Dr Ayman Shenouda Announcing the Collingrove Agreement following the rural and regional health forum in Canberra on Friday 9 February 2018 from L–R: ACRRM’s Dr Michael Beckoff, National Rural Health Commissioner Professor Paul Worley, Minister for Rural Health Bridget McKenzie, RACGP Rural Chair A/Prof Ayman Shenouda. A milestone agreement Those who have been part of this journey will understand the significance of the Collingrove Agreement. Although I think on this topic, even the most casual observer will be across the division that has chocked us for so long. It’s been a long and often dusty road but we’re now steered in the right direction and towards developing a national rural generalist pathway together. Finding that common ground was relatively easy in one sense. You see, the one thing I’ve noticed having travelled extensively over the past four years as Chair of the RACGP rural faculty is that patience, passion and persistence is a common trait of rural GPs or any GP for that matter. From Longreach to Carnavon or Katherine to Goolwa and everywhere in-between and regardless of which camp they belonged – ACRRM or RACGP - there lies a great determination and commitment for their patient and rural community. An unbreakable connection which binds us all in addressing rural health disadvantage and securing a healthier future for all. Navigating slightly rougher terrain But in finding that common ground between the two GP colleges - while the destination remained the same - the road itself was indeed rocky. So rocky in fact it required an all-terrain vehicle for all involved and sometimes perhaps a tank may have been a slightly better choice! Still, despite years of division, I think it was that same spirit that made the Collingrove Agreement possible. An easy headline it may have seemed to those filtering the news last Friday, but the “RACGP and ACRRM collaborating on national generalist pathway” was truly momentous. And certainly, for those around the table at Collingrove Homestead in the Barossa Valley, South Australia, collaboration soon became the only solution. Sharing a picture for history’s sake of those present on those momentous couple of days 11-12 January 2018. Securing the milestone agreement from L-R: Dr Melanie Considine, RACGP Rural Deputy Chair, RACGP Rural Chair A/Prof Ayman Shenouda, ACRRM Censor in Chief A/Prof David Campbell, our National Rural Health Commissioner Professor Paul Worley, ACRRM President A/Prof Ruth Steward and Dr Rose Ellis from the Rural Doctors Network.
A common goal While the agreement itself is only four paragraphs long - the common ground here was significant. We had 7 million reasons to get this right. It is about equity of access in meeting the health care needs of rural and remote Australians through a responsive needs-based solution. Together we were determined to secure a strong, sustainable and skilled national medical workforce to meet the needs of these communities. More than a definition This is, of course, more than a about a definition but it was always a sticking point. On one hand there were those focussed on the name or a tendency to favour a definition over others. On the other, we knew that developing skills around the ongoing care considerations are the areas that best serve the community. And there’s the commonality – supporting doctors to acquire the skills to meet the needs of their communities. A dedicated and clear pathway for rural GPs to acquire those skills and utilise them in a way that is valued and recognised are important workforce factors. This was the cohesion that brought the clarity to the definition. So here is it - “A Rural Generalist (RG) is a medical practitioner who is trained to meet the specific current and future health care needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team.” Pathway design Beyond the definition, it is the careful design of the pathway itself that will make the most difference. It needs to be a lot of things but at its core it is about ensuring the right skill mix against demand with supportive elements offering flexibility and choice. Key features which include a clear pathway for young doctors with flexibility that allows entry and exit at different stages. Ensuring adequate funding for the pathway itself alongside essential factors in establishing a critical mass of trainees but with enough flexibility for it to work within the varying jurisdictions. It should also allow lateral entry for practising GPs and other rural doctors who want to acquire new skills to address the shifting need in these communities. Ever changing needs like mental health and palliative care and in dealing with the extra problems which depend on the health needs and context of the community. The full range of competencies enabling them to deliver patient care closer to home in the primary and secondary care contexts. Or quite simply, training young doctors with the right skill set that makes them feel safe and supported to do their job which is addressing rural and remote community needs. There’s usually some bleeding before healing Despite years of focus, the disparity of health service delivery in rural and remote Australia remains a key policy failure. Much has been left to our overseas trained doctors who have been the backbone in delivering this care over this time. The lack of a solid training or workforce solution meant that the rural health system depended on individual efforts with very mixed results. Sometimes I feel the split between the colleges had to happen for us to be able to reach this agreement. The Collingrove Agreement is the culmination of 20 years of hard work by both Colleges in building capacity to deliver a needs-based solution for rural health. We’ve seen more collaboration over the past year than in the preceding 20 - through Bi-College Accreditation to this historic Collingrove Agreement. So, let’s keep it up! A Rural Generalist Pathway Taskforce is being formed in the coming months to work through the pathway design. There may still be a long road beyond Collingrove Homestead but I think this time it will be the recently resurfaced type! Ayman Shenouda
