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Canberra November 2012 Minutes

Outcomes from the Meeting

Represented at the meeting:

Adelaide University

Australian National University

Deakin University

Flinders University

Flinders University NT

James Cook University

University of Melbourne

Monash University

University of Notre Dame

University of Newcastle

University of New England

University of Sydney

University of Queensland

University of Western Australia

University of Tasmania

University of Wollongong

University of Western Sydney

Commonwealth Department of Health and Ageing


DAY ONE: Thursday, 8 November

  • Judi Walker (Chair) welcomed delegates to the FRAME Meeting. 70 registrants from a 15 universities - each Rural Clinical School (17) with one exception was represented at this meeting.
  • Acknowledgement to Amanda Barnard & her team: Fiona Jorgenson, Bea Hogan & Val Collits.

Department of Health and Ageing

  • Judi Walker introduced Penny Shakespeare (First Assistant Secretary, Health Workforce Division). Lou Andreatta, Padmaja Jha; Michelle Hilliard from Workforce Distribution were also present.
  • Items discussed included:
-          the current Health Workforce review to respond to policy & reform issues in the context of the Health Workforce 2025 Report
-          Jennifer Mason has been appointed Independent Chair & has been attending round table meetings, with a draft report due to government before Christmas.
-          Previous reviews to be looked at in regards to effectiveness of current programs.   It was acknowledged that sometimes the timespan of achievements is longer than program itself. Findings of the review will feed into 2013 budget cycle.
 
Achievements Report
  • Jennene Greenhill, on behalf of working group as set up at Ballarat meeting, presented “FRAME: 10 years of achievement.” (Attachment 1).

RCS Achievements

  • Each RCS provided their single most significant achievement:
-          Jonathan Newbery (University of Adelaide) – Working in an urban centric, traditional medical school, winning credibility with urban specialists & academics.
-          Amanda Barnard (ANU) – Development & implementation of robust & sustainable models of community-based vertically integrated education & training.
-          Barry Morphett (Deakin University) – Established a new medical school with $70m infrastructure; first graduates doing rural internships.
-          Jennene Greenhill (Flinders University) – 14 universities have imitated the PRCC which now has international recognition through publications & 5 ALTC grants.
-          Sarah Strasser (Flinders NT Remote Clinical School) – Establishment of the Northern Territory Medical Program & riding the waves.
-          Suzanne McKenzie (James Cook University) – 2005 – 2010 86% of graduates intend to practice outside of capital cities (compared with 32% others), 67% did internship outside of metro (compared to 17% of others).
-          Bill Adam (University of Melbourne) – Excellent teaching & learning educational outcomes & student support changing perceptions attracting students to RCS.
-          Judi Walker (Monash University) – Over 40% of total MBBS cohort now undertakes a minimum of 1 year longitudinal rural clinical placement in one of our RCS sites (all with excellent infrastructure) in a School (integrated RCTS/UDRH programs) which extends over 1000 km across rural Victoria.
-          Jenny May (University of Newcastle, joint medical program UoN and UNE) – Able to negotiate a rural medical school and department of rural health.
-          Joe McGirr (University of Notre Dame) – At this point, getting established and in particular, at Lithgow (a small GP run hospital without history of teaching students).
-          Geoff Nicholson (University of Queensland) – Over a decade, the total number of students completing ONE year at UQRCS has increased from 26 (in 2002) to 117 (in 2012) and in 2013 the number will be 137. The proportion completing two years has steadily increased to 31%. Evidence that attendance at UQRCS is a highly significant predictor of subsequent rural practice.
-          Tony Brown (University of Sydney) – We exist! 10 years ago there were 6 students – there are now 64 students across Dubbo & Orange with a waiting list desperately wanting to come and the good cycle of graduates supporting the program.
-          Timothy Skinner (University of Tasmania) – In 2013 the UTAS RCS was over-subscribed for first time, all intern places in our region filled by RCS students.
-          Geoff Riley (University of Western Australia) – Arguably our proudest achievement is that we are over-subscribed every year! But also Carrick Award in 2007 & Premier’s Award in 2008.
-          Jenny Akers (University of Western Sydney) – A wide variety of research activities & projects & strong commitment to Indigenous health.
-          David Garne (University of Wollongong) – 75% of students do a longitudinal rural experience, publications re longitudinal placements.

