Rural workforce training options to be debated

27 March 2017

Two health education proposals to help meet a chronic shortage of rural health professionals are on the agenda of this week's National Rural Health Conference.

Nurse practitioner and Rural General Practice Network Chair Sharon Hansen said last week's joint announcement by the University of Otago and University of Auckland medical schools for a rural interprofessional school of health couldn't be better timed and, if it goes ahead, could underpin the rural health workforce for the medium to long-term.

“A well trained primary health care workforce has never been so important. With the rural sector particularly suffering inequity of access to general practice, it is a timely move,” says Ms Hansen.

But Waikato University and the Waikato District Health Board, whose proposal for a Waikato Graduate Entry Medical School is currently being considered by government, are not convinced saying minor changes to the existing medical education programmes won't solve the rural health workforce crisis.

The proposals by the University of Otago and University of Auckland, and the Waikato proposal, will be discussed during a keynote session at the three-day conference that gets underway in Wellington on Thursday March 30. The session called "Does New Zealand need a rural school of medicine" is being led by rural hospital doctor and Otago university senior lecturer Garry Nixon alongside Ross Lawrenson who is a Professor of Population Health at Waikato University and clinical director (strategy and funding) at Waikato District Health Board.

The national School of Rural Health proposal was announced in a joint press release on March 21 by Otago and Auckland universities, in association with the Royal New Zealand College of General Practitioners (RNZCGP) and the New Zealand Rural General Practice Network (NZRGPN). The University of Waikato and the Waikato District Health Board (Waikato DHB)'s business case for a new four-year graduate medical school programme that would be "community engaged" and primary care-focused went to government in October 2016.

The main aim of the proposed national rural health school was to provide a 'sustainable' rural component for all health professional students by building an interprofessional facility based at up to 20 rural communities across the country.

The initiative is to build on existing interprofessional programmes like the Rural Immersion Programme at Gisborne (run by Otago and EIT which includes nursing and students from four other disciplines aside from medicine), the Rural Immersion Programme at Whakatane (run by University of Auckland in league with AUT and Waiariki Institute of Technology which includes 3rd year nursing students along with medical, pharmacy and physiotherapy students) and Auckland's Pūkawakawa programme in Northland for 5th year medical students.

The proposal is for the 20 inter-professional rural sites to be developed and governed in league with local iwi and communities, to be clinician-led and provide inter-professional education for all health professionals.

Dr Tim Malloy, president of RNZCGP said like most developed countries New Zealand was facing chronic shortages of rural doctors and other rural medical health professionals and there needed to be system changes, including new ways of training, to ensure rural communities have equitable accesss to services.

Hansen, a Temuka-based nurse practitioner, said there was a clear need to train more doctors, nurses and allied health professionals to ensure an integrated rural healthcare team.  "It is not a matter of replacing GPs with other health professionals, such as pharmacists or nurses, rather there is a need to ensure that more doctors, nurses and allied professions enter the rural health training pathway. 

University of Waikato vice-chance Professor Neil Quigley said the rural health school problem would not address the need for more doctors and the solution needed to be a fundamental change in the way New Zealand selected and prepared medical students for community service.  Waikato DHB chief executive Dr Nigel Murray said the Waikato Graduate Entry Medical School proposal would produce doctors who were more representative of the communities they served, focused on the health of high-needs communities and able to use the latest advances in technology.

The Waikato proposal has said it will focus on selecting graduates who are willing to serve high-needs communities and meet the health care needs of the population that lives outside the main centres (i.e. small cities, provincial towns and rural areas).  It was also to involve clinical education and training centres throughout the central North Island with the aim of having students undertake a "higher proportion of their clinical placements outside the main centres".

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