Medical Forum WA 07/13 Subscriber Edition July 2013 | Page 28

Guest Column

As a semi-urban GP who enjoys working rurally , I think I have gained an objective view of rural medicine issues – initially via locum stints and now through sessions in the Wheatbelt . Changes in models of rural care have increased patient and community expectations of general practice . As demands on shrinking general and procedural GP services increase , demands for specialist services also increase . Technology such as eHealth , TeleHealth and ETS helps with supply but it is by no means solving the service shortage .

There is a growing number and complexity of patients in rural areas needing both chronic and appropriate acute primary care . As a result , these patients are being inappropriately diverted to rural ED settings . This complicates the issues of hospital and RFDS transfers , rural hospital inpatient care and delayed access to primary care . All add to the cost of health provision .
The current solution involves increasing

Protecting an Endangered Species

Dr Will Thornton says rural GPs need serious support before they become a thing of the past .
the level of ED staffing with FACEM-led ETS access to city services , which has some benefits but it needs to integrate with the existing primary care service providers .
The usual solution to the shortage of GP service is to import it – and obviously overseas trained doctors ( I am one too !) play a vital role . But for a sustained long-term solution , local graduates need training in rural medicine . WAGPET , our regional training provider , is excellent but no longer are all their Registrars required to complete a rural term , and the assessment for entry reflects this . Yet country hospitals and general practice in the Wheatbelt offer amazing educational opportunities .
Workforce provision is challenging ; but local networks often have fiscal interests that outweigh the practical need of the community for continuity of care by a regular provider .
University courses are under fiscal pressure to reduce / rationalise the rural component of their courses , often pressured by the bureaucrats but also by content-driven and assessment-pressured students .
So , how to retain existing services and attract the new ?
What may work :
�� �������������������������������������������� ( such as the Rural Incentive Program )
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�� ����������������������������������� � remuneration for rural GPs .
What won ’ t work : �� ������������������������������������
�� ������������������������������������������� specialist-led services .
Retention is paramount and that involves looking after GPs who have served their community , 24 / 7 , for years .
Rather than ignoring burn-out , we need to look at providing some respite ( a model embraced by one Wheatbelt shire , where the local GP gets a five-day weekend every six weeks ), on-call cover such as ETS , assistance with ongoing education , finances and sessional cover . Why don ’ t Country Health Services provide performance reviews such as those encompassed in revalidation , rather than vilification and medical board referral ?
Without these issues being addressed , the rare rural GP will be a thing of the past . �
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