Department of Health & Ageing, Q & A Session – Lou Andreatta & Padmaja Jha

Topics and discussion included:

  • Joe McGirr: Senate Community Affairs Inquiry into Rural Workforce

Senate Inquiry over 300 written submissions, over 20 consultations at different locations with many issues & themes raised, including rural classification; education, training, 25% rural background. All recommendations relating to workforce distribution etc. will be considered in the review of health workforce. Government yet to finalise its response to Inquiry (3 months to respond). Independent Chair is familiar with recommendations & has been asking relevant questions at round table meetings and within DoHA. Senate Report and submissions on Senate Website

  • Sarah Strasser: Ongoing role of HWA, including changes proposed for rural/remote issues for clinical training and SLEs

HWA is a COAG initiative & the Commonwealth is only one player in decision making. Partnership agreement review is underway. HWA strategic planning has been successful yielding an evidence base to look at future predictions & formulate future policy. Future of HWA and role unclear.

  • Alexandra Meyer: Reporting issues - What makes a great RCTS report?

It is up to individual RCS how report is presented, providing it contains relevant information & response provided to show how each parameter is met. Including an addendum is an option. Currently there is no public access to collective reports. FRAME could request for reporting to be made public, i.e. FRAME website – options could include individual reports; anecdotal case studies etc. Agenda item carried over for discussion at caucus.

  • Jonathon Newbery: Expenditure of RCTS funds on seeding research activities to generate data for grant submissions etc

It’s possible this would be considered as it is within training and workforce, research into what rural communities need to deliver fully on parameters eg. a 12 month scholarship for research into relevant, specific rural health issues. Important that the funded research effort feeds back into education & training. Opportunities for reciprocity of research, recognising research as important for leverage in recruitment & retention with young career medical, nursing & allied health students, as they decide where they want to work. Innovation & new models happening in rural areas, publications needed.

  • Jenny Donelly: Funding stream 2014-17 – will the next funding round be based on a model similar to current model? What will be the student numbers census date and will funding be based on rural classification?

Will be considered in the context of the review of Health workforce programs - parameters may be the same. Funding may not be based on student numbers alone, also other things like where training was held.

  • Geoff Solarsh: At least 4 universities are interested in establishing new medical schools

Minister is not considering any new medical schools.

  • David Campbell – more likely to achieve workforce outcome if students are of rural origin (25%). Is DoHA considering applying similar policy to GP training?

Review is looking at continuum training and scholarships, and how can all link. This generated considerable discussion about rural generalist and rural specialist training and different models of vertical integration. Review wants to find out what vertical integration means, what is needed to make it happen, policy required and how to implement.

  • Georgia Van Guttner: Specialist training program - Will it continue to roll out?

2013 program rolled out, full allocation complete. Plans for 2014 in place. A number of RCS included in collaborations. Engagement is needed in this area.

  • Amanda Croft: New system for payment of funds has caused problems within universities

DoHA has introduced new system for payment of grants to help streamline the grants process. Health Workforce Division first to roll out, some teething problems. Once set up, both parties will have less paperwork. Once fully implemented it will be beneficial to all.

  • Timothy Skinner: Five per cent issue - when is centralised service a centralised service? What defines the 5%?

Policy thinking behind 5% rule, funding under RCTS needs to be expended in rural areas but recognises there is some expense in managing contractual arrangements. Not more than 5%. An RCS does not have to spend 5% on central administration. RCS should negotiate with its university.


FRAME ‘Vertical Integration’ Workshop

(Attachment 2 – FRAME Vertical Integration – ACRRM Rural Medical Generalism)

  • Meeting split into state/territory clusters with an aim to define vertical integration (VI) in rural medical education and training, shared understandings. What’s your RCS’s involvement in VI? What is required to make it work effectively in your region? What do you agree is the role of RCSs to make this work? What does this mean from a Commonwealth policy perspective?

Cluster groups:

  1. South Australia, Tasmania, Western Australia (Lucie Walters)
  2. New South Wales (Joe McGirr)
  3. New South Wales (Jenny May)
  4. Northern Territory and Northern Queensland (Sarah Strasser)
  5. Southern Queensland (Geoff Nicholson)
  6. Victoria (Geoff Solarsh)

After the FRAME meeting, workshop leaders prepared a one page response based on discussion which formed the basis of the FRAME submission to the Review of Health Workforce Programs (Attachment 3).

FRAME Issues

FRAME/MSOD Survey – Lucie Walters

Lucie gave summary of FRAME- MSOD project to date (Attachment 4 FRAME Survey Report).

Discussion included:

  • 2011 data reports sent to participating RCS in July.
  • Go to FRAME website to find demographic data, collective data also available by email (deidentified).
  • Started collection of 2012 data with 420 paper surveys and 169 online invitations. Collecting data between 4 weeks before students finish their clinical rural experience to 12 weeks after clinical experience.
  • Annual data will be published after completion of cycle.
  • Working to streamline report. Keen to make sure data is available to everyone.
  • Need to be thinking about what we can find from 2011 data to start generating the questions for 2013 data. Use it as research tool, not just to meet parameters. Groups of students going through multitude of similar experiences.