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A significant step in securing a stable rural medical workforce Dr Ayman Shenouda A rural renaissance It is great to see the Federal Government delivering on its commitment to increase the number of rural-based doctors in training.What we are experiencing right now in rural health can only be described as a rural renaissance. We have great leadership in our Rural Health Commissioner and now in our new Rural Health Minister making her mark and building on the great work of her predecessor. More intern placements in general practice is great news for rural doctors and their communities. This is an essential step in securing the next generation of rural GPs by ensuring our trainees receive broad exposure through prioritising primary care and general practice. These programs really work as they provide trainees with that essential insight to community medicine. Intern rotations in general practice The Rural Junior Doctor Training Innovation Fund (RJDTIF) program provides primary care rotations for rurally based first-year interns. It builds on existing state and territory arrangements to provide primary care rotations in addition to hospital rotations. . Last week, Rural Health Minister, Senator the Hon Bridget McKenzie, announced a $1,304,967 Federal Government grant for the Murrumbidgee Local Health District to increase intern rotations throughout the region. I’m proud to be contributing with my practice in Wagga selected to participate and we will be rotating five interns a year through this program. It was great to show Minister McKenzie around my practice and have a chance to discuss how to provide that valuable community exposure early. The Minister showed a deep understanding of what is required in placing policy priority on general practice. She shared my vision that every junior doctor should have a rotation in general practice as part of the first two to three years of training. Quality training experience In our practice, we have GP specialists, new fellows, GP registrars, interns and medical students working alongside nurses and allied health professionals. We aim to support the integration of vertical and horizontal teaching enhanced through a multidisciplinary team environment. A strong teaching culture and established education networks also ensure we have the hospital and community partnerships to enhance exposure and demonstrate for our trainees the diversity of general practice. We’ve worked hard to build the required supportive infrastructure and systems to make this work which needless to say is also reliant on a solid business model. Keeping them there Targeted exposure strategies like these ensure trainees can develop the broad range of skills required. It provides essential rural exposure for interns to learn the complexities of delivering services in rural areas while in a supportive general practice setting. My own experience with the PGPPP where I had 12 interns rotated in my practice really yielded results. From that cohort, about 70 per cent of them have chosen general practice as their training speciality. They loved the diversity and complexity general practice offered. It challenged them, kept them engaged and provided that important insight into the doctor-patient relationship. A little on the policy journey Addressing maldistribution has been dominant in the discussion at many Rural Health Stakeholder Roundtables in Canberra over recent years. Certainly, greater exposure to general practice for junior doctors has been central to RACGP Rural advocacy around securing an integrated rural training pathway. Particularly in ensuring more emphasis on primary care and generalism early in medical education. But really making generalism a foundation of junior medical training – a discussion made more difficult on the back of a defunded PGPPP. This was a significant policy obstacle when you consider that what we were pursuing was more of a supercharged PGPPP but specifically for rural areas. We needed a solution that would boost the number of GPs as well as address the gap in the rural pathway by providing intern rotations in general practice and primary care. We knew there was a strong learner preference for rurally based internships. We also knew that potentially we had lost a cohort of potential rural GPs as the gap from the PGPPP hit hard and narrowed our opportunities. A win for general practice It certainly was a long policy process getting here. This is the why this program, which was the result of a long period of sustained advocacy, is such a significant win for general practice. It is clear much of the hard work over many years is starting to pay off particularly in rural health. This is a significant step forward in securing a stable medical workforce to address maldistribution. Health Advocacy in 2018 Dr Ayman Shenouda Where are we now? I’m not the first to say that the 24-hour media cycle has taken a toll on our democracy. Some even say it killed journalism. I think the true damage lies in a loss of thoroughness and depth of thought. More specifically, the effects of the demise of principled advocacy and what it now takes to shape and change policy. Twitter now seems to set the policy agenda. But we’ve been in this chaotic and unpredictable world for some time now and we’re never going back to the pre-digital era of journalism. In mobilising support, is there the time and patience left to build a policy dialogue? Without it, we are just left with a policy vacuum and random tweets that lead us nowhere. Inclusive policy Considered policy development