The maldistribution of medical workforce between metropolitan, rural and remote areas of Australia is well-known. Existing remuneration mechanisms and business models have made it difficult for General Practitioner (GP) private practices to operate, especially in rural areas. In Western NSW, 41 towns are projected to face complete GP market failure by 2029.

To address this, an innovative model of primary care has been trialled over four years in a sub-region of Western NSW that covers four small rural towns with populations less than 1500 experiencing market failure – Tottenham, Tullamore, Trundle and Trangie (4T’s).

The 4T’s model is a whole-of-healthcare model, utilising a single-employer mechanism to allow the Local Health District (LHD) to employ Rural Generalists, clinical and administrative staff to work collaboratively to deliver acute, emergency and comprehensive primary care services across the sub-region. This model is novel in NSW as traditionally LHDs have not stepped in to run primary care, including when this impacts hospital services. The hypothesis behind the model is that communities are stronger by working together to better meet local health needs. The model pools both Federal and State health resources through a 19(2) Exemption to maintain service access where traditional market forces have failed.

The project is supported by local communities and regional health stakeholders and has received project support from the Australian Government through the Collaborative Care Program.

This presentation will provide an overview of the enablers and barriers for providers interested in implementing a whole-of-health, single-employer model in small rural communities. It will also share the evaluation findings of the 4T’s model to date, covering the four domains of value-based healthcare.

This Case Study demonstrates the potential of the 4T’s model, as one way of overcoming the intractable challenges of maintaining access, quality and sustainability of primary healthcare in a rural context.

1. A case study demonstrating the potential of the 4T’s whole-of-healthcare, single-employer model in small rural communities, as one solution to overcome the intractable challenges of maintaining access, quality and sustainability of primary healthcare in a rural context.
2. Enablers and barriers for implementing a single-employer model in small rural communities, using collaborative regional approaches.
3. Evaluation findings of the 4T’s model to date, covering the four domains of value-based healthcare.

BACKGROUND: Primary healthcare provision in Bangladesh, a developing country, contrasts starkly with Australia, a G20 nation. This study examines primary healthcare delivery in two contrasting rural settings: Bhola, a densely populated island in Bangladesh; and the Gemfields, a marginalised, sparsely populated region in Queensland, Australia. This paper aims to compare and contrast how medical practitioners in these two environments perceive their scope of practice in response to infrastructural constraints and very different regulatory frameworks. It also looks at how the COVID-19 outbreak has influenced the implementation of telehealth in both settings.

METHODS: Qualitative interviews were conducted with 51 rural health practitioners: 28 unqualified medical practitioners and eight formally-trained medical professionals on Bhola Island; and 15 health professionals in the Gemfields.

RESULTS: Bangladesh and Australia face a common problem: a chronic shortage of qualified healthcare providers in rural areas. This deficit is mainly caused by the reluctance of qualified medical practitioners to relocate from urban areas. Other shared problems include limited health literacy, inadequate control regulations, and misuse of prescription medicine. In Bhola, residents turn to informal ‘village doctors’ due to restricted access to government facilities. In contrast, the Gemfields residents cannot readily access allopathic medicine due to greater regulatory control of healthcare delivery, so eschew government healthcare because of low trust in authority and governmental services.

CONCLUSION: COVID-19 has prompted a shift in scope of practice of healthcare professionals in Australia and the strengthening of telehealth offerings in remote areas such as the Gemfields. Here, the pandemic triggered a loosening of the regulatory framework surrounding formal healthcare provision, with face-to-face consultations put on hold and telehealth developing by default in response to emergency needs. However, the Bangladeshi ‘solution’ to similar rural healthcare challenges, in a much more laissez-faire regulatory setting, continues to be more locally ‘appropriate’ and clinically risky.

At the conclusion of my presentation, attendees will take away these key messages:
1. Innovation arises out of necessity.
2. Less role delineation may help to meet community health needs.
3. Extended scopes of practice may help to reduce service constraints and fill vital service gaps.

