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Canberra September 2014 Minutes

18 + 19 September 2014

Rural Clinical Schools and Regional Medical Schools from the following Australian universities were represented at the meeting:

University of Western Sydney

Monash University

Australian National University

Flinders University

University of Wollongong

University of Sydney

University of Notre Dame Australia

Deakin University

University of New South Wales

James Cook University

University of Newcastle

University of Tasmania

University of Melbourne

University of Adelaide

University of Queensland

University of Western Australia

 
  In Attendance
  Griffith University (Observer)
 
  The Commonwealth Department of Health was represented by:-
  Ms Penny Shakespeare (First Assistant Secretary, Health Workforce Division)
  Mr David Meredyth (Director, Regional Training and Education Reform Section)
  Ms Kate McCauley (Assistant Secretary, Training and Reform, Health Workforce Division)
  Ms Padmaja Jha ( Director, Workforce Grants, Grant Services Division)

Day 1 – FRAME and Commonwealth Department of Health

Welcome to Country by Ms Samia Goudie, Senior Lecturer, Indigenous Health, ANU.
Professor Nick Glasgow (Dean, ANU Medical School) welcomed participants to the ANU and Canberra, and congratulated the Department on the extremely successful policy that has supported RCSs and UDRHs in addressing rural workforce shortages. RCS staff were commended for their work, leadership, the example they set and encouragement they provide to graduates. Medical Schools are much richer for having rural clinical schools with RCSs broadening horizons and assisting Medical Schools to think differently about curriculum.
 
1.  Rural Clinical School/Regional Medical School Round Up
Three-minute presentations from each clinical school on one of the following topics
  • Progress collecting destination data, or
  • Research activity in supporting rural medical/health workforce outcomes, or
  • Activities around staff retention impacts and reducing professional isolation
See Appendix 1. Powerpoint Presentations
 
In Summary
University of Adelaide
  • Conducted a study of 2013 students.
  • Students indicated areas for improvement. Sites are very diverse but students want consistency across disciplines and sites.
  • Students acknowledge the importance of professional etiquette.
  • The RCS has been oversubscribed with rural requests. 73 applicants for 46 places.
Australian National University
  • Is a small medical school and data collection has reflected the size and intimacy of school (letters to students / survey / local sites keeping in contact / Facebook).
  • Data collection has been labour intensive and time consuming. ANU will now use a survey monkey tool.
  • There are issues in terms of the rural pipeline and availability of rural internship places. ANU students do not have priority unless they completed Year 12 in NSW.
Deakin University
  • Covers an area approximately 300 km east west and 150 km north south.
  • There are 2 hospital based RCSs - Warrnambool & Ballarat and 10 longitudinal placements.
  • It is difficult to compare the different towns.
  • Deakin has introduced initiatives to reduce professional isolation including the creation of Regional coordinators, building working relationships with hospitals and general practices, improving collaboration & cooperation.
Flinders University
  • The School of Medicine is 40 years old and next year the University celebrates 50 years.
  • The new Vice Chancellor, Professor Colin Stirling commences at end of 2015 and has a good understanding of Medicine.
  • Flinders is proud of the proportion of graduates working in RA4 and RA3.
  • There are limited internships available in SA. Flinders encourages policy makers to push for more GP and specialist pathways.
James Cook University
  • Conducts an Exit Survey in which they collect data and ask graduates to consent to being contacted.
  • Uses a Facebook page and sends friend requests.
  • In the future, JCU will select every 5th cohort to maintain close contact.
  • 67% of graduates are working outside major cities and 47% in outer regional / remote areas.
University of Melbourne
  • Peer review for medical educators.
  • Formal accreditation – CPD points.
Monash University
  • Graduate Tracking Study with data from 2004-05 cohorts to present day.
  • Early results indicating that the relationship between the total number of weeks in Years 4 and 5 rural placement and rural outcome is statistically significant.
University of Newcastle
  • New building in Tamworth and a joint medical program with the University of New England
  • Colocation has created opportunities for interprofessional learning activities with nursing, allied health and medicine.
  • Newcastle is supporting health professionals to reduce isolation through interprofessional activities including clinical skills bootcamps, simulation activities in small town sites, critical care masterclass.
University of New South Wales
  • 3 different types of surveys – Undergraduate Destination Survey, Graduate Destination Survey & FRAME survey.
  • Results indicate graduates with 3 years of RCS experience indicate rural areas as their preferred work location.
University of Notre Dame Australia
  • Campuses at Sydney and Fremantle. RCSs at Lithgow, Wagga Wagga and Ballarat.
  • Lifestyle factors decision impact on GP trainees.
  • There are pathways to general practice around the Wagga campus but specialist pathways are limited.
  • Practice models influence decision to practice rurally.
  • RCS impact on intension to practice rurally.
University of Queensland
  • Surveyed graduates from 2002 – 2011 to gain a cross sectional snap shot.
  • The questionnaire was long and collected a lot of data.
  • Results have been submitted for publication.
University of Sydney
  • Plenty of rural exposure means graduates are more likely to work rurally.
  • Sydney has RCSs at Dubbo, Orange, Lismore & Broken Hill.
  • There are insufficient PGY1 places and very little vocational training opportunities.
  • RCSs are graduating doctors with no pathway for them.
University of Tasmania
  • Study compared graduates from the RCS with graduates from clinical schools in Hobart and Launceston.
  • Snapshot study using APRHA database & Postcodes for 2002 – 2013; 974 graduates; 202 RCS; Located 89% of students.
  • Mapped grads against postcodes to see where currently practising.
  • RCS grads 4 times more likely to work in RA3-5 areas compared with other UTAS grads.
  • More work needed on the pipeline / specialist training places.
University of Western Australia
  • UWA & UNDA (Fremantle) have a joint RCS program at 14 sites across WA.       It is the biggest school in Australia and most staff are local doctors teaching into the program.
  • The RCS hosts lots of meetings both f2f and via VC, but more is needed to keep staff engaged.
  • The RCS is cultivating research and it is making a difference, keeping tutors interested and enthusiastic.
University of Western Sydney
  • 2 rural clinical schools – Bathurst / Lismore.
  • 301 Graduates to date.
  • 50% of student intake has to be from Western Sydney. It is difficult to encourage graduates to leave Western Sydney to practice rurally.
  • UWS is looking to learn from other universities.
University of Wollongong
  • Graduated 4 cohorts to date.
  • Looking at student intentions.
  • Longitudinal integrated clerkship. Not all end up in GP.
  • Now time to track students. Next phase in research is to see if intentions translate into reality.
Key messages
  • There is an urgent need for more post graduate training posts / removal of barriers to rural practice.
  • It would be useful for the Department to see data and results, reports, published studies etc.  Data are helpful when briefing Ministers on outcomes.
  • The longer students spend in RCS, the stronger the intention to go rural.
  • Research indicates short term rural placements do not influence rural career but do change knowledge and attitudes towards rural health.
  • Shorter rural placements in earlier years are used as a recruiting tool into long term rural clinical placements. Early clinical immersion influences decision to go rural in years 3 – 5.
  • The current FRAME position is that individual universities should determine whether to allocate funding towards short term rural placements or longer term rural placements.

