2017 18 ANNUAL REPORT Supporting rural health in New South Wales, Australia
About this Report This report is for the period 1 July 2017 to 30 June 2018 and is the 30th full year Annual Report for the NSW Rural Doctors Network and its predecessor organisation. Financial data has been audited by Cutcher and Neale, Chartered Accountants, Newcastle NSW 2300. This report is available to download from our web site at www.nswrdn.com.au To obtain printed copies or to seek further information please contact the NSW Rural Doctors Network on 02 4924 8000 or email publicity@nswrdn.com.au ABN 52 081 388 810 Published by the NSW Rural Doctors Network (2018) ISSN 1441-1830 (print) ISSN 2202-2657 (online)
Contents
Chair’s Message
2
Chief Executive Officer’s Message
3
Profile of the NSW Rural Doctors Network
4
Organisation Structure
5
Purpose, Goal & Values
6
Board and Executive
8
Workforce Snapshot 2017–18
10
Financial Performance 2017–18
12
Highlights 2017–18
13
Financial Statements & Statutory Reports 2017–18
43
Abbreviations 58 Index 60
Lithgow Blast Furnace, NSW
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nsw rural doctors network annual report 2017 –18
Chair’s Message As the NSW Rural Doctors Network (RDN) celebrates 30 years of service to the clinicians and communities of rural NSW, we pause to acknowledge the successes of the past and thank both the Commonwealth and NSW governments for their continued support. As we reflect on the past, our focus naturally drifts to the future and how RDN will continue to evolve to meet future needs in an ever-changing landscape while remaining true to its origins and purpose.
"We remain particularly committed to marginalised communities and the needs of our nation’s First Peoples."
To this end, the Board has immersed itself in the strategic planning necessary to ensure RDN does not lose relevance, particularly to the communities who are finding novel solutions to the workforce and service provision challenges they face. We remain particularly committed to marginalised communities and the needs of our nation’s First Peoples. In 2017–18, we launched RDN’s Aboriginal Engagement Plan (AEP) to reinforce our guiding belief in equality and equity and set out how RDN will assist in working towards Aboriginal health equity. The Plan builds on our existing commitments and relationships, which we are reaffirming with the resigning of our Memorandum of Understanding with the Aboriginal Health and Medical Research Council of NSW at the 2018 Annual General Meeting.
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I would like to thank RDN’s staff for the dedication and professionalism they have brought to their roles and the enthusiasm with which they have embraced the changes over the past 12 months. The executive, led by Richard Colbran, has continued to provide the stability and leadership necessary for staff to excel. Finally, I am most indebted to the Board members for their support, dedication and hard work over the last year, in particular the Deputy Chair, Dr Ros Bullock.
Dr John Curnow Chair
Chief Executive Officer’s Message As RDN celebrates 30 years, I would like to reaffirm our commitment to supporting the health and wellbeing of NSW’s remote, rural and regional communities. RDN is driven by a fundamental belief that access to quality healthcare is the right of every Australian, no matter where they live. Our contribution is to support the growth of the rural health workforce, the sustainability of services and the capability development of health professionals so they are as effective as possible.
"RDN is driven by a fundamental belief that access to quality healthcare is the right of every Australian, no matter where they live."
This Annual Report offers a summary of our activities and performance over the past year. Complementary to our long-standing programs, we have successfully introduced the Australian Government Department of Health’s new Rural Health Workforce Support Program (RHWSP), and Health Workforce Scholarship Program (HWSP) to NSW. The response across all workforce cohorts has been positive and it is wonderful to see workforce support and development opportunities like this offered. RDN’s relationships with its stakeholder organisations are important and valued and we sincerely thank them for their continued support of, and commitment to, rural health. We appreciate our strong working relationships with both the Australian Government Department of Health and the NSW Ministry of Health, and in the coming year we celebrate the 20th anniversary of our partnership with the Country Women’s Association of NSW; and the 10th anniversary of our Memorandum of Understanding with the Aboriginal Health and Medical Research Council of NSW. These relationships have been fundamental to RDN’s operations and community engagement over the past decades. This year we launched RDN’s Aboriginal Engagement Plan (AEP), reaffirming our commitment to the health and wellbeing of Aboriginal people and our strong working
relationships with the Aboriginal health sector. RDN’s Aboriginal Advisory Group was instrumental in forming the Plan and all staff have completed cultural training modules. We extend our thanks to the Advisory Group members and Western NSW TAFE. I would like to personally thank RDN’s Board and staff for their outstanding efforts this year. Periods of change are not easy, and they have demonstrated understanding and professionalism. I would also like to acknowledge Chair Dr John Curnow; Dr Ros Bullock, who this year stepped down as RDN Chair; and Dr Geoff White, a formidable stalwart of rural health, who left the Board in late 2017. Looking ahead, continuing the realignment of our program activities is important. Our commitment to producing an annual Rural Primary Health Workforce Needs Assessment is pivotal to our design and program methodologies and will ensure resources are invested to the areas of most need. The philosophies and principles of deliberate and integrated team-based care are becoming mainstream thinking, as is the appetite to investigate new care and business models, all of which will only be successful with a ‘one team for community’ mindset. Finally, as this report is prepared, rural NSW faces the prospect of a continuing dry spell, if not full-blown drought. This is a huge concern and we wish our communities well. We also remind all rural health professionals of the importance of self-care in tough times and offer our support whenever it is needed.
Richard Colbran Chief Executive Officer
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nsw rural doctors network annual report 2017 –18
Profile of the nsw rural doctors network The NSW Rural Doctors Network (RDN) is a not-for-profit and nongovernment organisation and is designated by the Australian Government as the Rural Workforce Agency (RWA) for health in New South Wales (NSW).
PROGRAMS AND SERVICES
RDN also works with:
RDN offers a range of services, programs and activities across NSW that:
• Aboriginal Community Controlled Health Services to support health services for Aboriginal peoples
• help remote, rural and regional communities, general practices and health services to find suitably skilled and qualified General Practitioners (GPs), nurses and allied health professionals to work in their towns
• rural NSW Primary Health Networks (PHNs) to support remote, rural and regional GPs and the health workforce
In NSW, RDN administers on behalf of the Australian Government Department of Health, the Rural Health Workforce Support Program (RHWSP); Health Workforce Scholarship Program (HWSP); National Rural Health Student Network (NRHSN); the John Flynn Placement Program (JFPP); and the Outreach Program, comprising the Rural Health Outreach Fund (RHOF), Medical Outreach Indigenous Chronic Disease Program (MOICDP), Healthy Ears, Better Hearing, Better Listening (HEBHBL), Visiting Optometrists Scheme (VOS), Aboriginal Eye Health Coordination (AEHC), Ear and Eye Surgical Support Services (EESSS), and the Chronic Disease Management and Prevention Program (CDMPP).
• assist suitably skilled and qualified GPs, nurses and allied health professionals to pursue careers in remote, rural and regional NSW (this includes both Australian and International Medical Graduates/ Overseas Trained Doctors)
• university medical faculties to promote rural medicine.
Our NSW Ministry of Health activities include the NSW Rural Resident Medical Officer Cadetship Program; NSW Rural Resident Medical Officer Cadetship Program for Indigenous Students; the NSW Medical Undergraduate Program; and medical education conferences for current and future remote, rural and regional health professionals. RDN separately administers the Bush Bursaries and Country Women’s Association scholarships.
• deliver a wide range of health outreach services to rural towns
RDN aims to ensure that the highest possible standard of healthcare is provided to remote and rural communities through the provision of a highly skilled health workforce.
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• support existing remote, rural and regional doctors, nurses and allied health professionals through the provision of Continuing Professional Development (CPD) activities and succession planning • provide financial support for further study, training and short courses • assist in finding locum support for remote, rural and regional GPs, including through our unique and free RDN Locum Match service
• support remote, rural and regional medical partners and families • provide a range of scholarships, support and information for students studying medicine or health-related degrees in NSW.
• local communities, governments and rural Local Health Districts (LHDs) on workforce matters
ORGANISATION STRUCTURE RDN’s organisation structure is aligned to its key corporate functions and program areas, with five service pillars.
RDN SERVICE PILLARS
INFORMATION AND TRANSLATION
EDUCATION AND TRAINING
Data services
Conferences and events
Knowledge translation Business intelligence Application development ICT administration
Scholarships Future workforce
HEALTH WORKFORCE
OUTREACH SERVICES
STAKEHOLDER ENGAGEMENT
Attraction, retention, planning and assessment
Specialised and multidisciplinary health services
Stakeholder engagement
Recruitment and workforce development
Health practitioner upskilling
Town-based planning and community engagement
Service planning and coordination
Strategic communications Public relations Professional network
Rural and Aboriginal health Chronic disease Eye health Hearing health
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nsw rural doctors network annual report 2017 –18
OUR PURPOSE, GOAL & values 6
PURPOSE To improve access to quality healthcare for people in remote, rural and regional New South Wales.
GOAL To support the provision and retention of adequate numbers of high-quality health professionals in remote, rural and regional New South Wales.
VALUES Underpinning our approach to our work are our values, which we embed in our daily operations:
ACCOUNTABILITY
We commit to being responsible for our actions.
ADAPTABILITY
We are agile and responsive to changing needs in order to create solutions and make a positive difference for our stakeholders.
COLLABORATION
We share and contribute to collective processes to create more effective practice and achieve specific goals and outcomes.
EXCELLENCE
We strive to achieve and maintain high quality standards in our relationships and services.
INTEGRITY
We live and work by a set of ethical standards and behaviours.
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nsw rural doctors network annual report 2017 –18
Board and EXECUTIVE
L-R // Dr Lauren Cone, Dr Ros Bullock, Richard Colbran (CEO), Dr John Curnow, Ms Jill Ludford, Mr Dave Karlson (General Manager), Dr Rose Ellis (Director – Governance and Health Service Development). Absent // Dr John Kramer OAM, Ms Christine Corby OAM, Dr Henry Hicks, Dr William Lancashire.
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BOARD
EXECUTIVE TEAM
The Board of Directors is responsible for determining overall policy and priorities of the organisation and for ensuring that the NSW Rural Doctors Network meets funding agreements and contractual obligations.
The RDN Executive team is responsible for implementing the policy and priorities of the organisation as determined by the Board of Directors and ensuring that funding and contractual obligations are completed as agreed.
The 2018 Board of Directors appointed at the November 2017 Annual General Meeting comprises:
Chief Executive Officer
Mr Richard Colbran
Director – Governance and Health Service Development
Dr Rose Ellis
Chair
General Manager
Mr Dave Karlson
Dr John Curnow
Deputy Chair Dr Ros Bullock Treasurer
Dr Lauren Cone
Secretary
Dr Rose Ellis
Director
Dr Geoff White OAM Finished 13 December 2017
Director
A/Prof John Kramer OAM
Director
Ms Jill Ludford
Director
Ms Christine Corby OAM
Director
Dr William Lancashire
Director
Dr Henry Hicks Appointed 13 December 2017
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nsw rural doctors network annual report 2017 –18
RURAL NSW HEALTH WORKFORCE SNAPSHOT
2017–18
2,611 206,265 Occasions of Service delivered to rural NSW patients through health outreach, including 124,967 Occasions of Service for Aboriginal Australians.
896 HEALTH OUTREACH PRACTITIONERS PROVIDED
152,373
rural GPs and Registrars working in 649 country NSW practices.
676 rural GPs who are Visiting Medical Officers in rural NSW hospitals.
11 DOCTORS recruited to the Five Year OTD scheme and 6 completed the program.
hours of clinic and upskilling sessions for patients and local health practitioners.
21% 21% of the NSW rural medical workforce are registrars.
292 DOCTORS
800 years 10
OF COLLECTIVE MEDICAL SERVICE TO COUNTRY NSW COMMUNITIES BY 24 DOCTORS HONOURED AT THE ANNUAL RDN RURAL MEDICAL SERVICE AWARDS.
42
DOCTORS
had Provider Numbers dependent on the Rural Locum Relief Program.
currently enrolled on the Five Year OTD scheme providing service to 29 rural towns.