takes time. Good public policy relies on effective community involvement and consultation. Good implementation is also important. The process of implementation seems to be skipped entirely from the process these days, which makes the type of incremental change required in healthcare almost impossible. There seems neither the time nor the inclination for the inclusive process required for good policymaking. Even when good policy process does occur, it can all fall over in an instant as was the case recently for constitution recognition which went down without the noise it deserved. The doctor as advocate would be familiar with similar policy disappointment. It’s been a long road to reform and there has been plenty of blocks along the way. It’s clear that it is harder to get attention in such a cluttered space. Healthcare advocacy What does it take to shape and change policy in our own policy space? We advocate at different levels from individual patient advocacy through to more public advocacy or policy leadership roles on the national and sometimes international level. In a world ruled by Twitter, there’s not a lot of time for considered well design policy solutions. The type you need to communicate the evidence base or get the required policy reasoning across. But we still need to build that policy dialogue. This is why it is so important for us – as a community of healthcare professionals – to get it right. By getting it right I mean following good policy process. But how can we avoid the pitfalls of advocacy? Media can certainly help to set the agenda but I think a focus on inclusion is the best place to start. Right place, right time Magic happens when the right people are at the right place at the right time. When things are politically aligned and people at the table are smart and genuine in their intent - the moment when they recognise what leadership is all about - then Magic follows. When there is no personal or financial gain, leaders start to have a sense of what can be gained through collective advocacy for the benefit of their community. When the vision is clear and simple to understand by all involved implementation becomes a lot easier. Integrity always shines through Some people believe that politics is about being smart enough to make a lie look convincing. Sometimes this falls somewhere between a lie and a falsehood or the new “alternative facts” and post-truth era we now find ourselves in. Some politicians think they know better. They might even get away with some temporary gain but believe me, the power of truth has a longer and more effective success. People can smell dishonesty no matter how enticing a master deceiver may be. It is integrity that always shines through the brightest here. Making collective impact work When there is a genuine and clear goal that addresses the common agenda, people get together to make what look like impossible change feel like a walk in the park. This requires a collaborative approach to creating change to facilitate mutual support and collective impact. When you win the hearts and souls of people, what seemed impossible becomes not only possible but a lot easier to achieve. When everyone in the room feels safe and heard by others, suddenly they will be able to see and value others contributions. In my opinion, you should leave your personal views and judgment of others outside the room. After all, we need to be clear about one thing - it is not about you, it is about others and the trust they’ve placed in you to present their opinion. Some may not agree with me but at the end of the day, everyone is entitled to have their own views. Let’s hope health advocacy in 2018 is a place of inclusive reform. That we work together towards collective impact and a common agenda that will see sector-wide improvements. National Rural Health Commissioner: Putting the rural health agenda back on track Dr Ayman Shenouda A rural champion A visit this week to Wagga from our National Rural Health Commissioner Professor Paul Worley provided a great chance to work through some of our highest rural health priorities. This new champion for rural patients is exactly what we needed. He fits the job description well – independent, impartial and “a fearless champion” for rural health. He also has alongside him a strong rural health sector full of ideas for building a strong Australian rural health system. Getting the agenda back on track Rural patients are finally getting the focus they deserve and this is our chance to get the rural health agenda back on track. I think we finally have the policy settings in place for this to occur. But it all has to be orchestrated in a way that sees very specific locational needs acknowledged and addressed. This is where the new rural commissioner role comes in. We all have a key role here. There’s still a great deal of work which now needs to occur to ensure every instrument in this vital ensemble can be fully utilised. It is those featured instruments – whether string, woodwind, brass or percussion – each with its own unique qualities that really need to shine. These are the ones that fill in a critical gap and vital if we are going to provide a performance worthy of rural Australians. National Rural Generalist Pathway The first task is the National Rural Generalist Pathway. If we are to get this policy right we will need a broad policy lens with a commitment to needs-based planning encompassing all disciplines. We know that a sustainable health workforce solution for rural Australia needs to factor in flexibility in policy design. By this, I mean allowing for an optimal skill mix which is capable of meeting the very specific service needs of that community. Local needs analysis It is clear that we need reforms that can address maldistribution to meet growing service demand. But to do this we need to look at what is really happening in