Retaining rural and remote health professionals - National Strategic Framework for Rural and Remote Health
Retaining rural and remote health professionals
Workforce development has tended to focus on medical practitioners, however, the entire health workforce needs to be developed in keeping with cross-disciplinary and generalist requirements. In the overall remodelling of health practice in rural and remote areas, inter-professional education and ongoing training will be essential.
There is a critical need to expand existing scopes of practice and create new roles to optimise workforce capacity and to meet health care needs. The development of more advanced roles for rural GPs, including obstetrics, surgery and anaesthetics, and for nurse practitioners is seen as a useful strategy to strengthen and maintain a skilled rural health workforce.
It is also important to consider the roles and scopes of practice of a wide range of other health care workers including remote health workers, nurses, allied health workers, midwives, Indigenous health workers and vocationally trained workers.
Rural Generalist Medicine (Queensland)
In August 2005, the Queensland Government announced the recognition of a new category of senior doctor called the ‘Rural Generalist’. Rural Generalist training commenced in 2007 within the Rural Generalist Pathway.
Queensland officially recognised Rural Generalist Medicine in 2008. As a specialist equivalent medical discipline, Rural Generalists can:
gain a professional status and a service value equivalent to that of a medical specialist
receive a specialist-level remuneration package, including a ‘private practice’ allowance.
The Rural Generalist Pathway provides supported training through medical school to Rural Generalist Medicine practice.
The practice of Rural Generalists includes rural general practice and hospital-based practice with at least one advanced skill in a specialist discipline. Rural Queensland will benefit from the priority advanced rural skills of obstetrics, anaesthetics, Indigenous health, emergency medicine and surgery.
In the future, Rural Generalist Medicine increases the prospect of rural and remote communities being well supplied with doctors seeking rather than being coerced into rural service.
It also potentially improves the chances of Indigenous communities being well supplied with doctors whose advanced skills in Indigenous health will provide a medical service dedicated to their unique needs.
In developing initiatives for a sustainable rural and remote health workforce, there is now sufficient evidence to bring the focus of recruitment strategies towards shorter retention cycles. In place of expectations of GPs staying in town for decades, workforce planning should focus on three to seven year cycles, dependent on the workforce group. This re-orientation of strategy requires ongoing efforts and continual succession planning.
Planning for education and training in rural and remote areas needs to recognise that the professional, personal and community-based activities of health care providers often overlap in small communities. Health care providers and health service managers are often effectively ‘on call’ continuously and, therefore, special effort is required to enable them to undertake their continued training and development.
Workforce planning, education and professional development should involve active partnerships with the tertiary education sector and other national bodies, such as professional colleges, national peak bodies, and the national accreditation and registration system.
An example of a successful model that combines specialist roles for nurses, with the appropriate training, guidelines and partnerships to support them is outlined below:
Remote Area Nursing Emergency Guidelines and Training (Victoria)
There are fifteen Bush Nursing Centres (BNCs) located in remote and isolated communities throughout rural Victoria. BNCs provide key primary health and emergency stabilisation services to these communities. Due to the remoteness of these communities, BNC nurses may be the only health care professionals available to provide first line care in the event of a medical or trauma emergency.
BNCs can employ Remote Area Nurses (RANs) who are up-skilled to provide time critical emergency response and stabilisation care in the absence of a medical officer or paramedic. The regulatory framework in Victoria provides for RANs to have the delegated responsibility to provide emergency care provided that they have completed annual competency based training based on the Victorian Remote Area Nurses Emergency Guidelines (RANEG).
A key component of this model is the partnership between BNCs and Ambulance Victoria. Ambulance Victoria conduct annual competency based training and provide peer support and mentoring to the RANs. RANs through joint dispatch arrangements with Ambulance Victoria provide a first response to emergency calls in their community and are able to arrive and commence emergency care to patients substantially prior to paramedic or medical officer assistance.
The Framework seeks to build a health workforce that meets the needs of rural and remote communities through better recruitment, training and continual professional development, and retention of skilled health professionals and non-clinical health workers to achieve Goal 3:
Rural and remote communities will have an appropriate, skilled and
Strategies are outlined in the following table.
Outcome area 3: Health workforce
Goal 3: Rural and remote Australia has an appropriate, skilled and well-supported health workforce
Improved recruitment, retention and distribution of rural and remote health service providers
Build a health workforce that meets the needs of local communities
Improved availability of training and continuing professional development programs for rural and remote health professionals