone of providing specialist-led clinical consultation directly to rural patients using video-enabled technology. The Emergency Telehealth Service (ETS) has grown into a 24/7 virtual emergency department, managing more than 27,000 consultations in 2021. The range of clinical services available to support our regional clinicians using telehealth has expanded to include inpatient care (2018) and mental health (2019), obstetric and midwifery, palliative care and, most recently, transfer coordination (all commenced in 2022). We will present an overview of our 10-year journey, highlight areas of innovation and success, as well as outline challenges we have and continue to face.
Plenary sessions
Opening Session:
Julieanne Gilbert MP
Assistant Minister for Health and Regional Health Infrastructure, Queensland – Welcome to Brisbane
Emma McBride MP
Federal Member for Dobell, Assistant Minister for Rural and Regional Health
Plenary Session 1:
Russell Roberts
Australian Journal of Rural Health
Editor in Chief 2017–21 – AJRH 30 Years
Jason Waterford
HESTA Australia Ltd
Plenary Session 4:
Helen Haines MP
Independent Federal Member for Indi
Closing remarks:
Stephen Gourley
Deputy Chair, National Rural Health Alliance
Concurrent presenters
Alice Cairns
Alice Cairns is a senior research fellow with James Cook University, Centre for Rural and Remote Health. In her current role, Alice’s research interests have focused on developing place-based models for delivery services in very remote communities. She is an occupational therapist who received her PhD focusing on youth mental health from the Queensland University of Technology in 2017. Prior to commencing her PhD, Alice specialised in mental health rehabilitation in clinical and management roles.
A co-designed community rehabilitation service for Cape York communities: feasibility and acceptability
Background: To address the gap in culturally safe and accessible community rehabilitation services in remote communities, stakeholders in two Cape York communities co-designed and implemented an interprofessional student-assisted community rehabilitation and lifestyle service. Funding for the service was provided by the Northern Queensland Primary Health Network. The evaluation of this service aimed to explore the feasibility and acceptability of the service in the first 12 months (July 2019 – June 2020) from the perspective of all the stakeholder groups (clients, families, community organisations, allied health students and health staff).
Methods: Feasibility and acceptability was determined by occasions of service (OOS), referral rates, failure to attend (FTA) rates, student placement offers versus placements filled. One-to-one semi-structured interviews with 40 people representing all stakeholder groups explored stakeholders’ perceptions of the service.
Results: During the first 12 months, 783 OOS were provided to 46 clients. A total FTA rate of 14% was recorded trending down as the service became more established, 50% in the first month to 0% in month twelve. Placements for 29 allied health students (206 weeks) were offered, 15 (117 weeks) were filled. COVID-19 restrictions impacted both on student placements and reduced OOS from March to June 2020. Themes from interviews were analysed using a SWOT analysis. Strengths included cultural responsiveness, integration of care, reliability and continuity of service, and building community capacity. Weaknesses included reliance on student workforce, extra coordination between health professionals, role clarity and scope of practice. Opportunities included the funding model and stakeholder commitment to community needs. Threats included sustainable funding structures and attracting student workforce.
Discussion: This initial 12-month evaluation found the student-assisted community rehabilitation service to be feasible and acceptable. Acceptability indicators improved as the service developed and responded to client and community needs. Reciprocity between the service, clients and community organisations was highly valued. Adequately funded place-based co-design of health care and student training models can lead to feasible and acceptable service models for very remote and Indigenous communities.
Expanded practice for rural community pharmacy: pharmacist, health professional and stakeholder perspectives
An expanded role for pharmacists, although emerging in Australia, has been a priority for pharmacy associations internationally. ‘Expanded practice’, ‘extended practice’ and ‘full scope of practice’ are terms used to describe the extension of the pharmacist’s role. Expanded services are tasks usually provided by other health professionals (HPs) and offered in addition to pharmacists’ usual medication management services. Rural Australian community pharmacists have been frequently identified as being well-positioned to expand services to address adversities of healthcare access for rural and remote populations.
An ethnographic lens of rural culture was utilised for this descriptive qualitative study. Semi-structured, in-depth interviews were conducted with pharmacists (12), doctors (8), nurses (4), allied health professionals (11) and stakeholder representatives (8). Thematic analysis using an inductive and deductive approach was guided by a multi-level lens of macro- (policy level), meso- (HP level) and micro- (consumer and community level) perspectives. The World Health Organization (WHO) framework for integrated people-centred health services provided aligned strategies to support the theoretical framework for the analysis.
Key findings at the macro-level included agreement that governance is needed to clarify the terms used to describe expanded practice as a first step to developing an expanded practice framework. In addition, government support and funding provisions were needed for sustainability. The meso-level revealed an expectation that expanded practice would improve rural pharmacist recruitment and retention through improved professional satisfaction. Effective collaboration and coordination with other healthcare providers in a community was described as essential at the meso-level to ensure success and acceptability of expanded services. The importance of ensuring pharmacists have the required knowledge, skills, quality assurance and safety measures in place, as well as capacity including time and space, were also identified at the meso-level. The micro-level highlighted the opportunity expanded service development presented to empower and engage consumers through rural community pharmacies.
As pharmacists internationally continue to expand their scope of practice, these results provide first evidence for Australian rural pharmacists to consider when planning for and developing expanded practice models. Recognition of challenges and motivators across policy, health professional, consumer and community levels is needed in order to design and develop sustainable expanded pharmacy services to improve health service provision in rural and remote communities.
Josephine Canceri
Josephine Canceri is a third-year medical student at the Western Sydney University (WSU) School of Medicine. Josephine has been undertaking research with WSU’s Bathurst Rural Clinical School exploring the uptake of the National Bowel Cancer Screening Program in rural communities. Josephine’s project focuses specifically on the role of general practitioners in initiating and navigating conversations of bowel cancer and bowel cancer screening.
Serious toilet talk: rural general practitioners' perspectives on preventive bowel cancer screening
Background: Colorectal cancer (CRC) is the third most common cancer in Australia and second leading cause of death. With 90 per cent of CRC being potentially preventable with early detection, optimal National Bowel Cancer Screening Program (NBCSP) participation is critical for mortality reduction and cost-effectiveness. Currently, testing averages 44 per cent, significantly below the 60–70 per cent target. Participation is further reduced within rural communities, exemplifying CRC disease burden and mortality with increasing rurality. Western New South Wales (NSW) is no exception to this. While numerous barriers limited patient participation, the resounding facilitating factor enhancing NBCSP uptake is general practitioner (GP) endorsement. This research explored rural GP NBCSP experiences to elucidate circumstances unique to rural and regional communities which impact utilisation and access of preventive medicine resources.
Methods: Semi-structured interviews are being used to explore GP (~n=15-20) experiences with the NBCSP and preventive screening within western NSW. Participants are GPs currently practicing in western NSW with at least one year of regional practice experience. Interview questions explore GP experiences in NBCSP administration and preventive screening, common patient perceptions and how these conversations were navigated, barriers and facilitators for patient participation as well as recommendation to improve NBCSP uptake and facilitate GP endorsement. Interviews are audio-recorded for transcription and analysed using reflexive thematic analysis.