 
2.  Department of Health: Broad Strategic Environment – developments post Budget
   
Ms Penny Shakespeare, First Assistant Secretary, Health Workforce Division
 
  • The change of government has led to a different approach at the Commonwealth level.
  • The Federation White Paper is looking at interaction between Commonwealth and State / Territory responsibilities especially in Health and Education.
GP & Specialist Training
  • The environment for General Practice training is changing.       PGPPP is not continuing. PIP payments have been doubled. There will be a public tender process for regional training providers.
  • The Commonwealth is reviewing different sources of funding for clinical training and looking for increased transparency and rationality in funding areas.
  • The National Medical Training and Advisory Network has transferred to the Department.
  • The Department is seeking better evidence base for Commonwealth, State & Territory investments.
  • The Department is informed about workforce numbers required and in what specialtiess. A subgroup is looking at training capacity in rural areas.
  • There is a commitment at the government level to continue the current model of training, determined by the Medical Board, AMC and colleges.
  • The Department is picking up the functions of GPET.
Funding Agreements
  • The Government is looking to reduce expenditure wherever it can. There will be no expansion of funding and no indexation. Efficiency dividends will be applied more generally.
  • There will be possible changes to way programs are structured. Funding agreements will relate to specific constitutional factors in relation to provision of medical services and benefits to students.
  • The new Secretary, Martin Bowles, takes up his position in mid October.
Discussion covered the following topics:
 
25% rural intake
  • The Department is keen to set achievable targets for all participants in the program.
New medical schools
  • The Government’s current position is not to support new medical schools.
Specialty Training in rural and regional Australia
  • There is a need to build capacity and look at the relationship between specialist medical colleges and universities.
Rural Training Pipeline
  • As there is no central health system, different sectors and different levels of government have to work collaboratively. It is important to have hospital based training positions and opportunities for primary care training in the right locations,.
Potential for 3GA provider number status for junior doctors
  • There are legislative restrictions on salaried doctors and Medicare. (Section 192 of Health Act)
National Medical Training Advisory Network
  • The existing structure will continue. The NMTAN will present reports on medical workforce to health ministers. Secretariat provide by Department, chaired by independent Chair.
  • Its function is to look at what’s happening and make projections out to 2030 based on assumptions, data models. It will make policy decision recommendations to policy leaders.
RA classifications
  • The Department is working on RA classification and districts of workforce shortage.
The issue of state jurisdictions charging medical schools for training
  • Internal working groups from the Departments of Education and Health are developing the Federal position to respond to an increasing likelihood that charges will be introduced. Discussions with the University sector will take place as soon as the government has determined the way forward.
RCTS funding
  • Funding will be influenced by the Medicare co-payment, deregulation of university funding, etc.
Process for FRAME to provide advice to the Department
  • The Department will work with the FRAME Policy Group to gather feedback and input.