57 MEDICAL
260 GPs
STUDENTS
ATTENDED RDN’S 4 REFRESHER AND PROCEDURAL CONFERENCES.
GPs recruited to country NSW towns.
51
DOCTORS
oriented to rural general practice through 4 New Rural GP Orientation workshops.
days
2,206
152
61 41 39
relocation grants awarded to new recruits.
Rural Locum Relief Program recipients achieved Fellowship.
NURSES and allied health practitioners
of GP locum service provided through 76 placements to 39 locations.
recruited to country NSW towns, including 11 placements in MMM 6 and 7 locations.
16
cadets
undertaking rural service as junior doctors at NSW rural base hospitals.
106
fellowship
grants
Figures at 30 June 2018
Rural Locum Relief Program doctors achieved a grant to assist with Fellowship exam preparation.
29 STUDENT CADETS, INCLUDING 6 INDIGENOUS STUDENTS, SUPPORTED.
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Aboriginal Controlled Community Health services provided with recruitment assistance.
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nsw rural doctors network annual report 2017 –18
Financial Performance 2017–18 table 1 RDN financial performance from 2012–18
2017–18
2016 –17
2015–16
2014 –15
2013 –14
2012 –13
Revenue
$27.422m
$27.183m
$25.311m
$20.297m
$18.644m
$14.758m
Expenses
$27.175m
$26.888m
$24.383m
$18.870m
$18.435m
$14.360m
$0.247m
$0.295m
$0.928m
$1.427m
$0.209m
$0.398m
Surplus REVENUE
Overall revenue in 2017–18 increased marginally by $0.239 (0.9%) over 2016 –17. The increase came mainly from the continued expansion of Outreach services while income from the Rural Health Workforce support Program (RHWSP) was down on 2016–17. New funding was received from the Health Workforce Scholarship Program (HWSP) and National Rural Health Student Network (NRHSN), however as HWSP funding commenced late in 2017, a large percentage of these funds have been carried over to 2018 –19. EXPENSES Expenses increased marginally, by $0.287m (1%), with the majority of the increase due to changes in corporate structure that will enable RDN to respond to changes in rural workforce demands and meet deliverables required under the new RHWSP. Other income
Other income
NRHSN
chart 1
MoH
Conferences $248,546
0.79%RHWSP
RDN sources of funding in 2017–18
RHOF
$4,915,252
15.67%
MOICDP
$10,706,240
34.14%
HEBHBL
$1,219,500
3.89%HEBHBL
RHWSP$1,009,420
3.22%MOICDP
$1,736,127
NRHSN HWS
VOS
EESSS
$466,000
5.54%
HWS
CDMPP EESSS VOS
RHOF
1.49%
Conferences
CDMPP CDMPP$1,213,428
3.87%
RHWSP
$4,884,857
15.58%
HWS
$3,839,508
12.24%
NRHSN
$207,000
0.66%
Other VOS income
$915,395
2.92%
TOTAL
$31,361,273
100%
EESSS
MoH
HEBHBL Note: the above revenue reflects what was received in the year. The results in Table 1 include funds that may be carried forward to future years or funds previously carried MOICDP forward which are being brought to account in the current year.
RHOF 12
Conferences
HIGHLIGHTS 2017–18 Emeritus Professor Paul Worley National Rural Health Commissioner In 2017, Emeritus Professor Paul Worley was appointed as Australia’s first National Rural Health Commissioner. The Commissioner’s first priority is the development of a National Rural Generalist Pathway for the rural and remote primary healthcare workforce, beginning with medicine and then extending to other disciplines. RDN was privileged to welcome Professor Worley to provide the keynote address at the 2017 NSW Rural GPs Conference. This was one of the Commissioner’s first public addresses following his appointment and
delegates enjoyed the opportunity for an in-depth two-way discussion. Across the year the Commissioner and his staff made multiple visits to NSW as part of the National Rural Generalist Pathway consultations. RDN has been pleased to support the efforts of the Rural Health Commissioner. In 2018, RDN’s Director – Governance and Health Service Development, Dr Rose Ellis, was appointed to the National Rural Health Commissioner’s office on a part-time secondment as Director of Jurisdictional Engagement.
collaboration for rural health Across 2017–18 the level of cooperation and collaboration between the seven Rural Workforce Agencies for health nationally continued with significant success.
The Rural Workforce Agency Network (RWAN) has been established to provide a regular forum for strategic and operational planning and to encourage a nationally consistent methodology where appropriate. This approach has particularly strengthened the national approach to the new Rural Health Workforce Support Program (RHWSP). RWAN was also successful as a consortium in securing and delivering national service contracts with the Australian Government Department of Health including the John Flynn Placement Program (JFPP), Health Workforce Scholarship Program (HWSP) and the National Rural Health Students Network (NRHSN). Rural Health Workforce Australia (RHWA) has also continued its support for the Rural Workforce Agencies through the delivery of a coordinated work plan.
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nsw rural doctors network annual report 2017 –18
Health Workforce Needs Assessment Under the new Rural Health Workforce Support Program (RHWSP) funding agreement with the Australian Government Department of Health, RDN undertakes an assessment of the NSW health workforce in areas rated 2 – 7 under the federal Modified Monash Model (MMM) geographical classification system for medical services. The Rural Workforce Agencies (RWAs) agreed on a nationally consistent approach for the Health Workforce Needs Assessment (HWNA), commencing in 2017–18 with a focus on the General Practitioner (GP) workforce. An Activity Workplan (AWP) was then developed to address the three core elements of the RHWSP – access, quality and sustainability. RDN’s collaborative approach to rural primary health workforce issues allowed it to bring a strong track record of working with key stakeholders to the HWNA and AWP processes.
AIM To produce the analysis of workforce maldistribution and current shortages, RDN focused on three specific areas: • The distribution of the current rural GP workforce throughout rural NSW, identifying towns that have below average distribution of GPs to support the population when compared with the rest of the state.
• The skills of the rural GP workforce and identifying gaps in skills needed to improve effectiveness and quality of the existing GP workforce. • The sustainability of the future rural GP workforce and its distribution considering trends or reasons that impact on that sustainability. Planning also commenced for an allied health and nursing Health Workforce Needs Assessment.
HEALTH WORKFORCE STAKEHOLDER GROUP A statewide Health Workforce Stakeholder Group (HWSG) is mandated as part of the RHWSP to endorse the approach to the HWNA and AWP. The Group comprises representatives of Local Health Districts (LHDs), Primary Health Network (PHNs), the Aboriginal Health and Medical Research Council of NSW (AH&MRC of NSW), the Royal Australian College of General Practitioners (RACGP), the Australian College of Rural and Remote Medicine (ACRRM), training providers, regional training hubs, the NSW Ministry of Health, RDN’s Outreach Program and NSW Ambulance. Given the complexity and diversity of rural NSW, and the multiple stakeholders to consult, RDN chose to take a regional approach by forming seven regional stakeholder groups to contribute more localised information into the HWNA and the HWSG.
REGIONAL STAKEHOLDER GROUPS RDN began the HWNA process by workshopping workforce data outputs defined by the agreed methodology for seven regions across NSW, currently aligned to rural PHN boundaries. These regional workshops included representation from PHNs, Aboriginal Controlled Community Health Services (ACCHSs), LHDs, non-government organisations (NGOs), GP Synergy and members of the NSW Rural Medical Training Forum (RMTF). The groups meet biannually to offer local feedback and context to the data, achieve a consensus on the most pressing issues relating to access, quality and sustainability, and determine the locations to be deemed hotspots. RDN also engages stakeholder groups in seeking collaborative solutions to the identified issues. From this consultation process and underpinned by the HWNA, a statewide AWP was developed and aggregated. Regional AWPs were also developed, recognising that while there are many common issues, there are regional variations to the needs identified and a one-size-fits-all approach is not sufficient.
"While there are common issues...a one-size-fits-all approach is not sufficient."
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nsw rural doctors network annual report 2017 –18
RDN's Aboriginal Engagement plan RDN’s Aboriginal Engagement Plan (AEP) was initiated in August 2017 as a key organisational development initiative. Its goal is to reinforce RDN’s commitment to Aboriginal health and wellbeing and ensure that future activities are evidence-based, effective and tangibly contribute to improving access to quality primary healthcare services for Aboriginal people. The AEP builds on RDN’s existing commitments and relationships including the longstanding Memorandum of Understanding with the Aboriginal Health and Medical Research Council of New South Wales (AH&MRC of NSW), embedded cultural awareness and safety training for staff, and the well-established work plans for Aboriginal Medical Services.
The AEP aims to increase RDN staff awareness of cultural safety and cultural competency, and support RDN’s broader strategic goals that relate to Aboriginal health equity. It sets out objectives to achieve these aims.
REAFFIRMING RDN’S ABORIGINAL COMMITMENT
Since its inception, RDN has reaffirmed its commitment to health equity and equality for Aboriginal people, through Dr Ros Bullock’s speech at the 2017 Rural GPs Conference; and participation in events acknowledging Aboriginal Significant Days of Commemoration including the 10th Anniversary of the Apology to the Stolen Generations, National Sorry Day, National Reconciliation Week and NAIDOC Week.
“The NSW Rural Doctors Network has a long history of working to increase access to health services for Aboriginal people across NSW. One of the main ways we do this is by working in partnership with Aboriginal organisations. Our partnership with the Aboriginal Health and Medical Research Council of NSW. This partnership has remained strong for two decades and produced a number of innovative programs such as the Indigenous stream of the Rural Resident Medical Officer Cadetship Program. “It is important to re-emphasise and reaffirm our continuing commitment to supporting health equity for Aboriginal people in NSW. “In doing so we recognise and acknowledge the policies and practices of the last 200 years that have led to this inequity and had an indelible impact on the health and wellbeing of Aboriginal people. “Speaking from the heart of a rural doctor, we value all Aboriginal people in our communities – your culture and stories, your knowledge of the land and its working. You have given us so much already, and we as a nation haven't always listened or appreciated it. “The RDN Board, CEO and staff would like to reaffirm our commitment through continuing strong and productive partnerships with communities, health providers and the health organisations that serve them.”
L-R: Uncle Rod Towney, Maxine Greenfield and Lillian Gordon – TAFE NSW, with Uncle Bill Smith – Awabakal LALC at RDN’s 2017 Staff Development Workshop.
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This is an edited extract of a speech by (then) RDN Chair Dr Ros Bullock at the 2017 Rural GPs Conference.
L-R: The Awabakal LALC's Ray Kelly Jnr; Aboriginal Elder, Uncle Bill Smith; (then) Assistant Minister for Rural Health, The Hon David Gillespie MP; artist Saretta Fielding; and RDN CEO, Richard Colbran, at the opening of RDN's new Hamilton office, December 2016, with Malang Nguyran – Together Us All.
MALANG NGUYRAN – TOGETHER US ALL In 2017, RDN engaged Aboriginal artist Saretta Fielding to create an artwork for its new offices in Hamilton, NSW. Malang Nguyran – Together Us All celebrates going forward together and signifies the sharing of cultures, capturing the beauty, diversity and connections of Aboriginal peoples and valuable partnerships across the community, reflecting RDN’s aspiration for ongoing cooperative and collaborative relationships with all Aboriginal communities across NSW. RDN also commissioned a digital artwork design that reflects the artwork theme of Malang Nguyran – Together Us All in design, story and colour palette, for use across its communication collateral.
SARETTA FIELDING Saretta Fielding is a Wonaruah woman based in Lake Macquarie, NSW. Through her artwork, she aims to evoke emotion, enhance connection to spirit and country, and invites the viewer to ponder and experience something new. Ms Fielding’s artworks are connected to country in style and design using a sand-based medium. The highly textured pieces embody the age-old sandstone engraved artworks created by her ancestors. Artist Saretta Fielding.
