Enhancing Rural Healthcare through Rural Generalist Recognition

 
 
National Rural Health Commissioner
Adj. Prof. Ruth Stewart
Monday, 6 November 2023
 
Rural Generalist Recognition
 
 
Acknowledgment of Country
 
I acknowledge the Traditional Custodians of the land, the Mandandanji people,
 on which I am meeting you from today.
I pay my respects to the Elders of this land and waterways, ancestors who have come
before us and those who are with us and guide us today.
I would also like to acknowledge emerging leaders within our communities.
I extend my respect to all Aboriginal and Torres Strait Islander people here today.
Rural Generalist Recognition Taskforce Members:
 
Adjunct Professor Ruth Stewart, NRHC
Dr Michael Clements, Chair, RACGP Rural
Marita Cowie, CEO ACRRM
Andrew Hayward, National Rural Manager, RACGP
Dr Ewen McPhee, ACRRM
Dr Ken Wanguhu, RACGP Rural Censor
Paul Wappett, CEO RACGP
Mary Jane Streeton, Project Officer, RG Recognition
 
A medical practitioner who is trained to meet the specific current
and future healthcare needs of Australian rural and remote
communities, in cost-effective way, by providing both
comprehensive general practice and emergency care and
required components of other medical specialty care in a hospital
land community settings as part of a rural healthcare team.
 
What is a Rural Generalist?
 
The Collingrove Agreement
 
 
What is RG specialist field
and protected title
 
Source: MBA, June 2018 
https://www.medicalboard.gov.au/Registration-Standards.aspx
 
Rural Generalist Specialist field
 
Benefits of RG
Recognition
 
Professional excellence
Recognition of extra
years of training and
extra clinical
responsibilities
RG profession inspires,
trains, and mentors, new
generation
RG profession shares
learning and focusses
research toward best
practice
 
Workforce planning
Rural services
planning build-in RG
options
RG workforce
training and support
RG job portability
across
States/Territories
 
Named job
Aspirational career
for 
doctors of future
Rural patients know
their 
doctors’ 
skillset
Rural communities
and health 
services
advertise for
 
doctor
with 
RG 
skillset
 
Quality-assured care
Rural care assured
against training
standard that reflects
job
Rural care
 
assured
against a common,
national training
standard
Processing doctors’
qualifications
to practice in hospitals
simplified
(credentialing)
Why is Rural Generalist Recognition needed?
 
The process of RG
Recognition
 
Initial proposal - 
Dec 2019
MBA Advice – 
Aug 2020
Additional information (incl. consultation)
July 2021
Approval to proceed to Stage 2 –
 Nov 2021
Application to OBPR – 
Feb 2022
Approval to proceed w/o RIS – 
May 2022
Source: AMC Flowchart, Sept 2018, MBA website,
https://www.medicalboard.gov.au/registration/recognition-of-medical-specialties.aspx
Stage 1 – Initial Assessment
Stage 2 – Detailed Assessment
 
Stage 2 application – 
Dec 2022
AMC Assessment Panel formed –
 late 2022
Application reviewed/consultation drafted  - 
July 2023
Consultation Paper MBA endorsed  – 
Aug 2023
National Consultation
 -
 Oct-Dec 2023
AMC Assessment Panel reviews feedback and drafts report
(may involve additional steps - stakeholder discussions,
expert advice)
AMC Assessment Panel advice
Final Steps....
 
AMC
 RoMSAC review and advice
AMC SEAC review and advice
MBA review and advice
HMM 
decision (specialist title and specialist
field created on register)
AMC accreditation of RG programs
 
1.
Has need been substantiated?
2.
Positive consequences
3.
Negative consequences
4.
Key issues for focus
5.
Negative patient impacts
6.
First nations peoples impacts
7.
Key stakeholders for further consultation
8.
Impacts with other GPs and other medical
specialties
9.
Impacts for rural general practice, unnecessary
deskilling
10.
Economic impacts for govt, business, consumers
 
Consultation Questions
 
 
 
medboardconsultation@ahpra.gov.au
 
T
h
a
n
k
 
y
o
u
 
Other information
 
Integrated rural care
Rural patients can receive
coordinated care f
rom
community/ACCHS clinic
to hospital and back
RGs have the range of
skills to pivot to fill local
service gaps
RGs diverse skills can
make other local health
services viable
All RGs trained for GP and
generalist care
 