Results: Data collection and analysis is ongoing. GPs perceive a lack of public awareness and media promotion in the region, as well as limited health literacy as principal barriers in engaging western NSW residents with the NBCSP. However, GPs also identified that, following discussions of NBCSP participation, its requirements and potential benefits, most patients subsequently utilise FOBT testing, either through the NBCSP or privately purchased kits. Incorporating preventive screening discussion as part of regular ‘check-up’ appointments was found to normalise the topic and enhanced patient understanding of asymptomatic testing, increasing test uptake and positive result follow-up. Automated system reminders were identified as helpful to both patient and practitioner to ensure test completion.
Conclusions: This research will enable a more comprehensive understanding of the barriers and facilitators which impact patient NBCSP participation in this regional centre. Engagement of regional primary health care will facilitate the development of specific strategies to promote NBCSP endorsement by GPs and the multidisciplinary primary healthcare team within non-metropolitan areas. These strategies will aim to improve patient care and reduce the CRC disease burden within our rural Australian communities, bridging the health gap defined by postcode.
Elizabeth Cardell
Elizabeth Cardell is a Professor of Speech Pathology at Griffith University, where she set up the new Master of Speech Pathology program in 2012. She has held senior leadership roles within Griffith University including Acting Head of the School of Allied Health Sciences and currently is Deputy Head (Learning and Teaching) in the School of Medicine and Dentistry. As an experienced clinician with over 30 years’ experience in public and private sectors, Elizabeth has deep understanding of current and future training and workforce needs. Her commitment and innovation in health workforce education and training has been acknowledged though a Principal Fellowship of the Higher Education Academy (UK). Elizabeth is an accreditation adviser for Speech Pathology Australia, is the expert external member of the Australian Physiotherapy Council’s Assessment Committee, and is Editor for the International Journal of Speech Language Pathology. As a researcher, she has 60+ publications and has procured around $4.4 million in grants and tenders targeting skills training and evaluation, new models of care, clinical pathways, extended scope, simulated learning, culturally responsive health care, and evaluation of workforce initiatives. Elizabeth is committed to dissemination and has over 100 presentations at invited professional development workshops and conferences.
Evaluation of the Queensland Health Allied Health Rural Generalist Pathway 2019–22
Aims: The Allied Health Rural Generalist (AHRG) Pathway was developed in Queensland Health between 2014 and 2018. Following successful evaluated trials, the Pathway was embedded in system funding and employment structures. The AHRG Pathway is an integrated service, workforce and training strategy that supports rural and remote health service outcomes. The Pathway includes: (1) early-career, designated training positions for nine allied health professions supported by postgraduate training in rural generalist practice; and (2) a leadership development program for senior allied health professionals (AHPs).
The purpose of this project is to examine the implementation and outcomes of the AHRG Pathway 2019–22 on:
- workforce development and sustainability
- training and development
- service development and delivery.
Methods: This project employed a mixed-method, implementation-effectiveness hybrid design to evaluate the pathway using both retrospective and prospective data. Primary data sources included: (1) online surveys with AHPs involved in the AHRG Pathway (such as trainees, managers/supervisors); (2) online surveys with a matched cohort of rural AHPs without connection to the Pathway; and (3) follow-up semi-structured interviews and virtual site visits with focus groups. Secondary data included de-identified AHRG Pathway program documentation and payroll data used to compare longitudinal tracking of trainees/participants and matched cohorts.
Survey data were analysed using descriptive and non-parametric statistics and content analysis. Individual interviews and focus groups were recorded, transcribed and analysed to identify themes. Both survey and individual interview data informed questions asked of key contacts and focus group participants at the virtual site visits.
Results: Preliminary findings describing factors for engagement in the AHRG Pathway include interest in rural practice/career and professional development, and indicate challenges and enablers of success, including the key role of the professional supervisor and access to protected development time. Attraction and retention factors include workforce and service pressures.
Strategies used to address the methodological challenges of investigating small, dispersed rural and remote teams will be presented, including the use of virtual site visits and leveraging existing finance and payroll data.
Conclusion and relevance: The AHRG Pathway is being implemented in most state and territory health systems and the primary care sector nationally. Outcomes from this evaluation can guide decision-making on improvements and investment in the strategy.
Jessica Carew
Jessica Carew is the Branch Manager for Strategy, Policy and Privacy at the Australian Digital Health Agency. Before joining the Agency in October 2021, to pursue her passion for public health and social policy, Jessica held senior roles in the Commonwealth Treasury, the Department of Industry and the Australian Taxation Office. These roles have involved policy development, stakeholder engagement, state and territory negotiations, and industry standards development. Jessica holds an Executive Masters of Public Administration from the Australian National University, a Graduate Diploma in Public Health and Bachelor of Applied Science (Public Health) from the University of Canberra.
Working towards the future: transforming the health and wellbeing of Australians through digital health
Digital health is changing the healthcare ecosystem in Australia. Yet, the future of digital health is about people. COVID-19 led a seismic shift in the uptake of digital health. Consumers and providers now appreciate the critical role technology can play in supporting better health and wellbeing and its potential to ease pressure on the health workforce and reduce wastage and duplication in government spending. But there’s more to be done to realise the opportunities that digital health offers to ensure our health system is nationally connected and accessible so that consumers, including those in rural and regional areas, can access the care they need when and where they need it. This presentation will outline how the Australian Digital Health Agency is collaborating across the Commonwealth, across different tiers of government, with healthcare peaks and consumer groups and healthcare providers to drive uptake and connection – including work to develop the next National Digital Health Strategy and work to drive greater interoperability that facilitates the exchange of clinical information easily and securely to support continuity of care and better patient outcomes.
Belinda Cash
Dr Belinda Cash is an early career researcher with the Regional Australia Mental Health Research and Training Institute and social worker with clinical and academic expertise in mental health and social gerontology. Her work is focused on the psychological and social health and wellbeing of older adults and their caregivers in rural Australia.
The protective role of social supports for older caregivers in rural Australia
Informal care is most often provided by unpaid family members, with studies consistently demonstrating a significantly higher incidence of psychological disorders, levels of stress and poorer wellbeing in caregivers when compared to non-caregivers.
Limited social supports and formal services in rural areas, compounded by the pandemic and bushfires, have highlighted the importance of digital platforms in maintaining social connection and wellbeing. This mixed-methods study used quantitative surveys and in-depth interviews to investigate the relationship between online social supports and/or in-person social supports with depression and burden for older rural caregivers.
Regression analysis techniques were used to explore the relationships between online and in-person social supports and the experience of burden and depression in older rural caregivers. In-depth interviews then provided insights into the specific aspects of social support valued by caregivers in rural areas, providing useful considerations for the development of interventions to address known issues of isolation and depression for older caregivers in rural Australia.
Samantha Chakraborty
No biography provided.
Variation in the provision of medical abortion in primary care in Australia
Aim: Abortion is an essential healthcare service. In Australia, early medical abortion (EMA) is available up to nine weeks’ gestation and can be delivered via telehealth or face to face. However, there are a number of system, provider and patient barriers to integrating EMA into primary care in Australia, which leads to variability in the availability of EMA services, particularly in rural and remote areas. We undertook a study to determine how EMA service provision varies across the Australian primary care landscape.
Methods: We undertook a cross-sectional study of Pharmaceutical Benefits Scheme (PBS) dispensing data for females aged 15–54 dispensed MS-2 Step® between 2015 and 2019 in each Australian Bureau of Statistics Statistical Area 3 (SA3). Standardised rates of MS-2 Step dispensed were calculated for 2019 stratified by state and level of remoteness.
