Rheumatic heart disease (RHD) is a preventable condition and, since the 1990s, acute rheumatic fever (ARF) has occurred almost exclusively in the Aboriginal and Torres Strait Islander population, particularly in young people between the ages of five and 14 years. Many people are burdened by the disease throughout their lifetime, therefore people with ARF are susceptible to further episodes and with that comes the high risk of valvular damage (RHD). ARF and RHD are preventable conditions and, despite the medical advances in recent years, the associated benefits at population and community level have not been as evident in the Aboriginal and Torres Strait Islander population.

The 2020 ARF/RHD Guidelines recognise the cultural and structural barriers for Aboriginal and Torres Strait Islander peoples requiring evidence-based care. As professionals, we must understand the complex relationships between the social, cultural, political and economic situations in which people live. Centrality of culture and the importance of workforce is highlighted in the guidelines.

RHDAustralia has created the Champions4Change program in which people living with ARF and RHD, their family members, carers and health workers are able to share ideas and stories to inspire others to take charge and make a difference for themselves and their communities.

RHDAustralia Champions are utilising their local communities’ knowledge of culture and language to raise awareness about ARF and RHD in their community. Champions value the importance of positive patient experiences within the rural and remote primary healthcare settings such as secondary prophylaxis (BPG) administration. The Champions are involved in resource review and development; RHDAustralia promotes co-design of resources through Champions4Change workshops and engagement.

Introduction: General practice is the most common source of health care for people who use methamphetamine. The aim of this study was to explore primary care providers’ understandings of access to, and service utilisation by, this group.

Method: Semi-structured interviews were conducted with general practitioners, practice nurses, and alcohol and other drug service providers from two large towns in rural Victoria.

Key findings: Participants reported that availability (workforce shortages, time, complex clinician–client relationships), acceptability (stigma) and appropriateness of care (skill mix, referral networks, models of care) were associated with access to care for this population. Affordability of care was not perceived to be of concern.

Discussion: Availability of care is not enough to ensure utilisation and improved health outcomes among consumers who use methamphetamine. Provision of services to this group and to other substance-using populations requires the right ‘skill mix’ across and within healthcare organisations.

Implications for practice or policy: We need to move away from the ‘supply’ of health care alone. Instead, integrated models of primary care are needed to meet the needs of this population, particularly in rural areas.

The admitted stroke telerehabilitation project is a service innovation partnership between the WA Country Health Service and North Metropolitan Health Service, Osborne Park Hospital Stroke Rehabilitation Unit, that is improving access to specialist rehabilitation closer to home for country patients. As current activity-based funding (ABF) models do not support clinical service provision from metropolitan hospitals to patients admitted at country hospitals, identification of a sustainable funding model beyond the initial seed funding was a priority to maintain demonstrated positive patient outcomes.

A bespoke dashboard outlining key patient and system-level outcomes was developed to demonstrate the value proposition needed to leverage sustainable regional operational funding to support service continuance. The dashboard enabled reliable pre- and post-implementation comparison of patient outcomes between a control and study group at the regional hospital, demonstrating an improvement in quality of stroke rehabilitation care. A 23 per cent reduction in average length of stay for stroke rehabilitation was also observed in the study group (evaluation period 1/4/2018 to 31/12/2020), with associated net cost avoidance of approximately $80,310.

Modelling suggests the cost of providing this service from July 2021 will be relatively cost neutral and, with service set up costs already incurred, annual net cost avoidance is predicted to increase over time.

Following demonstration of service efficiencies and cost avoidance, the service transitioned from seed to regional hospital operational funding from July 2021.

Key learnings include:

1. Benefits of early engagement of data analytics team using custom evaluation tools to capture service efficiencies, to inform transition of other digital health service innovations from proof of concept to business as usual within WA Country Health Service.
2. Siloed approaches to health service funding can inhibit innovation where the ABF framework does not provide a clear provider (metropolitan) and patient (country) mechanism to support specialist-admitted service provision.

