RDN Orientation to General Practice in Rural NSW

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NSW RURAL DOCTORS NETWORK

Orientation to General Practice in Rural NSW JULY 2016

Supporting Rural Health in New South Wales, Australia

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Contents Introduction 3

Medicare Safety Net

24

Being a GP in Australia

Medicare Provider Numbers

24

Overview 5

Medicare Benefits Schedule (MBS)

25

General practice in Australia

5

Pharmaceutical Benefits Scheme (PBS)

25

Professional Indemnity insurance

6

Australia’s private health insurance system

27

Good medical practice

6

Primary healthcare

27

Mandatory reporting

6

Community healthcare

28

Grants and financial incentives for rural GPs

6

Health facilities overview

29

Medicare rebates and rural practice incentives

8

Typical organisational structure of a rural hospital

29

Aboriginal and Torres Strait Islander health

11

Mental health care

29

Patient complaints

11

Aged care

30

Professional support organisations for rural NSW general practice

Evolution of the Australian Industrial Relations (IR) system

31

11

Two main IR systems

31

Rural medical family support

12

Employment arrangements for health professionals

32

CRANAplus Bush Support Services

12

General practitioners – basis of appointment

32

New Rural GP Orientation Training

13

Wages and conditions for health professionals

32

Rural Doctors Association of Australia (RDAA)

33

RDA hospitals in New South Wales

33

4

RDN New Rural GP Orientation Program

14

Family planning and sexual health resources

15

Other resources

15

Continuing Professional Development Opportunities

16

RDN refresher and procedural conferences

17

Rural Emergency Skills Training

18

RDN WebEd – online education

18

Additional Assistance Scheme

19

Vocational training for GPs

19

Other CPD opportunities

19

Overview of the Australian Healthcare System

20

Australia’s system of government – an overview

21

The federal health context

21

The state health context

21

The ‘pillar’ agencies of NSW healthcare

22

Healthcare delivery in a diverse country

22

Australia’s public health system – Medicare

23

Medicare levy

23

Medicare cards

23

Superannuation 33 Life in Australia

34

Geographical information

35

Australian principles, values and culture

37

Newcomers to Australia

37

Aboriginal and Torres Strait Islander peoples

38

Driving in country NSW

38

Opening a bank account

40

Housing and accommodation

40

Finding employment for your spouse or partner

41

Schools 42 Pets and wildlife

43

Other relocation considerations

43

Appendix 1. Acronyms

44

Appendix 2. Glossary

46

Appendix 3. Resource List for Aboriginal Health Information

52

Disclaimer While NSW Rural Doctors Network (RDN) has attempted to ensure that the material in this handbook is accurate at the time of release, it covers a range of matters that are subject to regular change. No liability for negligence or otherwise is assumed by the organisation or its contributors should anyone suffer loss or damage as a result of relying on the information provided.

References to external websites are provided for the reader’s convenience and do not constitute endorsement of the information at those sites or any associated organisation, product or service. RDN accepts no responsibility for the accuracy, completeness or currency of material contained on any external website that is referred to in this handbook.

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introduction Welcome to general practice in rural New South Wales (NSW). In the health sector, rural NSW is considered any location outside metropolitan Sydney, the Central Coast to Newcastle, and Wollongong.

This handbook introduces you to the NSW and Australian Health Systems, and what it means to be a general practitioner in rural NSW. It is a basic guide to what is a complex range of topics for doctors new to rural NSW general practice.

We aim to provide details on where you can seek further information, including websites and contacts.

You will be able to research topics of interest and obtain up-to-date information.

As the Rural (Health) Workforce Agency (RWA) in NSW, the NSW Rural Doctors Network (RDN) develops and administers services and programs to improve the recruitment and retention of General Practitioners (GPs) and provides a central information resource for rural medical support initiatives in NSW. RDN is a not-for-profit, non-government organisation with more than 1,300 members, including more than 900 doctor members, and is funded by both the NSW and Australian Governments.

RDN has produced this orientation handbook with funding from the NSW Ministry of Health.

Welcome again to rural NSW, and please donâ&#x20AC;&#x2122;t hesitate to contact RDN through the website at www.nswrdn.com.au or by phone 02 4924 8000.

Dr Ian Cameron Chief Executive Officer NSW Rural Doctors Network

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Being a GP in Australia

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Watch more videos

about working as a rural GP in New South Wales on RDN’s YouTube channel. www.youtube.com/user/ nswrdn/videos

Every doctor practising medicine in Australia must be medically registered with the Medical Board of Australia. Under the Health Practitioner Regulation National Law Act 2009 there is a range of registration categories: specialist, general, provisional, limited, and non-practising.

General practice in Australia

International Medical Graduates (IMGs) may be eligible for limited registration under one of the following pathways: Competent Authority Pathway, Standard Pathway or Specialist Pathway. More information can be found by visiting the Australian Health Practitioner Regulation Agency (AHPRA) website at www.medicalboard.gov.au/Registration/International-Medical-Graduates.aspx or the Australian Medical Council (AMC) www.amc.org.au/assessment/pathways

In Australia, General Practice, as defined by the RACGP, is “person centred, continuing, comprehensive and coordinated wholeperson health care to individuals and families in their communities” Source: www.racgp.org.

Overview

The AMC is the national body that oversees medical training, including the accreditation of medical schools and colleges, and administers examinations for overseas trained doctors to ensure IMGs meet the same standards as new graduates from Australian medical schools. Each IMG must have primary source verification of their medical qualifications when seeking registration in Australia.

See: www.amc.org.au/assessment/psv DoctorConnect is a useful website providing information for practising doctors and potential doctors wishing to work in Australia: www.doctorconnect.gov.au

au/becomingagp/what-is-a-gp/what-is-generalpractice/

The Australian healthcare system is a very good but complex system that carries with it a need for understanding of both rights and responsibilities. It is potentially rewarding professionally, clinically and financially; however, it also carries a significant level of responsibility and need for ethical behaviour.

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Professional Indemnity insurance According to the provisions of the Health Care Liability Act 2001, every doctor practising medicine in Australia must hold approved professional indemnity insurance or fit within an exempt category. This is also a requirement of medical registration. www.health. gov.au/internet/otd/publishing.nsf/ Content/medicalIndemnityCover

Good medical practice The Medical Board of Australia prescribes codes and guidelines to guide doctors and give clear direction on the professional behaviour expected of them when working in Australia.