Results: In 2019, while dispensing rates of MS-2 Step were greatest in inner regional, outer regional and remote parts of Australia, at 7.2 prescriptions dispensed per 1,000 women, approximately 30 per cent of women across Australia lived in an area where no general practitioner (GP) provided EMA services, and 27 per cent lived in an area where no community pharmacy dispensed MS-2 Step.
Relevance: While rates of MS-2 Step prescriptions are higher in regional and remote areas compared to major cities, there remains a large proportion of areas where there is no GP or pharmacist provision, suggesting local access is limited in many rural and remote areas.
Conclusion: The higher dispensing rates in regional and remote parts of Australia may in part be explained by telehealth provision and by the lack of surgical abortion options in these areas. However, there remains a large proportion of areas where there is no local GP or pharmacist provision of EMA. Greater attention must be given to supporting local primary care providers, including GPs and community pharmacists, to deliver EMA in their own communities.
The ORIENT study: improving access to long-acting reversible contraception and medical abortion
Aim: Ensuring access to contraception and abortion services is a priority of the National Women’s Health Strategy 2020–2030. Women in rural and remote areas often experience difficulties in accessing long-acting reversible contraception (LARC) and medical abortion services. Extending the scope of practice nurses using innovative nurse-led models and task-sharing could help to overcome some of the access issues. While such models exist in community health and family planning settings in Australia and internationally, they have not been developed or evaluated in general practice. The ORIENT study aims to increase access to LARC and medical abortion for women in rural and regional Australia, through implementing an innovative nurse-led model in primary care.
Methods: ORIENT is a five-year pragmatic, stepped-wedge, cluster randomised controlled trial. We will co-design, implement and evaluate a nurse-led model of care that includes contraceptive implant insertions and use of telehealth to support LARC and medical abortion. Thirty-two general practices will be recruited. Online training, educational outreach through academic detailing, and a virtual Community of Practice will be utilised to support implementation. The evaluation will include changes in rate of LARC and MS2Step prescribing, and a cost-effectiveness analysis of the intervention compared to usual care.
Findings: It is anticipated that broadening the scope of practice nurses to provide LARC and medical abortion services in general practice will increase LARC uptake and access to medical abortion for women living in rural and regional areas of Australia.
Relevance and conclusion: The ORIENT study will equip practice nurses with the resources, networks, knowledge and skills to increase the delivery of LARC and medical abortion in rural and regional areas. This has the potential to decrease unintended pregnancies and improve reproductive health outcomes for this priority population in Australia.
Brett Chambers
Mr Brett Chambers is a clinical pharmacist with over 10 years’ experience in rural and remote hospital pharmacy. Brett has a keen interest in health projects, ehealth and research, and previous roles include implementing an electronic medication management solution. Brett has coordinated the development and implementation of a virtual clinical pharmacy model of care and worked with health researchers on the evaluation framework. Brett was recently acknowledged as Emerging Researcher of the Year 2020 by the Western NSW Health Research Network.
Rural health services' experience of a virtual clinical pharmacy service
Background: Many small rural and remote hospitals do not have routine access to pharmacy services and medication management is undertaken by doctors and nurses. To support the quality use of medications, a virtual clinical pharmacy service (VCPS) was implemented to eight hospitals. The pharmacist uses the electronic medical record, electronic medication management and a wireless teleconferencing cart to provide medication reconciliation, medication review, patient counselling, advice on prescribing, and administration and staff education. The uptake of telehealth services is reliant on local healthcare staff who can be challenged by new models of care, technology, re-organised tasks and changes to processes.
Aim: To evaluate staff perspectives of a new virtual pharmacy model of care and identify potential areas for improvement.
Methods: Focus groups were conducted with doctors, nurses, allied health and pharmacists at each hospital via videoconference. The focus groups were held at least three months after the implementation, to provide adequate time for staff to attain a working knowledge of the service. Focus group discussions explored issues, benefits and barriers. Data was transformed using thematic analysis informed by Appreciative Inquiry to focus on the strengths of the service and identify further improvements.
Results: Fifteen focus groups were conducted between July 2020 and April 2021 with a total of 67 staff. The study identified key themes including benefits to patients through access to specialist medical knowledge, improved staff confidence and safety in medication management, and enhanced compliance with accreditation standards. Challenges identified included communication and coordination. Key factors for maintaining and scaling up the virtual services were identified and will be discussed.
Discussion: The VCPS brought a positive, collegiate culture regarding medication management. Healthcare staff felt the VCPS worked well overall and saw it as an efficient way to increase access to healthcare services for smaller rural and remote hospitals.
Shellander Champion
My name is Shellander Champion and I am a proud Adnyamathanha, Kuyani, Mirning and Kaprun woman, currently living in Port Augusta, South Australia, on Bangarla country. I am the provider for my family and a mother to a young boy living with Autism.
My son is my world and the reason I am where I am today. He has taught me so much and is the reason I have a fire in my belly to make sustainable and long-term change for our Mob in the disability space. My son was one of the first trial participants for the NDIS back in 2013 in South Australia. He has now been on the Scheme for 10 years and, during this time, I have worked across the government, non-government and Aboriginal Community Controlled sectors supporting families to have better access to the NDIS and disability services.
I am currently studying a Certificate IV in Indigenous Leadership through my current role as the Systems Implementation Coordinator with the South Australian West Coast ACCHO Network (SAWCAN). SAWCAN is a consortium of five Aboriginal Community Controlled Health Organisations (ACCHOs) along the Eyre and Far West Coast of South Australia. My role is to build the capacity of the workforce across each of our ACCHOs to improve access and broader knowledge and education around the NDIS. I do this by facilitating local workshops, conferences and training sessions to Mob that break down the complex government policy into practical ways of working that align with Aboriginal and Torres Strait Islander ways of doing, being and knowing.
My goal for the future is to embed long-term change in the government systems so that Aboriginal and Torres Strait Islander programs and services are driven and led by Aboriginal and Torres Strait Islander people because only we know how to best deliver these to our Mob.
NDIS Ready: supporting rural and remote ACCHOs on their NDIS journey
The National Aboriginal Community Controlled Health Organisation (NACCHO) is the national peak body representing 143 Aboriginal Community Controlled Health Organisations (ACCHOs) nationally on Aboriginal and Torres Strait Islander health and wellbeing issues. Our membership operates more than 450 clinics which contribute to improving Aboriginal and Torres Strait Islander health and wellbeing through the provision of comprehensive holistic primary health care, and by integrating and coordinating care and services, including for disability.
The NDIS Ready: Aboriginal and Torres Strait Islander Market Capability Program (NDIS Ready) recognises the additional barriers ACCHOs face in registering and delivering services sustainably under the NDIS. In line with the National Agreement on Closing the Gap, NDIS Ready demonstrates the ability for government and the community controlled sector to work together in genuine partnership to develop the capability of the community controlled sector to deliver culturally appropriate disability services to their communities.
NDIS Ready is underpinned by four key initiatives, all designed to develop and promote the capability of ACCHOs and their communities to understand and sustainably deliver NDIS services:
- NDIS Ready project officers situated in each jurisdictional affiliate
- a targeted grant round
- a communications Initiative
- consultation through a series of Yarning Circles.