Aim: To promote engagement and design of maternity care stillbirth prevention resources for rural and remote health practitioners, to assist antenatal care decisions in limited-resource and/or remote maternity settings. Specifically, to adapt the Safer Baby Bundle (SBB) education and resource package to address issues facing rural and remote women, families and clinicians, to end preventable stillbirth.

Methods: The SBB is a national initiative recognising the government’s commitment to reduce late-gestation stillbirth (after 28 weeks) by at least 20 per cent. The SBB includes five elements of care that address smoking cessation, fetal growth restriction (FGR), decreased fetal movements (DFM), side sleeping and timing of birth. Partnering with CRANAplus, we are piloting and evaluating the SBB educational materials (Masterclass and Webinars) to ensure relevance in rural and remote contexts. Consultation will explore priorities of rural and remote health professionals and families, including targeted co-design with Aboriginal and Torres Strait Islander communities.

Relevance: Stillbirth is a serious public health problem with wide psychosocial, emotional and financial burdens on families and service providers. Women in rural and remote settings experience an intersection of multiple social inequities and an almost doubled stillbirth risk. Experiences of poverty, service access and health literacy contribute to an increased risk of poor outcomes in pregnancy and birth. Furthermore, in remote areas, 65 per cent of women identify as Aboriginal and/or Torres Strait Islander, who experience the highest rate of stillbirth nationally (14.6 per 1,000 births). Data on causes of stillbirth in this population indicate that many are preventable with improved care and community awareness.

Results: SBB education has been implemented into existing CRANAplus Maternity Emergency Care and Midwifery Upskilling courses and in CRANAplus magazine for dissemination to remote and isolated health professionals. Further engagement to embed this with remote tertiary education providers has also been initiated. Piloting and consultation of the SBB Masterclass to rural and remote clinicians commenced in December 2020 and is ongoing. Initial feedback has identified key areas requiring adaption for rural and remote antenatal settings include variations of the DFM and FGR pathways to reflect low-resource capabilities and inclusion of additional infographics for low-literacy individuals.

Conclusions: This project promotes community engagement and co-design in resource development to benefit rural and remote health providers and communities. This project will encourage women in isolated areas to engage in discussion of risk-reduction measures with their providers and will provide tools to healthcare professionals to reduce preventable stillbirth.

Introduction: Women in rural, regional and remote Australia experience unique challenges when accessing maternal health and gynaecological services (services), compared to counterparts in metro areas. There is evidence to suggest that these challenges result in the inequitable access of services in geographically isolated areas. This inequity extends to the availability of the obstetric and gynaecology (O&G) workforce, with notable O&G workforce shortages in rural, regional and remote Australia.

While these challenges are widely acknowledged, there is paucity of data on: (1) the type and acuity of services; (2) the O&G workforce composition; and (3) the barriers that impede effective service delivery across rural, regional and remote Australia.

Methods: We are conducting a mapping research project that aims to: (1) map the geographic distribution of services, O&G workforce, levels of service and population demographics in rural, regional and remote Australia; and (2) explore the perspectives of consumers on the facilitators and barriers they face when accessing the services.

The mapping research project is being piloted in Western Australia as:

• an observational cross-sectional study of rural, regional and remote hospitals that provide services. Clinical leaders will complete an online survey that covers the following themes: available services, current and proposed models of care, proximity to relevant services and workforce data
• focus groups with Aboriginal and non-Aboriginal consumers and non-birthing partners to explore the barriers that affect service provision and access in rural and remote areas, and how services might be made more effective and consumer focused
• an online mapping platform that will highlight population demographics and consumer service utilisation data.

We hypothesise that the mapping research project will provide a comprehensive overview of services across rural, regional and remote Australia, identify current gaps, and provide valuable information on emerging workforce, models of care, population trends and barriers to effective service delivery.

Results: Preliminary qualitative data from the observational cross-sectional study, focus groups and the interactive online population and service mapping will be presented.