These are accessible at www.medicalboard.gov.au/CodesGuidelines-Policies.aspx The Australian Medical Council (AMC) Good Medical Practice (the Code) sets out principles that characterise good medical practice and makes explicit the standards of ethical and professional conduct expected of doctors by their professional peers and the community in Australia. www.amc.org.au/index.php/ about/good-medical-practice The Code complements the AMA Code of Ethics and its values consistently align with the Declaration of Geneva and the International Code of Medical Ethics issued by the World Medical Association.

More information: • AMA Code of Ethics – ama.com.au/position-statement/ ama-code-ethics-2004-editoriallyrevised-2006 • Declaration of Geneva – www.wma.net/ en/30publications/10policies/g1/ • International Code of Medical Ethics – www.wma.net/ en/30publications/10policies/c8/

Mandatory reporting Mandatory reporting is the legal requirement to report suspected cases of child abuse and neglect. All jurisdictions throughout Australia possess mandatory reporting requirements, which differ from one jurisdiction to another; in NSW: • Who is mandated to notify? A person who, in the course of their professional work or other paid employment, delivers healthcare to children; and a person who holds a management position in an organisation, the duties of which include direct responsibility for, or direct supervision of, the provision of healthcare to children.

• What is to be notified? Reasonable grounds to suspect that a child is at risk of harm and those grounds arise during the course of, or from, the person’s work.

• Maltreatment types for which it is mandatory to report: Physical abuse, sexual abuse, emotional/ psychological abuse, neglect, exposure to family violence.

More information: • Relevant sections of the Act/ Regulations – Sections 23 and 27 of the Children and Young Persons (Care and Protection) Act 1998 (NSW). www.austlii.edu.au/au/legis/nsw/ consol_act/caypapa1998442/ • The NSW Government Department of Family & Community Services provides resources for mandatory reporters at www.community.nsw. gov.au/preventing-child-abuse-andneglect/resources-for-mandatoryreporters • New South Wales Mandatory Reporter Guide www.keepthemsafe. nsw.gov.au/reporting_concerns

Grants and financial incentives for rural GPs There are several grants available to GPs to encourage rural medical practice uptake, providing for such activities as relocation to a rural area, attendance at RDN’s Continuing Professional Development (CPD) conferences, upskilling as a condition of medical registration, and financial incentives to practise in rural and remote locations.

Some of these grants are administered

by RDN while others are available through external providers.

Transition Grants Transition Grants are administered by RDN in NSW on behalf of the Australian Government’s Rural and Remote General Practice Program (RRGPP). Up to $5,000 is available to eligible GPs transitioning to rural and remote NSW communities that are in need of general practice services.

More information, eligibility criteria and application forms are available at www.nswrdn.com.au/site/index. cfm?display=427816#Transition Continuing Professional Development (CPD) Vouchers RDN CPD vouchers are available to eligible GPs who are new to rural general practice, to enable attendance at an RDN conference. Vouchers cover full registration fees and, for GPs in more remote locations, an additional $500 toward travel and accommodation is provided.

Application forms and eligibility criteria are available from the RDN website at www.nswrdn.com.au/site/index. cfm?display=427816#CPD

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There are several grants available to GPs to encourage rural medical practice uptake...

Clinical Orientation (Training) Grants Clinical Orientation (Training) Grants are administered by RDN in NSW on behalf of the Australian Government’s RRGPP program. These grants are available to eligible doctors to cover the costs of training in advanced life support and/or Sexual & Reproductive Health as a stated condition on their medical registration.

Please check eligibility criteria for these grants via the RDN website at www.nswrdn.com.au/site/index. cfm?display=427816#Clinical Rural Procedural Grants Program The Rural Procedural Grants Program (RPGP) is an initiative of the Australian Government. It provides financial assistance for procedural GPs in rural and remote areas to access relevant activities in order to assist them in maintaining or updating their skills.

The program has two components: • GPs practising Emergency Medicine: Grants up to a maximum of three days training at $2,000 per day or a total of $6,000 per GP per financial year.

• GPs practising Surgery, Anaesthetics and/or Obstetrics: Training grants of $2,000 per day to a maximum of $20,000 per GP per financial year.

More information: www.nswrdn.com.au/ site/index.cfm?display=400909

General Practice Rural Incentives Programme

Rural Locum Assistance Programme

The General Practice Rural Incentives Programme (GPRIP) is an Australian Government incentive that commenced on 1 July 2010. GPRIP aims to promote careers in rural medicine as well as increase, recognise and retain medical practitioners in rural and remote Australia.

From 1 April 2016 Aspen Medical is managing the Rural Locum Assistance Programme (Rural LAP), which is an amalgamation of the Nursing and Allied Health Rural Locum Scheme (NAHRLS), the Rural Obstetric and Anaesthetic Locum Scheme (ROALS) and the Rural Locum Education Assistance Programme (Rural LEAP).

To be eligible, medical practitioners must deliver primary care services and/ or undertake GP registrar placements in regional and remote NSW. Payments are scaled according to MMM locations, length of practice and clinical workload of eligible services.

More information: www.nswrdn.com.au/ site/index.cfm?display=57833 Additional Assistance Scheme The Additional Assistance Scheme (AAS) provides educational and financial assistance to eligible doctors to support their efforts towards achieving Fellowship of either the Royal Australian College of General Practice (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM).

More information: www.nswrdn.com.au/site/additionalassistance

More information: www.rurallap.com.au

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Medicare Rebates and Rural Practice Incentives Medicare Provider Numbers A Medicare provider number is required to access Medicare rebates for services provided to patients. To qualify for a Medicare provider number, an application must be made through Medicare Australia. The number is location-specific and identifies the Medical Practitioner and the services they are providing, requesting or referring to.

Eligibility for a Medicare provider number is determined by the Health Insurance Act 1973 and its regulations. Refer to Sections 19AA and 19AB of the Act for more information: www.doctorconnect.gov.au/ internet/otd/publishing.nsf/Content/ section19AB www.doctorconnect.gov.au/ internet/otd/publishing.nsf/Content/ section19AA Medicare billing arrangements by doctors will vary depending on whether they choose to ‘bulk bill’ patients. Bulk billing means billing Medicare directly with no additional charge to the patient.

A practitioner may also choose to charge the patient a different fee for which the patient will need to pay the fee plus the gap.

Rural Locum Relief Program In 1996 the Australian Government restricted access to Medicare provider numbers for new medical practitioners.

