Moving closer to the National Rural Generalist Pathway

Amanda Lyons

18/02/2019 2:34:00 PM

Ayman Shenouda, Chair of RACGP Rural, talks to newsGP about continued progress and his positive vision for rural general practice.

Associate Professor Ayman Shenouda is positive about the progress of the National Rural Generalist Pathway.
Associate Professor Ayman Shenouda is positive about the progress of the National Rural Generalist Pathway.

The large gaps in health outcomes between people who live in metropolitan Australia and those in rural and remote areas – including higher rates of disease and injury and poorer access to health services – are well-known and often-cited.
Despite these sometimes disheartening statistics, Associate Professor Ayman Shenouda, RACGP Vice President and Chair of RACGP Rural, believes it is important to remain optimistic.
‘One should not lose hope, and [the RACGP’s] responsibility as a college is to our communities, as much as it is to our members and our doctors, for the future,’ he told newsGP.
For Associate Professor Shenouda, this sense of hope now also has a very practical foundation, manifested in the recent release of the National Rural Generalist Taskforce’s National rural generalist pathway draft advice.
The work towards creating the National Rural Generalist Pathway (the Pathway) is intended to provide a nationally consistent training framework that will provide trainees with the medical skills needed to meet the specific needs of rural and remote communities.
Much of the groundwork for this process was laid last year by the Collingrove Agreement, in which the RACGP and the Australian College of Rural and Remote Medicine (ACRRM) agreed to work collaboratively to help produce the framework.
One of the first steps towards this vision was the definition of ‘rural generalist’, agreed upon by the RACGP and ACRRM as:
‘A medical practitioner who is trained to meet the specific current and future healthcare needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.

Production of the National Rural Generalist Taskforce’s draft advice involved consultation with the RACGP and other organisations involved in rural and remote healthcare.
‘Both of the colleges were heavily involved in the Taskforce, but there was also representation from all major stakeholders,’ Associate Professor Shenouda said.
‘They are helping the Rural Health Commissioner have an understanding of what’s happening on the ground and how to move forward with the rural generalist pathway.’

The RACGP and ACRRM came together in 2018 to help develop of a national framework for rural generalism. L–R: ACRRM’s Dr Michael Beckoff, National Rural Health Commissioner Professor Paul Worley, then-Minister for Rural Health Bridget McKenzie, Associate Professor Ayman Shenouda.
According to Associate Professor Shenouda, four aspects of the paper are of particular importance, the first being the recognition and definition of the term rural generalist.
‘The second part is about the program itself and how it would work, and how we can manage that with the jurisdiction; because every jurisdiction has different ways of doing things, so we want to acknowledge that, but we have to have a pathway or program that we are all agreed on,’ he said.
‘The third is about remuneration. The idea is, any extra money would be attached to the skill you can perform, not to a title.’
The skills that can be required of GPs working in the bush are defined, for Associate Professor Shenouda, by the needs of their communities.
‘It’s building up on the core skills that GPs have, with additive skills in response to the community needs,’ he said.
‘Those skills can vary from emergency skills or obstetrics or palliative care, and they’re very important, because of the huge discrepancy between health outcomes in urban and rural communities. We need to be mindful that those communities have no other options, and need a doctor with those additive skills to be able to deliver safe and high-standard care for their patients.
‘So this becomes a very patient-centred, community-centred approach, to have the doctors to deliver those skills where they are needed.’
The fourth aspect of the paper is about evaluation of the Pathway, to provide accountability on whether it is properly delivering the required training and services.
‘It is about assessment, so some evidence base to what you are doing and how it’s working, and whether it is effective in delivering those needs or not,’ Associate Professor Shenouda said.
‘We need to have an evaluation framework within [the Pathway] to make sure that we are doing the right thing.’
Now that the draft advice has arrived, the Pathway will move into the implementation phase, which Associate Professor Shenouda hopes will be appropriately supported by the Federal Government.
‘There are a lot of positive signs, but we need to also put the value of this proposition to the Federal Government, that their investment in such a thing is worthwhile,’ he said.
‘It will require working with the Rural Health Commissioner and the Government, and I think there will be also involvement with the states, because part of the rural generalist training can depend on state hospital-based training.’
While there is still plenty of work to be done, Associate Professor Shenouda feels positive about what is to come. He also highlights that the RACGP will continue its involvement for the good of its members and their patients.
‘I can tell you that there is full support from the college into this,’ he said.
‘At the end of the day, it’s not only about the doctors; it’s about improving the standard of care in rural communities.’

National Rural Generalist Pathway rural health

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