FRAME Succession Planning Study – Lee Krahe

  • Phase 1 of study is complete. All contact details of previous Directors of RCS over past 10 years has been collected. All except 1 university participating.
  • Volunteers requested to work with Kee Krahe on phase 2 to determine survey questions.

Rural Clinical Academic Leadership – David Campbell and Judi Walker

David Campbell focussed on preparing rural clinical academics as leaders and the outcomes of workshops held in South Africa and Canada during 2012 (Attachment 5).

ACTION: South African Workshop Report to be posted on FRAME website.


DAY TWO: Friday, 9 November

Review of Rural & Remote Health Workforce Innovation & Reform Strategy

Etienne Scheepers Executive Director Innovation & Reform, HWA

  • Update on HWA activities and its four work streams.
  • Update – workforce innovation & reform: 70 projects running across Australia.
  • Aboriginal & Torres Strait Islander programs – flagship program is the up-skilling of Aboriginal health workers to Aboriginal health practitioners Looking for providers who can do the gap analysis and provide training to those interested. Quite challenging – intention to provide training as close as possible to person.
  • Aged care workforce reform. What is the appropriate workforce, how can we achieve outcomes? Have appropriate interaction between sectors. Safe medication management; prevention of functional decline; building capacity; building capacity to deliver coordination of care within the community. Looking at innovative and different workforce models how to best address issues. Evaluation underway. A lot of innovation happening but not applied consistently. Difficult to pick up innovative idea, no ‘innovative toolkit.’
  • Expanded scope of practice. A number of sites implementing advanced practice roles. Nursing advance practice (emergency, paediatric, mental health, rural/regional care); expanded scope practice role for physiotherapists; extending the scope of paramedics where they do not pick up and transport to hospital but provide care under supervision of medical practitioner; physician assistant trial, Medical Generalist pathway – big theme in work being planned, clear in evidence; allied health generalists.
  • FRAME comments around HWA proposed national mechanism. Historically difficult for colleges centrally to drive regional agenda. Rural Clinical Schools have the knowledge to broker arrangements regionally.
  • Health practitioner prescribing pathway for practitioners other than medical practitioners. Pathway will be going out for consultation. Looking at the safety quality overlay, other requirements? Draft document on the HWA website.
  • Mental health program – looking at peer workforce, how to better develop & utilise peer workforce. Mental health practice standards under review, agreement to be developed, for competencies for mental health professionals.
  • Competency – one project is developing national competency framework. Means different things to different people. National leadership framework. Document to set up core competencies needed at all levels for health practitioners. Testing phase with education service providers on proposed competency report. Useful in looking at curriculum setting, describing roles, looking at competencies required for a sustainable health system.
  • HWA Inspire 2012 Conference – sold out. Need and program is seen as useful.
  • Draft National Rural Health Workforce Strategy       - 38 consultation visits across rural Australia. HWA is interested in feedback – are we hitting mark in terms of focus? What is most important? What did we miss? What advice is there for implementation of strategies? Happy to take general comments, via form, or email directly.
  • There were questions about HWA funding for clinical placements and future sustainability. Etienne Sheepers explained that the current Agreement ends in June 2013 and forward plans will reflect outcomes from the Review of Health Workforce Programs and other reviews. HWA is planning to continue but governance arrangements could change as well as scope.

AMSA – FRAME relations

Catherine Pendrey (Vice-President External, Australian Medical Students Association) & Helen Jentz (CEO) ( Attachment 6 - AMSA FRAME presentation)

  • Survey sent to RCSs early this year highlighted the need for communication between AMSA and FRAME.
  • Catherine presented an overview of AMSA’s governance and policy areas with particular reference to rural and indigenous issues.
  • AMSA – FRAME: Peak representative body of medical students; leading body rural Australian Medical Educators; common objectives, advance progress through collaboration.
  • AMSA Secretariat is located in Canberra. Best way for this to work is for communication via the AMSA CEO, Helen Jentz. She will ensure that relevant new AMSA Executive members are introduced to groups like FRAME.

This email address is being protected from spambots. You need JavaScript enabled to view it.

FRAME issues

FRAME Leadership Course – Judi Walker and Jennene Greenhill

  • 4 day leadership course the week before the Broome Meeting 5 - 8 May. (Broome meeting is 9-10 May).
  • Based on Harvard and ASME Educational leadership courses targeting emerging rural academic leaders.
  • Anyone with a passion for educational leadership wanting to be involved welcome.

