How the rural ‘can-do’ approach enables GPs to overcome the challenges of rural and remote medicine

It’s an exciting time to be in rural and remote health, especially for advocates of the rural generalist practice model.

The appointment of a National Rural Health Commissioner, the commitment to a national rural generalist pathway, the signing of the Australian Government Compact with the Australian College of Rural and Remote Medicine (ACRRM), and the Government’s Stronger Rural Health Strategy, all point to an openness to big ideas and new approaches for our sector.

National Rural Generalist Program
The process to develop a national rural generalist training and practice pathway continues to build momentum and the National Rural Health Commissioner is set to provide detailed recommendations in early 2019.

ACRRM hopes that this work will pave the way for broad recognition across the health care policy sector, that ‘rural and remote’ is distinct and best served by ‘rural and remote’ models of care.

The rural generalist model recognises that to meet their communities’ needs, health practitioners in rural and remote areas assume a broader, more flexible and team-centred practice and take on the heightened responsibilities that come with geographic isolation.

Internationally, these approaches are also gaining traction. The Rural WONCA (World Federation of Family Doctors) Conference in April this year unanimously endorsed the Delhi Declaration which emphasised the importance of this approach and the Declaration has now been published on the World Health Organization website.

Vocational training
With the transfer of Government general practice training management to the Colleges, ACRRM is moving to a more direct role in delivering its training. At the same time, the Government’s Australian General Practice Training (AGPT) program now explicitly recognises the distinctions of the ACRRM Fellowship model, with rural generalist designated training places and rural generalist policies to support them.

An important outcome of this has been the upscaling of ACRRM’s Fellowship selection process, which explicitly selects for rural competency. It is through this process that ACRRM selects the right candidates for registrar training. The process has been applied on a smaller scale for over a decade and has been shown to have a strong positive association with rural retention outcomes. The process model breaks new ground internationally and has attracted considerable global interest.

Disruptive technologies
It seems every day that a new technology appears, presenting new possibilities for overcoming the tyranny of distance. As these make their way into systems planning, the rural sector needs to be part of the conversation if translation of these into fit-for-purpose rural solutions is to occur.

Technologies that can potentially bring specialist services to the point of care in the rural or remote community, such as point-of-care-testing systems, portable ultrasound, Holter monitors for continually recording heart activity, and digital health all present opportunities that need to be explored and progressed.

Rural and remote practitioners globally, continue to be enthusiastic adopters of digital health, as was reinforced to us at the Digital Health International Policy Directions workshop ACRRM held at the WONCA (World Federation of Family Doctors) in Seoul earlier in October 2018.

Now, more than ever, we need to challenge those who suggest that excellent quality health care can’t be delivered to rural and remote people close to home. Policy makers need to recognise that it can and is, but not through urban models - this requires a ‘rural approach’ enabling innovative, fit-for-purpose solutions.

Rural advocates need to continue our disruptive influence on national health policy, to push forward with new ideas and new ways of doing things.

A few weeks ago, one of our ACRRM Fellows, while boating on the Whitsunday passage in Queensland, boarded a neighbouring vessel and provided life-saving emergency care to a shark attack victim. At the same time, ACRRM Fellows based in Antarctica are contributing to work by NASA into how to support the health and wellbeing of humans in space. And at ACRRM’s recent national conference, RMA18, Dr Jillann Farmer, who leads the United Nations health responses in international humanitarian crises such as the Ebola outbreaks, talked about the value of our skill set for the work of her healthcare teams.

The rural ‘can-do’ practice approach that enables us to overcome the challenges of geography and offer safe, high quality care within the context of the resources and circumstances at hand, is an invaluable skill set from which the wider health care community can learn.