Training and access must be major priorities for Australia’s new rural health tsar

Reducing cost of living pressures for Australians living outside the major cities and improving training pathways for rural generalists ought to be major priorities for the new National Rural Health Commissioner, the RACGP urged Thursday following passage of the legislation.

The Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 passed the Senate overnight, providing for the establishment of a new rural health tsar to develop and advise the government on a national rural generalist pathway.

Rural health heavyweight Gordon Gregory has examined the Commissioner role in two excellent pieces for Croakey here and here, urging independence and sustained political support to ensure its potential is fully realised.

The National Rural Health Commissioner Bill has this evening passed the Senate unopposed. Summing up was by Fiona Nash – its progenitor.

— Gordon Gregory (@gnfg) June 14, 2017

Terrific news! Congratulations @DaveGillespieMP and all supporters. Looking forward to progressing this important work! @RuralDoctorsAus https://t.co/gSjdDvD5BL

— ACRRM (@ACRRM) June 14, 2017

The #Senate has agreed to the Health Insurance Amendment (National Rural Health Commissioner) Bill 2017 – thks @DaveGillespieMP #ruralhealth

— NSW RDN (@NSWRDN) June 14, 2017

The Royal Australian College of General Practitioners welcomed passage of the legislation as a major advance for rural and remote health, and said the position must push for more equitable funding addressing the broader determinants.

“More than 30 per cent of Australians live and work in rural Australia yet rural Australians receive far less than 30 per cent of health funding,” said RACGP President Dr Bastian Seidel.

“The Rural Health Commissioner must lead the development of an equitable funding model to support rural patients, not just for health care but also to address the social determinants of health.”

Cost of living pressures, particularly related to accessing health, must be a major priority of the Commissioner who, he said, “must make it their priority to reduce this unnecessary stress on Australians when they visit their GP.”

The Rural Doctors Association of Australia said the role had “real potential to bring about significant, positive reforms in the rural health sector.”

“He or she will play a particularly important role in rebalancing the maldistribution of doctors and other health professionals between urban and rural Australia — and through its role in developing and implementing the government’s promised National Rural Generalist Pathway to help deliver the next generation of doctors with advanced skills to rural and remote communities,” said RDAA President Ewen McPhee.

McPhee said the Commissioner would play a “crucial role in the wider challenges facing rural healthcare, including improving health outcomes for Aboriginal and Torres Strait Islander people and boosting mental healthcare access in the bush.”

Seidel said the RACGP was advocating for the role to go to an experienced rural GP with a good understanding of rural workforce issues (a great piece on this here) as well the importance of patient-centered care and transformative potential of digital health.

“Participation in the rural health workforce across medical specialties and allied health must be promoted by the Rural Health Commissioner,” added Seidel.

“They should also lead strategies to monitor and address workforce misdistribution through strengthened national planning and training policies that ensure doctors are training to deliver care where it is needed, alongside targeted incentive aligned to addressing workforce and retention barriers in rural and remote communities.”

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RACGP rural chair Dr Ayman Shenouda said the role ought to support the expanding rural generalist role, with fellowship training recently extended beyond “whole-patient care to whole-of-community care including aspects of public health and advocacy” as well as advanced training in palliative care, mental health, Indigenous health, child health, adult internal medicine and small town rural general practice.

“A one size fits all approach to rural general practice training clearly does not work and it is essential that rural general practice training reflects flexibility and responsiveness to community needs,” Seidel said.

“Congratulations to Minister Gillespie on leading the introduction of this significant legislation.”