Discussion: Findings from the mapping research project will be fundamental for service and workforce planning as they will help identify current service and workforce gaps, and provide targeted recommendations to improve maternal health and gynaecological service delivery. The recommendations will also be made to the project sponsor, the Australian Government Department of Health, and they will help support future service and workforce planning, and facilitate steps towards achieving equitable access for all women.

The Goulburn Valley Public Health Unit (GV PHU) encompasses eight local government areas in northern regional Victoria. The GV PHU COVID-19 Vaccination Program consists of six fixed vaccination sites, across five local government areas. The program expanded its model of care to include two mobile outreach buses: ‘Jabba the Bus’ and ‘Maxine Vaccine’.

These vaccination buses provided an alternative model of care by helping lessen barriers that people face when considering vaccination options. We considered issues such as geographical distance from a fixed site, transport availability (access and timetabling for both public and private), health literacy limitations, diversity within the population, and acknowledged the unforeseen everyday barriers that members of our community may face.

Collaborative relationships were established with community health organisation providers, fundholders of High-Risk Accommodation Response, and key organisations including the Ethnic Council of Shepparton and District.

Unexpected success factors included staff seeking opportunities to be rostered on the buses, overwhelming positive community interest, social commentary and media promotion – it far exceeded expectations.

The COVID-19 pandemic has had a profound impact on both patients and practitioners in the way in which they access and deliver services. In response to the pandemic the Australian Government introduced a range of changes to both the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). This included the introduction of a range of new MBS items to facilitate telehealth consultations (either by teleconference or videoconference) to reduce face-to-face contact for patients and providers, and the introduction of e-prescriptions. In addition, some service providers limited or ceased practice in response to outbreaks of COVID-19.

It is well recognised that there is variability in health service access and delivery across remoteness areas. There has also been variability in the impact of the pandemic depending on geography, with the majority of cases occurring in major urban areas.

This paper presents an analysis of the use of MBS and PBS services geospatially and over the pandemic period to date, with a focus on changes in service use and delivery during the various outbreaks and associated lockdowns.

Aims: This study explains the factors considered by people attending a regional emergency department (ED) for treatment of non-urgent health conditions.

Methods: Maximum variation sampling guided the selection of patients presenting to a rural ED with the following low-acuity conditions: injury, fever, pain, request for medication prescription and other non-urgent issues. Semi-structured interviews (n=35) were conducted between 8 am and 10 pm every day of the week. Interviews were recorded and transcribed. Thematic analysis generated themes describing factors influencing patients’ decisions. Critical realism guided this qualitative study, focusing inquiry on the complex and interconnecting nature of pre-existing structures and individual agency on ED attendance.

Relevance: Patients with low-acuity health conditions often seek treatment in EDs, despite the resources and systems not being designed to provide such care. It’s often assumed patients choose the ED due to poor health literacy or lack of afterhours access to primary care services. However, the reasons why rural patients choose EDs for treatment of low-acuity conditions is not well understood. This study offers new knowledge about the complex and intersecting relationship between rural health service factors, social-contextual beliefs, patient factors and the influence all of these have on a patient’s decision to attend a rural ED for non-urgent care.

Results: Patients identified service factors, including lack of timely access to a general practitioner and convenience of being able to access a range of tests, as main factors driving their decisions to attend ED with low-acuity conditions. Broader social-contextual beliefs, including established trust in ED staff due to previous positive encounters, also drove decisions. Patient factors included lack of awareness of, or confusion about, other healthcare options, low health literacy, needing peace of mind, and advice from a health professional, family member, health site on internet or helpline directing them to ED.

Lack of timely access to a general practitioner during usual business hours was an issue for just over half of participants, with 17 per cent of the patients interviewed directed to ED from general practice as no appointments were available.

