ACRRM's feedback on the Draft Concept of Operations: Relating to the introduction of a

Personally controlled electronic health record (PCEHR) system

6 June 2011

ACRRM qualifications (Fellowship) will allow general practitioners to work as specialist GPs anywhere in Australia. However, the College is particularly committed to providing access to the unique education, support and advocacy needs of those working in remote and rural areas throughout the country.

The consolidation of healthcare information and medicines for individual patients represents a sensible improvement to the system that is likely to improve continuity of care and better health outcomes. As such, ACRRM is a strong advocate of a national electronic health record system.

It is noted that understanding of the planned PCEHR has not penetrated far into rural and remote Australia, least of all into the more geographically and culturally isolated communities such as Indigenous and remote communities. It would be important to ensure that this lack of understanding is addressed with appropriate communication and information strategies highlighting the potential benefits to these communities, especially when considered with telehealth capability. ACRRM through its membership should be a key partner in current and future communication strategy to rural and remote Australia general practitioners and communities.

The key to PCEHR is connectivity to the internet. Until universal bandwidth and technology is available across rural and remote Australia and the population of these communities grasp and are educated and able to access and use the technology there will need to be full consideration of non-internet based enrolment, support, accessibility and usage.

Open or download the College's submission.

ACRRM's submission, commenting on

National Health Workforce Innovation and Reform Strategic Framework for Action

6 June 2011

The College's submission comments on all sections of the National Health Workforce consultation document. These included:

• The case for change is well made and encompassing of key issues. The College supports the paradigm shift to thinking about workforce design “backwards” from the outcomes for communities and consumers and population need. However, to maximise the likelihood of success of the new strategies that are developed, it will be important that all activities and actions be very well informed and pragmatic about the changes that will be required in the current system. It is important that the current system is supported to evolve and “improve” rather than “reinvented”. There is a strong risk of disenfranchising our current workforce, leaders and individuals if the process is not well managed.
• We note HWA will work with governments and organisations to focus on key domains that will address the high priority health areas. It would be useful to articulate the mechanism that HWA will employ to achieve this so that key points of engagement and expectation for all parties are clear.
• The College supports the priority areas outlined and recommends these be reflected more specifically and overtly in the subsequent strategy sections of the framework so that they are given a more tangible meaning and priority in the direction and expectations of the framework.
• Overt reference to improvements in the “quality” of the system (i.e. ability to deliver consistently to the agreed standard/outcome) should be included overtly as a key issue and objective for reform. The College believes this is a critical factor and should be a key indicator of success. It is the consistency in delivery of specific outcomes that will indicate improvement and successful reform. For example, if the overall productivity, size and scope of the existing workforce and system increases, but the distribution of these results are significantly and urban settings, then ACRRM would argue that the reform has failed. “National average” outcomes and performance will not deliver a realistic level of practical change and improvement to communities that is required.
• Evaluation references seem to focus on evaluating in the early design and implementation stage, rather than long term outcomes and success in meeting goals.

Open or download the College's submission.

ACRRM submission to the Finance and Public Administration Reference Committee

Inquiry into the administration of health practitioner registration by the Australian Health Practitioner Regulation Agency

18 April 2011

ACRRM has been a strong advocate of national registration. The rural and remote health workforce is generally very mobile, so the ability for health professionals to work across various State and Territory borders without needing to be assessed for registration each time represents a sensible improvement to the system.

Similarly, the introduction of nationally consistent methods and systems for assessing practitioners against regulatory and registration requirements, should create improved transparency and understanding of requirements for both the general public and health professionals. National recognition of outcomes from these processes should also assist to reduce bureaucracy and inefficiencies in reassessment of qualifications and standards.

AHPRA has achieved its goal of implementing the transition to the new system of national registration for 10 health professions. This has been a highly significant and important undertaking for Australia and the Agency deserves recognition and credit for completing this, particularly within the short time frame that was set for it.

As with any new, large scale national system there are bound to be a range of operational problems and challenges that impede the smooth implementation of the system during its first 12 months. AHPRA has clearly experienced a range of issues from the time of transition, with database reliability, at medical registration renewal period, and throughout for the registration and accreditation of overseas trained doctors.

Some of these issues may have been able to have been identified and overcome had the initiative had a longer planning, consultation and preparation phase. However, some issues only become apparent once a system is in place and operational.

ACRRM believes AHPRA has been generally competent in its establishment and administration of the new registration system but there is need for AHPRA to improve its performance and responsiveness in order to build confidence and support for the system within the health professions and the general public.

Read the full text of the ACRRM submission to AHPRA

ACRRM submission to the House of Representatives
Standing Committee on Health and Ageing

“Inquiry into Registration Processes and Support

for Overseas Trained Doctors”

February 2011

The Australian College of Rural and Remote Medicine (ACRRM) is an Australian Medical Council (AMC) accredited medical College for the specialty of general practice particularly in the context of rural and remote practice. As approximately 40% of Overseas Trained Doctors (OTDs) work in rural and remote environments and are a critical part of the medical workforce, the College is committed to provide education and support to these doctors to ensure that they have the skills and knowledge base required to provide safe quality medical practice in the communities they serve.