 
3.  RCTS Parameters and Reporting Framework - Workshop with DoH Health Workforce Division
 
Reporting framework.
  • In line with the government’s red tape reduction agenda, the Department is looking to streamline the reporting system, capture really important outcomes and present in an efficient way.
  • The reporting system should enable both monitoring of individual university’s performance as well as reporting to government on the outcomes of the program as a whole.
  • The Department would like to trial self -assessment of outcomes-based information providing a set of questions to enable RCSs to provide succinct and relevant information with additional information provided as attachments.
  • If RCSs are not meeting the parameter, the Department would like evidence of mitigation or risk management strategies.
Parameters – discussion included:
  • Simplify parameters - Outcomes, outputs and processes.
  • Leave to RCSs to report process driven outcomes - staff, students, curriculum.
  • Smaller series of realistic high level outcomes about what influence RCS can have on rural workforce development backed up by key activities RCSs need to do. Some quantifiable, standardised targets plus KPIs – data as to whether outcomes have been achieved.
  • Mix of qualitative and quantitative indicators.
  • Parameters served as a repository to founding philosophy – don’t want to lose completely.
  • Look at how parameters are described and assess the risks. Eg: fairly high level and vague and not identifiable to individual students would have a high risk rating.
Parameter 2
  • Short Term placements – important to maintain the option. (See previous discussion).
Parameter 3
  • Rural people delivering rural education is important. Faculty members who have worked in the bush for a long time provide a depth and richness of experience to the program. Students respond positively.
Parameter 4
  • Process parameters allow RCSs to influence Medical School policy eg: 25% rural enrolment enables the RCS to actively work with Admissions for adjustments around ATAR, adjustments for rural student disadvantage.
Parameter 5
  • In the past there has been broad description around community engagement. Now revise the language so it links to what students do in the community.
  • Vertical integration agenda, demonstrating partnerships. Link to student and workforce outcomes.
  • Workforce programs are designed to provide a benefit to the rural community.
  • Community engagement in terms of students as leaders in the community. When students graduate, they have established a place within the community and parameter 5 enables RCS to do that.
Parameter 6
  • Progressing the rural health agenda – could now be more focussed on research and the rural pipeline.
  • RCSs could be encouraged / invited to provide representation on various areas involved in progressing the training pipeline eg integrated health networks.
  • The way the parameter is described needs to allow for relationships with training providers.
Parameter 7
  • At present, Parameter 7 is quite flexible. There is variation between the Clinical Schools on the focus of Parameter 7 and variable results.
  • There was some discussion as to the role of Medical Schools in Indigenous health given the large metropolitan Indigenous population.
  • The Department will engage with universities to determine how RCSs can influence more broadly issues around Indigenous students getting into medicine and graduating, as well as all students interacting with Aboriginal Medical Services.
  • The Australian Medical Council needs to encourage urban parts of the universities to do better with regards to Indigenous health.
  • RCSs shouldn’t be responsible for Indigenous health curriculum. That is the role of the university.
  • Where there has been success in enrolling ATSI students, the challenge is in supporting them through the medical degree. It is a complex and difficult job.
Parameter 9
  • Don’t change set targets that have been successful eg: 5% infrastructure charge.