Conclusions: Patients assessed the severity of the presenting complaint and need for treatment on a background of service factors, social-contextual beliefs and individual factors. Our findings provide a sophisticated understanding of how rural people make decisions when seeking health care for non-urgent complaints. Improving access to general practitioner appointments during business hours would reduce use of this rural ED for low-acuity conditions.

Background: The relocation of city dwellers to regional communities in Australia, in response to the COVID-19 pandemic, has generated population growth and a housing shortage. Workers cannot find affordable homes in their communities and social support services are overstretched. These circumstances negatively impact health and wellbeing in the community. While media reporting and emerging quantitative research has identified rapidly rising housing costs as the source of many difficulties facing regional communities, there is a paucity of research capturing the narratives of community members themselves.

Aim: To explore expectations and visions of housing affordability across generations of residents in regional Victoria. Develop collaborative partnerships for research, governance and community engagement activities focused on solution generation.

Method: This innovative project is using a participatory co-design mixed method, incorporating ‘modified’ citizen science approach. Data is being collected over three concurrent phases: (i) consolidation of what is known about current housing stock and the sociodemographic profile of the region, which will include a description of the housing and health needs of this population with attention to aging, mental health and wellbeing, and access to services and employment; (ii) focus group interviews/workshops across three priority community groups – older people, First Nations people and school leavers – to explore perceptions and understanding of affordable housing and what, if any, influence this has on their health and wellbeing. The interviews will be audio-recorded, transcribed and thematically analysed; and (iii) specific community groups (such as a local youth group ages 16–24 years, business/industry) will be invited to take and submit an image by post or online (still photo) of what affordable housing means to them, along with a 100-word explanation of the significance of their chosen image. Qualitative content analysis of texts will be undertaken. A curated public exhibition of the images and texts will be held across the region. Community members will vote on their preferred housing image. This is designed to provide the local shire council with their community’s preferences, for consideration in future planning, in affordable housing that reflects the needs of the local community.

Anticipated outcomes: This project will deliver new insights into the socioeconomic and health consequences of rapidly changing housing affordability in regional areas, distilled from the perspectives of community members.

Trauma can have significant and pervasive long-term health consequences. Trauma-informed care is a strength-based approach to increase understanding and responsiveness to the impact of trauma and emphasises physical, psychological and emotional safety for both service providers and service users. Introducing trauma-informed care to reduce triggering and re-traumatisation has had positive results in the child welfare, juvenile justice, mental health and education fields. However, there is scarce evidence on implementation of trauma-informed policies and practices in health and primary care settings, particularly in rural areas.

The implementation of trauma-informed care offers an opportunity for healthcare systems and primary care providers to improve quality of care and the client experience. This may then increase longitudinal engagement and, in turn, improve health outcomes. The presentation outlines the work of a rural health service to integrate trauma-informed principles and practices for the benefit of the workforce, community and individuals. The driver for this initiative was the need to improve health care for those who are homeless.

The project is guided by the exploration, preparation, implementation and sustainability (EPIS) framework. A baseline survey of clinical and non-clinical staff’s (n=389) knowledge, attitudes and awareness of trauma-informed care was undertaken in late 2020. Respondents (78 per cent) indicated low awareness and gaps in access to resources and training. A change team of organisational ‘Champions’ was established in 2021 (preparation) to develop and lead an organisation-wide trauma-informed strategy.

The presentation will provide examples of the team’s actions at each stage of implementation. Increasing staff awareness of trauma to include events such as accident or disaster (flood, fire, drought) or the cumulative damage of family violence and childhood abuse, all compounded by circumstances such as poverty, isolation and racism, was the initial preparation step. Context-specific language has been applied to the trauma-informed principles to ensure relevancy to staff and the community. Another preparation action has been to embed staff wellbeing into all service and program areas through internal organisational communication, staff meetings and supervision processes. Using the EPIS framework is critical to monitoring the effects of these actions. The project will generate evidence on the effectiveness of Champions as mechanisms for sustainable change.

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.

