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Q & A on ‘Perspectives on the Issues and Challenges in Rural Training
 
Jennene Greenhill – Flinders University
 ‘What are the challenges now going forward and what are the top 3 priorities of research to be identified? What would you like to see from our research programs?’
 
Susan Wearne – a priority would be that I would love to see specialist training accreditation undertaken where one or two local rural/regional specialists are supported remotely by specialists in Melbourne or Sydney. Research into different models of ‘on call’ would be ideal. Currently we have a model of care where the GP or the nurse does everything. Would like to see the everyone who works rurally is able to have a life as well as being a good clinician.  
 
Carmel Tebutt – The key priority for MDANZ is that we are particularly interested in looking at where students who identify with working in rural settings actually end up, and if not why not. We have a very rich data base and need to link up with the National Health workforce data to do the research effectively and efficiently. We are currently talking with AHPRA and the department and FRAME about ways to make this happen.
 
Tony Hobbs – Health care home model about to be implemented. Voluntary registration and bundle package of care. Very important to make sure that the workforce is looked after.
 
Another issue is the primary health networks and evaluating their performance over time.
 
John Wakerman – Flinders NT
‘There are 3 national gaps that have come up in the conversation today
 
First is around resourcing of primary care in this country, especially in rural and remote areas.
 
Second gap is that we have been struggling with no electronic records for decades unlike Canada which has good communication and good electronic records with electronic discharge summaries being made available within 24 hours in remote areas.
 
The third is related to the IT infrastructure to support primary care information that is available at a national level.’
 
Tony Hobbs - Capacity for numbers in the workforce is really important and distribution and mix is critical as well.
 
There have been lots of incentives and programs over time which have not resolved the situation
 
Maldistribution needs to be addressed
 
Not able to put anything on the table today but clearly will take that message back to the department.
 
Challenges for FRAME as a group, how does FRAME think it would best be served?
 
There have been stops and starts with the electronic health records. Enabling infrastructure that sits behind it is also really important
 
Having access to good download speeds - NBN roll out is a critical issue, having access to wireless is another issue which is currently being debated,
 
Tele health and tele medicine are both underutilised at this time
 
In the Primary care advisory group discussions had recently, the use of e-health and tele medicine were key enablers and one of the requirements of health care home will be to use what is actually there at the moment. One of the problems is that in primary care we don’t actually use the available infrastructure as best we should for not only the individual patients but making better utilisation of the practice held data for making us better informed about the local population.
 
The other conversation was remote access to care both into and out of the practice
 
David Kandiah - Monash Rural Health Bendigo
‘Interested in the panel’s thoughts that State rural stakeholders should be engaged in this type of discussion that we are having here today. They after all fund the training in the community and the hospitals
 
State governments need to be fully aware that they are a crucial part of the bridge between the funding and the delivery.’
 
Tony Hobbs - There is a National medical training advisory network with a broad representation including state and territory representatives. Carmel Tebutt is the MDANZ rep on that committee and Tony is the commonwealth rep. They are very happy to take suggestions from today’s forum back to that committee. Communication, inspiration and working towards common outcomes for training the workforce of the future, is very important.
 
Andrew Bonny – University of Wollongong
‘Interested to see responses from the panel regarding that as rural educators, academics and practitioners, we very readily see rurality as being equivalent of disadvantage.   Hence we see the need for training of doctors and provision of medical services, allied health services and multidisciplinary teams across rural areas.   Chronic diseases are very much a marker of disadvantage underlying rurality as such and all rural areas are not equal as we know.
 
My concern is that perhaps we need to be dealing in measures of geographic disadvantage as well as remoteness.’
 
‘What are your thoughts about rurality and levels of disadvantage within rurality and the possibility of placing these training hubs in areas of more disadvantage so that we can leverage more for the money being put into policy at the moment.’
 
Susan Wearne - Great idea and it is something that is being considered to be looked at in more detail
 
Tony Hobbs - From a Policy perspective this is the bread and butter of the PHN
 
Within a public health care network environment, there are going to be areas of very significant disadvantage
 
This is a role that Medicare locals are taking on, then trying to target those resources to the most in need
 
Part of that discussion is workforce, all of the these things need to be joined up
 
Role of the PHN in working with the local health district is crucial
 
Shouldn’t under estimate the power of the local community – local communities do support the drive for redistribution of funds to more disadvantaged areas.
 
Amanda on behalf of FRAME thanked the panel for attending today and for their time and contributions to the discussions.