 
4.  Rural Placement Information Project - Workshop with DoH Health Workforce Division
 
Background (See Appendix 2.)
  • Small project team is working on the website-based placement system in context of big picture policy work.
  • It is a low cost project designed to capture existing information about the opportunities available.
  • It can be difficult for students to navigate existing systems.
  • The idea is to capture information then have website developers design a tool to sit beside other resources on the Department’s website.
  • A lot of work has already been done. Available maps indicate the main training sites and training networks. The Department has a good idea of where training occurs and where overlaps are.
  • The Department is seeking new information on where there are post grad and pre vocational training opportunities.
  • RCSs have the networks and connections to source the information. The Department will seek information from other sources as well.
  • There will be some disclaimers. The website is not an offer of a position and positions might change. There will be links to more information, phone contacts, website links.
  • The website is designed to assist with forward planning, career options, training opportunities. There will not be too much text or drop down options..
Templates (See Appendix 3.)
  • The Department will populate as much information as possible then forward to RCSs to complete.
  • There was some discussion as to whether training facilities could populate and update data to encourage a sense of ownerships and improve accuracy, however the Website might not be advanced enough to allow for this. Ideally there will be limited data entry and the website will be updated on 6 – 12 month basis.
  • Undergraduate Training – information will be standardised to build excel spreadsheet report to website tool.
  • Prevocational training - address details will be mapped to the website.
  • The website will not be launched until the Department has consulted with jurisdictions.  The project is in the early stages to see if it’s workable. Data might be collected and mapped to the website in draft form.
  • Vocational Training – GP and Specialist. - Networks are changing. (Primary Health Networks are replacing Medicare Locals).
  • Main aim is to promote the website through AMSA and NRHSN with the potential to distribute around the secondary school networks.
 Feedback included the following issues:
  • Data become more complex further down the path.
  • Explanatory notes may require a link to the Medical School websites. All universities have different lengths of medical placements, minor and outreach sites, community rotations. The website needs to be reasonably understandable for secondary school students.
  • Input for base hospital intern rotations is complex.
  • Vocational training is complex and information may quickly be out of date if funded / not funded.
  • Rows rather than columns would make data entry easier.
  • More guidance is required on the definition of main sites/ hubs / minor outreach - clarity on size, explanatory notes, thresholds.
  • Consider using check boxes.
  • Focus on prevocational and vocational placements.
  • Undergraduate data - a test case for a workable website. Huge advantage for secondary school students / careers officers.

5Role of RCTS program in advancing Indigenous health issues and workforce development
    
Ms Samantha Palmer, First Assistant Secretary, Indigenous and Rural Health Division
 
  • Powerpoint presentation (See Appendix 4.) outlined statistics on ATSI population distribution, life expectancy and health outcomes.
  • Handout (see Appendix 5.) outlined the vision, principles and priorities for the Indigenous and Rural Health Division.
  • Discussion focussed on how RCSs can assist with turning principles into action on the ground.
  • Indigenous Australians Health Program has 19 KPIs and embedded Continuous Quality Improvement.
  • It was acknowledged that mental health illness underpins and interacts with many poor health outcomes.
  • The Department is engaging with the sector to determine how to measure the indicator around mental health / develop a measure that doctors can complete when engaging with a patient to arrive at a diagnosis about mental illness.
  • RCS can engage with regional managers and programs and ensure the work of the RCSs fits with the regional programs.
  • There is a strong focus on keeping Indigenous children in school and Indigenous people into work, empowering communities to make decisions about how government money in spent in their community. Need to ensure people are well enough to go to school and work.
  • Healthy lifestyles Teams are in place encouraging Indigenous communities to be active, eat well, give up smoking and improve access to primary care.
  • The “Break the Chain” advertisement focusses on Aboriginal people and has had a massive impact.
  • Aboriginal Medical Services are under increasing pressure to provide clinical placements.
  • There is a broad range of AMS. Services may need additional infrastructure and support to provide training.
  • Students are keen for clinical placements in Aboriginal controlled health organisations. The challenge for RCSs is to maintain relationships to be able to deliver the training.
  • There is a high expectation to increase employment of Indigenous people in private and public health settings. RCSs could work with the government to build the Indigenous workforce, through use of existing infrastructure for training eg: support and career pathways for Aboriginal Health Workers.

 6.  New developments in rural training pathways and the vertical integration agenda - Interaction of the RCTS network with other networks (eg IRCTNs, RTPs, PHNs)
    
Ms Janet Quigley, Assistant Secretary Primary Care Policy and Evaluation Branch
 
  • The Department is working on strategic long term policy for primary care.
  • System design - mental health interface / close links between research and future work in primary care.
  • 2014 Budget announced the acceptance of all recommendations from the Horvath report including the cessation of funding for Medicare Locals and introduction of Primary Care Networks from July 1 2015.
 Primary Health Networks (PHNs) (See Appendix 6.)
  • Designed to build links, reduce fragmentation and improve integration between health professionals.
  • There will be fewer PHNs to create economies of scale.
  • There will be general practice lead clinical councils reporting to the Board.
  • Community advisory council to give the community a voice and allow for local accountability and patient centred decision making.
  • PHNs will become regional purchasers and commission services rather than being service providers although they can become service providers where there is market failure.
  • PHNs will adopt best practice, be outcomes focussed and operate in line with the government agenda to reduce red tape.
  • PHNs will analyse health needs of the population, find innovative solutions for their area and better target resources to meet the regions’ needs.
  • PHNs will be focussed to research and best practice. Research supports PHNs and PHNs support research agendas.
  • Best buys, best values, innovation in design and delivery, best practice purchasing and commissioning.
  • The timeframe for development of PHNs is tight. The Department is currently developing policy parameters to be signed off by government.   PHNs will be up and running from 1 July 2015.
  • The Minister is keen to ensure that all entities can apply. PHNs could be state government, private health insurer, consortia, former Medicare Locals, or not for profit organisations.
 Discussion included the following issues:
 