There are challenges for all ACCHOs in transitioning to and sustainably delivering NDIS services. However, for rural and remote ACCHOS, the challenges of delivering NDIS services to their communities are often exacerbated by their remoteness and the vastness of their service footprint. NDIS Ready is designed to support all ACCHOs and through its four initiatives will start to address the unique or additional challenges faced by rural and remote ACCHOs. This oral presentation will discuss:
- how the four initiatives of NDIS Ready can help address some of the challenges of NDIS service delivery for rural and remote ACCHOs specifically
- the importance of programs which improve the capability and sustainability of rural and remote ACCHOs and their communities, like NDIS Ready
- identifying and developing next steps to support rural and remote ACCHOs on their NDIS provider journeys.
Catherine Clarke
Catherine Clarke is the Allied Health Manager, based in Cooktown. She has been living and working in the Torres and Cape area for six years. Catherine is an occupational therapist by profession and manages a team of eight allied health professionals who provide services to the eastern cluster of Cape York. The team are generalists who support people across the life span and within various environments.
Living remotely provides opportunities for service growth and development; it is important to work as a team and be flexible to meet the needs of the community. Working with Indigenous families to improve health is the primary focus; each member has their important role to play in that journey. There are plenty of challenges which makes life interesting, and the payoff of to live somewhere amazing is worth every minute.
Developing Healthcare in the Home for rural and remote Far North Queensland
Relevance and aims: In 2020, Queensland Health funded an initiative to develop a home-based model of care to safely reduce Torres and Cape Hospital and Health Service (TCHHS) episodes of in-hospital care in rural and remote areas of Far North Queensland. While home-based models of care have been established for years in many areas across Australia, the context within the region serviced by TCHHS required a customised approach given the unique community needs, geography and healthcare settings. This presentation provides details on the development of this model of care and provides insights for other healthcare services operating in rural and remote areas.
Methods: Initially a Steering Committee was established to oversee and design the required model of care. This committee was chaired by the Executive Director of Allied Health and included representation from nurses, allied health practitioners and Indigenous health workers from within the region. A decision was made early on to name the model of care Healthcare in the Home (HITH) to reflect the nature of work in providing alternatives to hospitalisation and empowering people to better manage their own care. The model is now embedded as usual care.
Results: Three sites were chosen according to their geography and ability to rapidly establish and support a broad range of community services: Bamaga, Cooktown and Weipa.
A HITH Coordinator role was initially established to assist in customising HITH for each site based on existing staff resources and specific health needs of the community. The HITH model of care commenced with establishment of a workforce of six allied health assistants (mostly Indigenous). Certificate IV training was provided twice in Cairns and a support clinician facilitated the learning. The workforce was arranged in pairs as a buddy system for each site.
Training was also provided for allied health teams at each site to facilitate competence and confidence in delegating work responsibilities to allied health assistants. The HITH model of care has now expanded to include allied health practitioners, nurses, health workers and administrative staff.
Indigenous allied health assistants and health workers have played a vital role in improving appropriateness of care, health literacy, cultural safety and compliance with care.
Conclusions: The HITH model of care can be customised to operate as an extension to existing health services in rural and remote communities.
Key Message: HITH is a viable hospital avoidance strategy in selected rural and remote areas of Far North Queensland.
Jude Cobb
Ms Jude Cobb is the Customer Engagement Officer in the Video Call team at Healthdirect Australia and works with health services to onboard clinics, train staff and provide up-to-date content in our Video Call Resource Centre library. Jude is passionate about video telehealth and believes all Australians should have equal access to health care, no matter where they live or their circumstances. Jude is an experienced telehealth specialist and presents regularly in various communities of practice, listening to health services’ needs and providing support and information. Jude is also an experienced teacher and trainer and runs regular training sessions and workshops designed to share knowledge about telehealth and the Healthdirect Video Call service.
Video telehealth: enabling the delivery of mental health care to rural communities
Mental illness affects one in five (20 per cent) of Australians aged 16–85 in any year and almost half of all Australians will experience a mental illness in their lifetime. Around seven million people live in rural and remote areas and face unique challenges due to their geographic location, with often poorer health outcomes than people living in metropolitan areas. Therefore, rural and remote communities are more likely to struggle to access the right mental health support as fewer mental health services are available.
Telehealth has been a key enabler for access to services in rural and remote communities and crucially, as we have seen during the COVID-19 pandemic, in maintaining access to care while under restrictions (lockdown).
Video consultations are the next best thing to having a patient in the consulting room as they enable clinicians to observe and interact with patients in ways not possible over the phone. The May 2021 Medicare Benefits Schedule telehealth summary reported mental health consultations accounted for 18 per cent of all telehealth services (n= 203,000) and, of that, seven per cent were conducted by video.
During the financial year 2020–21 COVID-19 pandemic, the Video Call service delivered over one million consultations in total across Australia, with over 1,200 new mental health clinics onboarded across primary and tertiary health sectors. Mental health clinics currently account for 15 per cent of all clinics using our service.
Case study: headspace has been a huge adopter of video consulting to deliver essential services to young people in rural and remote communities. headspace has seen an increase in the number of young people accessing their services during the pandemic response, especially from rural and remote areas. During the period 1 January to 31 July 2021, headspace services undertook over 6,600 Video Call consultations. This has bridged the social distance gap for those clients in rural and remote locations and has kept young people connected to their mental health service provider.
The Healthdirect Video Call service has been a key enabler to ensure continuation of service delivery.
This presentation will further outline headspace’s use case in our service and show how this model can be used effectively by other service providers in the mental health sector, especially in rural and remote areas. It will outline clinician experience in the use of Video Call for delivering mental health services and feedback from rural and remote patients using telehealth to manage their mental health.
Richard Colbran
Richard Colbran has held senior executive roles in health and social services charity organisations for close to 20 years. He is currently Chief Executive Officer of NSW Rural Doctors Network. He is an experienced senior executive of state and national non-profit organisations. Richard is a strong advocate for social leadership and has a professional interest in building contemporary business practices of NFPs to enhance the sector’s impact and benefit for communities. He has a commercial background in strategy, partnerships and program management, and values multi-agency and community collaboration that brings together strengths and competency of each partner for mutual benefit.
Building capability: using technology to bridge social distance
Background: It is well known that a high-quality, sustained health workforce contributes to a healthy population. However, health workforce retention continues to be an ongoing challenge for rural health. It is posited that improving a rural health practitioner’s capability could help to retain them working rurally for longer. With rapidly increasing access to, and use of, digital technology worldwide, there are new opportunities to build capability for those who are working in rural and remote areas.
Purpose: To explore important factors in building a health professional’s capability, including digital solutions to retain them longer in a rural location.
Method: In 2021, an evaluation of [name of platform], a popular digital platform that connects health professionals and organisations interested in rural health, asked members about the factors that impact on health workforce capability. Additionally, semi-structured interviews were conducted in rural NSW with 13 GPs and allied health professionals. Thematic analysis was used to analyse the data and themes identified were mapped to an overarching Framework.
