Rural duo practising medicine the Flinders Island way

Continuity of care has a different ring to it on Flinders Island.
 
Located 55 kilometres off Tasmania’s north-east tip, the remote, tight-knit community has around 900 residents – if you don’t include the steady flow of tourists and the movement of workers who spend part of their time on the island.
 
For local Rural Generalists (RG), Dr Lynne Davies and Dr Alex John, their connection with patients begins in the community, not the waiting room.
 
‘It’s really a very old-fashioned style of general practice where we provide continuity of care, we live in the community, we’re part of the community, we receive from the community, and we also hopefully help shape the community as well,’ Dr Davies tells newsGP.
 
‘It’s a pretty privileged position, really.’
 
Her colleague at Ochre Medical Centre Flinders Island, Dr John, describes it as ‘old-school general practice’.
 
‘We cover our own patients after hours, which is a chore but provides a better service for the community and reduces unnecessary transfer to Launceston,’ he says.
 
‘Continuity of care is so important and is missing in lots of rural and remote communities.’
 
Island appeal
The beauty of Flinders Island first attracted Dr Lynne Davies as a locum.
 
Known for its spectacular beaches, granite headlands, rugged natural beauty and Aboriginal history, it is the largest island in the Furneaux Group.
 
It’s also a very windy place due to the Roaring Forties, Dr Davies says, acknowledging the prevailing westerly winds that sweep through bringing cold weather and high ocean swells.
 
After qualifying in the UK, travelling and working around Australia, and having her own practice in New South Wales for close to 20 years, Dr Davies felt the island charm draw her in.
 
‘I came to do a locum on Flinders, probably about 20 years ago, and I loved it, which is what happens to a lot of people,’ she says.
 
‘Every chance I could get, I would come back and do a locum, and then gradually it just sort of reeled me in.
 
‘I’d been working regularly here for about 10 or 12 years and then made that final move that this was my home completely, probably round about [the time of] COVID.’
 
Dr John felt a similar calling to Flinders Island.
 
‘I originally moved there as it had the shortest moratorium of any of the Tasmanian sites. I planned to move on after I had completed my time but didn’t in the end,’ he says.
 
‘It’s a really beautiful place with great beaches and fishing and is quite chill. I call it a Tasmanian concentrate. You don’t have to lock your car or house. It’s that sort of place.’
 
A mixed workload
Working as a RG gives Dr Davies a way to provide more to her community.
 
‘Rural generalism helps to stop you becoming bored with the routine,’ she says.
 
‘There’s also a diverse range of patients as well as a wide range of socio-economic [circumstances] on the island. We have a bit of an artistic community. We have Aboriginal heritage, and the average age of the population is older than average, so we deal with a lot of chronic disease.
 
‘We also cover the emergency department and a small inpatient unit, and we have an aged care facility, so it can be quite busy during the day trying to juggle all those different roles while being on call and having a fully booked appointment book.
 
‘We then cover the Cape Barren islands, so one of us will fly over there once a week to do a clinic, and we’re also on call to support the nurse who is there 24 hours a day.’
 
Primary Health Tasmania describes Cape Barren Island (Truwana) as ‘about remote as you can get’.
 
‘It’s an island off an island (Flinders) off an island (Lutruwita/Tasmania) in the notoriously wild and unpredictable Bass Strait. It’s owned by the Tasmanian Aboriginal community, and 80 out of the 120 or so residents identify as Tasmanian Aboriginal.’
 
And it’s a place Dr John finds particularly rewarding to visit.
 
‘I really enjoy the weekly trips to the Aboriginal community on Cape Barren Island (Truwana),’ he says. ‘We fly there in a little plane and try to help the remote community.’
 
Deep connections
Part of the joys of working in such a close-knit community is the knowledge you gain over time about locals and connections you make. And the connection to patients is personal, Dr Davies says.
 
‘It’s the continuity of care that makes a huge difference, and the government definitely undervalues that role of primary health in providing good preventative care and chronic disease management,’ she said.
 
‘If patients do come to hospital, we know exactly what their background is, we know their social situation.
 
‘We know if they’ve got a dog at home that needs feeding which would make them want to discharge earlier, and we can arrange for someone to go and feed the dog, so we can keep that patient in hospital until they’re better.
 
‘We know what the discharge planning is like, we know what services they’ve got, we can therefore put in additional services if need be.
 
‘It’s definitely very rewarding when you can help people through their whole health journey.’
 
Dr Davies also thinks they’re doing something right to be able to manage the mixed load with two full-time equivalent GPs for the population.
 
‘Patients can generally get an appointment on the day, or maximum wait two or three days,’ she says.
 
‘It’s very rare that we get unnecessary presentations to the hospital, particularly after hours, because we manage people in hours and we have time and capacity to manage chronic disease properly in the practice.
 
‘That reduces the after-hours call outs – we don’t often see acute asthma, acute COPD exacerbations, acute diabetes complications.’
 
The flip side of this breadth of service to the community, Dr Davies says, is that ‘we are respected – there is mutual respect but people in the community are grateful for their care.’
 
An award-winning pair
It’s their deeply connected approach to community care that earned the pair a recent Rural Doctor of the Year Award from the Rural Doctors Association Tasmania (RDAT).
 
Presenting the award, RDAT President Dr Ben Dodds said ‘Lynne and Alex embody the dedication, leadership and community spirit that define rural medicine’ and have ‘an unwavering commitment to improving access to care for their community’.
 
He described Dr Davies as ‘a tireless advocate for rural and Aboriginal health’, consistently going above and beyond to improve healthcare outcomes for island residents, as well as a ‘passionate advocate’ for improved access to specialist and allied health services to the islands.
 
‘Alongside Lynne, Dr Alex John has been a devoted and dependable presence on Flinders Island for many years. [He’s] provided comprehensive care across all aspects of rural general practice and has played a critical role in supporting outreach healthcare services to Cape Barren Island,’ Dr Dodds said.
 
It’s recognition Dr Davies says feels even more special when shared with her colleague.
 
‘It’s just really nice particularly to win it jointly with Alex, as we work together, we work hard and I think we do provide a really good service together, so to have some recognition of your hard work is really nice.’
 
Dr John agrees, praising the team effort behind the award.
 
‘It was nice to get a bit of recognition for the years of service, and we have had a great team on Flinders Island for the last few years – so wonderful for the team to be recognised,’ he said.
 
Next generation of GPs
Dr John says he enjoys sharing his passion for general practice with medical students from the University of Tasmania and registrars who spend time on Flinders Island.
 
‘It’s a great place to see how great general practice can be,’ he says.
 
‘It also teaches holistic care and the benefit of continuity of care, which is a really difficult thing to measure.
 
‘Our role is elevated here because of the lack of access to lots of niche specialist services. As a consequence, our scope of practice is pretty high and our registrars enjoy that.’
 
So much so that the clinic’s recent registrar shared that his time on Flinders Island was the first time he had truly enjoyed primary care, Dr John adds.
 
Part of the reason for that is the team behind the GPs.
 
‘We are a small but beautiful and well organised practice team,’ he says.
 
‘We have a great manager and reception staff, nursing staff and allied health; all of which is supported by the Ochre team. We have consistently topped the Ochre health practice lists for about five years which is pretty remarkable.’
 
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continuity of care rural generalism rural medicine