Introduction
The [scholarship program] established in 1989, is a scholarship program with a return-of-service component administered by the [organisation name] on behalf of the [organisation name]. The program supports medical students interested in undertaking a medical career in rural NSW. It aims to address rural workforce shortages, thereby improving access to health services in rural areas where poorer health outcomes result in a higher rate of injury, hospitalisation and death.
The study identified key strengths and challenges of the [scholarship program]. In particular, the focus of this presentation will be the success of the scholarship program in increasing the number of medical practitioners working in rural and remote communities, and the influence of the scholarship program on geographical location for participants. It will also examine the factors that contribute to overall sustainability of the program.

Methods

The [scholarship program] Evaluation Survey was first conducted in 2012 and was repeated again in 2022. The survey is a repeated retrospective cross-sectional study design. Scholarship recipients who completed the program were eligible to undertake the survey. Using quantitative data, a comparison is made to variables in previous surveys. Logistical regression is used for the analyses.

Conclusions

It has been demonstrated that a targeted incentive-based scholarship schemes with a return-of-service component can be beneficial, particularly where they include ongoing support and reinforcement throughout the transition from undergraduate to postgraduate training.

The research findings presented will inform future policy, practice and rural incentivisation.

At the conclusion of my presentation attendees will take away
1.The [scholarship program] is a long running scholarship program, running for more than 30 years, which provides support to medical students with an interest to practice medicine rurally. 
2.Scholarship programs with a return-of-service component can influence Medical graduates decisions to practice rurally. 
3. Besides financial assistance, these programs also need to provide support to scholarship recipients.

Rural communities in Australia face many challenges in accessing quality health care including limited resources and often vast distances to travel with the geographical spread of rural towns. As a result, rural communities have poorer health outcomes, with higher rates of injury, hospitalisation and mortality.

No two rural communities are the same, each have different health services and workforce needs. Collaborative Care addresses this as an innovative model of care, targeting a place-based approach to support the development and sustainability of rural community’s health services and workforce models. Collaborative Care seeks to leverage existing resources within the health system underpinned by collaboration, co-governance, community engagement and action implementation.

This presentation will share the Collaborative Care framework, highlighting critical characteristics, key actions and important factors across five steps coordinated by community driven project teams.

1.Investigation - What do we already know about the primary health care needs in these communities?  

2. Engagement - Hear the views of community members, health practitioners, and the organisations that support them.

3. Co-design - Decide together how primary health care services could be shared among local communities.  

4. Implementation - Put the plan into practice and make sure communities know what to expect.

5. Evaluation - Look at what is working well and where improvements can still be made. 

This framework necessitates partnership with community as a key enabler. The Collaborative Care approach and framework are transferable between communities to allow localised solutions to achieving quality and sustainable health care access.

At the conclusion of my presentation attendees will take away
1. There is no single solution to the health care challenges facing rural communities in Australia, and globally.
2. Collaborative Care provides a framework by which rural communities can identify and prioritise their needs, implement programs to address these needs and evaluate programs implemented.
3. The Collaborative Care framework is adaptable and can be individualised to each community.

All around the world there are challenges attracting and retaining medical graduates into rural healthcare – New
Zealand is no exception. It has been widely published that rural origin, positive rural undergraduate experiences and rural post-graduate training pathways assist in the attraction and retention of doctors into rural communities. However, there is a lack of evidence in how these might apply in the New Zealand setting, what other influences there may be and how different aspects may interact to increase or decrease the
likelihood of someone ultimately choosing to work rurally.
This presentation will look at the outcomes from linking workforce data with the Medical School Outcomes Database (MSOD) data to demonstrate what influences rural career choice in New Zealand doctors

At the conclusion of my presentation attendees will take away

1. Knowledge of rural Workforce issues in general
2. Outcomes from NZ rural workforce data
3. Latest influences on rural career choice