Board structures
  • PHNs will be clinically appropriate, independent entities with their own board structures.
PHNs and LHNs footprints
  • Ideally LHNs and PHNs will work together.
  • Once boundaries are determined there will likely be a reasonable amount of congruence.
  • There will be a smaller number of PHNs than LHNs nationally. PHNs will have to deal with multiple LHNs. Eg: Victoria has 86 LHNs.
PHNs and GP continuing medical education
  • Discussions are taking place with the relevant Departmental Divisions.
PHN KPIs
  • A body of work is taking place around KPIs.  There will be a tiered approach. There will not be a re-tender if PHNs don’t meet KPIs in first 3 years.
PHCRED Strategy.
  • The final report is under consideration. The objective of the strategy is to improve efficiency and create opportunities for future improvements.
  • Research is critical to everything to do with primary care.
  • The government has an agenda to do things innovatively and differently than in the past.
  • There are monthly round tables and forums with people from CREs / various experts on primary care issues.
  • The Primary Care Policy and Evaluation Branch expect to put a report to the Minister’s office by end of year.
Medical Research Future Fund
  • The Fund is dependent on the GP co-payment and will take 20 years to mature before it starts giving out funding.
Medicare Locals vs PHNs
  • The Horvath Review highlighted that the scope of work varied, roles and responsibilities were not clear. Better efficiencies can be achieved if PHNs are bigger and aligned with LHNs. PHNs will refocus in line with Commonwealth priorities and patient outcomes. The government is keen on driving competition via a broader group of entities.

 Dr Andrew Singer, Principal Medical Adviser, Acute Care and Health Workforce Divisions
  • Dr Singer is an Emergency and Retrieval specialist based in Canberra. For the last 6 years he has been the Principal Medical Advisor in the Department of Health.
  • Dr Singer holds an Adjunct Appointment with ANU. He has worked with the AMC on medical school accreditation and is currently involved with specialist training accreditation. Dr Singer has a broad knowledge of what is happening in the specialist colleges.
  • There are a number of gaps in the training pipeline that need to be filled in rural areas.
  • To get the workforce numbers needed in rural / regional Australia a reverse hub and spoke model will be required with training for a rural career occurring as much as possible in rural areas.
  • At the Commonwealth level there are only 2 tools – funding and regulation. The Federation White Paper may affect funding.       Section 19AB Health Act has been an effective tool getting doctors to work in rural environments but the challenge is to get local graduates to work in rural areas.
Discussion included the following issues:
 
Teaching, Training and Research Activity Based Funding and accreditation of training posts
  • The role of the Commonwealth in ABF depends on the outcomes of the white paper.
  • There is quite a lot of work to be done around accreditation of training posts - Flexible arrangements, distance supervision, tele supervision etc.       The biggest limitation on accreditation as a tool in rural areas is supervision.
  • Colleges ensure standards are focussed on what is required for the training.
  • The HWA principle for hospital based accreditation was to focus on what’s required for training. If there are no supervisors, they cannot provide training.
The future of internship
  • If internship is removed, it has to be replaced with something else.       Graduates need supervision
  • There is debate about the compulsory elements of internship. For example some are for, some against a compulsory emergency rotation.
The quality of clinical supervision
  • Balance is needed. Supervisors are part of the normal curve. Medical schools are good at pushing requirements for training for supervisors and raising standards. The same clinicians are supervising students, interns and vocational trainees.
Continuous curriculum
  • Encouraging innovation allows for different approaches. Continuity of pedagogy is important - graduates are expected to be good clinicians and good educators.
  • Colleges no longer only offer Fellowship. There is now greater expectation of training for directors of training and supervisors, leveraging off what universities are doing or do it themselves.
Final Comments
  • RCSs will receive a much better hearing if they’re the solution rather than the problem.
  • Don’t wait to be asked to do something. If you can see a solution to a problem, bring it forward.

Day 2 – FRAME Business Meeting
 
RCS / RMS Directors Breakfast Meeting
  • Directors and Heads of Schools met to discuss the outcomes of the elections and the proposal for an alliance between FRAME and Medical Deans.
FRAME Business Meeting
 
1.  Ms Sarah Marks, Advisor to Senator Fiona Nash, Assistant Health Minister
  • Sarah conveyed Ministers Nash’s apologies for not being able to attend the meeting. The Minister is keen to work with stakeholders. There is a lot going on in the area of rural health and lots of opportunities to do good work.
  • The Minister’s direction in rural and regional health is to improve health outcomes, workforce and access.
  • $52.5m is being provided for GP infrastructure grants. The PIP for teaching medical students is doubling. Practices will have more capacity to teach students in rural areas.
  • The Minister’s office is looking closely at the RA classification system and receiving feedback on its perceived inadequacy and ideas to amend it to better serve communities.
  • Sarah will brief the Minister prior to her meeting with the FRAME Policy Group. FRAME members are encouraged to email Sarah if they have any queries or concerns.
Discussion included the following topics:
 