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nsw rural doctors network annual report 2017 –18
Telehealth as a workforce solution The Western NSW Rural Primary Health Care Telehealth Project developed a primary healthcare rural and remote telehealth strategy for implementation in partnership within Western NSW. The collaborating partners included Western NSW Primary Health Network (PHN), Western NSW Local Health District (LHD), Rural and Remote Medical Services, Bila Muuji Aboriginal Health Services, HealthWise, NSW Outback Division of General Practice, GP Access, Live Better, Hunter Primary Care and the George Institute for Global Health. A Rural Primary Health Care Telehealth Model was developed to facilitate workforce (relief) solutions with multiple entry points and pathways as determined by location, patient choice and conditions, and access to other available services. The model focuses on after-hours solutions in small rural NSW communities; reduction of Triage 3,4,5 Emergency Department (ED) presentations, particularly after-hours; development of robust nurse-led medically supported model(s) of care; and interoperability of telehealth infrastructure in the region.
Victoria Park, Dubbo, NSW
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L-R: RDN CEO, Richard Colbran; National Rural Health Commissioner, Prof Paul Worley; RDN Board member, Dr Ros Bullock; RDN Director – Governance and Health Service Development, Dr Rose Ellis; and Walgett Aboriginal Medical Service CEO, Christine Corby OAM, at the Western NSW Primary Health Workforce Forum.
Planning the Western NSW primary health workforce The Western NSW 2017–18 Primary Health Workforce Planning Framework Project has been a significant undertaking and there is much to celebrate. The project was conducted to develop a regional, integrated, long-term workforce framework. This will guide the development and implementation of policies, strategies, actions and services to address primary health workforce issues in the region and break the cycle of short-term reactive workforce measures. The critical highlights of this 12-month project include: • successful engagement of more than 40 organisations involved in primary healthcare delivery across the vast western region • development of an evidence-based Primary Health Workforce Planning Framework (the Framework) tailored for the region
• the coming together of more than 60 people at the Dubbo forum in July, with a presentation from Australia’s inaugural Rural Health Commissioner, Emeritus Professor Paul Worley
undertaken across all jurisdictions with policy makers, universities, the Aboriginal health sector, and a wide range of other rural stakeholder groups and practitioners to inform development of the Framework.
• identification of immediate priority actions
The Western NSW Primary Health Workforce Planning Framework and 2030 Western NSW Primary Health Workforce Priority Actions acknowledge the unique challenges of providing primary healthcare in Western NSW and the importance of providing timely access to quality and safe healthcare services, regardless of where people live. Equipped with a robust understanding of the challenges and potential solutions, the necessary tools and resources, and a willingness to work together to enable positive action, the collaboration is well-placed to facilitate future action.
• resourcing commitment, including the creation of a dedicated position for a Partnership Coordinator, to bring to life the Framework and Priority Actions. RDN was engaged by Western NSW Primary Health Network (PHN) to lead the project, and a collaborative methodology was established involving RDN, Western NSW PHN, Western NSW Local Health District (WNSW LHD), Far West NSW LHD and the Bila Muuji Aboriginal Corporation Health Service. Substantial consultation was
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nsw rural doctors network annual report 2017 –18
Supporting the rural workforce through professional development Over the last 12 months RDN has continued to develop and focus on providing the highest level of Continuing Professional Development (CPD) support for rural GPs in NSW by responding to upskilling requirements noted through RDN’s Health Workforce Needs Assessment and annual GP survey. With funding support from the NSW Ministry of Health, RDN expanded CPD training on offer by including some rurally located and focused Trauma Management workshops, which have been positively received. During the 2017 Rural GPs Conference in Coogee, RDN presented an afternoon of tuition for medical students. This provided an opportunity for student cadets to meet each other and hear about the opportunities and challenges of rural medical practice from junior doctors and other health professionals.
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REFRESHER AND PROCEDURAL CONFERENCES During 2017–18 RDN conducted a range of CPD conferences and events including two refresher conferences, two RDN procedural conferences (one on obstetrics, one on anaesthetics), an Outreach Forum, four New GP Orientation workshops and two rurally-based Trauma Management workshops. RDN conferences target rural GPs in NSW. However, rural GP registrars, medical students, Junior Medical Officers holding the NSW Rural Resident Medical Officer Cadetship, RDN cadets and federally funded Medical Bonded Scholarship holders are also encouraged to attend. Conference topics are selected based on feedback from rural NSW GPs to ensure delegates receive updates relevant to rural general practice and that the sessions assist GPs in satisfying Continuing Professional Development (CPD) education requirements to retain registration with the GP colleges. An extensive partners and children’s program is attached to the two refresher conferences, to encourage the whole family to enjoy a coastal weekend away, network with like-minded people and participate in activities such as beach games, zoo visits, shopping and craft.
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nsw rural doctors network annual report 2017 –18
table 2
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RDN's refresher and procedural conferences in 2017–18 STUDENT ATTENDEES
CONFERENCE
DATE
LOCATION
INCLUSIONS
ATTENDEES
Anaesthetics Procedural Conference
4–5 August 2017
Royal North Shore Simulation Centre
This CPD conference includes lecturestyle presentations and simulation workshops. Workshops focused on management of the obstetric, paediatric and adult patient from pre-anaesthetic assessment for elective surgery through to ED resuscitation and operating theatre room scenarios. GPs were split into four groups and rotated through four 75-minute themed workstations.
50 GP anaesthetists
n/a
Rural GPs Conference
23 – 27 November 2017
Coogee Beach
This CPD event has an emergency medicine theme, with topics including adult trauma/retrieval, airway resilience, cardiac emergencies, paediatric retrieval, eye emergencies and psychiatry. The conference also marked one of the first public speeches by the newly-appointed National Rural Health Commissioner, Professor Paul Worley.
130
32 (including 27 RDN cadets)
Refresher Conference
16 – 18 March 2018
Port Macquarie
This event attracts both procedural and non-procedural GPs and provides participants with the tools to upskill, meet their CPD requirements and network with peers. Medical students interested in becoming rural GPs also attend. Topics included a mix of interactive workshops and lectures such as adolescent mental health, women’s health, autism spectrum disorder and stress and anxiety in Aboriginal and Torres Strait Islander populations.
50
35 (including 22 RDN cadets)
Obstetrics Procedural Conference
25 – 26 May 2018
Sydney
This conference program includes lectures and workshops on topics such as anomalies of foetal growth, unwell neonate, perineal repair, neonatal resuscitation, thyroid disease and cholestatis, antenatal CTGs, obstetric emergencies, pre-eclampsia and infectious diseases in pregnancy.
24 GP obstetricians
n/a
NGPO WORKSHOPS
Dr Mary Stewart from Family Planning NSW delivering NGPO training in Newcastle, March 2018. The NSW Ministry of Health funds two New GP Orientation (NGPO) workshops per annum and, driven by demand, RDN funds two additional events. The workshops involve the continuation of an orientation program for International Medical Graduates (IMGs) and new GPs entering rural practice with an emphasis on doctors also likely to be Visiting Medical Officers (VMOs) in NSW rural hospitals. In 2017–18, the program was developed in collaboration with RDN’s Medical Advisor, Dr Paul Collett and workshop leader Dr Ros Bullock, a rural NSW GP from Cowra. Experts in their subject field were included as topic facilitators.
The program covers:
• medico-legal issues
• an overview of rural general practice
• professional and ethical issues
• life as a rural GP
• communication in general practice, including motivational interviewing.
• Indigenous health • family planning and sexual health • an overview of Fellowship training options, CPD and preparing for RACGP and ACRRM exams • an introduction to Australian General Practice Training (AGPT) • understanding the MBS, PBS and DVA • managing workplace illness or injury cases
In 2017– 2018, four workshops were held, in Sydney, Wagga Wagga, Newcastle and Orange, attracting 51 participants, each of whom received grants to assist with travel and accommodation costs. Through evaluations, 100 per cent of respondents rated the program as fully relevant to their place of practice.
• mental health in the GP setting
"I recommend [the NGPO workshop]. It’s very helpful for a new GP [and] covers most of the common concerning aspects. [I] felt more confident after finishing the course."
RDN WebEd Online education materials developed as part of NGPO contract deliverables continued to be available through RDN WebEd during the financial year. Review and updating of existing modules is an ongoing process. Modules are a minimum one-hour duration and attract CPD points with the ACRRM and RACGP for eligible doctors. On successful completion of a module, all learners receive a Certificate of Completion.
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nsw rural doctors network annual report 2017 –18
Nurturing the future workforce NSW RURAL RESIDENT MEDICAL OFFICER CADETSHIP PROGRAM One of the most important and successful initiatives jointly undertaken by RDN and the NSW Ministry of Health is the NSW Rural Resident Medical Officer Cadetship Program. Applications are open to medical students in NSW universities and medical students at interstate universities who completed Year 12 in NSW. Successful applicants receive up to $15,000 per year for the final two years of their medical degree; in return, students agree to undertake two of the first three years of their hospital training in an eligible rural NSW hospital. In the year to 30 June 2018, RDN received 46 applications for the 2018 cadetships (38 non-Indigenous and eight Indigenous) and awarded 12 new cadetships.
RDN cadets at the University of Newcastle Department of Rural Health, Tamworth.
ANNUAL CADET WEEKEND During this past year, 22 student cadets from Orange, Albury, Wagga Wagga and Dubbo attended RDN’s 12th annual Cadet Weekend, held at Tamworth from 6 – 8 April 2018. The weekend was an opportunity for student cadets to meet each other and establish networks before they become colleagues in PGY1. The event also
gives cadets an opportunity to visit a location where they could be based for their rural service. In organising the weekend, RDN worked with local medical practitioners in the area, the University of Newcastle Department of Rural Health (UDRH), Tamworth Health Service and the Health, Education and Training Institute (HETI).
Highlights included presentations from former cadet Dr Lauren Cone (GP/ Clinical Dean, Peel Clinical School UDRH) and Dr Amie Beattie (Critical Care) who spoke to the group about their experiences, doctor mental health and opportunities available to complete specialty training in rural centres.
"It's really nice to already have my face and my name attached to the future of rural medicine. It's a really exciting thing." Rachel Henderson, fourth-year RDN cadet.
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BUSH BURSARY SCHOLARSHIP As part of ongoing efforts to attract more doctors to rural and remote NSW areas to address areas of workforce shortage and improve healthcare for communities, RDN partners with local councils in NSW and the Country Women’s Association of NSW to deliver the Bush Bursary Scholarship. Lachlan Shire Council initiated the scholarship in 1996 and the CWA first contributed by funding a student in 1997 on its 75th anniversary. The scholarship provides students with $3,000 each to assist with their studies. In return, the students spend three weeks on a rural placement in country NSW during their university holidays. In 2017–18, 14 local NSW councils supported the program.
NATIONAL RURAL HEALTH STUDENT NETWORK
Members of the NRHSN Council at the March 2018 Council meeting. The Australian Government appointed the Consortium of Rural Workforce Agencies, led by RDN, to administer the National Rural Health Student Network (NRHSN) with Australian Government funding over three years from 1 January 2018. The NRHSN provides a powerful voice for students who are pursuing a career in rural health and plays an important role in helping engage with the next generation of rural health professionals studying medicine, nursing, midwifery
and allied health. The NRHSN has more than 9,000 members and represents 28 university rural health clubs around Australia, which host a range of events and activities that provide professional learning and a social base for students interested in rural health. The consortium of state-based workforce agencies aims to achieve national coverage for the NRHSN, a strong connection for its members and more opportunities for promotion among the broader rural health workforce.
Since January 2018, the eight NRHSN Executives have facilitated two Council face-to-face events; written position papers on a wide array of topics including Rural Generalism, Mental Health, and Aboriginal and Torres Strait Islander Engagement Guide; presented their position papers at various health conferences around Australia; and attended government roundtable meetings and the National Rural Generalist Taskforce meetings with the National Rural Health Commissioner.
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nsw rural doctors network annual report 2017 –18
NSW MEDICAL UNDERGRADUATE PLACEMENT PROGRAM RDN administers NSW Undergraduate Funding Grants on behalf of NSW Health to support travel and accommodation costs for short-term rural placements (up to eight weeks) of medical students. Since 1996, five universities in NSW and one in the ACT have received funding. In 2017–18, 1,252 students were funded for rural placements.