Medical practitioners who gained medical registration in Australia after 1 November 1996, and are Australian permanent residents or Australian citizens, are required to obtain postgraduate qualifications in order to access Medicare. For general practice, the only qualifications currently accepted for this purpose are Fellowship of the Royal Australian College of General Practitioners (FRACGP) or Fellowship of the Australian College of Rural and Remote Medicine (FACRRM).

The Rural Locum Relief Program (RLRP) is an approved workforce program under Section 3GA of the Health Insurance Act 1973 and was developed in response to the provider number restrictions to allow affected medical practitioners to attract Medicare benefits while providing medical services in rural and remote Australia and working towards obtaining postgraduate qualifications in General Practice.

While the RLRP is a national program, it is administered in New South Wales by RDN. It is RDN’s responsibility to ensure that a GP position meets the needs of the community, is appropriate for your skills and training, and adequate mentoring will be provided. The program has a maximum term of four years.

For full RLRP guidelines and eligibility criteria, please refer to: www.nswrdn.com.au/site/rlrp

Medicare Benefits Schedule and MBS Online The Medicare Benefits Schedule (MBS) provides general information on the arrangements for the payment of Medicare benefits. Compliance with the schedule is monitored through the Medicare system. The schedule is regularly updated and can be accessed through MBS Online at www.mbsonline.gov.au/ All or part of the schedule may be downloaded from www.mbsonline.gov. au/internet/mbsonline/publishing.nsf/ Content/downloads MBS Online provides useful resources and information that you can tailor to your practice, which makes it easier when it comes to billing Medicare for services.

More information is available through RDN WebEd:

Learn more through the RDN WebEd online course Understanding the Medicare Benefits Schedule for Rural General Practice thinkgp.com.au/understandingmbs-rural-general-practice

online education

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Rural Other Medical Practitioners Programme (ROMPS) ROMPS provides access by nonvocationally registered (VRd) medical practitioners to the A1 higher Medicare rebates when providing GP services in eligible rural and remote areas.

For non-VRd medical practitioners (not-yet-Fellowed), in order for the patient to attract the highest Medicare rebates, you must work in rural general practice in RRMA 4-7 locations. In special circumstances some RRMA 3 locations also qualify. Normally, non-VRd medical practitioners would access the lower A2 Medicare rebate.

Normally non-vocationally recognised medical practitioners would access the lower A2 Medicare rebate.

For ROMPs guidelines and eligibility criteria, visit the Australian Government Department of Health (DoH) website at www.health.gov.au/internet/main/ publishing.nsf/Content/work-pr-romps The RRMA demographic of your practice location can be found on the DoctorConnect website at www. doctorconnect.gov.au/internet/otd/ publishing.nsf/Content/locator and more information about RRMA and RA classifications can be found in the Glossary (Appendix 2).

Practice Incentives Program (PIP) The PIP is aimed at supporting general practice activities to improve quality, access and health outcomes for patients.

Payments are available for accredited practices that meet the eligibility requirements for each incentive, which includes: • Asthma Incentive • After Hours Incentive • Cervical Screening Incentive • Diabetes Incentive • eHealth Incentive • GP Aged Care Access Incentive • Indigenous Health Incentive • Procedural GP Payment Incentive • Quality Prescribing Incentive • Rural Loading Incentive • Teaching Payment.

Current PIP forms and guidelines are accessible from the Department of Human Services website: www.humanservices.gov.au/healthprofessionals/services/medicare/ practice-incentives-program

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Every doctor practising medicine in Australia must be medically registered with the Medical Board of Australia.

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Rural Doctors Association of NSW

Aboriginal and Patient Torres Strait complaints Islander health Indigenous Australians are identified as Aboriginal or Torres Strait Islander or both Aboriginal and Torres Strait Islander.

Indigenous Australian people have health needs that are unique.

Doctors and health services have a responsibility to provide quality care and patients have state and national contacts through which to pursue a complaint if they are unhappy with the way their complaint is handled by a professional or healthcare service:

The Council of Australian Governments (COAG) is committed to the Closing the Gap strategy that aims to reduce Indigenous disadvantage regarding life expectancy, child mortality, access to early childhood education, educational achievement and employment outcomes.

• National Health Practitioner Ombudsman & Privacy Commissioner www.nhpopc.gov.au/

More information about Closing the Gap is available on the HealthInfoNet website: www.healthinfonet.ecu.edu.au/closingthe-gap

• Australian Health Practitioner Regulation Agency (APHRA) www.ahpra.gov.au/Notifications. aspx

More information about the health system and Aboriginal and Torres Strait Islander people is available on the healthdirect Australia website: www.healthdirect.gov.au/indigenoushealth

• The NSW Medical Council www.mcnsw.org.au

All rural doctors should complete an Introduction to Aboriginal and Torres Strait Islander Cultural Awareness program such as:

Professional support organisations for rural NSW general practice

• ACRRM’s online Cultural Awareness module is proving a rewarding and enlightening experience for medical practitioners and their practice staff. The module, which leads to PIP Indigenous Health Incentive, provides learners with personalised commentary from the moderator. www.acrrm.org.au/culturalawareness-indigenous • The RACGP online training module. www.racgp.org.au/yourracgp/ faculties/aboriginal/education/ resources-for-gps-and-practicestaff/cultural-awareness • The Western Australia Centre for Rural Health has an online Aboriginal Cultural Orientation package for health professionals. lms.cucrh.uwa. edu.au/login/index.php • Refer to Life in Australia / Aboriginal and Torres Strait Islander Peoples in this guide for more resources on cultural awareness training for Indigenous peoples.

• Health Care Complaints Commission NSW www.hccc.nsw.gov.au Other useful sources of information are:

RDN works with the Rural Doctors Association of NSW (RDA), an industrial and medical political body that aims to improve the working conditions and pay for rural GPs with particular relevance to those who provide services as Visiting Medical Officers (VMOs) in the NSW public hospital system. We would strongly advise you to join, particularly if you intend to work in a NSW rural hospital as a GP VMO. Membership will give you access to a range of support services as well as the RDA computerised billing software – a must-have item to bill as a GP VMO. Website: www.rdansw.com.au/ Primary Health Networks Primary Health Networks (PHNs) are the Federal Government’s primary healthcare organisations. Their purpose is to support general practice in NSW. Website: www.health.gov.au/internet/ main/publishing.nsf/Content/PHNHome Australian Medical Association

RDN GP Locum Program The RDN GP Locum Program provides and facilitates short term locum relief for permanent GPs located in rural NSW RA2-5 locations. It aims to improve the retention of rural GPs by providing costsaving locum services.

For locum support, contact the RDN GP Locum team by email locums@nswrdn. com.au or phone 02 4924 8000.