Infrastructure funding
  • Infrastructure funding is for private general practices to add a room to the practice, enhance surgery capacity to take on students. RCS in some states still need support for infrastructure. FRAME would like to see the re-establishment of infrastructure funding alongside operational funding.
  • More funding is required for multidisciplinary teaching infrastructure in small hospitals. First tranche of RCSs were created in 2002 – facilities and infrastructure now old and tired. Without funds to upgrade, it is a significant issue.
  • Many RCS have infrastructure for existing numbers of students, but it would be a challenge to increase capacity.
Reliable broadband for teaching and learning
  • Changes to NBN, how rolled out in rural areas. Good fast reliable broadband is important for teaching, learning and service delivery and for telehealth.
  • Using digital technology for the delivery of the program saves travel time and is also a safety mechanism.
  • The government is working with local hospital networks on IT issues / networks however there are on the ground operational issues.
Rural Training Pipeline
  • RCS Infrastructure is there and can be used and built on rather than creating additional networks.
  • RCS Infrastructure and human resource capital offers opportunities for prevocational and vocational training.
  • General Practice pathways for rural medical graduates are important. It is essential that in the new GP training structure, rural pathways don’t get hijacked by the metro agenda.
  • Tackling the pipeline College by College is a failed strategy. RCS know local landscape – medical students, junior doctors, and are committed to seeing the training pipeline work.
  • Different models are needed in different areas. What works in one region might not work in another.
  • Vocational Training – seems discriminatory that PIP payment is confined to private general practice. We want to develop generalist surgeons but there are no practice payments for specialist generalist training eg surgeons. This could be an incentive for those working in rural areas.
Medicare Co-payment
  • Doubling of PIP payments is great but FRAME expressed concerns regarding the negative impact of the GP co-payment. Medical education may suffer.
  • There are concerns about the co-payment in high Indigenous populations / poor health outcomes / poor access to service / low access per population to Medicare dollars. The co-payment in rural areas is biased against those already having poor access and outcomes.
  • In rural areas, patients present to the hospital more than in metro areas.       The co-payment goes against the government’s policy of better primary health care and prevention. More patients will go to hospital, therefore losing continuity of care, intervention, and placing increasing pressure on hospitals.
  • Co-payments go against primary care health outcomes.
  • Co-payments have huge potential to reduce profitability and attractiveness of rural general practice, therefore negatively impacting on workforce.
Relationship between health and education portfolios – FRAME spans both.
  • Changes in funding of higher education will have significant impact on rural and remote campuses.
  • Deregulation of fees will impact on people from rural and remote areas accessing higher education. It is already expensive for students from rural areas to attend university metro campuses.
  • Good scholarship programs are needed to ensure rural areas are not disadvantaged - HECS relief or incentives for rural people to access higher education / work in rural areas are required.
Research as an integral part of RCSs.
  • RCSs need to have meaningful capacity to provide students with research support, otherwise they won’t be able to meet curriculum requirements and won’t be appealing.
  • Rural research is different from urban research. It can be difficult to develop research on local issues due to national perspective that research needs to be of national or international interest.
  • Plea for practical rural health research, funded differently or parameters around rural research.
Funding agreements
  • FRAME acknowledges the constraints and welcomes the opportunity for reform and streamlining processes.
  • However, it is important for the Minister to understand that RCSs are businesses and without a funding agreement, staff contracts cannot be renewed.

 
2.  Issues Raised on Day 1
Working Party to develop FRAME universal graduate outcomes study
  • It was agreed that it would be useful for FRAME to extract from existing data to produce a consolidated document / start designing the methodology to be used in a universal FRAME study.
  • The study will be incorporated into the work of the Research Working Group.
  • Key questions for the study - which is more important a 4 week rural experience, or a year or two clinical years for intention and success? Does the experience change / influence opinions if it doesn’t produce outcomes? What is the impact of rurality +/- rural clinical school experience?
  • It is important to consolidate what RCSs have into something useful for policy to help inform Department.
Opportunities for Policy Group to provide advice to Department about parameters and funding.
  • The Department will be consulting with Deans, it is important to ensure RCSs through Heads / Directors are giving Deans appropriate advice.
  • The Policy Group will meet with the Department.
Parameters
  • Funding parameters need to be framed in the right language so they don’t hit constitutional barriers.
  • The Commonwealth needs to invest in the rural training pipeline because it is in the interest of the student.
  • In terms of consolidation and efficiency – rural student clubs are at a distance and RCSs miss the student voice being integrated into the rural program budget. It was suggested that responsibility and funding for student clubs to be returned to RCSs.
  • It is important not to let the Federation debate become another State vs Commonwealth fight and an opportunity for the Commonwealth to redirect resources.
  • Government review of funded programs - Universities should be involved in PHNs, Regional Training Providers, Vocational Training. Huge sense to consolidate all workforce education and research program and universities are well placed.
NMTAN
  • It was suggested that FRAME have more formal links with NMTAN.
  • NMTAN is producing reports around workforce and planning that are going to impact FRAME.
  • FRAME was involved in initial discussions but don’t have a seat on the network. Some individuals for example, Richard Murray have a seat.
  • Current membership is not known, however RDA and NRHA are represented.
Action:   Add discussion of FRAME’s involvement with NMTAN to the Agenda for first Policy Group Meeting 2015. (Secretariat)
             Invite a representative from NMTAN to the FRAME meeting in May 2015. (Chair)
 