RURAL MEDICAL TRAINING FORUM RDN facilitates and supports the Rural Medical Training Forum (RMTF), which meets quarterly to support the development of a vertically and horizontally integrated rural medical education and training system to underpin a sustainable rural medical workforce in NSW. The RMTF includes representatives from the Aboriginal Health and Medical Research Council (AH&MRC), NSW/ACT Medical Schools, Rural Clinical Schools, University Departments of Rural Health, Departments of General Practice, Regional Training Providers, Specialist Colleges, NSW Ministry of Health, the Australian Government Department of Health and, more recently, the Rural Training Hubs. RDN has facilitated and chaired the Forum since its inception two decades ago and membership continues to grow.
JOHN FLYNN PLACEMENT PROGRAM The John Flynn Placement Program (JFPP), established in 1997, is funded by the Australian Government Department of Health. The Program was inspired by RDN’s Bush Bursary Program. It is currently administered by the Consortium of Rural Workforce Agencies, led by Health Workforce Queensland. Each year 300 rural placements are available to medical students from 21 Australian universities and approximately 90 places are awarded in NSW. During this reporting period, 340 NSW students were enrolled in the JFPP. Successful students are matched with doctors in rural locations and spend two weeks each year over three or four years working alongside a doctor while undertaking their tertiary studies, experiencing the diversity of rural practice and expanding their hands-on skills.
NSW JFPP student Stephanie Naidu in Kurri Kurri.
26
"Emily’s interactive poster highlights the diversity of Australian modern rural women while presenting the common barriers to healthcare they face."
Who’s your token modern rural woman? Emily Neville at the 62nd Commission on the Status of Women at the United Nations Headquarters in New York, USA.
Emily Neville is passionate about equitable healthcare for rural girls and women and this year she took her message to the United Nations (UN) Commission on the Status of Women in New York. Emily has been an RDN Rural Resident Medical Officer Cadet since 2016 and was an RDN Bush Bursary and Country Women’s Association scholarship recipient in 2015. She also represents junior doctors across NSW on RDN’s Early Rural Medical Career Advisory Group. Now in her final year of a medical degree at the University of Notre Dame, Emily is finishing her clinical years in the regional town of Wagga Wagga and has recently accepted an internship at Wagga Wagga Rural Clinical School, commencing in 2019. Emily has developed an interactive poster to highlight the diversity of Australian rural women while presenting the common healthcare barriers faced by rural females. The poster was created as a light-hearted and entertaining character quiz that navigates to diverse modern rural women. In March 2018, Emily presented her ‘Who’s Your Token Modern Rural Woman?’ poster to the Commission’s 62nd Session, held with the theme of Empowering Rural Women and Girls.
“Rural women have traditionally been stereotyped as one type of woman,” Emily said.
UNITED NATIONS
A C H ARAC TE R Q U I Z
BARRIERS TO HEALTH CARE Start Here DO YOU CONSIDER YOURSELF AS RURAL AUSTRALIAN?
yes
“My poster highlights that the modern rural woman faces any number and combination of barriers to healthcare.
no
sort of
HAVE YOU EXPERIENCED A DROUGHT?
no
yes
JILLAROO Female novice on a cattle or sheep station
DO YOU LIVE MORE THAN 150KM FROM A HOSPITAL?
Born and bred on a large farm these women travel far and wide mustering, tending to animals and roughing it in general. They live and breathe the outback and have no dramas rolling a swag.
no
no
DO YOU HAVE ACCOMMODATION IN THE CITY?
no
ARE YOU COMMUNITY MINDED?
DO YOU HAVE ACCESS TO A DOCTOR?
yes
only if it suits me
yes
DO YOU FEAR WHAT WILL HAPPEN IF YOU GET SICK?
yes
DO YOU EVER FEEL LONELY?
yes
no
yes yes
no
IS YOUR HORSE'S HEALTH MORE IMPORTANT THAN YOUR HEALTH?
DO YOU HAVE POOR INTERNET OR PHONE RECEPTION?
yes
ARE YOU STRUGGLING WITH DEBT?
yes
no
HAVE YOU EVER BEEN A RURAL SHOWGIRL? no
>500km
DID YOU ATTEND BOARDING SCHOOL?
yes
Victims of the White Australia Policy, the stolen generation and racism that continues to this day. Language is a barrier, she wishes she could communicate in her own language to someone who truly understands. Empowering the next generation is her mission.
yes
GRAZIER
yes
yes
DO YOU MANAGE MULTIPLE EMPLOYEES?
no
HAS YOUR FAMILY EVER BEEN DISPLACED FROM THEIR LAND?
yes
DO YOU CONSIDER YOURSELF ONE OF AUSTRALIA'S FIRST PEOPLES?
no
no
no
DO YOU RELY ON SOCIAL SERVICES?
yes
“I encourage everyone to have a go at the poster!” Emily said.
yes
no
yes
HAVE YOU BEEN AFFECTED BY WAR OR PERSECUTION?
DO YOU THINK YOU ARE HEALTH LITERATE?
sort of
yes
Backbone of the farm, Mrs Boss monitors the finances and manages the employees. Hard nosed and gets on with it. Will do anything to protect her loved ones and livelihood.
no
yes
IS ENGLISH YOUR FIRST LANGUAGE?
REFUGEE
yes
THE MODERN RURAL WOMAN Health care barriers that rural women and girls face
yes
yes
ARE YOU SURROUNDED BY POSITIVE ROLE MODELS?
no
no
yes
DO YOU LOVE A GOOD GOSSIP? no sometimes
yes
no
CAN YOU AFFORD TO GO TO GYM?
no
yes
Displaced Person Having recently escaped a war torn country, such as Syria, and settled in regional Australia, these women are desperately trying to adopt Australian customs and make new friends while struggling financially to provide for their families.
Struggling financially to make ends meet, food on the table is the main priority for these families. They work hard for little reward, might be poorly educated, rely upon the public health system and have poor health literacy.
no
DO YOU ATTEND FUNDRAISERS?
CAN YOU BAKE QUALITY SCONES?
Local Community Stalwart Regularly bakes for the Country Women’s Association and spends her weekends raising money for the local hospital fund or charity. She might be raising her own kids or looking after the kids of ten families.
THE COUNTRY BUMPKIN Lower Socioeconomic Status
MRS BOSS The Whip
no
ARE YOU A MEMBER OF THE COUNTRY WOMEN'S ASSOCIATION?
THE MOTHER HEN
The Elderly
no
Property Hieress Donned in RM Williams, the Grazier is heir to a large station with intention to marry her male equivalent. After completing her débutante she will win the local show girl competition. Maintaining face and the family empire is of uttermost importance.
DO YOU HAVE ACCESS TO FRESH FRUIT AND VEGETABLES?
no
THE FORGOTTEN Elderly person living alone on a property or in town, might be widowed, suffering from the beginnings of dementia or their family may have moved to the city. They fear who will look after them in the future.
yes no
no
yes
Her poster demonstrates that while modern rural women may struggle with a range of difficulties from drought and mental illness to limited internet access and farming accidents, no matter their circumstances, all rural women and girls have the right to equitable healthcare.
yes
no
yes
In creating the poster with her graphic designer friend Joy Li, Emily took inspiration from her rural family, friends and colleagues and the hardships encountered throughout their lives.
no
DO YOU NEED ASSISTANCE OR NURSING CARE?
no
DO YOU RELY UPON THE ROYAL FLYING DOCTOR SERVICE?
yes
ARE YOU PART OF THE STOLEN GENERATION OR A VICTIM OF WHITE AUSTRALIA POLICY?
INDIGENOUS AUSTRALIAN Australia's First Peoples
yes
no
City slicker, entertains the thought of a life in the country. Temporarily working in town and would love to move but has family ties elsewhere. The outsider tries exceptionally hard to fit in but never quite grasps the country mannerisms.
DO YOU HAVE TO TRAVEL FAR FOR SPECIALIST CARE?
CAN YOU NAVIGATE TECHNOLOGY?
no
City Dweller
yes
150500km
<150km
yes
yes
no
HOW FAR ARE YOU FROM YOUR FAMILY?
yes
HAVE YOU EVER FELT SOCIALLY ISOLATED?
THE OUTSIDER
ARE YOU CONSIDERED A LOCAL?
at times
sometimes no
HAVE YOU LOST A LOVED ONE TO SUICIDE OR DEPRESSION?
yes
no
DO YOU HAVE ACCESS TO ALLIED HEALTH?
no
sometimes
no
“She may be Indigenous, nonIndigenous, a refugee, live in the local community or on a farm. However, no matter her circumstances she cares about the future of healthcare for her local community, family and self,” she added.
COMMISSI ON ON T H E STAT U S OF WOME N
WHO’S YOUR TOKEN MODERN RURAL WOMAN?
THE AGGIE Country person working in the agricultural industry. The brains behind a good breeding program or a successful crop for the year, they might have a small hobby farm to their name but work full time as either a Veterinarian, Agronomist or in Agribusiness.
DO YOU REQUIRE AN INTERPRETER WHEN VISITING A DOCTOR?
The Modern Rural Woman faces any number and combination of barriers to health care. She may be Indigenous, non-Indigenous, a refugee, live in the local community or on a farm. No matter her circumstances she cares about the future of healthcare for her community, family and herself.
DO YOU STUDY AGRICULTURE OR AGRI-BUSINESS?
Agricultural Worker or Student
yes
no
no
THE TOWNY Inbetweener Country blood runs through their veins but they no longer live on a property. They fit in best in the country but can quite easily thrive in the ‘hip’ inner west of Sydney. Half city half country, they are often conflicted and half accepted by both communities.
This poster is a collaboration between Emily Neville and Joy Li, supported by the University of Notre Dame Australia. Printed by Darkstar Digital. AU T H OR
DE S I G N & I L LU ST R AT I ON
Emily Neville
Joy Li
School of Medicine UNDA
joyli.com.au
Neville, E. ‘Who’s Your Token Modern Rural Woman?’ Advancing the rights of women in rural areas through the use of technology to empower women around the world, 62nd Commission on the Status of Women, United Nations, Fordham University, New York, 2018 (12 to 23 March 2018).
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nsw rural doctors network annual report 2017 –18
Partnering for healthcare outcomes RDN’s Partnership Managers Katie McDonell (L) and Sarah Dowe. In March 2018, RDN introduced Regional Partnership Managers to streamline and coordinate communication between RDN and the organisations with whom we partner. The roles are responsible for building, maintaining and enhancing partnerships with people and organisations such as education and training institutions, service providers, Primary Health Networks (PHNs), Local Health Districts (LHDs), community organisations, Aboriginal Community Controlled Health Services (ACCHSs)
and health administrators. The Regional Partnership Managers also support the Health Workforce Needs Assessment (HWNA) process and coordinate regional stakeholder meetings and the subsequent Activity Workplans (AWPs). A primary focus of the roles is to facilitate the development and management of RDN’s Partnership Plans with key stakeholders. These plans recognise the significant benefits to be gained through enhancing existing working relationships and
collaboratively developing long-term, sustained initiatives to improve access to quality healthcare for people in rural, remote and regional areas of NSW. This is achieved through addressing and improving areas of need identified through the HWNA. The Regional Partnership Managers also facilitate collaboration, minimise duplication of resource use through careful planning and cooperation and identify gaps in services to rural communities.
WORKING WITH NSW AMBULANCE
CASE STUDY
RDN has developed a close working relationship with NSW Ambulance (NSWA). The partnership provides an opportunity for each organisation to share information, learn from the other and support their members to deliver high quality, culturally appropriate primary healthcare to rural communities. In 2017–18, a workshop was held to explore how NSWA and RDN could work more closely together to create access solutions for primary healthcare services. The workshop identified a shared vision and explored and identified strategies that could be locally tailored to meet the needs of individual communities.