Results: The ‘Framework for building Health Workforce Capability through using digital technology’ identifies elements of health workforce capability, cues to action, and benefits and barriers to using a technology solution to support rural health workforce capability. Whilst it could be assumed that low technology literacy would act as a barrier to the use of digital tools, this was not a significant factor in impeding participants’ willingness to adopt digital tools when social and professional networks weren’t available to them face to face. Capable people felt connected to others professionally and were recognised members of their community. They had access to education, training and supervision. Similarly, 56 per cent of the survey respondents said engagement with others on [name of platform] made them feel more capable in their role, suggesting this platform is an important part of the solution to building rural health workforce capability.
Challenges: That we understand what is needed in a digital or technology solution to help rural health professionals build or maintain their capability. To ensure rural health professionals are aware of digital for self-management when their rural circumstances prevent other forms of support.
Implications: The Framework may guide health workforce planners, HR professionals, policymakers and app designers in developing technical solutions. Understanding the factors that make up a health professional’s capability and the cues to maintain their capability may help to strengthen technical solutions to support health workforce capability.
Integration of Australia’s healthcare system: lessons learned
Background and aims: The Parliamentary Inquiry into Health outcomes and access to health and hospital services in rural, regional and remote New South Wales (the Inquiry) is examining the provision and availability of health services in non-metropolitan areas. Reporting and recommendations coming out of the Inquiry, as well as the submissions and associated transcripts, constitute a rich source of data for those working to support rural health. This study identified key themes to determine how they inform key collaborative initiatives addressing health access and equity across regional, rural and remote New South Wales from a health workforce perspective.
Method: [Organisation] selected 81 pieces of the most relevant data from the Inquiry (70 submissions, five transcripts and six sets of supplementary questions). These submissions were largely made by advocates (organisations, unions, government, peak bodies) and consumer groups. The main issues or recommendations in each transcript were themed and counted.
Results: Amongst other key themes that will be reported, a desire for health system integration at the local, state and federal levels, to help navigate Australia’s often fragmented health system, strongly emerged from the transcripts. It is also a draft recommendation in the Primary Health Reform Steering Group. Fragmented approaches reduce health workforce capability and the capacity of the health system to provide continuity of care, which leads to untimely access to care, the delivery of poor-quality services, duplication and inefficient use of resources.
We will present insights into how integration of parts of the health system and levels of government can be achieved through existing initiatives, such as the innovative Collaborative Care program funded by the Australian Government. This is a community-centred approach to addressing primary healthcare challenges in remote and rural NSW that can be implemented more broadly.
Challenges: To break down healthcare silos to address remote and rural workforce recruitment and retention, workforce capability, health service financial sustainability and continuity of care.
To create a system’s view and increase collaboration between governments and local stakeholders. This relies on learning the lessons from approaches that aim to bridge the social distance.
Implications: A strong commitment to collaboration and innovation is central to addressing the problem of our complex and fragmented health service. If we are to create better access to health services for rural communities, we must play a strong advocacy role in relation to policy, strategies and approaches that aim to break down the siloed approaches.
Amanda Collings
Ms Amanda Collings started her nursing career in 1984 as a student nurse at The Royal Melbourne Hospital. Since that time she has worked full time continuously to the present day. She has held many different positions working remotely, regionally and in metro. Her principle area was in perioperative services but she commenced working in projects 12 years ago and enjoys the many and varied things that come across her desk in this role.
Transitioning telehealth into a sustainable model of care: where is the evidence?
The aim of this study was to evaluate the implementation and impact of widespread telehealth by all relevant departments and disciplines at Bendigo Health, during the COVID-19 pandemic.
Specific research questions explored were:
- What is the human experience (staff and patients) of widespread telehealth use?
- What triage criteria and business rules were used to support decisions regarding telephone, video or in-person consultations and why?
- What are the costs versus benefits of the scaled up telehealth service?
The COVID-19 pandemic significantly increased the use of telehealth, defined as ‘the use of telecommunication technologies for the purpose of providing a clinical consultation with a patient’. One of the main drivers of this change was the need to provide health care to our community while adhering to the ‘stay at home’ rules. This initiative and subsequent study has provided an opportunity to analyse what was learned from this experience and ascertain what changes we should keep in place.
For this study, questionnaires were developed for consumers, clinicians and administration staff.
Focus groups were also held via videoconferencing for both clinicians and administration staff to delve further into the lived experience and gain an understanding of issues that may impact upon sustainability of telehealth services.
We received responses from 468 consumers (303 telephone and 165 videoconference), 157 clinicians and 22 administration staff.
This presentation will discuss the findings from this initiative and share the learnings and recommendations developed as a result of this study.
Eliza Collins
Eliza Collins, Bachelor of Oral Health (BOH), is an oral health therapist who has an interest in Aboriginal oral health. After completing a graduate-year program with Poche in Boggabilla, Eliza decided to begin her research journey by undertaking a BOH Honours degree program. This paper presents her Honours research.
This project is supervised by Ms Tracey Hearn (MPH), proud Yorta Yorta woman and Manager of the Oral Health Centre at Rumbalara Aboriginal Cooperative in Victoria, and Professor Julie Satur (Dip Appl Sci DTherapy, M HSci, PhD), Director of Engagement and Indigenous Programs at the University of Melbourne Dental School.
Consulting the Rumbalara Aboriginal community about their oral health
The legacy of colonisation, assimilation policies, racism and victim-blaming approaches to health have created inequality in health for Aboriginal people that is reflected in their oral health status. Rumbalara Aboriginal Cooperative (RAC) provides health and community services, including dental services, to around 2,000 Aboriginal and Torres Strait Islander people living in rural Victoria. Despite the development of the emergency dental program into a comprehensive dental service, oral disease levels are of concern and access to care appears not to be meeting community need. The aim of this study is to consult the Rumbalara community about their oral health to understand their lived experiences with oral health and dental services and the barriers and enablers for oral health.
Methods: Using an Aboriginal and Torres Strait Islander knowledge framework and co-designed approach, this study consulted the Rumbalara community about their oral health. Following ethics approval from the University of Melbourne and engagement with the community, 20 Aboriginal people (aged 19–61 years) participated in digitally recorded semi-structured interviews and yarning circles in a setting of their choice. Transcripts were de-identified and returned to participants for verification prior to thematic analysis. A community mentor was involved in the study throughout to ensure cultural rigour and validate interpretation of the data.
Results: Themes emerging from the data included the importance of community-centred services, fear of dental treatment, shame, communication, trust and clinical dental experiences dominated by deficit perspectives.
Discussion: Experiences of dental care had often been related to pain driving attendance, resulting in experiences that multiply fear and anxiety. While community-based care was considered a strength, the approach to individual dental advice and care often resulted in increasing shame and diminishing trust. Increasing participatory approaches to delivering dental care may increase engagement and trust, and develop critical oral health literacy.
Conclusions: The study has identified important gaps in cultural and clinical understanding between the community and dental service providers. These findings will be returned to RAC and used to inform the delivery of oral health and dental services, and to develop oral health promotion programs at RAC and cultural safety preparation for student dental practitioners, to enable Aboriginal and Torres Strait Islander people to increase control over their oral health.
Christine Connor
Christine Connor is a senior primary healthcare nurse from Inverell, New South Wales.
Christine has been employed in the nursing industry for close to forty years, working in all areas of health from the hospital setting to community health and educating school children.