How general practices and allied health services are established and what services they provide can be something of a mystery. Primary healthcare services can pop up and disappear without rhyme or reason. This is due to being provided by small businesses through mostly fee-for-service funding. But demand for primary health services can be measured and it can be planned for in rural communities, as experience on the NSW North Coast has shown. While service planning is not a new approach, it is not applied often or consistently in primary health care. Could this old dog be taught new tricks?

Healthy North Coast, delivering the Primary Health Network program on the NSW North Coast, is demonstrating the benefits of applying collaborative service planning methods to complex health access issues. The Healthy Living and Ageing Strategy and Primary Care Access initiatives are two case studies where service planning methods are assisting to meet the health needs of older populations and reduce pressure on emergency departments (EDs).

Case study 1: One in five people on the North Coast are aged 65 years or over. This is predicted to be nearly one in three by 2036. The development of a North Coast Healthy Living and Ageing Strategy is demonstrating how the use of systems dynamic modelling can be used to forecast the impact of interventions in meeting the needs of a growing ageing population. Consumer input and social research is guiding planning priorities so that system dynamic models are designed to meet the community’s vision for how they want to age.

Case study 2: Across the North Coast, younger generations are utilising low-urgency care in hospital EDs at rates above the national average. The Primary Care Access initiative is applying the use of comparative data analysis of both acute and primary care to assess concerning areas of need. An outcomes-focused co-design process is utilising key informants, consumers and potential service providers to drive the stimulation of innovative models of care and new ways of working. Collaborative commissioning processes will follow in 2022.

Rural communities deserve the very best health care that is possible. Through the utilisation of service planning methods, and the application of contemporary tools such as systems dynamic modelling, Healthy North Coast has learnt valuable lessons that are applicable in other regional and rural areas.

Prevalence of diet-related chronic disease is higher in rural and outer-regional areas than in metropolitan centres of Australia. Increasingly, links are observed between unhealthy food retail environments and adverse health outcomes. Research continues to show that food environments in rural and outer-regional areas of Australia lack healthy choices, are often more expensive and initiatives to impact this inequity are limited.

This presentation will overview the combined research of five published studies by our team that demonstrates this inequity experienced by residents of rural communities. Firstly, a critical review found that existing tools do not adequately measure food supply in rural communities. Secondly, the ‘best’ tools available show that the healthiness of the food supply is poor, and healthy food is less available, of lower quality and more expensive than in urban centres. Thirdly, a diet consistent with the Australian Guide to Healthy Eating, if available, costs more in rural than in urban centres. Fourthly, during COVID-19, food supply to rural areas suffered pressures in addition to those in urban environments. Finally, an international review of food retail initiatives found very few that targeted the unique challenges faced by rural communities.

We conclude that research in rural food supply provides both unique challenges and vast opportunities that could be addressed through collaborative research methodologies to address the inherent inequities in both the food supply and subsequent diet-related disease.

Active healthy ageing is a priority in Australia, with an increasingly older population, in particular in regional areas. In Australia, only 14 per cent of residents in major cities are aged over 65, but 19 per cent of regional residents are in this age group. In Victoria this difference is even more pronounced, with 23 per cent of the population of regional Victoria aged over 65.

While walking can be important for all age groups, it is a significant component of active healthy ageing, providing physical and mental health benefits, independence and social connections. Understanding how easy or attractive it is to walk in a specific town or neighbourhood is known as walkability. There are complex relationships between an environment and its walkability, including physical characteristics such as the state of footpaths, shade or volume of traffic, the attraction of both the destination and the route, and perceived safety. It would be easy to assume that small communities are surrounded by nature, and therefore walkable. However, the opposite is often true, with limited places to walk that are both safe and interesting. As a result, older residents are often lacking access to the single activity that could most benefit their health and wellbeing – walking.