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A 2018–19 NSWA and RDN Workplan has been developed to plan and define the activities, which include: • NSWA involved in RDN planning meetings including being an active member in both the Health Workforce Stakeholder Group and the seven RDN Regional Stakeholder groups • RDN as an active member of the NSWA clinical governance committee • NSWA participating in RDN townbased planning meetings • NSWA Paramedic Connect Model implemented in four new rural towns that are vulnerable to loss of primary health workforce
• NSWA and RDN holding quarterly executive partnership meetings to ensure continued sponsorship, governance, resourcing of and communication about RDN and NSWA collaborative projects. Both organisations agreed to an evidence-based model to enhance current services, examine potential future service models and build relationships. Embedding and sustaining new models was identified as a key focus area.
Manu Ndayissia (R) with RDN CEO, Richard Colbran, at the 2017 Rural GPs Conference.
Rising above the barriers Motivated by a passion for helping others and excited about the difference he can make to rural health in Australia, 32-year-old medical student Emmanuel Ndayissia (Manu) is an RDN Bush Bursary Scholarship recipient and cadet who’s risen above significant barriers in his pursuit to become a doctor. Manu spent his primary school years in refugee camps and schools in Tanzania and Nairobi, fleeing genocide twice from his birth place in Rwanda and living through his dad being jailed for the “crime” of being educated. Manu travelled to Kenya before arriving in Adelaide, Australia as a refugee with his parents and four of his eight siblings in 2011. Manu attended TAFE for three months to learn English, which he said “…was achievable because I had a goal and purpose” before enrolling in, and completing, a three-year Bachelor of Health Sciences at the University of Adelaide. Manu also worked as a casual labourer, kitchen and laundry hand while studying. In 2015, Manu began studying medicine at the University of Notre Dame, Sydney and was later awarded the RDN Bush Bursary and Country Women’s Association Scholarship. The
Scholarship provided Manu with $3,000 to assist with associated study costs and, in return, he spent two weeks on a rural placement in Orange, NSW during his university holiday.
Manu’s plans have been shaped by his observations and experiences while on rural placements in locations such as Wagga Wagga, where he is completing his final two years of medical school.
Manu was also awarded the RDN NSW Rural Resident Medical Officer Cadetship in 2016. Cadets, such as Manu, receive up to $15,000 per year for the final two years of their medical degree and, in return, agree to undertake two of the first three years of their hospital training in an eligible rural NSW hospital.
“In Wagga, people will travel hours just to see you and are very appreciative. My conscience won’t allow me to work in a place where you’re fighting for patients, when there are patients out there needing me,” he said.
"I have a taste for rural health now." Manu is thankful for the support provided by RDN to broaden his knowledge of rural health in Australia. “To experience and expand on my understanding of rural health in a practical sense helped cement my plans to work rurally,” Manu said. “RDN was very helpful and I had great support. I was able to attend conferences and meet like-minded students and rural candidates who also provided good mental support.”
Manu plans to finish medical school and specialty training in obstetrics or general surgery and provide services to smaller rural communities. He also wants to improve Aboriginal health. “Before I arrived in Australia, I imagined it as heaven. But when I started my studies in public health, I realised the state of Aboriginal health isn’t great and Australia wasn’t the heaven I thought it was for some people. “That’s when it hit me – I want to play a part in improving that. I want to shift the forecast. The future is already here…and this is what I want to do. “I have a taste for rural health now,” Manu said.
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nsw rural doctors network annual report 2017 –18
Health Workforce Scholarship Program The Health Workforce Scholarship Program (HWSP) is an initiative of the Australian Government Department of Health and is administered in NSW by RDN. The Program aims to improve access to health services in rural and remote areas by supporting an increase in skill, capacity and scope of practice of the rural primary health workforce. Primary health professionals working in rural and remote locations (MMM 3-7) and providing services full or part-time in the private or non-state government primary health sector are eligible to apply.
table 3 Identified upskilling and training areas to be funded by the HWSP
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The HWSP offers two types of funding: • Scholarships: A payment up to $10,000 per year, for up to two years, toward the cost of completing a postgraduate course leading to a postgraduate qualification. • Bursaries: A payment up to $10,000 (maximum of $10,000 in total in one year) for professional development and upskilling course fees and associated accommodation and travel-related expenses.
Each year, RDN works with stakeholders to identify regional and local health workforce skills, capacity and needs through a Health Workforce Needs Assessment (HWNA). The HWNA forms the basis for determining the allocation of scholarships and bursaries, across identified upskilling and training areas. RDN opened HSWP applications in November 2017.
Aboriginal and Torres Strait Islander Primary Health Care
Aged care and associated conditions
Chronic disease management
End of life/palliative care
Severe and complex conditions
Culturally safe practices and practitioners
Mental health management
Team/coordinated patient care
Children and young people
Improved patient health literacy and self-management
Dr Justin Gladman.
PUTTING THE HEALTH WORKFORCE SCHOLARSHIP PROGRAM INTO ACTION Dr Justin Gladman, an Aboriginal GP Registrar who works for the Royal Flying Doctor Service, received funding from the Health Workforce Scholarship Program in 2017.
“I applied to RDN for scholarship funds to undertake the Sydney Child Health Program after identifying that a significant amount of my clinic load was concentrated on children and paediatric care,” Dr Gladman said.
Michael Fisher is an Aboriginal Health Worker at Moree Aboriginal Residential Rehabilitation Service. When he first applied to RDN for Health Workforce Scholarship Program funding in 2017, he received funding to study a TAFE Diploma of Alcohol and Other Drugs (AOD). Having successfully completed the course, Michael then applied for additional scholarship funding in 2018 to further his work with other Aboriginal
services to address drug and alcohol issues in the Moree community. Michael received additional Program funding to undertake a TAFE Diploma of Mental Health. “A lot of my AOD clients in residential rehab are being treated for mental health issues as well as alcohol and drug addiction. This qualification will provide me with a better understanding of how to further support and help these clients in the local community,” he said.
CASE STUDY
Dr Gladman was also one of the first recipients of the Rural Resident Medical Officer Indigenous Cadetship as a medical student and undertook his return of service at Tamworth before joining the Rural Generalist Program.
“I’m committed to making a difference in rural health and this scholarship is helping me upskill to provide more focused child health care and improved health outcomes for my community of Broken Hill,” he added.
“As a qualified Mental Health Worker in the local rehab service I’ll be able to better counsel, refer and advocate for our Aboriginal patients suffering from alcohol and drug addictions,” Michael added.
"I’m committed to making a difference in rural health and this scholarship is helping me upskill to provide more focused child health care and improved health outcomes for my community of Broken Hill." Dr Justin Gladman
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nsw rural doctors network annual report 2017 –18
Tumut’s Main Street, NSW, Australia Image courtesy of Miriam Hewson
©
Town-based planning RDN’s town-based planning approach seeks to find potential strategies that will fit each rural town to sustain the GP component of primary healthcare services. The approach is based on the premise that every rural town in NSW is different because of its population profile and socioeconomic status, the elements of its primary healthcare service, and the resources and enthusiasms to support the primary healthcare workforce.
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Town-based planning is examining the unique situation of each town, its health workforce and the population served, and putting strategies to the health workforce and the community for comment, preferences and support. The methodology is grounded in international, national, state and local policy and workforce research evidence, and the population, business and health service of the area in question. In 2017–18, RDN established town-based planning in the Tumut community in response to one of the town’s two GP obstetricians and its only GP anaesthetist relocating, placing the busy obstetrics service for the area under threat.
A change in ownership of the GPobstetrics practice, an emerging proposal for a different approach to training procedural GPs from the Regional Training Hub at the University of NSW, and the announcement of a $50 million allocation to build a new Tumut District Hospital, have opened additional possibilities for GP workforce sustainability strategies that can be developed ready for workforce and community consideration. The methodology being trialled in Tumut includes an inbuilt evaluation component to confirm its suitability as a statewide approach and guide its implementation in other rural medical towns.
Dr Alexander John with his family on Norfolk Island.
WORKING IN PARADISE Norfolk Island recruitment
Marketed as offering 360 degrees of wonder and described by Captain James Cook in his journal as “paradise”, Norfolk Island offers prospective GPs a fantastic work-life balance with a short commute to work, picturesque outlook and an active, welcoming community in which to live and raise a family. Yet, despite its many benefits as a lucrative place of employment, securing permanent GPs to the island is challenging. Norfolk Island is a region 7 under the federal Modified Monash Model (MMM) geographical classification system for medical services. An isolated and remote location, RDN’s Health Workforce Needs Assessment (HWNA) identified Norfolk Island as a priority area for a GP service. Attracting locum GPs to Norfolk Island isn’t impossible. However, finding someone who understands island life, is prepared to live remotely long-term and focus on the primary healthcare needs of a close-knit community of just over 2,000 people is more challenging. In December 2017, following a lengthy recruitment process working closely with multiple stakeholders and prospective employees, Dr Alexander John accepted the position of GP for the Norfolk Island Health and Residential Aged Care Service (NIHRACS), a multipurpose service (MPS) offering acute care, emergency services, aged care and a general practice.
RDN collaborated closely with the Department of Infrastructure and Regional Development, the South Eastern Sydney Local Health District, the Central and Eastern Sydney Primary Health Network and NIHRACS to successfully recruit Dr John. At the time, Dr John was living and working on Flinders Island, considering multiple employment offers and prioritising the happiness, education and lifestyle of his wife and three daughters. RDN facilitated a practice visit for Dr John to Norfolk, arranged a school visit for his family, suggested suitable accommodation, workshopped issues of concern and negotiated the contract with relevant stakeholders. After Dr John accepted the role, RDN staff offered him advice and support to help him transition into his new position, including facilitating conversations between Dr John and relevant stakeholders regarding his needs and long-term support. Dr John has welcomed the opportunity to make a difference to the Norfolk Island community. “Working on Norfolk gives me the chance to experience fascinating cradle to grave medicine, where it is possible to make a genuine difference to individual lives and the broader local community,” Dr John said.
Dr John has also praised the work-life balance he now has. “I am afforded a relaxed pace of life. We leave our house and car unlocked and people put fruit on the front seat of my unlocked car. It’s the opposite to stealing from someone’s car! “There is world-class snorkelling, uncrowded pristine beaches, great surf, outrigging, walking trails, culture and team sport opportunities for the children. “I was reflecting on the situation and it struck me that [my family and I] would not be here on this beautiful island without [RDN’s] intervention. “The girls were splashing in the water and have made friends with local kids – the whole community is so accepting!” RDN is extremely proud to have worked with four organisations to successfully recruit Dr Alexander John for NIHRACS. In less than a year, Dr John has made a positive impact on the health of the Norfolk Island community by being a highly-motivated, engaged, enthusiastic and passionate practitioner. Dr John provides excellent holistic care that is delivering better patient care and improved patient outcomes.
“The focus here is on patient outcomes and not on generating income,” he said.
"The focus here is on patient outcomes and not on generating income." 33
nsw rural doctors network annual report 2017 –18
Fourteen doctors received their RDN Rural Medical Service Award in person from RDN’s Chair and CEO during the annual Rural GPs Conference at Sydney in November 2017.
Rural doctors recognised for more than 800 years of combined service to country NSW RDN honoured 24 outstanding GPs in 2017 for more than 800 years of combined service to country NSW communities.
• Dr Robyn Yabsley for 35 years of service to Murwillumbah
• Dr Geof Marshall for 36½ years of service to Corowa and Bathurst
• Dr John Rogers for 35½ years of service to Muswellbrook
• Dr John Moran for 38 years of service to Murwillumbah
The annual Rural Medical Service Awards recognise GPs who have dedicated the past 35-plus years providing health services to the people of rural, regional and remote NSW.
• Dr Patrick Giltrap for 36 years of service to Cooma, Gilgandra and Gulargambone
• Dr Don Bourquin for 41 years of service to Singleton, Tullamore, Anna Bay and Shoal Bay
• Dr Francis Antonio for 36 years of service to Bomaderry
RDN presented awards to 14 doctors in person at the annual Rural GPs Conference in Sydney. They included:
• Dr Ian Tait for 36 years of service to Milton and Ulladulla
• Dr Phillip Knowles for 42 years of service to Moss Vale, Bundanoon and Wagga Wagga.
