 Unsettling times in our communities and across the world
It is an unsettling time. We know young people, their parents and teachers have been preoccupied with school closures for several weeks. We are aware that families in our community are facing new challenges, juggling the responsibilities of caring for family members – young and old. Thousands of people are adjusting to new working arrangements, while others, in casual employment or small business are fearful about future incomes. And then there are the health professionals. The GPs and their teams. The medical and nursing professionals working at hospitals. The Nurses working in aged care. The Aboriginal Health Workers reaching out to support communities. These professionals have been working for weeks to respond to, and prepare for, the spread of COVID 19. We knew COVID 19 was coming and its impact was to going to be significant. Australia’s leading medical professionals and GPs having been working around the clock to prepare Australia, the health system and GP practices. Thankfully, our politicians have been listening to the medical experts and responding to their advice. But more needs to be done. As at 3:00pm on 25 March 2020, there have been 2,423 confirmed cases of COVID-19 in Australia. This figure is rising I am still hopeful it will flatten in response to the recent restrictions . GPs are on the frontline. Every day, we see patients who need testing or who are displaying symptoms that are causing them to be concerned. As GPs we balance keeping our staff and ourselves safe, whilst also attempting to achieve continuity of care. There is a long road ahead for each of us and our communities. Our patients look to us as the calm providers of advice. They seek out our guidance and look to us to reassure them. We have the skills and expertise to be at the frontline of the campaign to keep all of us healthy and safe. However, to do this role well, we need open lines of communication with decision makers, access to evidence, timely testing and plenty of PPE. Australia has more than 26,000 specialist GPs[i]. We are working in communities all across Australia. We want to help our patients and their families through this time. To do this we are going to need our support networks, our leaders and our resilience. I am confident that Australia’s GPs are up to the challenge. Our communities are depending on it. [i] Medical Board of Australia. Registrant Data – December 2019. Accessed 22 March 2020 https://www.medicalboard.gov.au/News/Statistics.aspx
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A collaborative approach is what we need for rural GP training
I recently had the opportunity to host a Rural GP Summit in Alice Springs. The summit brought together the key people and organisations that contribute towards ensuring there is quality general practice in rural Australia. At the summit, we analysed what is working well to support GPs to train in rural Australia. We also acknowledged the need for improvements. Including harnessing innovative contemporary learning models, which are flexible, and offer new opportunities. For more details about the announcements the RACGP made at the Rural GP Summit and the opportunities this will create for registrars, see link here. For me, the greatest outcome from the Rural GP Summit was seeing the willingness of delegates to come together to talk about, and debate, the future of rural general practice education and training. There was such generosity in the sharing of ideas and solutions. There was also courage to discuss what is not working well. We all know about the challenges associated with supporting general practitioners to train and work in rural Australia. We know about the struggles to enlist experienced supervisors, and the barriers that prevent registrars from feeling confident to undertake their training in a rural community. We have lived through the historical division between GP organisations and have witnessed the arm wrestling that occurs between Commonwealth and State Government agencies. All of which creates confusion and duplication and further prevents GPs from addressing community need. However, we also know that working in rural Australia, as a GP, is one of the best jobs there is. Where else do you get to use all of your training (sometimes before lunchtime) to provide continuity of care for your community. Rural general practice is about teamwork. Working in teams to address community need in a rural community, is immensely satisfying. Listening to the discussion and ideas at the Rural GP Summit has given me hope. It has confirmed to me that we need to build collaboration into the design and delivery of future rural general practice training. We need to ensure junior doctors and registrars are at the table when the education and training frameworks are created. We need to invite medical educators and supervisors to be part of the discussion about how we deliver general practice training in rural Australia. We need to regularly invite feedback from our partner agencies and rural stakeholders. We also need to work with our stakeholders to monitor trends and to mobilise our collective energies and resources, when there are obstacles that are hindering high quality general practice training in rural Australia. If we can work in collaboration, I am confident we can reform our current approaches to rural general practice training. I am hopeful we can create new flexible models that reflect the aspirations and expectations of our current and future registrars. If we can harness the energy and insights of our registrars, educators and rural stakeholders we can achieve great things. Our rural communities will be the big winners if we can get this right. Ayman Shenouda
Comprehensive community general practice, coupled with emergency management, is the heart that will keep rural generalism alive
I recently had the opportunity to spend a few days in Western Australia meeting with GPs, government officials and experts in rural and remote health. It is apparent that comprehensive community general practice, coupled with emergency management is the heart that will keep rural generalism alive. This was evident during my visit. The leadership of GPs such as Dr Michael Mears in Esperance and Dr Michael Livingston in Ravensthorpe demonstrated how rural generalism is thriving. I met Dr Mears and 11 of his colleagues, early one morning. This group of 12 GPs, representing a number of local GP clinics, provide comprehensive primary care, as well as emergency medicine, anaesthetic, obstetrics and surgical services. They shared with me their collaborative model for addressing patient need within their community. They are outstanding educators and are committed to supporting the next generation of rural GPs. I enjoyed the opportunity to discuss the RACGP’s vision for general practice and to hear their ideas for the future of rural generalism. I was also privileged to meet with Dr Michael Livingston at his practice in Ravensthorpe. His practice supports a community of 2000 people and he is a passionate rural generalist. His approach to comprehensive patient care is leading to outstanding health outcomes. It was also great to meet with his wife and family. The commitment and sacrifice they offer to the community of Ravensthorpe is remarkable. Michael shared with me his concerns about the viability of general practice in rural WA communities and the impact on patient care from a lack of integration between Commonwealth and State governments. Michael has many ideas for enhancing the sustainability of general practice in rural and remote Australia. When I am next in Canberra, I intend to speak to the issues and ideas shared with me in Esperance and Ravensthorpe. I am keen to ensure that MPs and government officials hear and act upon the voice of grassroots GPs. The visit to WA gave me the opportunity to meet with leaders and rural health experts at a number of relevant agencies including WAGPET, WA Department of Health, WACHS, Rural Health West, the AMA, Rural Clinical School of WA and the WA Primary Health Alliance. I was briefed on the challenges of recruiting health professionals to work in rural WA and how communities thrive when there is continuity of care from a GP. It was good to receive an update on the efforts of many to provide medical students, junior doctors and registrars with fantastic education and training experiences. Rural and remote WA is a wonderful place to learn how to become a great GP. I have returned from my trip, energised about rural general practice and inspired by my colleagues in WA. I extend my appreciation to Adj Professor Janice Bell and her team at WAGPET for arranging the visit. I also wish to acknowledge the following individuals who meet with me and shared their expert knowledge on rural health care in Western Australia.