In this research we aimed to measure walkability for older residents of two regional north-east Victorian towns – Chiltern (population 1,244; 20 per cent aged over 65) and Rutherglen (population 2,109; 24 per cent over 65). Participants were recruited to carry GPS devices over multiple days, from which we derived information on where, when, how often and how long participants walked, and produced walkability maps. We also surveyed participants on their perceptions on the walkability of their town, and held focus groups particularly focused on people’s relationship with nature and what influence this has on walking behaviour.

The results show that access to walking in both towns is limited, with most participants repeatedly walking the same route and that, within the populated areas of both towns, there is very limited public open space or walking paths. We propose a number of strategies to increase the walkability of small towns, such as improving connectivity, places of interest and resting places, to make walking more attractive and accessible to older people, benefiting the entire community. This geospatial analysis approach to assessing walkability can be applied to rural and regional communities across Australia.

The Integrating Health Care Planning for Health and Prosperity in North Queensland (or place-based planning) project aims to improve the responsiveness of health services to the health needs of communities in the North Queensland region. The region is defined by the boundaries of the five hospital and health services from the Mackay region through to the Torres Strait and west to the Northern Territory border. The project is expected to improve community involvement in health service planning, and accessibility and quality of healthcare services in regions of relatively high unmet need. More efficient, re-designed healthcare delivery models will also benefit health services.

The three-year project is being conducted in two phases. In phase 1, publicly available data was collated and mapped using ArcGIS to visually display population, health and workforce data, and service information. The resultant Northern Queensland Health Atlas is an online interactive tool that enables data layers to be overlayed and indicators (such as health outcomes, service availability and health workforce) compared. Challenges experienced included publicly available data lacking currency due to data publishing delays. In addition, comparative analysis between indicators was hindered by the different geographical units (for example, statistical areas or local government areas) used in different datasets. The use of publicly available data in Phase 1 sets a foundation for sustainability and replication by any individual or community who may be interested in conducting place-based planning.

Following this, a gap analysis was conducted to identify unmet health need in the North Queensland region, drawing on key principles of healthcare equity. A composite Index of Unmet Need was developed that highlighted areas of greater unmet need and informed consultation with key stakeholders to prioritise four communities for the next project phase. In phase 2, place-based planning with four communities will co-design, implement and evaluate new models of care. Research will be undertaken to evaluate the co-design process, the outcomes delivered (what works in which contexts, for whom and how) and the impact of these on local and regional health service provision (including economic impacts). Indicators of impact likely to be used in the evaluation include those relating to quality of care, efficiency, service provider and consumer satisfaction, and process acceptability and sustainability.

This presentation will provide a brief overview of the project and showcase the Northern Queensland Health Atlas. It will also discuss project challenges in relation to the reliability, availability and accessibility of data.

Mentoring can be a critical aspect of goal setting and achievement career development for medical students and doctors in training, particularly during times of change. It is also reported as being an important tool in encouraging mental health and wellbeing when it is offered. In 2019, the online mentoring platform, Mentorloop, was rolled out across two regional medical training sites in rural New South Wales. This program was implemented in response to requests from the two groups that became the mentee cohort: medical students undertaking extended rural clinical placements and doctors in training at the two rural hospitals. The program had the dual goal of supporting career development and creating supportive social networks for the participants.

Over the past three years, the platform has enabled over 300 mentors (senior clinicians) and mentees (students and doctors in training) to engage in mentoring relationships based not only on proximity and discipline, but demographics, interests and cultural connection. Each year our number of mentees and mentors has grown as new students and doctors in training move to these communities and local senior clinicians return annually to re-commit to the program. Through this time, we have learned about the logistics of implementing a widescale and multisite program, how to promote authentic engagement and meaningful partnerships. Critical to the implementation of the project was knowing when not to use the full functionality of the platform, namely the choice to manually match mentors and mentees, rather than allow the program to automate this process. While this process was more labour intensive, we believe this work was central to high satisfaction scores and feedback from both mentors and mentees.

This presentation will review the implementation and ongoing evaluation of the project, and case studies of successful and unsuccessful mentoring partnerships. We will share lessons learned, lessons we’re still learning and our plans for the future of the program as we continue our aim to support the development of the rural medical workforce and promote mental health and wellbeing in our students and doctors in training.

