‘Now or never’ for united rural front

After two decades of being defined by their differences over rural health, Australia’s two GP colleges have struck an accord to revive old-fashioned multi-skilled general practice in country Australia.

Under the guidance of Rural Health Commissioner Paul Worley, RACGP President Dr Bastian Seidel and ACRRM President Associate Professor Ruth Stewart pledged to work together to develop a training pathway for rural generalist doctors to meet a 2019 deadline.

The landmark pact comes more than 20 years after disgruntled rural doctors broke away from the RACGP to form ACRRM. The period since has been marked by bickering, notably over the RACGP’s opposition to ACRRM’s bid to have rural generalism recognised as a distinct specialty.

But Dr Seidel, a GP in rural Tasmania, said the two sides had a common mission to restore rural health, and the time was “now or never”.

“This is a once-in-a-generation stellar alignment, and it is now or never to make it work.

“We need to shift from making promises to rural communities, to delivering to rural communities,” he told The Medical Republic.

“Rural GPs and RGs are the centrepieces of rural healthcare. Those practitioners need to be trained, supported and retained in rural communities.

“ACRRM and the RACGP are ready to deliver for our members, funders and patients.”

Associate Professor Stewart, who practices on Thursday Island in the Torres Strait after more than 20 years as a rural generalist in Victoria, praised the RACGP’s readiness to negotiate and reach an agreement.

“And I take my hat off to Paul Worley. His mediation skills came to the fore,” she said.

She described the agreement as a “seismic shift in medical politics”, which the two leaders could not have achieved without the backing of doctors in both colleges who were determined to address the disparities in healthcare for rural patients.

“I see it as if Bastian and I, as college presidents, have reached out to shake hands across a high wall,” she said.

“We can only grasp each other’s hands because we stand on the shoulders of our college leaders and members; good people who see that rural generalism can turn around health care for rural and remote communities in Australia.” 

The so-called Collingrove Agreement was settled in short order during a two-day retreat in the Barossa Valley in Professor Worley’s home state of South Australia.

It defines a rural generalist as a medical practitioner equipped to provide  “comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team”.

The accord is “consistent” with the Cairns Consensus Statement on Rural Generalist Medicine devised by ACRRM and acknowledges the respective contextual position statements on rural generalism by ACRRM and the RACGP.

Dr Stewart said each college would pitch in to devise an agreed national training program and an industrial framework, which would likely take a different form in each jurisdiction.

“The bottom line is that there have to be jobs at the end of the training, and it’s up to the jurisdiction to determine what those jobs will be,” she said.

“The first task will be to address the deficits that exist,” she added.

ACRRM’s curriculum incorporates training for GPs in 11 advanced skills – including mental health, paediatrics, obstetrics, anaesthetics and emergency.

The RACGP offers an added qualification, the FARGP, aimed at producing multi-skilled rural doctors.

Dr Seidel said he was “absolutely” optimistic that the spirit of cooperation and the need to produce results for a 2020 deadline would win out over past frictions.

“Neither Ruth Stewart nor myself have an interest in reliving the past,” he said.

“We have a rural generalist from Thursday Island and a rural GP from Tasmania representing both colleges and, although the scope of our organisations is very different, our interests are very much the same when it comes to rural health,” he said.

“Those interests are very much aligned with the interests of the National Rural Health Commissioner and the interests of the ministers for health and rural health in Canberra.”

Dr Ewen McPhee, a past president of the Rural Doctors Association of Australia, said the importance of the accord could not be overstated. “It wasn’t a fait accompli,” he said.

“Bastian and Ruth have stuck their necks out in a very strong show of high-quality leadership.  These two guys have made a leap of faith.

“Given all the history – and given the fact that ACRRM has done so much to develop and rediscover procedural rural general practice and define the discipline and create the initiative and give young doctors the motivation to rediscover it – it is important.”

Current RDAA President Dr Adam Coltzau said he was surprised at the speed of the agreement and the amount of work Professor Worley had accomplished in the past few months.

In Canberra for the recent annual round of meetings between rural doctors and politicians, Dr Coltzau urged both sides of politics to show similar bipartisan support to continue the momentum.

“I made the point that it needs to continue, with support from both sides of the house,” he said.

“There’s no use having these guys trained if there is nowhere for them to work.

“The federal government needs to help make sure that rural hospitals stay open and they have beds.”

While rural hospitals were seriously under threat on some states, Queensland had been reopening and extending services, he said.

Victoria Cook, a final-year medical student at Sydney University, who was in Canberra for the day-long round of political meetings, said the significance of the pact was not lost on the younger generation.

“Students were excited by the agreement between ACRRM and RACGP, it was great to see everyone in the same room,” the AMSA vice president said. “Students generally aren’t interested in the politics, they just want everyone to get on with the job.

“We know in the past that vocational training has been put in the too-hard basket; too many stakeholders, too many moving parts.

“This recent progress gives us hope that these things can be put aside to focus on the goal.

“We want the pathway to be ready for us when we graduate.”

Professor Worley, appointed last year as the first National Rural Health Commissioner, is currently forming a taskforce of experts to help drive the rural generalist agenda.

More details about the work ahead will be revealed when Professor Worley presents his first report to the national parliament at the end of this month.