these communities. Skills planning through a rural generalist pathway solution must, therefore, encompass a much broader skill mapping exercise. This needs to be steered toward more integrated care and with a focus on the full multidisciplinary skill mix required to keep those services going. We need to find ways to capture current skill depth so that this can be prioritised better in policy. Reinforcing the importance of primary care and coordination of care so that the policies can follow. But really plotting that essential skill mix required to support rural models of care. Future supply and demand (against need) It is about having that critical mass of health professionals to achieve a sustainable service environment. This not only lifts constraints enabling more equitable access to services but creates a way to mobilise and build on peer support. In turn, reducing burn-out by formalising mechanisms for peer support-support networks. It provides safer working hours and leaves room for internal backfill for relief, as well as professional development or space to take on a supervising role. There’s been plenty of workforce planning occurring – PHNs, LHNs, and RHWAs – but we lack that common formula. No-one can see at a national level where the true hotspots are. We need to establish what constitutes a minimum workforce requirement or mix for a particular population size and then apply that across the country. Matching and forecasting the needs is complex but we have evidence-based approaches to estimating health workforce demand. HWA did years of work around it. I think we must clarify this area of workforce policy as a first key step. Once we have this formula then we’ll see a situation where training investment meets demand. There is just not enough aligning in terms of training pathways with workforce planning. This is vital as you can’t have a situation where you have three GP anaesthetists and no GP-obstetrician. This level of planning would also help in terms of succession planning and reassure those committing to these pathways that there is or will be a position for them. It provides a planned career pathway for them. Broad skill depth Broad skill depth is vital to addressing patient need in rural communities. We need to find a way to embed in workforce policy those skills most relied on in meeting this need. I think the discussion is also broader than the training pathway itself. We have to have an equal focus on the requirements of the existing workforce in meeting shifting community need. Training solutions need to enable private community-based practice. We really need to ensure we encompass a range of approaches factoring both procedural and non-procedural skills if we are going to align closely to need. If we support the full skillset required then we are closer to reflecting within the training the full scope of skills practised in rural general practice to meet community needs. This is how we can ensure we produce the next generation of doctors with the skills needed to provide both primary and secondary care. Training Hubs Past policies have had an impact on both recruitment and retention. It all comes back to securing that critical mass (of students). Early exposure which can establish that community connection early which can continue through to intern, prevocational and vocational training years. We’ve always said that we need to invest in more localised training solutions to provide for that community connection and rebuild a teaching culture. The hubs are well positioned to facilitate that vital community connection and link the various stages of training in a rural setting across the full training continuum. The training hubs provide that essential framework now but it is about facilitating those vital partnerships. This is how we can structure training against local healthcare need and service construct and build in those supportive factors so early exposure can be a positive experience. Nurture rural intention We need to nurture rural intention through targeted incentives and sufficient rural exposure strategies. A strong commitment to rural should come with benefits. Capture those wanting to pursue rural through a nurtured pathway and supports which include an investment in mentoring. Truly support RMOs skills and career path aspirations and reinvesting in these years by getting back the PGPPP in its true form. Newly developed policy offering primary care rotations through the new rural community-based interns is certainly acknowledged but it is a minimised model which really needs to be expanded. Vertical continuity over time Focusing more effort on areas that provide both a training benefit and meet a community health need is a way to secure an enduring rural benefit. Realising that a focus on the full multidisciplinary team is key to providing more integrated and improved patient-care strategies. Building this capacity through vertical integration of teaching and learning which promotes shared responsibilities. It’s that continuity that is needed most – vertical continuity over time to allow for varied exposure which results in the more resilient doctor. Flexibility is needed to ensure training reflects the local service context with an equal focus on community-based training. It helps develop that understanding of optimal care pathways providing continuity of care and a collaborative integrated care approach. Team and teaching culture Developing a strong team culture early has to also be a key focus. Those working in rural Australia know that it takes a dedicated team and an enduring local commitment to tackling the many challenges in delivering regional, rural and remote healthcare. We need to ensure more exposure to multidisciplinary team environments as well as enabling hospital and community partnerships through supportive policy. This is where the pathway solution