25% rural origin
  • Students are using 33% as benchmark.
  • Some RCSs have noticed a drop in the numbers of rural students applying. There is concern that if the quota increases, quality will decrease with too low entry scores.
  • The Department acknowledged that nationally RCSs collectively are doing better than 30%.
  • There are ties to the consolidated outcomes data. It was suggested if outcomes and intake figures are good nationally, leave the quota as is.
  • Changes to RA classification might impact rural intake.

 
3.  FRAME / Medical Deans Alliance
  • After the last FRAME meeting, Directors / Heads were asked to consider and endorse the original proposal. The result was not unanimous.
  • Consultation with Medical Deans is still taking place and the issue will go to the full meeting of Medical Deans in October. Each Dean has been sent a copy of the alignment proposal. Most RCS Directors / Heads had discussions with Deans.
  • Richard Murray is now on the Executive of Medical Deans so it now has rural voice.
  • Important issues emerged during the process. RCSs are all very different, with different types of relationships within universities and faculties and varying degrees of autonomy and control over budgets.
  • Judi Walker and Richard Murray will attend the Medical Deans Conference in October and present an amended proposal to the Deans, suggesting a more staged approach.
  • The amended proposal will put the focus on rural health as a strategic objective of Medical Deans. RCSs are the experts in rural health and rural medical education and training and can provide advice to the Deans to assist them to meet their strategic objectives.
  • It will be suggested that the alliance focuses on specific issues or projects – the first being the rural pipeline and post grad medical training agenda.   There may be funding opportunities that FRAME is unable to capitalise on as it cannot hold funds. Medical Deans can hold funds. FRAME can apply for funds through Medical Deans to run projects.
  • The FRAME / Medical Deans alliance will be more achievable if it is a formal respectful partnership, not a demand for money and secretariat.
Action:    Amend the FRAME / Medical Deans alignment paper for presentation at the Medical Deans Conference in October.   (J.Walker / R.Murray)

 
4.  Outcomes of Elections (Chair and Policy Group / Executive Advisory Group)
Chair – Amanda Barnard.
Policy Group – Julian Wright, Joe McGirr, Jennene Greenhill, Richard Murray, Debbie Wilson and Jennifer Lang.
Judi Walker will also be a member of the Policy Group as immediate past Chair

5.  FRAME – MSOD Study

  • Surveys are currently being distributed to Universities.
  • Students are required to respond to the survey within 8 weeks of completion of the course / time in RCS - Some after 1 year, some after 2 or 3 years.
  • This year’s survey contains a question from AMSA re student support and the financial impact of undertaking rural clinical placements.
  • It was agreed that the survey should not be too long or onerous, and that it should not change much from year to year or it will be difficult to compare. The core questions haven’t changed, but there is opportunity for additional questions as required.
  • RCSs are asked to consider any additional questions and forward to Lucie Walters.

6.  Research Working Group

  • There was a good response to the snap shot survey after Kumara Mendis’ presentation in Port Lincoln.
  • Data available on the website. It indicates RCS are building capacity and producing outcomes for the parameter around academic and professional workforce.
  • The Research Working Group will progress the universal graduate outcomes study.

7.  eJOURNAL

Management
  • JCU provides management of the journal.
  • Sponsors include UDRHs, ACRRM, RCSs. The Journal Management Committee is looking to broaden contributions.
  • The journal continues to be a victim of its own success. 100 articles are submitted every fortnight and this has impacted on turn-around times in relation to editing and copy and production.
  • The Journal Management Committee is looking at ways to increase efficiency, modernise and update -automate back of house processes, working with editorial board, putting the brakes on articles coming through, extra staff have been employed to clear backlog.
  • Subscription notices will shortly be distributed. Subscriptions are not increasing. The letter will provide an update to subscribers as to the activities of the Journal Management Committee.
Editorial
  • Australian contribution to the journal is disproportionately high.
  • The delay in turn-around time is in part due to not having enough reviewers. Each article is sent to 2 local and one international referee.
  • FRAME members were encouraged to add their name to the list of reviewers if not already on it.
  • Amanda Barnard will work with the production team to email new reviewers with details, and obtain information as to special areas of interest.
 Action: Present a detailed update on the eJournal (numbers, etc) at the next FRAME meeting. (A.Barnard)