Delivering health messages in small communities: thinking creatively and locally
Each year, four primary healthcare nurses deliver health promotion activities to small towns and villages in an area spanning fourteen local government areas, and covering over 99,100 square kilometres. These small communities face numerous barriers to accessing health services and information – including isolation, lack of transport, poor internet access, higher than state and national levels of chronic disease, and low health literacy. Added to these challenges are those of recent drought, bushfires, mouse plague and the uncertainty of the COVID-19 pandemic. This program relies on the support and funding of our local primary health network.
In 2020–21, 1,545 people attended 215 health promotion activities in 59 towns and, of those, 176 identified as Aboriginal and/or Torres Strait Islander. These events lead to increased general practitioner (GP) appointments, increased health screening and improved access to services. We rely on meaningful community engagement and collaboration to deliver quality events.
Through trial and error, we have developed successful strategies and learnt the pitfalls in running community health promotion events. We use a variety of creative approaches to deliver important health messages.
We recently coordinated 14 comedy shows in 14 bushfire-affected communities – empowering communities to remain connected and to enjoy a laugh and meal. These events include important health messages and the opportunity to chat informally to trained staff. Communities talk about these events for months, and the feedback is positive.
On World Kidney Day in 2019, in a small community of a few hundred people, 62 rural women gathered to hear talks on the importance of screening for kidney disease. Forty health checks were completed and many women subsequently made appointments with their GPs to discuss their results. We also discussed cancer screening and the various financial supports available to rural people.
Feedback from a local GP, following a men’s night in a small community, confirmed GP appointments increased by over 30 per cent following our event.
We also deliver health activities in small rural schools, recognising that health messages, including oral health, are important for all age groups. Other topics we deliver include bush kids’ first aid, farm safety and cooking. Some of these schools have only a handful of children.
This unique program is delivered by local nurses and their partners, who are passionate about the health of their small rural communities. Through health promotion activities, important health messages reach rural people and are delivered in a way that is meaningful and responsive to community needs.
Meredith Connor
As Future Workforce Team Leader for Health Workforce Queensland, Meredith has the privilege of developing and delivering rural immersion programs and activities to university health students across Queensland.
Future workforce programs are strategically designed to connect health students with future placement and employment opportunities while establishing strong links with rural health professionals and services to progress student rural career journeys. One such program is GROW Rural, a highly regarded three-year longitudinal health student program that runs cohorts in three Queensland Primary Health Networks (PHNs).
Underpinning the ethos of GROW Rural is generating a group culture reflective of the team-based approach and collaborative practice which defines rural health care. The sense of community generated within the student group over the three-year program is enhanced by scenario-based skill sessions with local health professionals, ongoing interaction with GROW Rural communities through involvement in community-led events and enjoying rural hospitality as billets.
This collaborative approach is also extended to how we work with participating communities, service providers and health professionals, all of whom actively contribute to the program’s development and facilitation. Importantly, GROW Rural’s whole of community approach encourages and gives rural communities the opportunity to participate in growing their region’s future workforce.
Outside of work Meredith spends most of her time training and recovering from triathlons.
GROW Rural: evaluation of an innovative interdisciplinary rural immersion program
Background: There is increasing importance placed on efforts to ‘grow your own’ health workforce to build health workforce sustainability in remote/rural communities. Despite university activities to support this, opportunities for undergraduate remote/rural placements remain limited, especially for allied health/nursing students, with placements not always focused on rural lifestyle experiences. It has also been difficult to model the interdisciplinary health teams required in smaller communities. This prompted Health Workforce Queensland to implement a pilot immersion experience, GROW Rural (GR). GR is a unique co-designed program to facilitate three-day interdisciplinary immersion experiences for undergraduates. With a focus on interdisciplinary clinical experiences, rural lifestyle and networking, the program visits the same communities over three years.
Method: Networks established by a senior health practitioner were activated across three physically close communities in central Queensland: a mining community; a farming community; and an Aboriginal and Torres Strait Islander community. A planning committee was formed in 2017 comprising health leaders and community members to co-design activities for the first year. GR was promoted to students through social media networks. Student selections were based on written application and interview. Medicine, nursing/midwifery and allied health students were eligible. Following the first GR, two students were elected to the planning committee. Online evaluations were undertaken after each weekend, including an overall evaluation in 2019.
Results: There were 30 undergraduate student participants, 15 from medicine and 15 from nursing/midwifery and allied health. Overall student and community participant ratings at the conclusion of the three years were positive. Student ratings indicated that GR had promoted interest in rural practise and positively impacted rural practise intentions. Community ratings indicated that GR was viewed positively and had had an impact on student future rural career intentions. Other positive outcomes included some students organising university placements through GR networks. Of the 15 students who have entered the workforce as of July 2021, seven (47 per cent) were working rurally.
Conclusion: GR provided undergraduate health students a unique and positive glimpse into the possibilities of future careers as rural practitioners through an interdisciplinary immersion experience. Early conversion rates of students into rural practitioners were extremely positive. The impact on rural communities has also been positive and provided a mechanism to ‘grow’ the future workforce and showcase what their communities had to offer the future practitioners. The co-design approach has provided a unique method to facilitate a program supported by health students and the rural communities involved.
Cath Cosgrave
Cath is a social scientist and qualitative researcher with internationally recognised expertise in the field of rural health workforce and community development. Cath is committed to strengthening the evidence base to support policy and practice changes to address rural access inequities and resourcing challenges and to support rural communities to become thriving places. She believes that effective rural solutions must be place-based and has extensive experience working in partnership with health services, local councils and community services/groups to develop person/community-centred, strength-based solutions. Cath has extensive evaluation experience in process and outcome evaluation including formulating logic models and developing results frameworks.
A novel whole-of-community strategy for addressing wicked rural health workforce problems
Attract, Connect, Stay (ACS) is a two-year philanthropically funded project. ACS addresses chronic rural health workforce shortages through the application of a strategy for rural communities to self-fund, establish and sustain a Health Workforce Recruiter & Connector (HWRC) position. The main outcome of the ACS project is the creation of a tested blueprint (instruction guide with tools and resources) for other Australian rural towns to utilise to create and sustain their own HWRC.
The HWRC’s role is to successfully attract health professionals (allied health, doctors and nurses) who are a ‘strong fit’ for rural health services (private/public, primary/tertiary) as well as for the local community. A core focus of the HWRC is to provide tailored support to newly recruited health workers and their family members with settling in, making social connections and to thrive in-place (including employment support for partners).
The HWRC was originally developed ten years ago in Marathon, a small rural town in Ontario, Canada. Since then, the position has been continuously funded and managed by a consortium of representatives from local health services, local government and business stakeholders. Outcomes from having a dedicated health workforce recruiter and connector include the successful attraction and retention of a broad range of health professionals.
In August 2021, after extensive community consultations followed by an expression of interest process, three local government areas in north-western New South Wales were selected to pilot the establishment of a HWRC position in Australia. Through a co-design workshop process, the three communities were supported to self-fund, establish and sustain a HWRC. The workshops focused on:
- developing a governance and management structure
- collecting baseline health workforce data
- establishing measures of success
- sustainability planning.
Once the positions were recruited, a digital network was established between the communities and the HWRCs to provide support and share learnings. In 2022, the project was extended into Victoria and elsewhere in New South Wales to test the applicability of the blueprint for other rural towns.
The blueprint was developed by the project implementation team using continuous quality-feedback cycles. An external evaluation was undertaken alongside the implementation to capture processes and mechanisms to support the refinement of the blueprint and measure the impacts and outcomes of both the blueprint and HWRC positions.