More information: www.nswrdn.com.au/ site/index.cfm?display=108654

The Australian Medical Association (AMA) is an independent political organisation representing the professional interests of doctors in NSW and across Australia in all areas of practice, both private and salaried positions, whether specialists, academics, researchers or student/trainees. More information: • NSW – www.amansw.com.au • National – www.ama.com.au

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Rural medical CRANAplus family support Bush Support Services The NSW Rural Medical Family Network (RMFN) is funded by RDN to support and assist medical families in rural and remote medical practice by:

The NSW Rural Medical Family Network is funded by RDN to support and assist medical families in rural and remote medical practice

• Creating a friendship network through the Bush Friends Mentoring Program to lessen feelings of loneliness and isolation experienced by some rural families.

• Providing family programs at CPD weekends and medical conferences.

• Providing crisis assistance for rural doctors and their families who are stressed or ill.

More information is available on the RMFN website at www.rmfn.org.au or phone the NSW Family Program Coordinator on 02 6545 2461.

CRANAplus is a member-based organisation dedicated to the development and delivery of safe, high quality primary healthcare to remote and isolated areas of Australia through the education and support of remotely-based health practitioners and advocacy for the issues affecting them and the people in their care. It provides Bush Support Services (BSS) through a 24-hour helpline, which is staffed by psychologists who have worked in rural and remote areas. The BSS provides free and confidential (callers can remain anonymous) personalised care for remote health professionals working in rural and remote locations.

More information: crana.org.au/ support/about-bush-support-services/ Bush Support Line (open 24 hours): 1800 805 391

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New Rural GP Orientation Training

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An ever-increasing range of orientation training is becoming available for GPs, including OTDs, and doctors new to rural general practice. Searching the medical college websites–RACGP and ACRRM–is a good place to start. Below are some examples of training opportunities.

RDN New Rural GP Orientation Program RDN runs a New Rural GP Orientation Program (NGPO) for all GPs who are new to rural NSW practice, including Overseas Trained Doctors (OTDs).

The two-day introduction to rural general practice is considered valuable preparation for transition into rural NSW medical practice and supports GPs in delivering high quality medical services to rural NSW communities.

Program content includes: • Clinical orientation e.g. working as a rural doctor, introduction to Sexual Health/Family Planning, communication in general practice

• Professional orientation e.g. introduction to NSW Ministry of Health, Medicare Benefits Scheme, Pharmaceutical Benefits Scheme, cultural awareness, accessing GP/VMO support organisations, pathways to Fellowship and exam preparation, managing workplace injury or illness cases • Social orientation e.g. achieving work/life balance, Rural Medical Family Network supports.

Enquiries about the NGPO can be directed to RDN’s Medical Retention team by email rhwprograms@nswrdn. com.au or phone 02 4924 8000.

Some of the NGPO modules are available through RDN WebEd, RDN’s online education support service, at thinkgp.com.au/new-rural-gporientation, along with other learning opportunities such as Medicare billing matters.

LEARN ONLINE Some sessions from the NGPO workshop are available as online learning modules through RDN WebEd. All modules are accredited for CPD points with the RACGP and ACRRM. Learn at a time and place that suits you. thinkgp.com.au/new-rural-gporientation

online education

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Family planning and sexual health resources

Family Planning NSW The State Family Planning Associations provide valuable support and training resources. Family Planning NSW (FPNSW) offers a number of face-to-face and online courses: • Courses, scholarships and training grants: www.fpnsw.org.au/index_ education.html • Online modules: thinkgp.com.au/ fpnsw

NSW Sexually Transmissible Infections Program Unit The NSW Sexually Transmissible Infections Program Unit (STIPU) provides online training in sexual health. Courses are accessible at thinkgp.com.au/stipu and include: • STI Contact Tracing for General Practice • Key features in managing STIs STI testing tool.

Website: www.stipu.nsw.gov.au

Other resources

The Victorian Postgraduate Medical Council has an excellent orientation manual but note that some items are specific to Victoria: www.pmcv.com.au/img/resources-for-imgs/orientation-manual

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Continuing Professional Development Opportunities

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GPs and doctors are required to maintain skills through Continuing Professional Development (CPD) activities to be able to practise in Australia. There is a range of opportunities for rural GPs, some of which are listed here.

Itâ&#x20AC;&#x2122;s useful to be aware of the RDN GP Locum Program, which facilitates leave for rural GPs for such activities as CPD events. For locum support, contact the RDN GP Locum team by email locums@nswrdn.com.au or phone 02 4924 8000. More information: www.nswrdn.com.au/site/index. cfm?display=108654

RDN refresher and procedural conferences RDN facilitates several CPD opportunities each year for rural NSW GPs, including family-friendly conferences. RDN CPD events involve clinical lectures, workshops and discussion groups, as well as other lifestyle topics such as financial management, doctor health and family wellbeing.

RDN also runs procedural medicine conferences on rural emergency skills, anaesthetics, obstetrics and GP surgery (these conferences do not cater for families).

Upcoming RDN CPD events: www.nswrdn.com.au/site/cpdconferences

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Rural Emergency Skills Training The Rural Emergency Skills Training (REST) course: • Enables rural GPs to enhance their emergency medicine skills • Trains urban GPs for rural locum work by broadening their clinical skills and offering essential emergency medicine skills training.

REST courses are run twice per year in NSW by the Australian College of Rural and Remote Medicine (ACRRM).

The two-day training and assessment program is held during a weekend and includes lectures, demonstrations and practical components.

Funding is available to eligible rural GPs to attend the course through RDN’s Clinical Orientation (Training) Grant: www.nswrdn.com.au/site/index. cfm?display=427816#Clinical More information is available on the ACRRM website as well as upcoming courses in NSW: www.acrrm.org.au/ continuing-development/face-to-facelearning/courses/rural-emergencyskills-training-rest

RDN WebEd – online education RDN WebEd is RDN’s online education support service for GPs to learn at a time and location that suits their schedule.

A range of training courses are available to support rural NSW health professionals and practices in non-clinical aspects of their roles, for example: • Understanding the Medicare Benefits Schedule for Rural General Practice.

• New Rural GP Orientation – some modules from the face-to-face workshop.

All modules are accredited with the ACRRM and the RACGP, with automatic CPD points notification to the colleges for eligible doctors. A printable Certificate of Completion is issued at the end of each module for learner portfolios.

Courses are free of charge, though registration of RDN WebEd is required.