 
 
RG attracts doctors
to rural careers
RG is an attractive rural
career option
RG is career with high rural
retention
Appeal of jack-of-all-trades
medicine
Offers viable career option
for doctors wanting to go
rural but interested in
specialist care
 
 
 
Rural access to
emergency care
Most
 
rural hospitals do not
have any specialist emergency
physicians
RGs:
Provide rural emergency care
inc. obstetrics,
anaesthetics  and retrievals
Manage rural  hospital
emergency depts
Support local emergency
rosters
 
Rural access to
specialised services
25%
 fewer specialist services
received by people in rural areas,
than people in cities
60%
 fewer specialist services
received by people in remote
areas, than people in cities
Without local RGs, rural families
bear costs of accessing urban care
Local care  is most needed by the
most disadvantaged people (older,
low-income, chronically ill,
disabilities)
RGs enable care on-country
 
Why do we need Rural Generalists?
 
Rural expenditure gap:  
$6.55b p/a, $850p/c
(
NRHA, 2023)
GP services p/c compared to major cities:
-
9% lower (OR)
-
36% lower (R/VR)
 
Non-GP services p/c compared to major cities:
-
25% lower (OR)
-
59% lower (R/VR)
 
 
 
 
Source: 
AIHW. (2021). 
Medicare-subsidised GP, allied health and specialist health care
across local areas: 2019–20 to 2020–21.
 
Case for change – services
access
 
Application for RRM as a medical specialty 
2005
Draft National Framework for RGM  
2011
Commitment to NRGP, National Rural Health
Commissioner 
2014
NRGP Taskforce National Consultation 
2017
NRGP Recommendations 
2018
 
RG Summit , Cairns 2017
 
Early steps…
Slide Note

Date of event: Mon 6 Nov 2023

Event location: via Zoom

Presentation theme: Public consultation on RG recognition

Time allocation and breakdown: 19:00-20:30 (AEST)

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Rural Generalist Recognition acknowledges the vital role of medical practitioners trained to address diverse healthcare needs in Australian rural communities. The program ensures quality care, professional excellence, workforce planning, and offers an aspirational career path for future doctors while enhancing rural healthcare services.

  • Rural Healthcare
  • Medical Practitioners
  • Workforce Planning
  • Healthcare Quality
  • Rural Communities

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  1. Office of the National Rural Health Commissioner Rural Generalist Recognition National Rural Health Commissioner Adj. Prof. Ruth Stewart Monday, 6 November 2023

  2. Acknowledgment of Country I acknowledge the Traditional Custodians of the land, the Mandandanji people, on which I am meeting you from today. I pay my respects to the Elders of this land and waterways, ancestors who have come before us and those who are with us and guide us today. I would also like to acknowledge emerging leaders within our communities. I extend my respect to all Aboriginal and Torres Strait Islander people here today.

  3. Rural Generalist Recognition Taskforce Members: Adjunct Professor Ruth Stewart, NRHC Dr Michael Clements, Chair, RACGP Rural Marita Cowie, CEO ACRRM Andrew Hayward, National Rural Manager, RACGP Dr Ewen McPhee, ACRRM Dr Ken Wanguhu, RACGP Rural Censor Paul Wappett, CEO RACGP Mary Jane Streeton, Project Officer, RG Recognition

  4. What is a Rural Generalist? A medical practitioner who is trained to meet the specific current and future healthcare needs of Australian rural and remote communities, in cost-effective way, by providing both comprehensive general practice and emergency care and required components of other medical specialty care in a hospital land community settings as part of a rural healthcare team. The Collingrove Agreement

  5. What is RG specialist field and protected title

  6. Rural Generalist Specialist field Rural generalist medicine, Specialist RG Source: MBA, June 2018 https://www.medicalboard.gov.au/Registration-Standards.aspx