This presentation presents project findings, highlighting the effectiveness and that HWRCs are critical health workforce infrastructure. It presents rural communities with a way forward that engages the whole community and is strengths-based.
The Teen Clinic: removing barriers to primary healthcare access for rural youth
Young people in rural Australia have limited access to health care and are at increased risk of poor health outcomes. The Teen Clinic model was developed to increase healthcare access for school-aged young people (12–18 years) living in small rural towns (less than 5,000 people). Developed by the Bega Valley Medical Practice (BVMP), Teen Clinic began operating in 2015. It now operates in five other medical practices throughout coastal southern New South Wales and far-eastern Victoria.
Nurse-led Teen Clinics apply a free, early intervention approach to care coordination. Nurses serve as a soft-entry point to the medical practice where young people are triaged, screened and/or health education is provided. Support is provided for a wide range of medical and non-medical issues including sexual and mental health concerns. Nurses can refer patients to general practitioners and/or other providers as needed.
The Teen Clinics have been implemented over time and are at various stages of maturity, they present a significant opportunity to reflect on how context and time impact on delivery and performance of the care model, including youth and community buy-in.
Working with the six medical practices operating Teen Clinics, researchers from the University of New England and the University of Newcastle designed and undertook a process and outcome evaluation of the Teen Clinics. The evaluation was philanthropically funded by the Foundation for Rural & Regional Renewal with additional financial support by the BVMP.
The evaluation’s purpose was to ascertain: (i) community perceptions on the key deliverables and benefits of having the Teen Clinic service operating in their town and (ii) what is working best for whom, in which sites, why and when.
Data collection included: interviewing representatives from community groups, organisations involved with local youth and staff from the participating medical practices; and anonymously surveying youth concerning their access and user experience.
This presentation will focus on the key findings on community perceptions of the value of the Teen Clinic model in supporting young peoples’ health/wellbeing needs, how it works in different settings and the viability of replicating the model in other rural towns.
Jacqueline Cotton
Dr Jacquie Cotton is a Lecturer and Researcher in Rural Health for Deakin University School of Medicine. She lectures and chairs the units HMF701 Agricultural Health and Medicine, and HMF702 Healthy and Sustainable Agricultural Communities. She has completed a Graduate Certificate in Higher Education and is involved in development of curriculum and assessment within the Graduate Certificate of Agricultural Health and Medicine. She has multidisciplinary scientific and industry expertise, in particular translational research within human population health, occupational health and safety, agrichemical exposure and culture/behaviour change. She is a member of both the Victorian Farmsafe Australia committee and the recently formed Agriculture Safety Reference Group established by WorkSafe Victoria.
Farmer HAT: empowering health, wellbeing and safety practices online
Introduction: Geographic isolation, limited availability of services and a heavy seasonal workload can all prevent farmers from actively prioritising their health, wellbeing and safety. However, we also know that farm men and women are interested in taking a proactive role and ownership of their own health, wellbeing and safety. The Farmer Health Assessment Tool (Farmer HAT) has been developed in collaboration with farmers and service providers as a way of overcoming these barriers – enabling farmers to identify their individual risks and empowering them to take control of their own health, wellbeing and safety.
Farmer HAT is a free, secure online self-assessment tool developed to promote a safe farming culture and healthy personal behaviours without leaving the farm. Farmer HAT can be completed by individuals or by farming groups to stimulate relevant discussions and promote collective action. Farmer HAT involves a series of questions about health, wellbeing, lifestyle behaviours and farm safety practices. Using a traffic light system, Farmer HAT provides rapid feedback and presents targeted information and resource material to address identified risks and improve personal health, wellbeing and safety practices – and ultimately (and important for farmers) support the health of the farming business. Users can save, download and print results and track their self-assessment results over time – showing improvement, maintenance or decline in health, wellbeing and safety indicators. Farming groups can also engage in the platform and discuss/take action on the group results through their nominated group leader. A pilot program and evaluation of Farmer HAT was recently conducted.
This presentation will provide further detail about the co-development of Farmer HAT with industry, demonstrate how the tool can be used and report findings from the evaluation of the pilot program.
Gear Up for Ag™: engaging youth to shift farm health and safety
Background: Using a collaborative and interactive approach, Gear Up for Ag™ was developed to provide young adults with evidence-based safety information about a range of agricultural health and safety topics. Partnering with the Ag Health & Safety Alliance (US), the National Centre for Farmer Health adapted the Gear Up program for use in Australia. Students participate in discussions and demonstrations about practical health and safety strategies, including correct usage of personal protective equipment (PPE). Students are empowered to adopt safe behaviours and practices and influence safe practices on the farm, at home and in their future workplace.
Aims: Gear Up for Ag™ aims to influence agricultural safety culture by engaging with students in a practical and interactive way, to build their understanding of common agricultural hazards, improve understanding and knowledge about their impact, and ways to mitigate safety risks.
Methods: Pre- and post-program surveys were developed based on Kirkpatrick’s four-level training evaluation model. Data was collected between February and June 2021 (n=120 students across eight rural Victorian locations). Data is collected using Qualtrics and completed as a classroom activity. The pre-program survey is completed two weeks prior to onsite delivery of the education session and the post-program survey three to six weeks after the session. This program has been assessed and approved as a quality assurance activity by Deakin University.
Results: Baseline data identifies the program is effectively reaching the target population – with over 73% of participating students currently assisting or working on farm, 77% reported working on farm before the age of 15 and 76% plan to work in agriculture.
Initial analysis of post-program surveys show improvements in student safety knowledge, attitudes and behaviours including: 96% of students have improved knowledge of farm hazards, 57% say that the program has influenced their own farm safety behaviours, 97% report improved understanding about why respiratory protection should be worn, with 76% now using a disposable P2 dust mask in appropriate situations, and 91% have a better understanding of how rollover protection devices on quad bikes can protect the rider.
Discussion/conclusion: The program – tailored to the needs of agricultural students – improves understanding and knowledge to positively influence farm safety behaviours and practices. This is central to decreasing the incidence of injury and fatality on Australian farms and building a workforce that understands the importance of their own health, wellbeing and safety on the farm and at home.
Anna Couch
Anna Couch graduated from La Trobe University in 2014 with a Bachelor of Health Sciences/Master of Podiatric Practice. She completed her graduate year at the Royal Melbourne Hospital working as a member of the Diabetic Foot Unit. Anna now works as a podiatrist at Peninsula Health and is completing a Doctor of Philosophy at Monash University.
Anna has worked on multiple projects across her different employment settings. Anna’s key successes include integrating prescribing rights into the podiatry department at Peninsula Health and her role as Research Assistant of the PAIGE: Podiatrists in Australia Investigating Graduate Employment study.
Recruitment and retention of Australian podiatrists: an online survey
Introduction: The podiatry workforce has demonstrated skills in improving health outcomes and quality of life for people who have complications of diabetes such as neuropathic foot disease, foot pain and vascular impairment. Appropriate and timely management of these complications can prevent lower limb amputations. Rates of amputation are higher for people living outside metropolitan settings, yet these are precisely the areas where there are long waiting periods and podiatry services are limited. The primary aim of this study was to describe factors relating to recruitment and retention of Australian podiatrists. Secondary aims included describing the differences between podiatrists working in metropolitan and non-metropolitan locations.