Photo 1: Dr Michael Livingston and family in Ravensthorpe, Western Australia Photo 2: Dr Mears and colleagues in Esperance, Western Australia Dr Ayman Shenouda  When we stand together, great change is possible
I love being a GP. I love being part of the general practice profession. Our community of GPs is vibrant and diverse. We are passionate about the profession of general practice and compelled to improve the health of our patients and families. As I think about how to make general practice even better, I think about creating new opportunities for GPs to come together. I believe it is through working together that we can make change happen. In my experience, collaboration to bring about change is never clear cut, quick or easy. It is messy, fragmented, divisive, confusing and draining. However, collaboration when it works can bring about change that was never thought possible. Throughout my career I have joined committees and working groups in a hope my voice and actions will contribute to bringing about change. Sometimes these roles have led to positive outcomes, other times I have become frustrated at the barriers put in the way of positive progress. One of my most positive experiences, in collaborating for change, has been as Chair of RACGP Rural. It has been in this role that I have seen how change can happen. One such change, achieved through the collaboration of many GPs across Australia, relates to rural generalist medicine. The focus of the rural generalist reforms have been about obtaining recognition and subsequent remuneration for the advanced skills of rural general practitioners. Debates have centred on how to enable general practitioners to work in both primary care and hospital settings in rural communities. It has also been about supporting the next generation of rural general practitioners to acquire and maintain skills in advanced areas of general practice. I am optimistic that the rural generalist reforms, championed by so many GPs, will be positive for the profession and for rural communities. Bringing about fundamental change to general practice is hard. I have seen general practitioners spend their whole careers championing rural general practice and rural generalist medicine. I have seen them represent their profession on committees and working groups where change has not seen possible. But I have seen how change can happen, when there is alignment on vision, sustained leadership, a willingness to try something new and a commitment to collaboration. Hard working general practitioners know how to get things done. When these same GPs find commonality and a way to work together change becomes possible. I am hopeful as a profession we can create other opportunities to come together to make general practice the profession of choice for young doctors. I am keen to hear your ideas. How can we work together to make change happen in general practice? Send me your thoughts or give me a call. Dr Ayman Shenouda  Bushfires continue and the essential role of GPs in supporting their communities
This week, it has been heartening to learn about the contribution of general practitioners during the Australian bushfire crisis. A number of GPs have contacted me to share their experiences. The recent RACGP article on the role of GPs in Merimbula is a great example of GPs coordinating the health care needs of their fire affected community. https://www1.racgp.org.au/newsgp/professional/paper-cups-for-spacers-oxygen-from-dive-shops-how I have also heard first-hand about the challenges GPs have experienced in providing essential primary care in partnership with state and federal agencies. It is evident there are lessons to be learnt. Conversations and planning is needed now to ensure, state and federal agencies immediately collaborate with general practitioners. Along with my colleagues, I am advocating for greater recognition of the role of GPs during an emergency crisis. General practitioners have the required expertise and need to be part of future disaster planning at a state and commonwealth level. For bushfire affected communities, GPs are central to community rebuilding. General practitioners will be there to support individuals and families as they assess their situation and begin the task of rebuilding their homes, lives and incomes. Patients in these communities will want timely access to GPs. They will expect continuity of care and coordinated support from their GP as they engage with multiple agencies to rebuild their lives. General practitioners are ready for this work. The two new Bushfire Recovery Agencies, one at a Commonwealth level to be led by Mr Andrew Colvin, and one in Victoria to be chaired by Mr Ken Lay have important work to do. Their work will benefit from engaging now with rural general practitioners working on the ground with fire affected communities. I recommend these agencies appoint a general practitioner to work alongside the leadership. The role of the GP would be to inform appropriate consultation, ensure genuine community responses and smart investments that benefit the long term health needs of communities impacted by bushfires. As the threats from Australian bushfires continue, I extend my thanks to GPs in these communities for their work and I hope they continue to be safe. |
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