The rural workforce has experienced chronic workforce shortage for several decades. With the aging rural medical workforce and the inability to replace retiring GPs, many communities are already suffering reduced access to basic medical services that those in the city take for granted.

Barriers such as the lack of flexibility in policy application and training arrangements were highlighted in the RACGP report to the Department of Health – New Approaches to Integrated Rural Training for Medical Practitioners (2014). The same issues still exist nationally, particularly in rural and remote areas. The RACGP, along with GP training organisations and rural workforce agencies, have been actively addressing some of these in a piecemeal fashion over the intervening years since the report. The challenge of training rural GPs includes the lack of adequate supervision for trainees when rural doctors are already overloaded with clinical demands.

It is vital that we increase recruitment into general practice and, more specifically, nurture those who are interested in working in rural locations. The rural GP/rural generalist training needs to provide tailored support and case management to ensure trainees are appropriately prepared for the demands of rural and to ensure safety and a quality training experience. This will increase the likelihood of rural retention in the longer term. Alternate models of training will also ensure that flexibility is available to support training in a challenging context where there is a lack of traditional supervision resources. With the transition to college-led training, it is a golden opportunity for the college to coordinate all stakeholders in the sector to work together to ensure our future GP workforce is rural ready.

This session will explore the new RACGP profession-led community-based training model, with a focus on what this will mean for rural general practice. The session will start with an overview of the new model followed by a discussion of key topics, including how RACGP can improve access to training in rural areas, how the RACGP training model will enable safe supervised practice, what supervision models can be used, and how the new model can benefit the future of the rural general practice workforce. We will also explore innovative models on how rural and non-rural GPs can be involved in supervision.

Family and domestic violence (FDV) is a major health and social issue affecting one in six Australian women and one in 16 men (AIHW 2018). Regional areas have distinctive attitudes and experiences of FDV compared to metropolitan areas and wider Australia. In the City of Greater Geraldton, a Western Australian regional area with a population ~39,000 (ABS 2016), rates of assault by a family member are 2.4 times the state rate/100,000 and 3.3 times the metro rate/100,000 (WA Police 2021).

To assist community prevention efforts, a community-wide survey, the Local Community Attitudes and Exposure to Violence Survey (LCAEVS), was designed as a surveillance and monitoring tool to inform and measure the effectiveness of a regional FDV primary prevention strategy. The local survey was adapted from the ANROWS National Community Attitudes to Violence Against Women Survey (NCAS) 2017 (ANROWS 2017). Analysis of LCAEVS responses were completed by sociodemographic subgroups – sex, age, Aboriginal identification and education level – and results were compared to NCAS results where possible.

We present the results from the baseline survey (2019).

Results:

• The local survey showed high rates of FDV behaviours reportedly present in the community.
• Compared to the NCAS, the LCAEVS results for ‘Attitudes of Violence Against Women’ and ‘Attitudes Towards Gender Equality’ were generally more supportive of non-violence and gender equality than those reported in the NCAS.
• Knowledge and attitudes towards gender equality and FDV were shown to be highly influenced by gender, with significant differences between males and females in their knowledge regarding behaviours that are considered as domestic violence, including physical violence, non-physical aggression threats of violence.
• There were also significant differences between males and females in their attitudes towards violence, with males more likely to excuse violence and to diminish the responsibility of the perpetrator, and more believing that a woman is at least partially responsible for a violent act against them.
• There were also significant differences in attitudes towards gender equality, with females being less likely to believe in rigid gender stereotypes.
• Compared to the NCAS, fewer people reported knowing where to seek help for FDV locally.
• This whole-of-community baseline survey will be used to inform: the targeting of local primary prevention messages through education, media and community discussions to help address the ongoing drivers of FDV; and monitoring of changes to these measurements over time, to inform the local primary prevention program impact evaluation.