Editorial: What about allied health?

The recent Federal Budget announced a welcome Stronger Rural Health Strategy - $550m over ten years of new and modified programs intended to achieve better health care in country Australia.

The largest part of this contribution is directed to supporting the work of general practices. 

The focus on medicine is not surprising. The Federal Government has few levers to influence health outcomes in rural areas, and assisting doctors is perhaps the most obvious option.

The biggest share of Federal funding to health is via the Medical Benefits Scheme (MBS) and hospital funding at a 40:60 split with the States. 

The Commonwealth also funds rural workforce agencies to focus attention on recruitment and retention of doctors, GPs in particular, in rural areas. 

Incentives intended to support GP practices in rural areas have been a feature for many years. This support has often taken the form of direct financial payments to GP practices – either to support new models of care (eg mental health care plans, after hours GP services), or to offset some of the costs borne by practices in providing medical services to a local community. 

But what of the raft of other health professionals that do not require a MBBS qualification? 

Isn’t the need of other professionals that come under the ‘allied health’ banner just as significant as it is for medicine? Healthcare is more than the service provided by one professional discipline.

Holistic health care requires the assistance of a range of professionals, each working in a coordinated and integrated way to address the needs of the consumer (at individual level) and the community (more generally).

Let’s consider the following graph:

Medical practitioners and other health professionals, FTE per 100,000 population, 2014
 

Clearly we have a problem. As you move away from cities access to a local allied health practitioner diminishes markedly. 

Interestingly though, the distribution of GPs actually improves with increasing remoteness.

Which brings me to a key point. 

Successive budget cycles have focused on addressing the maldistribution of the medical workforce.  

Through the combined efforts of workforce agencies, incentive payments, training and recruitment (including overseas recruitment) strategies and other schemes, the distribution of the medical workforce has been improved. 

As we know, counting GPs that are actually practicing in full-time equivalent terms is difficult, and the upturn depicted in the graph is only one indicator of GP numbers and distribution. But it is a clear sign of progress. 

Now it’s time as a nation to turn our attention to other health professionals. We must learn what we can from the GP focused programs to address the maldistributon of allied health professions. 

Let’s identify the things that are just as applicable to encouraging all health professionals to live and work in country areas.

The generalist pathway

On a closely related topic – indeed part of the longer term solution to addressing the shortfall of health professionals in the bush – the Federal Government has agreed to develop a generalist training pathway for general practice. 

Rural generalism is about the acquisition of additional skills that are required in a rural setting. Again, the requirement is not exclusive to medicine.

While generalist skills may be different across health professions, the fact that every health professional practising in rural areas requires a mix of skills is not. 

Professor Paul Worley, National Rural Health Commissioner, has been asked to design the generalist pathway for GPs and I am pleased to be working closely with Paul in this regard.

I also very much look forward to helping to develop a generalist pathway for other health professions in the not too distant future. 

I know that the development of generalist training pathways for the allied health professions will provide an expanded opportunity for end to end training opportunities in rural and regional settings.

It will best equip our health professionals for the wide variety of work they’ll experience in rural and remote areas.  

This, together with the successes in addressing short term workforce maldistribution in medicine, can and should be applied to the rest of the integrated care team!