• More information: www.nswrdn. com.au/site/rdnwebed • Visit the RDN WebEd website: thinkgp.com.au/rdnwebed

• Recruitment-Ready for Practice Managers – information and resources to assist with selecting the right person for a position and tips on retaining them.

online education

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General Practice is seen as a specialist medical discipline in Australia.

Additional Assistance Scheme The Additional Assistance Scheme (AAS) provides financial assistance to eligible doctors to support their efforts towards achieving Fellowship of either the Royal Australian College of General Practice (RACGP) or the Australian College of Rural and Remote Medicine (ACRRM).

Eligibility criteria apply.

More information is available on the RDN website: www.nswrdn.com.au/site/ additional-assistance

Vocational Other CPD training for GPs opportunities General Practice is seen as a specialist medical discipline in Australia.

Recognition as a GP specialist carries with it significant financial and perceived quality benefits. More information: • www.health.gov.au/internet/main/ publishing.nsf/Content/work-stagpt • www.agpt.com.au The Remote Vocational Training Scheme allows rural GPs to undertake GP vocational training (both RACGP and ACRRM) in rural areas via distance education and remote supervision. www.rvts.org.au For GPs working towards postgraduate Fellowship, the curriculum and pathway to vocational registration can be followed in either the RACGP or ACRRM or both.

For further information, please visit: • RDN’s Pathways to Fellowship web page www.nswrdn.com.au/ fellowship • Australian College of Rural and Remote Medicine www.acrrm.org. au/vocational-training • Royal Australian College of General Practitioners www.racgp.org.au/ becomingagp/what-is-a-gp/whyfellowship/

In addition to the CPD opportunities that RDN facilitates, upskilling can also be accessed through these organisations: • PHNs www.health.gov.au/internet/main/ publishing.nsf/Content/PHN-Home • RACGP www.racgp.org.au/education • ACRRM www.acrrm.org.au/courses-events RDN also promotes education opportunities through its weekly e-newsletter, Monday Message.

• View newsletter archives: www.nswrdn.com.au/site/ newsletter • Subscribe: www.nswrdn.com.au/site/subscribe

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Overview of the Australian Healthcare System

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Australia’s system of government – an overview Australia is a federation, a constitutional monarchy and a parliamentary democracy.

It is a federation of six states: New South Wales (NSW), Queensland (QLD), Victoria (VIC), South Australia (SA), Tasmania (TAS) and Western Australia (WA); each of which has their own government. There are two self-governing territories: The Australian Capital Territory (ACT) and the Northern Territory (NT).

The federal government has no power to override the decisions of state governments except in accordance with the federal Constitution, but it can exercise that power over territories.

Read more about Australia’s system of government: www.australia.gov.au/topics/government-and-parliament

The federal health context The Australian Government’s role through the Commonwealth Department of Health (DoH) is to develop national health policies, including those directly relating to the healthcare of all Australian Citizens and Permanent Residents, by regulating and providing funding.The Medicare system funds medical services such as: • Medicare Benefits Schedule (MBS) which subsidises health services.

• Pharmaceutical Benefits Scheme (PBS) which subsidises medications.

• Aged care services, such as nursing homes.

• Health services to Defence Force members.

• Health services to Aboriginal and Torres Strait Islander communities.

In general terms, the Commonwealth has developed a broad policy of leadership and financing role in health matters and focuses on the areas of public health, research and national information management while the states and territories are largely responsible for the delivery of public sector health services and the regulation of health workers in the public and private sectors.

The states and territories deliver public acute and psychiatric hospital services, including school health, dental health, maternal and child health and environmental health programs.

More information on federal health services is available through the DoH website: www.health.gov.au/internet/ main/publishing.nsf/Content/Home

In New South Wales there are 15 Local Health Districts (LHDs) that are responsible for providing health services in a wide range of settings, from primary care posts in the remote outback to metropolitan tertiary health centres.

LHDs work in conjunction with PHNs to ensure continuity and integration of primary healthcare services.

More information about LHDs: www.health.nsw.gov.au/lhd/pages/ default.aspx

The state health context Each Australian state and territory has its own Department of Health to administer state-based health services.

In New South Wales it is administered by the NSW Ministry of Health (MoH). The NSW public health system is world-class.

It is the biggest public health system in Australia with more than 220 public hospitals and more than 100,000 staff who form the health workforce.

MoH supports the executive and statutory roles of the NSW Minister for Health and provides regulatory functions, public health functions (disease surveillance, control and prevention) and system manager functions in state-wide planning, purchasing and performance, and monitoring of hospitals and health service.

In addition, two specialist networks focus on Children’s and Paediatric Services, and Justice and Forensic Mental Health: • Justice Health: www.justicehealth. nsw.gov.au/ • Sydney Children’s Hospital Network: www.schn.health.nsw.gov.au/ A third network operates across the public health services provided by three Sydney facilities operated by St Vincent’s Health. These include St Vincent’s Hospital and the Sacred Heart Hospice at Darlinghurst and St Joseph’s at Auburn.

More information about St Vincent’s services: www.svmhs.com.au/ The Ambulance Service of NSW is responsible for the delivery of frontline pre-hospital care, medical retrieval and health related transport: www.ambulance.nsw.gov.au/ More information on NSW health services is available through the MoH website:www.health.nsw.gov.au/Pages/ default.aspx

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The ‘pillar’ agencies of NSW healthcare Agency for Clinical Innovation (ACI) The Agency for Clinical Innovation (ACI) is the lead agency in New South Wales for promoting innovation, engaging clinicians and designing and implementing new models of care.

Website: www.aci.health.nsw.gov.au/ Bureau of Health Information (BHI) The Bureau of Health Information is a board-governed organisation that provides independent reports about the performance of the NSW public healthcare system.

NSW Kids and Families NSW Kids and Families provides leadership to the NSW health system. It partners with stakeholders to champion outstanding health, wellbeing and healthcare for all children, young people and families and reduce the health impact of sexual, domestic and family violence, child abuse and neglect.

Website: www.kidsfamilies.health.nsw. gov.au/ Cancer Institute NSW The Cancer Institute is Australia’s first state-wide cancer control agency. It is dedicated to lessening the impact of cancer by keeping as many people off the cancer journey as possible and improving outcomes in diagnoses, treatment, care and ultimately survival.

Website: www.cancerinstitute.org.au/

Website: www.bhi.nsw.gov.au/

NSW Mental Health and Drug and Alcohol Office

Clinical Excellence Commission (CEC)

“The Mental Health and Drug & Alcohol Office (MHDAO) is responsible for developing, managing and coordinating NSW Department of Health policy, strategy and program funding relating to mental health and the prevention and management of alcohol and drug related harm. The office also supports the maintenance of the mental health legislative framework.