• Dr Virginia Wrice for 35 years of service to Gundagai • Dr Paul Mara for 35 years of service to Gundagai
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• Dr Peter Bowles for 36 years of service to Gloucester and Mullumbimby • Dr Cathy Marshall for 36½ years of service to Corowa and Bathurst
The dinner presentation was attended by more than 200 guests, representing GPs from across remote, rural and regional NSW, the award recipients and their families.
Rural GPs awarded OAMs The late Dr Keith Beck. Image courtesy of Port Macquarie News.
The contribution of the late Dr Keith Beck to rural health was recognised when he was honoured in the Queen's Birthday 2018 Honours List. Dr Keith Beck was recognised posthumously with a Medal of the Order of Australia (OAM) in the General Division for service to medicine. A recipient of RDNâ&#x20AC;&#x2122;s prestigious Rural Medical Service Award for long-standing medical service to rural NSW communities in 2011, Dr Beck spent 60 years in rural practice. Dr Beck demonstrated extraordinary medical care, passion and advocacy for senior and geriatric healthcare during his many years of rural practice as a GP and locum in the NSW communities of Crookwell, Goulburn, Wauchope and surrounds. Dr Marjorie Cross was also recognised, in the Australia Day 2018 Honours List. The dedicated GP received an OAM for her outstanding provision of rural health service in Captains Flat, Bungendore and surrounding areas in rural NSW over the last 30 years. As well as providing long-term service and commitment to her communities, female rural medical practitioners, registrars and medical students, Dr Cross has supported RDN as a member for the past 20 years.
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nsw rural doctors network annual report 2017 –18
Health OUTREACH HIGHLIGHTS The Australian Government’s Outreach Program, administered by RDN in NSW and the ACT, aims to increase access to health services for rural communities and Aboriginal people.
• Healthy Ears, Better Hearing, Better Listening (HEBHBL)
The Program removes distance, cost and cultural safety barriers by supporting medical specialists, nurses and allied health practitioners to deliver clinics in rural and culturally safe settings. More than 1,200 Outreach services were supported in NSW and the ACT during the 2017–18 year.
• Ear and Eye Surgical Support Services (EESSS)
• Visiting Optometrists Scheme (VOS) • Aboriginal Eye Health Coordination (AEHC)
• Chronic Disease Management and Prevention Program (CDMPP).* *CDMPP is funded by the Australian Government through contracts with the NSW Outback Division of General Practice and Western NSW Primary Health Network.
The Outreach Program is funded by the Australian Government and comprises: • Rural Health Outreach Fund (RHOF) • Medical Outreach Indigenous Chronic Disease Program (MOICDP)
chart 2
RDN maintains a strong partnership network with more than 60 rural health organisations including Aboriginal Community Controlled Health Services (ACCHSs), Local Health
Districts (LHDs), Primary Health Networks (PHNs) and non-government organisations (NGOs) that participate in regional stakeholder meetings to identify priority needs, emerging themes and plan and coordinate services. In addition, RDN and the Aboriginal Health and Medical Research Council of NSW (AH&MRC of NSW) work in partnership to support many aspects of the Outreach Program, including culturally safe planning, implementation and evaluation. RDN and its partners work to provide equity of access including the prioritisation of service needs in the most rural communities, demonstrated through the distribution of activity across MMM categories.
2017–18 Outreach clinic hours provided per 1,000 population
Modified Monash Model – Metropolitan (1) to Very Remote (7)
7 6 5 4 3 2 1
0
100
200
300
400
500
Clinic hours provided per 1,000 people
36
600
700
800
"206,000 Occasions of Service were delivered – the highest achieved in any year."
The Outreach Program has continued to make a tremendous impact on increasing access to health services for people living in rural and Aboriginal communities over 2017–18. RDN acknowledges the valuable contributions of the more than 200 health practitioners, administrators and organisations to the Outreach Program’s achievements, including: • 206,000 Occasions of Service (OoS) delivered, the highest in any year • 125,000 (61%) OoS accessed by Aboriginal people. This reflects the uptake of many Outreach services specifically designed to increase access to health care for Aboriginal communities. These include chronic disease, mental health, hearing and eye health services • 18,300 Outreach visits and 150,000 clinic hours delivered in more than 170 towns across NSW and the ACT • 900 health practitioners representing more than 120 health disciplines and sub specialties delivered Outreach clinics, including medical specialists, allied health practitioners, nurses and Aboriginal health workers or practitioners. 2018 Outreach survey feedback indicates: • 98% of patients were very satisfied or satisfied with the delivery of their Outreach service • 86% of patients believed this service had improved their access to health care • 89% of patients felt much better or better about their health after accessing an Outreach clinic
• 98% of health practitioners are motivated to provide care for disadvantaged people; 88% to provide complex health care in challenging situations; and 87% to support rural health colleagues. • 83% of health practitioners intend to continue Outreach for three years or more. Twelve regional working groups and two state/territory advisory groups of Aboriginal eye health stakeholders have continued developing partnerships to identify and prioritise eye health pathway needs and solutions.
2018 RDN OUTREACH FORUM RDN’s second Outreach Forum was held over 14 and 15 June at the Maritime Museum in Darling Harbour, Sydney. The Forum was an opportunity for the wider Outreach community to network, exchange knowledge, and discuss challenges and opportunities. The event brought together 110 delegates comprising a cross-section of health administrators, practitioners, and other stakeholders involved in the Outreach Program. Plenary and table-top sessions focused on collaborative partnerships, community engagement, innovative Outreach models, Aboriginal health, chronic disease prevention and Medicare models.
37
nsw rural doctors network annual report 2017 –18
Indigenous spectacle program pilot sees success An eight-year-old Aboriginal boy from Walgett is achieving success at school thanks to a pilot program that allowed him to receive free spectacles.
of eligibility for the scheme, with the objective of improving access to spectacles for Aboriginal people on low incomes.
Facilitated by RDN and with approval from the NSW Department of Family and Community Services, the Western NSW Eye Health Partnership worked with Vision Australia, Optometry Australia and the Brien Holden Vision Institute Foundation in 2018 to develop a six-month pilot to extend the NSW Spectacle Program to all Aboriginal people.
Before the pilot, many Aboriginal patients prescribed spectacles couldn’t afford them. Children were particularly vulnerable under the existing system, relying on adults for the purchase and collection of their spectacles.
Walgett Aboriginal Medical Service was selected to trial the expansion
The eight-year-old boy had previously been prescribed spectacles but hadn’t received them as his parent couldn’t meet the cost. Through the pilot program, the boy now has the spectacles he needs. With his vision
problems corrected, his school teacher has noticed an improvement in his attention and learning. With new spectacles and regular optometry review, the education, health and wellbeing benefits for this child are priceless. There are now 14 pilot sites operating in NSW, in the hope that the success of the changes in eligibility for Indigenous communities to access spectacles will lead to expansion of the initiative across NSW.
TRAC-ING FOR SUCCESS IN TELEHEALTH
CASE STUDY
This year, RDN joined the Western NSW Primary Health Network (WNSW PHN) to fund the Telehealth in Residential Aged Care (TRAC) Program. TRAC operates in Broken Hill, Dubbo and Wentworth to deliver video consultations between residents of aged care facilities and health professionals including GPs, allied health professionals and specialists. It also strengthens care coordination initiatives to enhance multidisciplinary care and improves in-reach support available to residents.
38
Originally operating with pilot funding from the Australian Government, TRAC reduced the number of residents presenting to hospital in Broken Hill and Dubbo. “One of the critical needs in our rural communities, and particularly remote communities, is high-quality aged care facilities and access to medical and clinical professionals, so the workload is stretched,” RDN CEO, Richard Colbran, said.
“TRAC has worked well and continues to improve. It is something to celebrate.” RDN and WNSW PHN are funding TRAC until 30 June 2019 while alternative long-term funding models are explored.
Leanne Uren with Dr Ross Cooper (L) and Dr Roger Welch in Moree
On the road with Outreach
By Leanne Uren, RDN cadet, University of Notre Dame, Lithgow On 9 and 10 May 2018 I travelled to Moree to complete a rural Outreach clinic, arranged and sponsored by RDN. After a bumpy flight on the small Qantas Dash, I arrived safely and raring to go. At Pius X Aboriginal Medical Service, I met with ophthalmologist Dr Roger Welch, his assistants Kimberly and Shelby, and local optometrist Dr Ross Cooper. They have been providing eyecare services to the remote town of Moree for almost 20 years, first through a surgical bus and more recently through Moree Hospital. Dr Welch travels with his assistants from Queensland for three days each month for these clinics. DAY ONE It was a busy morning, assessing many eye conditions that required specialist review. One lady had a retinal hole that was slowly impairing her vision and Dr Welch used laser to repair the defect. Another patient was one of the few people in Australia that had been given a prosthetic iris after both his irises had been permanently deformed following a bilateral blast injury from a fire hose. We then went to Cooper and Smith Optometrists where Dr Cooper and
Dr Roger Welch ran the pre-op clinic for the following day's surgeries involving the use of slit lamps to assess cataracts and biometry to measure the eyes for the intraocular lens. I also observed Lucentis eye injections for wet macular degeneration and diabetic retinopathy. Dr Welch told me he was amazed at the advanced stages of eye disease he sees in the area â&#x20AC;&#x201C; many cataracts are much more complicated and difficult to treat than you would ever see in the city, due to the significant issues of access. After an exhausting day we enjoyed a fine meal together at the local hotel, after which some of us went back and relaxed in the hot artesian spas at our motel. DAY TWO The next day was an early start at Moree Hospital for surgery. It is a small hospital, with only two theatres that operate part-time. The ladies in theatre (Kim, Maureen, Bronwyn and Jill) have worked there for more than 30 years and were lovely and happy to teach. The attending GP anaesthetist, Dr Lauren Vernon, is halfway through her Rural Proceduralist training and was most helpful, telling me great stories
about her experiences so far and giving me some clinical tips. I observed cataract surgery, which involves sedation, a local eye block, phacoemulsification, and implant of new intraocular lens. After a full day of surgery, we went back to the clinic to follow up on some of the day's patients, and book in more patients for cataract surgery in three months. The last patient of the day was an emergency visit from a nine-year-old girl who had alcohol wash splashed in her eye and had been brought in by her worried Mum. I am most grateful for the opportunity given to me by the NSW Rural Doctors Network to accompany the Moree Outreach Clinic and extend a big thank you to Dr Welch, Dr Cooper and their teams, the ladies at the Moree Hospital, and Healthwise for assisting with travel arrangements. The experience really opened my eyes (pun intended) to the difficulties of accessing specialist eye services in a remote community like Moree.
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nsw rural doctors network annual report 2017 –18
MOBILE WORKFORCE
Members of the RDN team at the 2017 Staff Development Workshop.
People and Culture RDN PERFORMANCE PROGRAM RDN’s Performance Program has been introduced to embed a system that supports the achievement of the organisation’s strategic goals through dayto-day operations. This coordinated organisational-wide approach enables a direct line of sight between workplans and allocation of resources at strategic program, team and individual levels. The Program was developed from organisational reviews and staff feedback in 2016 –17 and implemented from January 2018 and will become a feature of RDN’s ongoing operational approach. The Performance Program uses a Balanced Scorecard (BSC) framework with six organisational measures tailored for use by non-government health charities: • Purpose and impact • Quality of service • Stakeholder engagement and relations • Finance, infrastructure and systems • People, culture and leadership • Governance and management
40
In the past year, RDN has invested heavily in technology to support its mobile workforce. A web-based collaborative platform that integrates with the organisation’s office-based systems allows the team to work on documents in real time as they travel throughout NSW. RDN has also set up video conferencing technology to enable staff and stakeholders in multiple locations, either in an office or on the road, to conduct face-to-face meetings.
