New research builds framework for innovation in rural health

A new article in the Australian Journal of Rural Health explores innovation in rural health through the lens of four small towns in Western New South Wales (NSW).

Collaborative care: Primary health workforce and service delivery in Western New South Wales—A case study was published by the partners of the Collaborative Care program, a joint initiative exploring innovative models of care in rural NSW. The program in Western NSW is supported by Western NSW Local Health District, Western NSW Primary Health Network and NSW Rural Doctors Network.

In the rural towns of Tottenham, Trundle, Tullamore and Trangie (the 4Ts), market failure over time had caused the closure of every private general practice. This left these four communities without a local general practitioner (GP).

Existing remuneration mechanisms and business models have made it difficult for private general practice to enter the towns. Some providers said the towns were simply not large enough to support private practice. However, each town has a multipurpose service (MPS) with a GP clinic space, an emergency department, limited acute care beds and residential aged care.

The 4Ts case study explores the collaborative principles used by Western NSW Local Health District to work with these small communities to find a solution.

Lead author, Dr Robyn Ramsden PhD, believes the concept of ‘health workforce literacy’ was one of the key drivers of success.

‘It’s about communities understanding what is needed and some of the rural health workforce challenges,’ said Dr Ramsden.

‘In the 4Ts, communities initially thought they needed a doctor in each town. But when they were provided with information on the challenges associated with this, local health needs and alternate shared options with the support of telehealth, these communities were able to reach a different conclusion. They didn’t necessarily need a town GP, what they needed was consistent access to a GP service.’

Working with the communities, Western NSW Local Health District employed GPs and nurses in primary care clinics and shared them across the four towns. These clinics are co-located within the MPS. They employ a medical centre manager to coordinate the services and use telehealth technology to support communities when a GP is not onsite.

Dr Shannon Nott, Rural Director of Medical Services for Western NSW Local Health District, says community engagement was a critical part of the implementation.

‘We have been working with the 4Ts communities for over two years now and would not have been able to deliver solutions without the input and feedback from local community members and groups, health councils, staff and local councils, coordinated across all levels of government,’ said Dr Nott.

‘We have further work to do, but we are now at the point of refining what we deliver to meet local health needs.’

The 4Ts model is currently being evaluated through the Collaborative Care program. Collaborative Care is a planning and community engagement tool to build health workforce literacy and drive system change at the local level.

Dr Ramsden believes the Collaborative Care framework could be helpful in many other rural settings.

‘In the article, we identify key elements of effectiveness in establishing the 4Ts model. This includes the need for coordinated health system planning, better integrating of existing resources, active community engagement and building health workforce literacy,’ said Dr Ramsden.

‘The study adds to the body of knowledge about how to successfully develop a collaborative primary healthcare workforce model in practice.’

A toolkit is currently being developed as part of the program, to support future activities in other communities. Those involved in supporting the 4Ts implementation believe the solution is scalable if resourced and well-supported.

The Collaborative Care program received funding from the Australian Government and integrates with existing Australian Government and NSW Ministry of Health initiatives. The 4Ts is one of five Collaborative Care projects currently being evaluated in rural NSW.