The Clinical Excellence Commission (CEC) is responsible for leading safety and quality improvement in the NSW public health system. It was established in 2004 to promote and support improved clinical care, safety and quality across New South Wales.

Website: www.cec.health.nsw.gov.au/ Health Education and Training Institute (HETI) The Health Education and Training Institute (HETI) undertakes a core role in supporting the NSW health system in its education and training requirements.

HETI works closely with LHDs, specialty health networks (SNs), other public health organisations and health education and training providers to ensure the development and delivery of health education and training across the NSW health system.

Website: www.heti.nsw.gov.au/

The work of MHDAO is delivered mainly through the mental health program and the drug & alcohol program, in partnership with Local Health Districts, Justice Health, Children’s Hospital Westmead, Non Government Organisations, research institutions and other partner departments.”

Source: www.health.nsw.gov.au/mentalhealth/ Pages/mhdao.aspx

Website: www.health.nsw.gov.au/ mentalhealth/pages/default.aspx

Healthcare delivery in a diverse country Challenges and innovations People living in Australia are fortunate to have a world-class healthcare system with a health expenditure that supports the objective of a healthy life expectancy.

However, there are unique challenges to providing healthcare in Australia to all communities: • The expanse of population settlement throughout Australia makes equitable access to health services an issue. People live in metropolitan, regional, rural and remote areas with diverse terrains and climates.

• Raising the life expectancy of Aboriginal and Torres Strait Islander peoples remains a challenge given that some Indigenous communities still experience diseases similar to populations in developing countries.

• Australia is a country whose cultural diversity is broad. It has become home to people from many ethnic origins. With more than 200 languages (including 43 Indigenous languages) and associated cultures, health practitioners need to be cognisant of this diversity in their community and in their role of providing appropriate healthcare services.

• Australia has an ageing population.

• Significant chronic diseases are a challenge for Australian health practitioners, in particular, diabetes, cancer, cardiovascular, chronic obstructive pulmonary disease (COPD), obesity, bone and muscular disease, and mental illness.

Yet there are some innovative solutions to health issues arising out of Australia’s unique history and needs. Notable among these are:

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• The Royal Flying Doctor Service; this service delivers care to remote areas by aircraft.

• Aboriginal healthcare services; these are funded principally to provide services to Aboriginal and Torres Strait Islander peoples. They may or may not be communitycontrolled.

• Aboriginal Community Controlled Health Services (ACCHSs); these are primary healthcare services initiated and operated by local Aboriginal communities to deliver holistic, comprehensive and culturally appropriate healthcare to the communities which control them.

• Australian Red Cross; this organisation operates Australia’s blood donation system and coordinates matching of donors and recipients for organ transplants. It receives Commonwealth, state and territory government funding for those activities.

• Local government also plays an important role in the provision of health related services e.g. through its responsibilities for sanitation and hygiene, food safety and water quality monitoring. Social planning and facilities that provide health promotion opportunities such as physical activity, access to healthy food and injury prevention are also administered by Local Government Authorities (LGAs). These are often referred to as Local Councils. LGAs are also involved in direct provision of community health services, such as community safety, Meals on Wheels, some Commonwealth Home Support Programme (CHSP) services, youth centres and child care services.

payment agency. Human Services administers Medicare on behalf of the Department of Health (DoH), who is responsible for developing Medicare policy.

“Medicare usually covers: • free or subsidised treatment by health professionals such as doctors, specialists, optometrists and in specific circumstances dentists and other allied health practitioners • free treatment and accommodation as a public Medicare patient in a public hospital • 75% of the Medicare Schedule fee for services and procedures if you are a private patient in a public or private hospital. This does not include hospital accommodation and items such as theatre fees and medicines We pay Medicare benefits in accordance with legislation governing Medicare and we have no discretion to pay benefits outside of this legislation.

The Medicare Benefits Schedule (MBS) lists services that are subsidised by the Australian government under Medicare.

Check if a service is listed under Medicare on the Department of Health MBS Online website www.mbsonline. gov.au Source: www.humanservices.gov.au/customer/ subjects/medicare-services

The organisation is responsible for administering payments and information for programs such as: • Medicare • Pharmaceutical Benefits Scheme (PBS) • Australian Childhood Immunisation Register (Immunisation Register) • Australian Organ Donor Register.

More information about Medicare services:

Australia’s public health system – Medicare Medicare Australia is administered by the Australian Government Department of Human Services (Human Services).

Medicare Australia is Australia’s principal health information management and

• Medicare website: www.humanservices.gov.au or www.humanservices.gov.au/ customer/dhs/medicare • Phone Medicare: 1300 302 122 • Email Medicare: medicare@ medicareaustralia.gov.au • Practice Incentives Program (PIP): www.medicareaustralia.gov.au/ provider/incentives/pip/ • Practice Nurse Incentive Program (PNIP): www.medicareaustralia.gov. au/provider/incentives/pnip.jsp

Medicare Levy Medicare is financed through progressive income tax and an income-related Medicare levy on Australian taxpayers and is the universal health insurance scheme for all Australian citizens and legal residents, and for citizens of countries with which Australia has a Reciprocal Health Care Agreement.

Eligible people may apply for a Medicare Card. See the Migrants and Travellers section of the Medicare site for more information: www.humanservices. gov.au/customer/services/medicare/ reciprocal-health-care-agreements

Medicare Cards Medicare Card holders have access to free treatment as a Medicare patient in public hospitals. Medicare also provides free or subsidised healthcare in the community to eligible patients including the services of general practitioners and specialists, and may cover part of the cost of patient tests and examinations.

Most people holidaying or studying in Australia are not eligible for a Medicare Card.

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Medicare Safety Net “If you see a doctor often, or have tests regularly, your medical costs could be high. Visiting a doctor or having tests may cost you less once you reach a Medicare Safety Net threshold.

Once you reach the relevant threshold, the Medicare Safety Net may provide a higher Medicare benefit for all eligible services for the rest of the calendar year. This may mean that visits to your doctor or having tests could cost you less. For example, once you reach the relevant threshold, you still pay the same amount upfront to your doctor, however you may receive a higher Medicare benefit, making your out of pocket expenses much less.”