MALIYAN CULTURAL AWARENESS TRAINING As part of its Aboriginal Engagement Program, RDN committed to the continuation of a Cultural Awareness Program, which aims to increase staff awareness of cultural safety and competency. RDN engaged the services of TAFE Western to provide employees with a training program, The Maliyan Experience, A Journey Into Cultural Excellence. The Maliyan Experience is a six-stage journey offering RDN employees the tools to integrate their knowledge and understanding of Aboriginal and Torres Strait Islander peoples and protocols into organisational culture, practices, standards and policies. All staff completed stages 1 and 2 in the reporting period.
STAFF DEVELOPMENT GRANTS
STAFF SERVICE AWARDS In 2017, 26 RDN employees were rewarded for their tenure.
RDN’s Dr Estrella Lowe with General Manager, Dave Karlson, receiving her award for 15 years’ service.
20 YEARS' SERVICE AWARD • Mina Zinopoulos 15 YEARS' SERVICE AWARD • Margaret Young • Dr Estrella Lowe • Glenda Wrightson 10 YEARS' SERVICE AWARD • Dr Elizabeth Barrett • Lisa Park • Nicole Beehag • Trish Tonkin • Dr Rose Ellis • Kim Carlson • Janice Hall • Angela Eyre • Sharif Bagnulo • Louise Fearnley 5 YEARS' SERVICE AWARD • Arna Wotherspoon • Gayle Goninan • Dr Paul Collett • Amanda Massett • Michael Edwards • Chris Roach • Aaron Jolly • Emer O’Callaghan • Melanie Ward • Sally Brugger • Dave Karlson • Rodney Kite
Each year, RDN employees can apply for grants of up to $5,000 to offset the cost of further education and/ or training. This initiative recognises the benefits of professional growth and development to staff and the organisation, through improving employee skills and knowledge; business performance, productivity and efficiency; nurturing innovation; and assisting with succession planning. Grants were awarded in 2017 to Claire O’Neill (Masters of Public Health, UNSW); Emer O’Callaghan (Masters of Health Services Management, Charles Sturt University); and Simon Lyddiard (Masters of Information Technology Management, Southern Cross University).
STAFF DEVELOPMENT RDN’s Dr Rose Ellis (L) and Dave Karlson, with Dr Elizabeth Barrett (centre) receiving her award for 15 years’ service.
RDN’s annual Staff Development Workshop was held over two days in Newcastle in December 2017. The aim of the Workshop was to clarify RDN's purpose, and direct staff energy towards embedding the organisation's values in their day-to-day work. Staff discussed their desire for a contemporary workplace and the infrastructure, systems and tools in place to allow the organisation to receive feedback, be accountable, and continually improve and demonstrate best practice. The workshop also provided an opportunity for staff situated in two different locations to come together and better understand departments and responsibilities.
RDN’s Dr Rose Ellis (L) and Dave Karlson, with Sharif Bagnulo (centre) receiving his award for 10 years’ service.
41
nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW Rural Doctors Network
Financial Statements & Statutory Reports
2017 18 CONCISE FINANCIAL STATEMENTS FOR THE YEAR ENDED 30 JUNE 2018
Responsible Persons' Report
44
Auditorâ&#x20AC;&#x2122;s Independence Declaration
48
Independent Audit Report
49
Responsible Persons' Declaration
50
Summary Statement of Comprehensive Income
51
Summary Statement of Financial Position
52
Summary Statement of Changes in Funds
53
Summary Statement of Cash Flows
54
Notes to Summary Financial Statements
55
Summary and Analysis
56
43
nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
RESPONSIBLE PERSONSâ&#x20AC;&#x2122; report Your Responsible Persons present their report on the Company for the financial year ended 30 June 2018. GENERAL INFORMATION Responsible Persons The names of the Responsible Persons in office at any time during, or since the end of, the year are: NAME
POSITION APPOINTED/RESIGNED
Dr John Curnow
Chair
Dr Ros Bullock
Deputy Chair
Dr Lauren Cone
Treasurer
Dr Lee Jeffery
Responsible Person
Resigned 19 July 2017
Dr Geoff White OAM
Responsible Person
Finished 13 Dec 2017
A/Prof John Kramer OAM
Responsible Person
Ms Jill Ludford
Responsible Person
Ms Christine Corby OAM
Responsible Person
Dr William Lancashire
Responsible Person
Dr Henry Hicks
Responsible Person
Dr Rose Ellis
Secretary
Appointed 13 Dec 2017
Responsible Persons have been in office since the start of the financial year to the date of this report unless otherwise stated. Company Secretary Dr Rose Ellis held the position of Company Secretary at the end of the financial year. Dr Ellis has worked for NSW Rural Doctors Network Limited for the past 12 years and her qualifications include BA (Hons), PhD. Dr Ellis was appointed Company Secretary on 23 November 2007. Principal Activities The principal activity of NSW Rural Doctors Network Limited during the financial year was providing health service information and support to the rural medical workforce of New South Wales. There have been no significant changes in the nature of NSW Rural Doctors Network Limited's principal activities during the financial year. Business Review The surplus from ordinary activities amounted to $246,497 (2017: $295,400).
44
Financial Statements 2017 18
OTHER ITEMS Significant Changes in State of Affairs There have been no significant changes in the Company's state of affairs during the financial year. After Balance Date Events No matters or circumstances have arisen since the end of the financial year which significantly affected or may significantly affect the operations of the Company, the results of those operations or the state of affairs of the Company in future financial years. Auditorâ&#x20AC;&#x2122;s Independence Declaration The lead auditors independence declaration for the year ended 30 June 2018 has been received and can be found on page 6 of the financial report. Short and Long â&#x20AC;&#x201C; Term Objectives The Company has established short and long-term objectives as outlined in the Company's business plan, which is reviewed on an annual basis. These objectives are both financial and non-financial and are aimed towards providing a comfortable and secure environment to its members that continues to meet their needs. These objectives are measured through both financial and non-financial key performance indicators that have been determined relevant to the medical support services industry. RESPONSIBLE PERSON INFORMATION Information on Responsible Persons Dr John Curnow Qualifications Special Responsibilities
BMed, FRACGP, Grad Dip Rural Chair
Dr Ros Bullock Qualifications MBBS (Hons), DCH, FRACGP, FACRRM, FARGP Special Responsibilities Deputy Chair Dr Lauren Cone Qualifications Special Responsibilities
MBBS, BSc (Med), FRACGP Treasurer
Dr Lee Jeffery Qualifications Special Responsibilities
Resigned 19 July 2017 MBBS (Hons II), BSc (Med), FRACGP Responsible Person
Dr Geoff White OAM Qualifications Special Responsibilities
Resigned 13 December 2017 MBBS, FACRRM, FRACGP, FAMA Responsible Person
A/Prof John Kramer OAM Qualifications MBBS, FRACGP, FACRRM Special Responsibilities Responsible Person
45
nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
RESPONSIBLE PERSONS' report Ms Jill Ludford Qualifications Special Responsibilities
(CONTINUED)
GCert Nursing, MHS Mgt Responsible Person
Ms Christine Corby OAM Qualifications Dip Health Services, GradDip Health Management, Dip Business Management Special Responsibilities Responsible Person Dr William Lancashire Qualifications BSc (Hons), MBBS, CCFP, FRACGP, FCFP Special Responsibilities Responsible Person Dr Henry Hicks Qualifications Special Responsibilities
Appointed 13 December 2017 MBBS, FRACS Responsible Person
Dr Rose Ellis Qualifications BA (Hons), PhD Special Responsibilities Secretary
46
Financial Statements 2017 18
Meetings of Responsible Persons During the financial year, six meetings of Responsible Persons and five meetings of Board Committees were held. Attendances by each Responsible Person during the year were as follows: Responsible Persons' Meetings
Audit, Risk & Compliance Committee Meetings
Number eligible to attend
Number attended
Number eligible to attend
Number attended
Dr John Curnow
6
6
5
5
Dr Ros Bullock
6
6
5
5
Dr Lauren Cone
6
6
2
2
Dr Lee Jeffery
1
–
1
–
Dr John Curnow
6
6
5
5
Dr Geoff White OAM
4
4
–
–
A/Prof John Kramer OAM
6
5
–
–
Ms Jill Ludford
6
4
–
–
Ms Christine Corby OAM
6
4
–
–
Dr William Lancashire
6
5
5
3
Dr Henry Hicks
2
1
–
–
Dr Rose Ellis
6
6
–
–
Insurance Premiums Paid for Responsible Persons The Company has paid premiums to insure each of the Responsible Persons against liabilities for costs and expenses incurred by them in defending any legal proceedings arising out of their conduct while acting in the capacity of Responsible Persons of the Company, other than conduct involving a wilful breach of duty in relation to the Company. The amount of the premium is not disclosed due to the terms of the insurance contracts and to protect commercially sensitive information of the Company. Signed in accordance with a resolution of the Board of Responsible Persons:
Chair Treasurer Dr John Curnow Dr Lauren Cone 18 September 2018
18 September 2018
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nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
Auditor's Independence Declaration to the Responsible Persons of NSW Rural Doctors Network Limited I declare that, to the best of my knowledge and belief, during the year ended 30 June 2018 there have been no contraventions of: (i) the auditor independence requirements as set out in the Australian Charities and Not-for-profits Commission Act 2012 in relation to the audit; and
(ii) any applicable code of professional conduct in relation to the audit.
Cutcher & Neale Assurance Pty Limited (An authorised audit company) N. Nancarrow CA Director Newcastle 11 September 2018
48
Financial Statements 2017 18 Independent audit report to the RESPONSIBLE PERSONS of nsw rural doctors network limited REPORT OF THE INDEPENDENT AUDITOR ON THE SUMMARY FINANCIAL STATEMENTS Opinion The summary financial statements, which comprise the summary statement of financial position as at 30 June 2018, the summary statement of profit or loss and other comprehensive income, the summary statement of changes in equity, the summary statement of cash flows, discussion and analysis of the financial statements and the Responsible Persons' Declaration for the year then ended, and related notes, are derived from the audited financial report of NSW Rural Doctors Network Limited for the year ended 30 June 2018. In our opinion, the accompanying summary financial statements are consistent, in all material respects with the audited financial statements, on the basis described in Note 1. Summary Financial Statements The summary financial statements do not contain all the disclosures required by Australian Accounting Standards – Reduced Disclosure Requirements. Reading the summary financial statements and the auditor’s report thereon, therefore, is not a substitute for reading the audited financial statements and auditor’s report thereon. Audited Financial Report and our Report thereon We expressed an unmodified audit opinion on the audited financial report in our report dated 19 September 2018. Responsible Persons Responsibility for the Summary Financial Statements Responsible Persons are responsible for the preparation of the summary financial statements on the basis described in Note 1. Auditor’s Responsibility Our responsibility is to express an opinion on whether the summary financial statements are consistent, in all material respects, with the audited financial report based on our procedures, which were conducted in accordance with Auditing Standard ASA 810 Engagements to Report on Summary Financial Statements.
Cutcher & Neale Assurance Pty Limited (An authorised audit company) N. Nancarrow CA Director Newcastle 19 September 2018
49
nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
RESPONSIBLE PERSONS' Declaration The Responsible Persons of the company declare that the summary financial statements of NSW Rural Doctors Network Limited for the financial year ended 30 June 2018, as set out on pages 9 to 14: (a) comply with Accounting policies as described in Note 1; and (b) have been derived from and are consistent with the full financial statements of NSW Rural Doctors Network Limited. This declaration is made in accordance with a resolution of the Board of Responsible Persons.
