Supporting rural primary care

By Margaret Deerain, Director, Policy and Strategy Development, National Rural Health Alliance 

Source: APNA Primary Times Winter 2023 (Volume 23 Issue 1)

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The National Rural Health Alliance (the Alliance) has been advocating for an innovative model of rural health care that aims to overcome the professional, financial and social barriers faced by health care workers who wish to work in rural contexts. The Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS) model is an evidence-based policy solution that will improve access to affordable, high-quality, culturally safe care, when and where it is needed. 

The Alliance is the peak national body advocating for healthy and sustainable rural, regional and remote (hereafter ‘rural’) communities across Australia. We have 47 members, and we value APNA as one of these members that cares about, and advocates for, the health needs of rural Australians. 

Every week in the Alliance office, it is normal to pick up a phone call from a primary care practice or community group in rural Australia concerned about a possible, or actual, closure of a general practice or other primary care service in their locality. This often occurs when a key health professional, such as the local GP, is retiring or needs to leave the town. It then becomes hard to recruit other health professionals to fill the gap and this can leave the remaining workforce stressed or worried about the future.  

For primary care nurses working in rural Australia, this will be no surprise at all. In fact, it is quite well known. In December 2022, the Strengthening Medicare Taskforce handed down its long-awaited report. Here is a snapshot of what it states:  

Rural and remote communities need rural and remote solutions. A variety of options are needed to improve access to affordable health care tailored to the needs, and drawing on the strengths, of local communities and to support sustainable primary care solutions in rural and remote communities now and into the future. Rural and remote communities should have the flexibility to design and fund solutions that better reflect the reality of what’s needed and can be sustainably delivered. This can only be achieved through consumer and community engagement, collaboration, and co-decision making at the local level. With support from all levels of government, introducing more blended funding models alongside fee-for-service will support primary care sustainability and foster innovative models of primary care in rural and remote communities.¹ 

Rural and remote communities need rural and remote solutions. A variety of options are needed to improve access to affordable health care tailored to the needs, and drawing on the strengths, of local communities and to support sustainable primary care solutions in rural and remote communities now and into the future.

The Alliance could not agree more. But we are concerned whether the words will be matched with the necessary funding and policy changes that can deliver real outcomes for primary care and the people living in rural Australia. The Alliance has been advocating for a model of primary care funding and service delivery that will support and sustain the health care workforce to provide essential primary care to rural communities. The model is known as Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS)^.2 

The Alliance has been working with several primary care organisations and grassroots individuals to develop and refine the PRIM-HS model of care. This has included costings of the model’s governance and employment strategies. In January 2023, the Alliance put forward a pre-Budget submission³ to advocate for immediate funding of these identified communities and others, where the model can work and add value to the region. 

The Alliance will undertake further advocacy for PRIM-HS as a long-term, sustainable solution that will link local entities and experts to work together and add to existing services. If implemented, the PRIM-HS model will provide a one-employer model that ensures stability, transferability and ongoing financial parity between those employed in local health services and those in urban centres. It will provide ongoing (at least 5 years) block funding and won’t rely fully on outdated Medicare patient subsidies that do not meet the actual cost of services. 

The Alliance believes this model can support the rural health workforce in many other ways. It will:  

• support interprofessional understanding and enable all professionals to work to their full scope of practice 
• ensure a critical mass of health practitioners to sustainably support on-call and after-hours demand 
• provide a base for visiting non-GP medical specialists and other visiting health professionals.  

It will also provide certainty of income and employment for health professionals who are considering rural practice, and remove the need for health practitioners, particularly early career professionals, to have the skills to establish and operate a financially viable rural practice, which can be a significant disincentive for working rurally. Through the key PRIM-HS principle of a multidisciplinary team, it will also overcome the perception that rural practice means professional isolation. 

Our Alliance, working together as partners and supporters of rural Australians, believes this model is a part of the overall picture to support the rural health workforce into the future.  

 

References 

 

1 Australian Government, Department of Health and Aged Care (DHAC), Strengthening Medicare Taskforce report, DHAC website, December 2022, accessed 24 April 2023. www.health.gov.au 

2 National Rural Health Alliance (the Alliance), Primary care Rural Integrated Multidisciplinary Health Services (PRIM-HS), the Alliance website, accessed 24 April 2023. www.ruralhealth.org.au 

3 National Rural Health Alliance (the Alliance), National Rural Health Alliance: 2023–24 pre-budget submission, the Alliance website, 27 January 2023, accessed 24 April 2023. www.ruralhealth.org.au 

 

 

The PRIM-HS in practice 

Imagine a rural town with 1,500 people. The closest regional centre is 300 km away and other primary health care (PHC) services are about an hour’s drive away. A small local hospital services the area, employing medical and nursing staff funded by the state government through the Local Hospital Network (LHN). 

The local general practice has advised the community that it will soon need to close its doors as it can no longer remain financially viable. The community is desperate to maintain access to PHC services, and so is the local government. If the general practice closes, many people will leave the district and their community will be depleted of businesses, schools, services, professionals and infrastructure. 

With funding, the National Rural Health Alliance’s proposed PRIM-HS model could be set up as a community-owned, not-for-profit organisation. It would be governed by a local board with members from key local stakeholders, such as the Primary Health Network, the LHN, community members, local government, aged care and/or NDIS providers, with a local leader as the chair. The board would consider the population’s health and services needs, and prioritise as a region by working with all stakeholders. 

This organisation might receive access to premises for PHC at the local hospital, or within a local government building. Blended funding (Medicare, block, fee-for-service billing) from the Australian and/or state government would enable it to achieve financial viability. It would pay the same amount and receive the same benefits as the regional health service so that it could maintain its workforce. 

These support mechanisms would support the reduced economies of scale and higher costs, in combination with fee-for-service billing mechanisms. The doctors working within the LHN might even be engaged to work within the PRIM-HS some days of the week providing PHC. Additionally, block funding would facilitate the employment of practice nurses, a nurse practitioner, an endorsed midwife and some allied health practitioners on a part-time basis, whose salaries would otherwise have been difficult to cover utilising existing funding mechanisms. 

This multidisciplinary team would be able to work together in a coordinated fashion, to provide high-quality, accessible and affordable health care in accordance with the community’s needs. It would also be the foundation for medical and health professional training. The multidisciplinary nature of the work would be professionally rewarding and supportive. 

If several sites were funded this way, there could also be collaboration across the sites with shared learning, research and support services.