has to extend beyond a focus solely on medicine. Improved support for supervisors has never had the policy focus it deserves. We need to increase the teaching capacity of rural communities while minimising the impact of burnout. Practice viability is a major consideration here. All these factors need to be considered in terms of ensuring a rural GP can take on a training or teaching role. Succession planning and providing that easy entry, gracious exit is key and would lift the load for many already overcommitted. A more sustainable future In designing rural policies which can provide a more sustainable future, the focus clearly has to come back to addressing health disparities between rural and urban Australians. A resilient multi-skilled generalist workforce capable of meeting current patient need now and into the future is all part of meeting that key requirement. We really need to capitalise on the policy settings we already have in place. The strong planning role of the PHNs and LHNs in identifying local level need. The facilitation role of the new training hubs in ensuring a more positive rural training experience. Existing strong College pathways and well-developed rural skills training program with inter-professional partnerships to build from. We now have that vital role in the National Rural Health Commissioner to ensure a more coordinated national policy and planning effort can occur. We’re well on our way in putting the rural health agenda back on track ensuring lasting change for rural Australians. [ends] Source: RACGP 2014. New approaches to integrated rural training for medical practitioners. Final Report. Available at: https://www.racgp.org.au/download/Documents/Rural/nrffinalreport.pdf A digital health future: The risks and opportunities Dr Ayman Shenouda An uncertain future Technology will never replace doctors. That part is clear (or to me at least). But there’s still a lot of uncertainty ahead and we’re all being told to prepare for significant changes. We’re now seeing daily discussions around the Fourth Industrial Revolution and that it will see unprecedented workforce change. Despite threats of robot doctors, online lawyers and automated architects, it will be those distinctly human capabilities that will prevail. It is our heart that distinguishes here and no amount of automation can replace it.[1] At the same time, we will need to be ready for it. Because, if, as predicted, technology sees radically different healthcare systems emerge we need to be ready to embrace this change. Leadership will be required in shaping and refining quality standards to ensure continued best care for our patients. Change is already here There are already some significant advances taking place providing a glimpse of what is to come. Much of what we are seeing now is user-driven as technology uptake in the community increases such as through iPhone health monitoring apps. There is certain strength in technology in empowering patients to take responsibility for their own health. Many aim to support self-management outcomes through patient empowerment, but it is clear that a lack of evidence-base undermines quality and safety in some. There is discussion around how certain free medical apps are placing patients at risk through false or misleading claims. From instant blood pressure apps giving falsely normal values to apps that claim to measure blood pressure, oxygenation, and more – all without any peripherals.[2] Health apps present significant challenges to regulatory authorities. And I’m sure it’s not easy for developers to navigate the regulatory pathways either. In Australia, we have TGA guidelines for what software constitutes a medical device. But how much monitoring is being undertaken to identify non-compliance, particularly around claims on these apps, is unclear. The next phase of change It’s clear a soulless search engine or app device is a long way from replacing a GP. But what about the next phase of change? Deep learning breakthroughs of machine learning and artificial intelligence and precision medicine are likely to influence the way we provide care. Big data analytics involve descriptive analytics, predictive analytics, and prescriptive analytics. It is the latter, in prescriptive analytics, which leverages descriptive reports and predictive data to identify actions that would produce maximum value to help us develop and adhere to optimal clinical pathways.[3] Clinical decision support (CDS) on the other hand is set to enhance health and healthcare teams. It will provide both healthcare teams and individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow.[4] GP leadership If the future of medicine is based on data and analytics in guiding decision making, then most critical to success will be that the GP remains in control of the clinical decision-making. To safeguard patients, address questions of liability, and foster trust we need transparency in terms of how clinical decision support tools derive their results.[5] Developers and vendors of clinical decision support tools must be transparent about their methodologies, capabilities, data sources, and limitations.[6] CDS in developing treatment plans will require leadership from the profession in terms of how we can integrate these systems successfully into our practices. In testing the efficacy of these emerging technology in improving the care and treatment of patients there will be a need for strong consistent discipline specific input. For Australian general practice, there is a role for our College in joining multidisciplinary technology assessment committees. Currently, the RACGP Expert Committee – eHealth and Practice Systems lead much of this work. The RACGP Technology Survey released earlier this month will help to gain more insight into the current trends in technology adoption in general practice.