 
8.  Leadership Program
  • Academic and Professional staff are eligible to participate in the Leadership Program.
  • The Program is part of succession planning to replace existing generation of rural health education leaders.
  • Evaluations from the Broome course are currently being reviewed to refine the course.
  • Participants agreed the program was very worthwhile and generated ideas that have been taken back to individual RCSs and implemented. The mix of academic and professional is excellent. The speakers were very relevant and inspiring. Pre-reading was helpful.
  • It was suggested that the course continue to be run over 4 days, immediately prior to the May FRAME meeting.
  • Funds generated by the program are used for future FRAME work.
 Action: Create an advertising flyer and circulate to determine if there are sufficient numbers to go ahead. (Secretariat)
 

9.  Proposal for annual Scientific Conference

  • Prior to 2014, the RCSWA had hosted an annual scientific meeting in WA. It was not held in 2014 due to cost cutting.
  • It was considered timely for the event to go national and be picked up by RCSs as part of the annual FRAME meetings.
  • University of Melbourne has allocated a day to host a research meeting in Shepparton in 2015. (Date to be considered in relation to the FRAME meeting and Leadership Program and confirmed.)

10.  Flinders / NOSM Muster

  • To be held at Uluru, October 27 – 31.
  • Preconference workshops include “Saddle up” and “The long way round”.
  • The Program includes inspiring speakers doing socially accountable, community engaged, edgy work.
  • For full details of the program and speakers, visit http://www.flinders.edu.au/muster2014/

11.  SRH, University of Sydney / RACP Meeting

  • “Medicine for the rural curious”. Dubbo 24 – 26 October.
  • Details for the Conference are available on the FRAME website. http://www.ausframe.org/images/pdf/Rural%20Medicine%20Conference%202014%20-%20Dubbo.pdf
  • The meeting is an initiative of the local health district and Medicare Local.
  • Metro trainees curious about rural practice are encouraged to attend.
  • Topics will address workforce and future directions, training opportunities in 2015 and job opportunities.
  • Guest Speakers include John Worthington, Andrew French, Robert Pickles and Ian Kerridge.
  • The Conference is not supported by pharmaceutical companies and FRAME members are asked to promote the conference to interested colleagues.

12.  National Rural Health Alliance
  • It is beneficial for FRAME to be a member of the NRHA, even though its core business is wider than education, training and research.
  • The NRHA is an advocacy group and can be a powerful advocate for FRAME.
  • FRAME has the opportunity to feed into submissions to ensure the rural health education voice is heard.
  • FRAME has a seat on Council, and the Chair will be representing FRAME at CouncilFest.
  • FRAME members are invited to attend the 13th National Rural Health Conference in Darwin, 24 – 27 May 2015. http://www.ruralhealth.org.au/13nrhc/
  • The Call for Abstracts is open and closes 28 November. Early Bird registration closes 31 January.

13.  ARHEN

  • ARHEN is the peak body representing the 11 UDRHs in Australia.
  • Nicky Hudson has just been elected as Deputy Chair of ARHEN Board with
Sabina Knight (Director Mt Isa) as Chair.
  • ARHEN supports networks including Executive Officers, Indigenous Health Officers, Pharmacy Officers, Simulation educators. The network groups with meet virtually or f2f at one of the ARHEN meetings.
  • Like FRAME, ARHEN Board meets twice annually - one in Canberra and one at a UDRH site.
  • Nicky is keen to encourage inclusiveness and partnerships.
  • ARHEN actively lobby on priorities.
  • ARHEN is looking at how to produce longitudinal tracking data for rural allied health and nursing graduates.
  • ARHEN can fund hold as an incorporated body and is able to do some big projects in rural health.

14.  May 2015 meeting – university of Melbourne, Shepparton, 13-14 May

  • Facilities have been booked for the week to allow for the 2 day FRAME meeting, the Leadership Program and a one day research meeting.
  • Content for the Research Meeting is to be considered. The Research Intensive in Port Lincoln was inspirational and made a huge difference to those who were lacking confidence.
Action: Those interested in planning the Research meeting are asked to contact Julian Wright
 

15.  Venue for 2016 meeting

  • University of Wollongong.
  • The UoW program is unique. All students are in longitudinal placement. UoW are happy to showcase what they do.
  • It was suggested that the FRAME meeting be held in Nowra.
  • University of Qld, Harvey Bay offered to host the FRAME meeting in May 2017.
Thanks to the Outgoing Chair
  • Judi Walker was thanked for the enormous amount of work she has done for FRAME, drafting papers and responses, moving FRAME into a powerful advocacy position.