Source: www.humanservices.gov.au/customer/services/medicare/medicare-safety-net

Medicare Provider Numbers Doctors To work as a doctor in Australia you may need to have a Medicare provider number. This number: • Uniquely identifies both you and the place you work • Allows your patients to claim Medicare rebates for the services you provide • May also allow you to raise referrals for specialist services and make requests for pathology or diagnostic imaging services.

If you satisfy the legislative requirements, a provider number may also be used to attract Medicare rebates for professional services rendered e.g. treat private patients. It does not automatically allow you to attract Medicare rebates for your services. You should ask your Australian employer which level of Medicare access for a provider number you need.

Refer to previous section “Medicare Rebates and Rural Practice Incentives” (page 8) for more information.

Nurses and Midwives Eligible nurse practitioners, midwives and allied health professionals are able to access specific items in the Medicare Benefits Schedule (MBS) and limited items under the Pharmaceutical Benefits Scheme (PBS).

To be eligible to access these services you must: • Be registered with the Nursing and Midwifery Board of Australia • Have an endorsement on your registration as a nurse practitioner OR a notation on your midwifery registration • Have a collaborative arrangement with one or more medical practitioners • Have a Medicare provider number and/or a PBS prescriber number.

More information is available from the Australian Government Department of Health website:

Allied Health Professionals “Medicare provider/registration numbers are allocated to allied health professionals to enable them to participate in the Medicare allied health and dental care initiative and to provide a method of identifying the place from which a service is provided.

Medicare provider/registration numbers are also allocated to physiotherapists, osteopaths, chiropractors or podiatrists for the purposes of enabling these health professionals to request certain diagnostic imaging services as set out in the Medicare Benefits Schedule (MBS) Book.

• Midwives www.health.gov.au/ internet/main/publishing.nsf/ Content/midwives-nurse-practqanda

An allied health professional applying for registration under the allied health and dental initiative must be in private practice, and services claimed under this initiative must be performed while working in a private capacity.”

• Nurse practitioners www.health. gov.au/internet/main/publishing. nsf/Content/midwives-nurse-practqanda-nursepract

Source: www.humanservices.gov.au/healthprofessionals/forms/hw063 (Excerpt from PDF document Application for an initial Medicare provider/registration number for an Allied Health Professional.)

Application for a Medicare and/ or PBS prescriber number: www. humanservices.gov.au/sites/default/ files/documents/2960-1102en.pdf

To be eligible to access these services you must apply for a unique provider/ registration number for each required location. Access the application form for an initial Medicare provider number: www.humanservices.gov.au/healthprofessionals/forms/hw063

See the Nursing and Midwifery Board of Australia’s website regarding the process to obtain endorsements and notations on your registration: www.nursingmidwiferyboard.gov. au/Registration-and-Endorsement/ Endorsements-Notations.aspx

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Medicare Benefits Pharmaceutical Schedule (MBS) Benefits Scheme (PBS) The Medicare Benefits Schedule (MBS) primary care items support primary care services including: general attendances, after-hours attendances, health assessments, chronic disease management and mental health care.

Some of these services provide particular target groups with preventative health care or improved coordination of multidisciplinary care for people with chronic (or terminal) conditions and complex care needs. The items include support for services which may be provided by practice nurses, Aboriginal health workers and other allied health professionals.

All provider numbers comprise: • A six-digit provider stem, or (0) 5 digits stems e.g. (0)12345.

• A practice location identifier, either a digit or alpha character.

• A check-digit (for validity) consisting of a single alpha character.

More information: www.mbsonline.gov. au/internet/mbsonline/publishing.nsf/ Content/Home You may also find the following factsheets helpful in interpreting areas of the MBS: www.mbsonline.gov.au/internet/ mbsonline/publishing.nsf/Content/ factsheets

Since 1948 the federal government has been able to make a range of prescription medicines available to eligible patients at a subsidised cost, whether patients access them by prescription from their community-based GP or Specialist or through the hospital system for discharged patients.

The Australian Government Department of Health oversees the management of the PBS. Medicare Australia administers the PBS and the listed medicines, as well as the approval for medical practitioners to prescribe PBS medicines. See the PBS website for more information: www.pbs.gov.au/info/about-the-pbs Pharmaceutical benefits can only be prescribed by doctors, dentists, optometrists, midwives and nurse practitioners who are approved to prescribe PBS medicines under the National Health Act 1953. You must apply to Medicare for a PBS prescriber number.

Learn more: www.pbs.gov.au/info/healthpro/explanatory-notes/section1/ Section_1_2_Explanatory_Notes

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Since 1948 the federal government has been able to make a range of prescription medicines available to eligible patients at a subsidised cost...

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Australia’s Primary private health healthcare insurance system Australia has a unique dual system of public and private healthcare, with private health insurance playing an important role in complementing the healthcare options such as choosing your own doctor, shorter waiting times for elective surgery and therapies not covered by Medicare. The Private Health Insurance Administration Council (PHIAC) regulates the private health industry. www.phiac.gov.au If you haven’t yet applied for permanent residency in Australia or if you come here on a temporary visa, it is a requirement of the visa that you purchase health insurance cover to protect yourself and your family for any unforeseen medical expenses. More information: www.border.gov.au Not all health insurance companies will cover 457 visa applicants but the following companies do. It is always advisable to shop around to get the best deals. RDN does not endorse any of these companies.

BUPA www.bupa.com.au/health-insurance/ cover/overseas-visitors/ MEDIBANK www.medibank.com.au/Visitors-Cover/ About-Working-Visa-Cover.aspx IMAN Australian Health Plans www.austhealth.com/457-visa-healthinsurance HCF www.hcf.com.au/healthinsurance/ overseas-visitors-health-cover/ Some private healthcover comparison sites: • www.iselect.com.au/overseasvisitors-cover.jsp?onsite=health _fr_health • www.457visacompared.com. au/457-visa-health-insurance/

Primary Health Care (PHC) incorporates personal care with health promotion, the prevention of illness and community development. The philosophy of PHC includes the interconnecting principles of equity, access, empowerment, community self-determination and intersectoral collaboration. It encompasses an understanding of the social, economic, cultural and political determinants of health. The aim of good PHC is to keep, and look after, people in their homes, utilising community health services/centres and GPs. The Australian Primary Health Care Research Institute (APHCRI) defines PHC as: “socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes health promotion, illness prevention, treatment and care of the sick, community development and advocacy.”

Source: aphcri.anu.edu.au/about-us/what-primaryhealth-care

More information on PHC can be found at the Primary Health Care Research & Information Service (PHCRIS) website: www.phcris.org.au

PHNs PHNs are the Federal Government’s primary healthcare organisations which replaced the former Medicare Locals from 1 July 2015.