Chair Treasurer Dr John Curnow Dr Lauren Cone 18 September 2018
50
18 September 2018
Financial Statements 2017 18 Summary Statement of Surplus or Deficit and Other Comprehensive Income For the Year Ended 30 June 2018 Note
2018 $
$
Operating revenue
2
27,112,375
26,901,891
Other income
2
306,684
280,588
(20,881,711)
(20,776,453)
(5,176,327)
(4,875,632)
Depreciation and amortisation expense
(185,786)
(333,799)
Administration expenses
(926,442)
(875,366)
Project expenses Employee benefits expense
2017
Loss on disposal of assets
(1,046)
(4,951)
Bad and doubtful debts expense
(1,250)
(20,878)
246,497
295,400
–
–
Surplus / (deficit) before income tax Income tax expense Other comprehensive income for the year Total comprehensive income
–
–
246,497
295,400
51
nsw rural doctors network annual report 2017 â&#x20AC;&#x201C;18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
Summary Statement of Financial Position 30 June 2018 2018
2017
$
$
Cash and cash equivalents
11,299,741
6,815,525
Trade and other receivables
1,283,069
1,568,029
111,579
90,459
12,694,389
8,474,013
1,888,469
2,060,230
ASSETS Current assets
Prepayments TOTAL CURRENT ASSETS Non Current Assets Trade and other receivables
616,632
668,375
2,505,101
2,728,605
15,199,490
11,202,618
1,157,699
1,259,969
742,167
816,544
Other liabilities
6,704,498
2,754,366
TOTAL CURRENT LIABILITIES
8,604,364
4,830,879
Property, plant and equipment TOTAL NON-CURRENT ASSETS TOTAL ASSETS LIABILITIES Current liabilities Trade and other payables Employee benefits
Non Current Liabilities Trade and other payables Employee benefits TOTAL NON CURRENT LIABILITIES
52
30,686
55,782
219,477
217,491
250,163
273,273
TOTAL LIABILITIES
8,854,527
5,104,152
NET ASSETS
6,344,963
6,098,466
FUNDS Accumulated surplus
6,344,963
6,098,466
TOTAL FUNDS
6,344,963
6,098,466
Financial Statements 2017 18 Summary Statement of Changes in Funds For the Year Ended 30 June 2018 2018
Accumulated Surplus $
Balance at 1 July 2017 Total comprehensive income Balance at 30 June 2018 2017
6,098,466 246,497 6,344,963 Accumulated Surplus $
Balance at 1 July 2016 Total comprehensive income Balance at 30 June 2017
5,803,066 295,400 6,098,466
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nsw rural doctors network annual report 2017 –18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
Summary Statement of Cash Flows For the Year Ended 30 June 2018 2018 $ CASH FLOWS FROM OPERATING ACTIVITIES: Receipts from customers and funding provider grants Payments to suppliers and employees Interest received Net cash provided by (used in) operating activities
CASH FLOWS FROM INVESTING ACTIVITIES: Proceeds from sale of plant and equipment Purchase of property, plant and equipment Loans to related parties – payments made Loans to related parties – proceeds from repayments Net cash used by investing activities
34,667,239
25,824,581
(30,519,429)
(28,112,024)
319,788
291,695
4,467,598
(1,995,748)
17,500
46,364
(147,546)
(344,849)
–
(2,200,000)
146,664
48,888
16,618
(2,449,597)
Net increase (decrease) in cash and cash equivalents held
4,484,216
(4,445,345)
Cash and cash equivalents at beginning of year
6,815,525
11,260,870
11,299,741
6,815,525
Cash and cash equivalents at end of year
54
2017 $
Financial Statements 2017 18 Notes to the Financial Statements For the Year Ended 30 June 2018 1. Accounting Policies The summary financial statements have been prepared from the audited financial report of NSW Rural Doctors Network Limited for the year ended 30 June 2018. The audited report for the year ended 30 June 2018 is available at request from NSW Rural Doctors Network Limited. The financial statements, specific disclosures and the other information included in the summary financial statements are derived from and are consistent with the full financial statements of NSW Rural Doctors Network Limited. The summary financial statements cannot be expected to provide as detailed an understanding of the financial performance, financial position and financing and investing activities of NSW Rural Doctors Network Limited as the full financial statements. The accounting policies have been consistently applied to NSW Rural Doctors Network Limited and are consistent with those of the financial year in their entirety. The presentation currency used in the financial report is Australian dollars.
2. Revenue and Other Income
2018 $
2017 $
26,433,179
25,953,405
Operating activities – Operating grants
581,595
838,012
– Medical practice income
10,200
25,350
– Scholarship income
42,000
45,780
– Sponsorship income
45,400
32,182
27,112,374
26,894,729
301,641
280,588
5,044
7,161
– Services and other revenue
Total operating revenue Other revenue – Interest income – Profit on disposal of assets Total revenue and other income
306,685
287,749
27,419,059
27,182,478
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nsw rural doctors network annual report 2017 –18
NSW RURAL DOCTORS NETWORK LTD ABN 52 081 388 810 (A Company Limited by Guarantee and having no Share Capital)
Summary and Analysis For the Year Ended 30 June 2018 OPERATING RESULT The surplus from ordinary activities for the year was $246,497, which is a decrease of ($48,903) compared to last year (2017: surplus of $295,400). STATEMENT OF SURPLUS OR DEFICIT AND OTHER COMPREHENSIVE INCOME Revenue Income for the year was $27,419,059 which mainly came in the form of grants from the Australian Government Department of Health and NSW Government Ministry of Health. The major projects funded by the grants were Rural Health Outreach Fund (RHOF) $4,946,129; Medical Outreach Indigenous Chronic Disease Program (MOICDP) $10,756,670; Visiting Optometrist Service (VOS) $1,019,489; Healthy Ears Better Hearing Better Listening (HEBHBL) $1,225,822; Eye and Ear Surgical Services (EESS) $466,000; Chronic Disease Management and Prevention Program (CDMPP) $1,213,428; Health Workforce Scholarship Program $3,868,794; Rural Health Workforce Support Program $5,036,444; and the NSW Primary and Community Based Service Program $1,970,596. Expenditure Total expenses for the year were $27,172,562 and the major spending areas were grants for provision of medical specialist services $17,464,958; grants to nursing and allied health professionals moving to rural areas $396,730; grants to assist doctors
56
undertaking their Fellowship $294,474; provision of technical conferences $433,131; scholarships and support to medical cadets and students $1,135,614; rental of premises in Newcastle and Sydney $376,630; and salaries and wages across all programs including locum General Practitioners and staff $5,176,327.
Members Equity
STATEMENT OF FINANCIAL POSITION
The company’s cash position showed an increase of $4,484,216 largely due to an increase in unexpended grants.
Assets Total assets increased by $3,996,872 to $15,199,490 due to an increase in cash invested because of a higher percentage of grant income remaining unexpended in 2017–18. This resulted in a $3,959,332 increase in grant income in advance which is balanced by a similar increase in liabilities. During 2017–18 funds held in cash and cash equivalents increased by $4,484,216 due to an increase in grant income in advance, These cash funds are retained in interest-bearing accounts to maximise interest while maintaining a low-risk profile. Liabilities Total liabilities increased by $3,750,374 to $8,854,526 due to the increase in grant income in advance, which offset the increase in assets. This increase of $3,750,374 (73.48%) impacted on the cash invested. Employee benefits reduced due to staff changes involving long-standing employees and closer scrutiny of employee leave balances.
The accumulated surplus now stands at $6,344,963 which increased in line with the surplus for 2017–18. The equity of the company increased due to the surplus of $246,497 from the year's activities. Statement of Cashflows
Operating Activities Cash inflows from operating activities increased $4,467,598 which is principally due to retaining unexpended funds at the end of the period. Investing Activities Cash received from investing activities during the year increased by $16,618 due to loan repayments received from Rural Doctors Resource Network (RDRN) Incorporated and offset by the purchase of assets net of disposals.
Financial Statements 2017 18
Sugar pine log forest, NSW
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nsw rural doctors network annual report 2016 –17
Abbreviations ACCHO Aboriginal Community Controlled Health Organisation ACCHS Aboriginal Community Controlled Health Service ACRRM Australian College of Rural and Remote Medicine ACT Australian Capital Territory AEP Aboriginal Engagement Plan AEHC Aboriginal Eye Health Coordination AGPT Australian General Practice Training AH&MRC Aboriginal Health and Medical Research Council AHS Aboriginal Health Service AMA Australian Medical Association AMC Australian Medical Council AMS Aboriginal Medical Service AOD Alcohol and Other Drugs AoN Area of Need ASA Australian Auditing Standards ASGC-RA Australian Standard Geographical Classification – Remoteness Area AWP Activity Workplan BA Bachelor of Arts BMed Bachelor of Medicine BSC Balanced Score Card CA Chartered Accountant CDMPP Chronic Disease Management and Prevention Program CEO Chief Executive Officer CPD Continuing Professional Development CWA Country Women’s Association DoH Australian Government Department of Health DVA Department of Veterans' Affairs DWS District of Workforce Shortage ED Emergency Department EESSS Ear and Eye Surgical Support Services ENT Ear, Nose, Throat GP General Practitioner HEBHBL Healthy Ears – Better Hearing, Better Listening Program HETI Health Education and Training Institute HRACS Health and Residential Aged Care Service HWNA Health Workforce Needs Assessment HWSG Health Workforce Stakeholder Group HWSP Health Workforce Scholarship Program ICT Information and Communication Technology IMG International Medical Graduate (also referred to as OTD) JFPP John Flynn Placement Program JMO Junior Medical Officer LALC Local Aboriginal Land Council LGA Local Government Agency LHD Local Health District
58
MBS MBBS MMM MoH MOICDP MoU MPS NAIDOC NGO NRHSN NSW NSWA OAM OoS OTD PBS PGY PHC PHN RA RACGP RaRMS RDA (NSW) RDAA RDCU RDN RDRN RHOF RHWA RHWSP RLRP RMTF RN RTO RWA RWAN SP TAFE TRAC UDRH VMO VOS WHO WONCA
Medicare Benefits Schedule Bachelor of Medicine, Bachelor of Surgery Modified Monash Model NSW Government Ministry of Health (NSW Health) Medical Outreach Indigenous Chronic Disease Program Memorandum of Understanding Multipurpose Service National Aborigines and Islanders Day Observance Committee Non-Government Organisation National Rural Health Student Network New South Wales NSW Ambulance Medal of the Order of Australia Occasions of Service Overseas-Trained Doctor (also referred to as IMG) Pharmaceutical Benefits Scheme Post Graduate Year Primary Health Care Primary Health Network Remoteness Area Royal Australian College of General Practitioners Rural and Remote Medical Services Rural Doctors Association (NSW) Rural Doctors Association of Australia NSW Rural Divisions Coordinating Unit NSW Rural Doctors Network Rural Doctors Resource Network Rural Health Outreach Fund Rural Health Workforce Australia Rural Health Workforce Support Program Rural Locum Relief Program Rural Medical Training Forum Registered Nurse Regional Training Organisation Rural Workforce Agency Rural Workforce Agency Network Succession Planning Technical and Further Education Telehealth in Residential Aged Care University Department of Rural Health Visiting Medical Officer Visiting Optometrists Scheme World Health Organization World Organization of Family Doctors
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nsw rural doctors network annual report 2017 –18
INDEX Abbreviations 58 Aboriginal Engagement Awards Financial Management Governance Outreach Partnerships People and Culture Workforce
16 – 17 34 – 35 12, 43 – 56 8–9 36 – 39 13, 18, 19, 28, 32 40 – 41 10 – 11, 14 – 15, 18 – 33
CHARTS Chart 1 // RDN sources of funding in 2017–18
12
Chart 2 // 2017–18 Outreach clinic hours provided per 1,000 population
36
TABLES
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Table 1 // RDN financial performance from 2012 – 18
12
Table 2 // RDN's refresher and procedural conferences in 2017–18
22
Table 3 // Identified upskilling and training areas to be funded by the HWSP
30
Contact Us Head Office Suite 1, 53 Cleary St HAMILTON NSW 2303 Phone: +61 2 4924 8000 Fax: +61 2 4924 8010 Email: info@nswrdn.com.au Sydney Office Suite 3, Level 5 241 Oâ&#x20AC;&#x2122;Riordan St MASCOT NSW 2020 PO Box 1111 MASCOT NSW 1460 Phone: +61 2 8337 8100 Fax: +61 2 8337 8110 www.nswrdn.com.au
www.nswrdn.com.au Cover photo: Canola field, Cowra
