Technology the future for country health

That was one of the views expressed at a panel discussion on the inequity of access to healthcare for those living in rural WA at last week's CWA of WA 95th State conference in Perth.

The health forum, Overcoming the tyranny of distance, heard from four panellists - WA Country Health Service assistant chief operating officer Margaret Denton, Rural Health West chief executive officer Tim Shackleton, WALGA president and East Pilbara shire president Lynne Craigie and WA Centre for Rural Health director Sandra Thompson.

The panel agreed access to healthcare and the recruitment and retention of doctors in country and remote areas were two of the biggest challenges facing WA's health industry.

Ms Denton said one of the ways in which the government was addressing the issue of access was by engaging with digital technology through its Telehealth service.

"Telehealth services are now in more than 90 locations across the State and they support clinicians on the ground everyday," Ms Denton said.

"If a patient turns up to one of our small clinics, you can have access to an emergency medicine specialist based in Perth, or anywhere in the world, because virtually we can connect to anywhere across Australia or internationally.

"This is great for clinicians who can feel quite lonely when faced with severe trauma and it's beneficial to patients in receiving access to emergency medical specialists."

Ms Denton said the Telehealth program had been expanded into an inpatient telehealth service that was in its early stages and a mental health telehealth service.

"The inpatient telehealth service is in about 28 locations, so if you're in a hospital and there is no GP in town we can keep you in that hospital if the clinical care is right for you, rather than transferring you out to a larger regional centre," Ms Denton said.

"Our new mental health service will also enable people to have access to emergency mental health care when they need it."

In terms of delivering therapy in rural areas, Ms Denton highlighted contemporary models of care that were reliant on therapy assistants delivering programs that had already been developed in collaboration with a patient.

"A therapist can see a patient on their visit to a remote community and develop a program which the therapy assistant can then deliver and be supervised at a distance by the therapist who may be hundreds of kilometres away," Ms Denton said.

"We don't have enough GPs and therapists on the ground in country WA, so relying on remote technologies will be the way of the future and it is one of our big initiatives."

Mr Shackleton pointed out that GPs seeing patients via telehealth weren't being paid for those sessions.

"However on November 1 this year the Federal government will introduce a Medicare payment for GPs who provide services via video conferencing to areas in remote WA," Mr Shackleton said.

He said the payments would be for Telehealth services provided to remote parts of the Pilbara, Kimberley, Goldfields and Mid West.

"We hope that's going to lead to a much bigger take up by doctors," Mr Shackleton said.

Ms Denton conceded there were WA locations where the emergency telehealth service wasn't currently viable because the technology infrastructure wasn't sufficient.

"It's definitely on our agenda, in terms of lobbying the Commonwealth to make sure we have that network enabled so we can do that remote work," Ms Denton said.

The panel also discussed some of the major challenges in recruiting and retaining GPs in rural and remote communities in WA.

Ms Craigie said often the housing available to GPs wasn't to the standard in which they wanted to live.

"Local government is trying to intervene in that space and provide housing that is of a standard that people will want to stay," she said.

"For example, in the Pilbara people don't want to live in a house that's not air-conditioned and who can blame them."

Ms Craigie said local government organisations were also looking at providing power and water subsidies to assist GPs in setting up their business in regional areas.

"Local government is very keen to partner in this space," she said.

Mr Shackleton said the Federal government had also been providing funds through Rural Health West to offset insurance costs for GPs, particularly for doctors delivering babies in country areas.

"Insurance costs for some GPs can be really prohibitive and the Federal government has done a fair bit to offset those costs," he said.

Ms Denton said a range of financial incentives to improve the attraction and retention of GPs into small communities through the Royalties for Regions initiative had also been reasonably successful.

But Professor Thompson said the issue of recruiting and retaining GPs in country areas was larger than just addressing housing, remuneration and insurance benefits.

"They are only one part of the equation," she said.

"People like working where they think they can make a difference and feel they are using their professional skills as they have been trained to use them.

"We need a whole community approach and social support in these rural communities.

"If people have a strong community connection - that's what will help keep them in those communities."

Mr Shackleton agreed the time had come to stop relying on bigger pay packets and nicer houses to attract doctors.

In terms of the scale of GP presence in the country, he said there were about 1000 GPs working outside of the metropolitan area, 550 of which had trained overseas.

"We have about a 10 per cent vacancy rate, so 100 vacancies, that we've really struggled to shift," Mr Shackleton said.

"Of those 100 vacancies about 25 of them are what we call priority one vacancies.

"These are positions where they are the only GP in town or they are part of a small general practice and the bulk of the priority one vacancies are in the Pilbara, Wheatbelt and Goldfields.

"This is clearly a bit of an issue for us, but the answer is in policy.

"The State and Federal governments are committed to a strategy which broadly involves getting Aussie country kids into medical school from high school, training them through a rural medical school and having them complete their post graduate training in country WA.

"We need to train people in the bush to keep them in the bush, that's where the intention needs to be."