Whole-of-healthcare access in small communities: the 4Ts model

Following the release of the federal Strengthening Medicare Taskforce Report, it is clear that innovation in the primary care space is essential.

Development is needed of mechanisms that allow communities, alongside local organisations and all levels of government, to support primary care in collaboration – particularly in rural and remote areas.

In Western New South Wales (NSW), the four rural communities of Tottenham, Tullamore, Trundle and Trangie (the 4Ts) have experienced market failure of private general practice primary care. Through collaboration, they have developed a model that aims to ensure the sustainability of primary care and its ability to better provide care for patients into the future. 

It is projected that 41 towns in the Western NSW region could face primary care collapse by 2029. To address this, Western NSW Local Health District (WNSWLHD) has been trialling a whole-of-healthcare model in the 4Ts since 2019.

The four small rural communities all have populations between 500 and 1500 people and are located 30 minutes apart. The WNSWLHD provides networked primary care clinics across all four communities, co-located with the town multipurpose service.

This model is innovative for NSW as, traditionally, local health districts have not stepped in to run primary care, even when hospital services have been impacted.

The 4Ts model utilises a single-employer mechanism to employ rural generalist doctors, as well as clinical, administrative and practice management staff, to collaboratively deliver comprehensive primary care, and acute and emergency services across the sub-region.

Services like the district’s Virtual Rural Generalist Service support doctors by minimising the strain on local clinicians through managing after-hours emergency department cases, thus reserving onsite medical staff for true emergencies.  

The model is enabled through a COAG Section 19(2) Exemption, which allows the WNSWLHD to combine federal and state health resources to deliver services that meet local needs.

The 4Ts model takes a place-based approach across the sub-region – with the hypothesis that communities are stronger when working together, rather than in isolation.

The project is led by WNSWLHD and implemented in collaboration with local health councils, local government, community groups, the Western NSW Primary Health Network and NSW Rural Doctors Network.

Bev Clarke, a Tullamore Community Engagement Group representative, says collaboration between communities was necessary to ensure and maintain access to essential healthcare services.

‘It got to the point when we were losing our full-time doctors, they were all at the retiring stage, so we had to get together and try and work out the best solution for keeping a medical service in the towns,’ Ms Clarke said.

Dr Shannon Nott, Rural Director of Medical Services for WNSWLHD, says the 4Ts model provides a way forward for small rural communities to maintain access to whole-of-healthcare services locally.

‘Through the 4Ts model, we have been able to retain primary care services in all four communities by supporting staff to work across the sub-region. It enables succession planning for retiring doctors and opens the door to training young doctors in our rural communities as well,’ Dr Nott said.

Dr Nott said community support has been critical to the project’s success.

‘Community collaboration has been integral and without a willingness to support each other, this model would not be possible,’ said Dr Nott. 

This innovative approach is currently being evaluated through the Collaborative Care Program – which has received project funding through the Australian Government Department of Health and Aged Care – to understand model outcomes, including its efficacy.

Further information on the 4Ts Project and Collaborative Care Program can be found at nswrdn.engagementhub.com.au/4ts