  7. Benefits of RG Recognition

  8. Why is Rural Generalist Recognition needed? Quality-assured care Professional excellence Named job Workforce planning Rural care assured against training standard that reflects job Recognition of extra years of training and extra clinical responsibilities Aspirational career for doctors of future Rural services planning build-in RG options Rural patients know their doctors skillset Rural care assured against a common, national training standard RG workforce training and support RG profession inspires, trains, and mentors, new generation Rural communities and health services advertise for doctor with RG skillset RG job portability across States/Territories Processing doctors qualifications to practice in hospitals simplified (credentialing) RG profession shares learning and focusses research toward best practice

  9. The process of RG Recognition

  10. Stage 1 Initial Assessment Initial proposal - Dec 2019 MBA Advice Aug 2020 Additional information (incl. consultation) July 2021 Approval to proceed to Stage 2 Nov 2021 Application to OBPR Feb 2022 Approval to proceed w/o RIS May 2022 Source: AMC Flowchart, Sept 2018, MBA website, https://www.medicalboard.gov.au/registration/recognition-of-medical-specialties.aspx

  11. Stage 2 Detailed Assessment Stage 2 application Dec 2022 AMC Assessment Panel formed late 2022 Application reviewed/consultation drafted - July 2023 Consultation Paper MBA endorsed Aug 2023 National Consultation - Oct-Dec 2023 AMC Assessment Panel reviews feedback and drafts report (may involve additional steps - stakeholder discussions, expert advice) AMC Assessment Panel advice

  12. Final Steps.... AMC RoMSAC review and advice AMC SEAC review and advice MBA review and advice HMM decision (specialist title and specialist field created on register) AMC accreditation of RG programs

  13. How do I put in a submission?

  14. Consultation Questions 1. 2. 3. 4. 5. 6. 7. 8. Has need been substantiated? Positive consequences Negative consequences Key issues for focus Negative patient impacts First nations peoples impacts Key stakeholders for further consultation Impacts with other GPs and other medical specialties Impacts for rural general practice, unnecessary deskilling Economic impacts for govt, business, consumers 9. 10.

  15. medboardconsultation@ahpra.gov.au

  16. @RuralHC_Aus @DrFayeMcMillan @NowlanShelley Thank you

  17. Other information

  18. Why do we need Rural Generalists? Rural access to specialised services Integrated rural care Rural access to emergency care RG attracts doctors to rural careers Rural patients can receive coordinated care from community/ACCHS clinic to hospital and back Most rural hospitals do not have any specialist emergency physicians 25% fewer specialist services received by people in rural areas, than people in cities RG is an attractive rural career option RGs: 60% fewer specialist services received by people in remote areas, than people in cities RG is career with high rural retention RGs have the range of skills to pivot to fill local service gaps Provide rural emergency care inc. obstetrics, anaesthetics and retrievals Without local RGs, rural families bear costs of accessing urban care Appeal of jack-of-all-trades medicine RGs diverse skills can make other local health services viable Manage rural hospital emergency depts Local care is most needed by the most disadvantaged people (older, low-income, chronically ill, disabilities) Offers viable career option for doctors wanting to go rural but interested in specialist care All RGs trained for GP and generalist care Support local emergency rosters RGs enable care on-country

  19. Case for change services GP and Non-GP specialist MBS expenditure by geographic classification 2020-21 access Rural expenditure gap: $6.55b p/a, $850p/c (NRHA, 2023) GP specialist services Non-GP specialist services GP services p/c compared to major cities: - 9% lower (OR) - 36% lower (R/VR) Services per 100 people MBS funding per 100 people Services per 100 people MBS funding per 100 people Non-GP services p/c compared to major cities: - 25% lower (OR) - 59% lower (R/VR) National 666 $34,064 102 $9,135 Major Cities 675 $34,349 106 $9,507 Inner Regional 675 $34,916 104 $9,061 Outer Regional 613 $31,730 80 $7,000 Remote/ Very Remote 431 $24,619 44 $3,889 Source: AIHW. (2021). Medicare-subsidised GP, allied health and specialist health care across local areas: 2019 20 to 2020 21.

  20. Early steps Application for RRM as a medical specialty 2005 Draft National Framework for RGM 2011 Commitment to NRGP, National Rural Health Commissioner 2014 NRGP Taskforce National Consultation 2017 NRGP Recommendations 2018 RG Summit , Cairns 2017

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