Unlocking sustainable rural health futures

By Carmen Ellis, Policy and Research Officer, National Rural Health Alliance 

One-third of Australians (just over seven million people) live in rural, regional and remote areas.1 Despite being a significant demographic, rural consumers have consistently poorer health outcomes mostly due to a lack of access to appropriate health services. Australia has a high-performing, highly trained rural healthcare workforce who are closely tied to the rural communities they work in, but they are in short supply. 

Nurses form the largest clinical workforce in Australia,¹ and allowing them to operate to their full scope of practice improves healthcare access for rural Australian communities that suffer continuing historical disadvantage.2 Enabling practitioners to work to their full scope of practice not only allows for the more effective deployment of the healthcare workforce, but also creates significant opportunities for innovation and collaboration.² 

Rural consumers face multiple barriers in obtaining high-quality and preventative healthcare. As remoteness increases, so does the burden of disease, preventable illness and death, and hospitalisations.1 In addition to this, household income, employment opportunities and access to primary care services all decrease with remoteness.₃ These problems reveal the effects of geographic isolation and a lack of sustainable investment in rural Australia. 

In 2023, the National Rural Health Alliance (The Alliance) commissioned a report, ‘Evidence base for additional investment in rural health in Australia’ undertaken by the Nous Group. The report revealed a total annual rural health spending deficit of more than $6.5 billion,4 meaning rural Australians miss out on approximately $850 a year per person in health funding. Healthcare funding models can be a barrier to enabling full scope of practice. The Alliance believes current reliance on the Medicare Benefits Schedule fee-for-service model alone limits options to support a multidisciplinary team working to a full scope of practice in rural settings. 

Working to scope of practice means undertaking a ‘full spectrum of roles, functions, responsibilities, activities and decision-making capacity that individuals within that profession are educated, competent and authorised to perform.’⁵ Recent moves to recognise the unique scope of practice in rural nursing include the National Rural and Remote Nursing Generalist Framework 2023–20276 and the release of Issues Paper 2, ‘Unleashing the Potential of Our Health Workforce – Scope of Practice Review’.⁷ The Issues Paper Two proposes reform in workforce design, development and planning, legislation and regulation, and funding and payment policy. 

Working to full scope of practice also has benefits for job satisfaction.² A key motivator for nurses staying in rural areas includes the opportunities for a broader scope that the rural context provides.⁸ With a predicted shortfall of 123,000 nurses by 2030, motivation for workforce development and retention cannot be ignored.⁷ This shortage has significant implications for rural communities. 

Individual, systemic, and organisational barriers can impede on practitioners’ ability to work to their full scope of practice, as can differences in legislation across jurisdictions. For example, nurse practitioners’ abilities to prescribe medication vary across states and territories, limiting their scope in certain locations.9 Supportive legislative and organisational frameworks must be created to reduce fragmentation of care through eliminating jurisdictional and interprofessional barriers.  

Utilising the full spectrum of multidisciplinary healthcare teams in rural Australia is critical to providing wrap-around care for rural consumers. The current Australian Government Scope of Practice Review provides an excellent opportunity to address current barriers to this and has the potential to lead to real reforms that can benefit rural communities. We will continue to work with government on this and a number of other reviews being undertaken that will have an impact on access to health services. The Alliance would like to see changes that mean the rural health workforce have increased satisfaction in their clinical roles, leading to increased workforce retention and in turn rural communities have access to increased quality health services and improved health outcomes.  

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