In recognition of the importance of this workforce for the safe medical care for our rural and remote communities, ACRRM has taken a deliberate decision to work across the full spectrum of assessment pathways that OTDs need to traverse in order to fill generalist medical roles.

We understand that ACRRM is currently the only specialist medical College in Australia that is accredited to play an active role in conducting assessments in each of the national OTD assessment pathways, that is:

• The Specialist Pathway for the specialty of General Practice
• The Competent Authority Pathway for non‐specialist medical practitioners; and
• The Standard Pathway for non‐specialist medical practitioners.

 Click to download or print:

 ACRRM submission to the Inquiry

ACRRM's response to "A Healthier Future For All Australians" Interim Report of the National Health and Hospitals Reform Commission

The Australian College of Rural and Remote Medicine (ACRRM) is the peak professional organisation for rural medical education and training in Australia. The College has more than 2500 members, comprising Fellows, Registrars, practitioners and students who practice in regional, rural and remote communities throughout Australia.

ACRRM welcomes the initiatives and reforms proposed by the National Health and Hospital Reform Commission in its Interim Report and believe that many of the directions outlined have the potential to be of significant benefit to rural and remote communities where our members predominately serve. The College takes this opportunity to provide feedback on specific reform directions that we consider are of major significance to the rural, remote and indigenous communities where access and health outcomes are demonstrably poorer.

Facing Inequities

Closing the health gap for Aboriginal and Torres Strait Islander peoples
ACRRM supports the proposed reform directions which aim to close the health gap and build a health system that is responsive to Aboriginal and Torres Strait Islander people and believe the needs of Aboriginal and Torres Strait Islander people should be a high priority within the Commissions reform agenda. ACRRM strongly supports reform directions 8.5 and 8.6. As a training college for rural and remote medicine we have placed an emphasis on developing the core skills, knowledge and attitudes which define exemplary practice in Aboriginal and Torres Strait Islander health in general practice. ACRRM primary curriculum incorporates training to ensure our registrars upon certification are both clinically and culturally competent in this area. ACRRM believes that addition investment should be made that supports vertical integration of teaching and learning for all health professional and in particular for Aboriginal and Torres Strait Islander health.

Delivering better health outcomes for remote and rural communities

ACRRM strongly supports the reform direction to increase the number of clinical places both at an undergraduate and postgraduate level in remote, rural and regional centres. The under supply of rural and remote health professionals particularly general practitioners as a major provider of primary health care has been a limiting factor in the provision of health care in rural and remote communities. With the increase in the number of medical students, system reforms are required to support quality teaching and learning in rural and remote environments. Additional investment in rural and remote education is required particularly relating to appropriate accommodation, learning and teaching facilities and supervisor/mentor support, recognition and remuneration. 

The longer term retention of doctors will be reliant upon issues such as work/life balance, career development and remuneration being addressed. Innovative models of care which are locally designed and supported through flexible funding models can contribute to building a quality workforce in rural and remote communities. Improving access to quality and appropriate health services for rural and remote communities is essential. ACRRM supports team based models of care and innovation in the use of information technology (IT) to increase care. ACRRM has throughout its history invested in IT as a major tool for education and training and for ongoing professional education and support for our members. This has also been an important tool for the delivery of medical specialist outreach programs such as the successful Tele-Derm service. Building IT capacity and increase investment in IT as a mode of delivering better health outcomes for rural and remote communities should be supported.

Supporting people living with mental illness

There is significant evidence that rural Australians face higher risk factors for depression and other mental health disorders than their urban counterparts. While ACRRM strongly supports reform direction 10.5 which calls for greater investment in mental health competency training for the primary health care workforce, and that is training be formally included as part of accreditation processes, ACRRM believes that significant investment should also be made to support the skilling and skill maintenance of the current rural health workforce in mental health diagnosis and management. 

Many of the current models of care in mental health are based on urban models where there is a range of mental health trained professional that can be drawn on, in rural and remote Australia it is in the main the general practitioner that is the central point of care for people with mental illness and access to other health professionals with appropriate mental health training is limited. It is essential to have education, training and support programs put in place for the professional on the ground in rural and remote communities to increase their capacity to diagnose and manage the care of people with mental disorders within the limited resources they have available to them.

Driving Quality Performance

Working for us: a sustainable health workforce for the future
ACRRM as the determiner and upholder of standards that define and govern competent, un-supervised rural and remote medical practice, we offer in principle support to the reform directions for education and training included in the section and would wish to participate in the future development and implementation of these reform directions.

In the absence of rural specialists, rural generalists with procedural skills are pivotal to the provision of safe and accessible procedural health services. With health workforce shortages worldwide and a de-population of generalist specialists, rural generalists can provide a significant and safe workforce for governments. ACRRM believes that investment in the further development of the rural generalist model will have significant benefit in addressing workforce shortages in rural and remote communities.