ACTION: Develop and circulate flyer and plan program (Judi Walker and Jennene Greenhill)


Aims of FRAME – Daryl Pedler

  • At Ballarat, it was agreed the ‘aims’ of FRAME were ‘tired.’ Working group of Ruth Stuart, Darryl Pedler and Geoff Riley revised the Aims which were discussed and further amended (Attachment 7 – Aims of FRAME).

ACTION: Place Aims of FRAME document on the FRAME website for comment

Future Structure of FRAME – Policy Group

  • Options for the future of FRAME were considered in the context of the structure required to achieve the agreed function and purpose of FRAME (Attachment 8 – Future Structure of FRAME).

ACTION: Options paper to be crafted as a survey to be sent to each RCS for response and feedback before the May FRAME 2013 meeting

FRAME website – Kumara Mendis

  • An email from Kumara Mendis was discussed re uploading relevant FRAME publications to website.
  • A big thank you to Helen Peacocke and Kumara Mendis for the effort on website creation and maintenance.

ACTION: Helen Peacocke to liaise with each RCS Manager re uploading of articles of relevance to FRAME

Celebration/Research Working Group – Jennene Greenhill

  • The next step is to publish what has been achieved, others welcome to join working group.
  • Meeting re research activities, perhaps breakfast meeting at Broome to identify themes making a real difference.

ACTION: Jennene Greenhill to progress the Research Working Group and arrange breakfast meeting in Broome

Academic Partnership with ACRRM – Richard Murray

  • Richard provided an update since the conversation in Ballarat re FRAME/ACRRM collaboration.
  • Particular interest is to provide alternative tracks to rural medical generalist careers.
  • To date engagement in this area has been underwhelmed.
  • Important opportunity for ACRRM to work with interested RCSs.
  • A lot of interest, but what is first step? If this is to be under FRAME umbrella, given life by individual Clinical Schools, need to look at resources, selection options.
  • Agreed that ACRRM should host a Workshop to extend conversations and develop a process to formalise academic partnerships with ACCRM, and potentially with other colleges by developing templates for negotiations.

ACTION: ACRRM to liaise with FRAME to invite interested RCS to a workshop in Brisbane in February

John Flynn Placement Program – Denese Playford

  • Recent meeting in Fremantle of the JFPP Advisory Committee, Denese Playford represented FRAME at meeting.
  • A good example of how we can have good representation on committees.

ACTION: Individual RCS to contact Dianne McClusky This email address is being protected from spambots. You need JavaScript enabled to view it. as key contacts for JFPP

ACTION: Arrange session at Broome meeting to provide feedback to ACRRM

Agreements & Reporting – Padmaja Jha

  • Padmaja Jha gave a quick update on housekeeping items.
  • Expend RCTS within financial period.
  • Those RCS that have not provided insurance certificates – please forward to Michelle Hillier.
  • RCS & RUSC programs – still a requirement to aquit agreements.
  • Underspends will be returned to DoHa via a debtor invoice.
  • Staffing changes in Health Workforce Division (3 branches, Headed by Penny Shakespeare): - - Workforce Distribution: Lou Andreatta, 4 sections - Padmaja (RCS UDRH programs); Specialist training programs (Jennie Della); GPET (Louse Modden & Andrew Benson); Retention rural incentive programs (Liz Murray).
  • Michelle manages overall RCS program.
  • Josie Dichiera at Melbourne office, and Karen Evans at Sydney – UDRH programs.
  • JFPP< continuing education programs, run separately, Suzan Charman.
  • Hoping for stability by early next year.
  • FOFMS (new programs). Trying smart forms for reporting online.

Matters arising from Day 1

  • Strategy paper to Review of Health Workforce Programs (see page 5)
  • Re-definition of rural origin and increase in rural student intake from 25 – 33%. Issue will be addressed through Review of Health Workforce Programs
  • Publishing EOY reports on ausframe

ACTION: Canvas through the survey of RCS (refer page 9)

Broome Meeting – Geoff Riley & Jenny McConnel

  • Confirmed date 9-10 May 2013 at Broome campus of Notre Dame University (6 acres; 20 staff)
  • Accommodation varied: Accommodation on site is basic, more for student use, but will be available during this time. Tourist accommodation in the area.
  • Look for direct flights from capital cities (Virgin/Qantas).
  • Other activities can include shopping, Aboriginal cultural activities.
  • Email: Jennifer. This email address is being protected from spambots. You need JavaScript enabled to view it. for further information and watch the ausframe list and FRAME website.

Dates for November 2013 in Canberra

  • Thursday 10 & Friday 11 October 2013 to be confirmed.