[7] It will be interesting to see these results (which closed 3 December) particularly the views of technology use to improve collection of patient data and for clinical decision making. Benefits in service improvements Emergent technologies which present new opportunities for healthcare service provision provide great promise. These are technologies that interface with patients in maintaining health, receiving care, and managing a condition. These new types of technologies – wearables, ingestibles, and embeddables – will be transformative. Management in the home for the elderly and frail will benefit significantly from new technical innovations. Just by adding in a number of sensors to the body to monitor we will support older Australian’s independence as well as take some pressures off the service system while keeping them safe. Reliance on these systems would need to be balanced or potentially worsen social isolation and loneliness which are already significant health risks for the elderly. The value of human contact and continued doctor-patient and nurse-patient relationships are vital here. Wearable technology The next phase of wearable technologies will see patients constantly monitored remotely through wearable skins sensors or smartphone apps with data uploaded directly to their health record.[8] These technologies aim to support the management of chronic diseases, such as diabetes and heart disease. The advent of the digital health coach (Next IT) to remind patients to take medications, schedule doctor appointments represent a new type of technology to support medication adherence. The UK is leading the wearable technology space with pilots underway which will see patients’ issues with state of the art wearable technology. These initiatives are designed to take pressure off the system but also to monitor conditions more effectively for a diverse patient cohort. Some pilots will enable independence for the aged through home monitoring systems with others supporting mental health patients stay in touch with support networks.[9] It is predicted that, as part of a widespread digital revolution of healthcare in Britain, within 5 years patients across the country will go online to speak to their GP via video link, order prescriptions or see their entire health record.[10] Digital divide For implementation in Australia, a final note on the digital divide is warranted. Equity remains an issue despite the promises of high patient engagement through new technologies. So much of the discussion around technology as an access enabler really misses this point. What about those millions of Australian households living without an internet connection? Telehealth implementation has been patchy in rural Australia due to the lack of fast and reliable internet, despite the (slow) rollout of NBN. Assuming we all get access by the time these technologies are fully realised, not all Australians can afford access to the internet or the digital resources required to drive new innovations. For equitable access, we would need to see policies that can provide unmetered online access for the disadvantaged. A commitment to extend the Health Care Card to address the digital divide should be in the planning if we are to strive for equitable access outcomes. Leading the discussion Healthcare’s technology revolution is likely to see significant change. Doctors have been described as late adopters of technology in the past. It will be important to be ready and even more important to be part of the discussion. That is, the one that is occurring now! Finding new ways to connect patients to our practice is positive and possible right now. Future broader technology enabled supports to integrate services and strengthen monitoring of patients can see a positive new change which can only enrich patient care. We’re on the cusp of enormous change and our combined leadership is required in balancing risk with opportunity. Let’s all take up the challenge. End [1] PwC. 20th CEO Survey. The talent challenge: Harnessing the power of human skills in the machine age. PwC. 2017. Available at: https://www.pwc.com/gx/en/ceo-survey/2017/deep-dives/ceo-survey-global-talent.pdf [2] Misra, S. IMedicalApps Feature. Another top free medical app that puts patients at risk with claims to measure blood pressure, oxygenation, and more. 26 October 2016. Available at: https://www.imedicalapps.com/2016/10/icare-health-monitor-health-app-patient-risk/ [3] Bresnick J. HealthIT Analytics Feature. The Difference Between Clinical Decision Support, Big Data Analytics. 31 August 2017. Available at: https://healthitanalytics.com/news/the-difference-between-clinical-decision-support-big-data-analytics [4] Ibid. [5] Bresnick J. HealthIT Analytics Feature. Transparency is key for clinical decision support, machine learning tools. 6 September 2017. https://healthitanalytics.com/news/transparency-is-key-for-clinical-decision-support-machine-learning-vendors [6] Ibid. [7] RACGP. Webpage. RACGP Technology Survey 2017. Available at: https://www.racgp.org.au/your-practice/ehealth/additional-resources/racgp-technology-survey/ [8] Skokowski P. Wearable Tech Feature. Wear your health on your sleeve: The next phase of wearable technology. 25 September 2015. Available at: http://www.wearabletechnology-news.com/news/2015/sep/25/wear-your-health-your-sleeve-next-phase-wearable-technology/ [9] Knapton S. The Telegraph. NHS remote monitoring will allow dementia patients to stay at home. 22 January 2016. Available at: http://www.telegraph.co.uk/news/health/elder/12113536/NHS-remote-monitoring-will-allow-dementia-patients-to-stay-at-home.html [10] Rigby M. Digital Health London. Spotlight: Innovation and Integration – The Future of General Practice. Available at: https://digitalhealth.london/spotlight-innovation-integration-future-general-practice/ |
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