Methods: This was a cohort study of Australian podiatrists using data collected between 2017 and 2020 through an online survey. Qualtrics® software was used to collect data and all participants provided informed consent. Variables known to impact recruitment and retention including age, primary work setting, number of working locations, exposure to regional/rural work and access to professional development were described. Univariate and multivariate logistic regression models were used to determine factors associated with location of work (as a pseudo-measure of recruitment) and leave direct patient care or the profession entirely (retention).
Results: There were 1,127 podiatrists (20 per cent of 5,613 registered podiatrists) who consented to participate in at least one of the survey waves. Podiatrists who grew up in a regional/rural area were less likely to work in a metropolitan location, yet podiatrists who undertook a regional/rural placement were more likely to work in a metropolitan location. Podiatrists who indicated they were planning to leave direct patient care within five years were less satisfied with opportunities to use their abilities, were less satisfied with their working conditions, were more satisfied with their working hours, had less personal accomplishment and less job satisfaction. Podiatrists who indicated that they were planning to leave podiatry work entirely within five years were less satisfied with opportunities to use their abilities, agreed they had a poor support network from other podiatrists, had less personal accomplishment, less job satisfaction and did not have access to annual leave.
Conclusion: Podiatrists identified professional burnout elements, poor connection with the podiatry workforce and feeling their scope of practice was limited as associated with a desire to leave direct patient care. These factors were similar for those that indicated that they would leave the profession all together, with addition of no access to annual leave.
Fiona Crawford-Williams
Fiona Crawford-Williams is a research fellow in cancer survivorship within the Centre for Healthcare Transformation at the Queensland University of Technology. Following the completion of her PhD at UniSA in 2016, investigating the effectiveness of public health interventions to reduce alcohol consumption, Fiona has applied her expertise in psychology to research exploring the information needs of cancer survivors and their families, as well as health service research implementing alternative models of care. Fiona currently works in close collaboration with Cancer Council Queensland, in a cancer survivorship research program targeting individuals living in regional and rural Queensland.
Fiona is also an active member of the Clinical Oncology Society of Australia (COSA) Survivorship Group and is currently undertaking a research fellowship project to identify current cancer survivorship research priorities in Australia. As an early-career researcher, to date Fiona has published over 20 peer-reviewed publications, has a H-index of 8 and has received more than $18,000 in small grant funding.
Preferences for post-treatment follow-up care among rural Australian cancer survivors
Background: As treatments improve, cancer survivors are living longer and many continue to experience ongoing health concerns and late effects. Specialist-led post-treatment cancer care continues to be most prevalent; however, this places a high burden on the acute care system and has a focus on detection of recurrence or new cancers which may fail to comprehensively meet cancer survivors’ holistic supportive care needs. Specialist-led care delivered in acute care settings also presents a challenge for cancer survivors living in rural areas who must travel to major centres for medical appointments.
Aims: The present study aimed to engage with cancer survivors living in rural Queensland to gain their perspective on more effective ways to provide post-treatment cancer care. Further, the study investigated barriers and facilitators to different aspects of post-treatment cancer care.
Methods: Semi-structured interviews and focus groups were conducted with cancer survivors living in diverse rural and regional settings across Queensland, as well as local service providers including cancer nurses, community health workers, and peer-support group coordinators. Qualitative data were audio-recorded then transcribed verbatim and were analysed using thematic analysis techniques.
Results: Three major themes were identified including (1) information content and provision, (2) accessibility of services and (3) interactions with health professionals. Findings suggested that health information provision post-treatment was inconsistent particularly regarding diet and exercise; survivors’ individual needs and attitudes after treatment varied greatly; and that the quality of relationships with health professionals was a crucial aspect of satisfaction with care. A multidisciplinary care model involving general practitioners and specialist cancer nurses more heavily was preferred and may lead to better care provided closer to home. Telehealth options such as telephone support or video consultations were considered viable, but most cancer survivors did not value web-delivery models of care. Referrals to relevant community health services need to be tailored to meet individual needs.
Conclusions: The current findings have important implications for healthcare delivery as they identify gaps in the current provision of quality holistic cancer care post-treatment. The findings suggest that ongoing information and positive interactions with healthcare providers would facilitate improvements in satisfaction among rural cancer survivors. Importantly, suggestions for changes to cancer care which could better address cancer survivors’ needs were identified by a diverse group of cancer survivors and health professionals in local communities.
Linda Cutler
Linda Cutler is originally from Canada, beginning her career in Australia as a nurse working in Tasmania and Queensland prior to moving to New South Wales (NSW). She has worked in rural and remote NSW in both acute and community settings. Linda has worked as a frontline clinician, as well as a senior executive with NSW Health in the clinical setting and in rural health education and training. Several innovative programs which Linda developed during her time in education and training include: the NSW Rural Research Capacity Building Program; the NSW Clinical Team Leadership Program and Videoconferenced Nursing Grand Rounds initiative. Her career in the public health system, as well as experience in working with the Royal Flying Doctor Service, has provided a valuable frame of reference for her current role as the Director of the Western NSW Regional Training Hub. Linda is based at the University of Sydney School of Rural Health in Dubbo and, in her role, works directly with local health services and other key stakeholders to support medical students and doctors in training to pursue a rural medical career.
Medical workforce data: degree of difficulty 10
The Western New South Wales (NSW) Regional Training Hub (the Hub) partnered with the Western NSW Local Health District (LHD) and invited the Western NSW Primary Health Network and NSW Rural Doctors Network to collaborate on a comprehensive medical workforce description and analysis. The Western NSW Medical Workforce Analysis took over a year to complete, with the data collection completed by the Hub with input and assistance from the LHD. This analysis aimed to map the volume and distribution of medical professionals in the region, highlight areas of maldistribution or workforce shortage and model the workforce moving into the future.
To understand and communicate the nature of the workforce distribution across the region, a model was developed using a standardised approach. However, given circumstances in the western NSW region, which are not dissimilar to most rural areas, the evaluation team and the expert panel, through much consultation, developed an ‘adjusted head-count measure’ to standardise the variability of workload to a full-time equivalent (FTE) pro rata. This data was mapped against data sets including the Australian medical workforce data, NSW (total) medical workforce data and ratios, rural NSW (excluding metropolitan Sydney), and the northern NSW region.
The analysis identified the disciplines of priority shortage, as well as disciplines with no workforce resident in the region. Workforce was distributed unevenly across the region with a centralisation towards Orange and Dubbo and away from remote sites, which is now mapped and quantified for the first time.
There were a range of hurdles that needed to be overcome in gathering, collating, analysing and communicating the workforce data. This included the withholding of information due to privacy, difficulty collating accurate local data pertaining to western NSW and the nature of medical workforce in western NSW. In some instances, this information proved unattainable. The process was significantly impacted by the fact that the period for data collection coincided with the outset of the global pandemic (COVID-19).
Like any in-depth analysis, certain assumptions have been made and there are limitations and caveats related to the data and analysis. This presentation will focus on the challenges, including limitations, caveats and assumptions made to produce the report which provides a sound foundation on which to build collaborative work in improving medical workforce opportunities into the future. This work is instructive and helpful to other rural areas as they attempt to analyse their medical workforce for planning and other purposes.