“PHNs have been established with the key objectives of increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes, and improving coordination of care to ensure patients receive the right care in the right place at the right time.”

Source: www.health.gov.au/internet/main/ publishing.nsf/Content/PHN-Home

RDN works with seven PHNs serving rural NSW. These are viewable, along with their contact details, on the RDN website at www.nswrdn.com.au/site/index. cfm?display=564479

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Community healthcare Each year many more people receive their healthcare in community-based settings than are admitted to hospitals.

This care is provided by GPs, community health services, allied health services and other community care providers.

NSW Ministry of Health has adopted the term “Primary and Community Health” to describe the overlapping primary healthcare and community health sectors and services.

Community health refers to a range of community-based prevention, early intervention, assessment, treatment, health maintenance and continuing care services delivered by a variety of providers. Community health services predominantly operate from a social

and connectivity between health care providers in primary care, community and hospital settings, and better access to community-based services close to home.”

model of health whereby improvements in health and wellbeing are achieved by directing efforts towards addressing the social and environmental determinants of health. The NSW public health system provides the majority of community health services.

Source: www.health.nsw.gov.au/integratedcare/ Pages/default.aspx

An ageing population, a shrinking health workforce and increasing health costs have driven a focus on health promotion and disease prevention by keeping Australians well and in the community.

“The NSW Government has committed $180 million over six years to implement innovative, locally led models of integrated care across the State to transform the NSW healthcare system.”

NSW Integrated Care Strategy

Source: www.health.nsw.gov.au/integratedcare/ Pages/Integrated-Care-Strategy.aspx

“Integrated care involves the provision of seamless, effective and efficient care that reflects the whole of a person’s health needs; from prevention through to end of life, across both physical and mental health, and in partnership with the individual, their carers and family. It requires greater focus on a person’s needs, better communication

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Health facilities overview Public hospitals include hospitals which have been established by governments as well as hospitals originally established by charitable or religious bodies, most of which are now directly funded by government. In addition, there are a small number of hospitals built and managed by private firms which provide public hospital services under funding arrangements with State governments.

Most acute care beds, emergency departments and outpatient clinics are based in public hospitals. Larger, urban public hospitals provide most of the more complex type of hospital care such as intensive care, major surgery, organ transplants and specialists’ outpatient clinics.

Private hospitals can be owned by forprofit and not-for-profit organisations such as large corporate operators and private health insurance funds. In the past private hospitals tended to provide less complex non emergency care, such as simple elective surgery. However, private hospitals are increasingly providing complex, high technology services.

Separate centres, found mostly in the private sector, provide same-day surgery and other non-inpatient operating room procedures. Many public hospitals provide such services on the same site as in-patient care.

In recent years the NSW Ministry of Health has been establishing Multi Purpose Service (MPS) facilities in smaller rural towns. These modern facilities are designed to integrate existing facilities and house aged care, acute hospital care and community health services on the one site.

Typical Mental organisational health care structure of a rural hospital Most rural hospitals employ a Service Manager (often referred to as an HSM – Health Service Manager) who is responsible for the day-to-day operations of the hospital.

Larger hospitals will generally employ a Director of Medical Services (DMS) or a Director of Clinical Services (DCS) who is usually a medical practitioner (often a specialised Medical Administrator with a Fellowship of the Royal Australian College of Medical Administrators (FRACMA)). In rural areas a DMS or DCS will oversee the administration of clinical services for a number of smaller hospitals or MPS facilities.

Larger hospitals usually employ a Director of Nursing overseeing Nurse Managers in charge of individual wards/ units. Smaller hospitals will usually have one Nurse Manager (who may also be the HSM), while a Registered Nurse (RN) is in charge of a shift.

Many rural hospitals do not directly employ doctors and many rural GPs have Visiting Medical Officer (VMO) appointments with the Local Health District to allow them to admit patients and to provide on-call services.

A VMO is a medical practitioner appointed by the hospital board as an independent contractor to provide medical services for hospital (public) patients on an honorary, sessionally paid, or fee-for-service basis.

A matrix style management system usually operates where a VMO will report professionally to the DCS/DMS, and administratively to the HSM. This means that nurses are the senior health practitioners permanently on site in the smaller rural hospitals and MPSs. Most LHDs have centralised systems of support in areas such as Finance, IT and HR support, as well as the diagnostic services of radiology and pathology.

“Mental health related services are provided in Australia in a variety of ways, including: hospitalisation and other residential care; hospital-based outpatient services; community mental health care services; and consultations with both specialists and general practitioners (GPs).

Access to psychologists and other allied health providers may, dependent on eligibility, be subsidised through initiatives such as the Better Access initiative which gives patients Medicaresubsidised access to psychologists and other allied health providers after the preparation of a Mental Health Treatment Plan by a GP. The Australian Government also subsidises mental health-related services through the MBS and prescribed medications through the PBS and RPBS. State and territory governments fund and deliver services and assist with broader needs, such as accommodation support.”

Source: mhsa.aihw.gov.au/background/

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Aged care Australia’s aged care system is structured around two main forms of delivery: • Residential (accommodation and various levels of nursing and/ or personal care). These services are mainly in the non-government sector, about half being operated by religious and charitable organisations.

• Community care (ranging from delivered meals, home help and transport to intensive co-ordinated care packages such as personal hygiene and house cleaning for people who would otherwise need residential care).

Aged Care Assessment Teams (ACAT) ACATs help older people and their carers work out what kind of care will best meet their needs when they are no longer able to manage at home without assistance.

They provide information on suitable care options and can help arrange access or referral to appropriate residential or community care.

The Australian Government provides funds to the state and territory governments specifically to operate and manage the ACATs. The states and territories also provide funding to the ACATs. More information: www.myagedcare.gov.au/eligibilityand-assessment/acat-assessments

CHSP combines these former programs:

ACATs assess and approve older people for Australian Government subsidised aged care services such as the Commonwealth Home Support Programme (CHSP).

• Assistance with Care and Housing for the Aged (ACHA) Program.

Commonwealth Home Support Programme (CHSP) “The Commonwealth Home Support Programme (CHSP) is one of the changes being made by the Australian Government to the aged care system to help older people stay independent and in their homes and communities for longer. The CHSP is one consolidated programme providing entry-level home support for older people who need assistance to keep living independently.”

Source: agedcare.health.gov.au/programs/ commonwealth-home-support-programme

• Commonwealth Home and Community Care (HACC) Program • National Respite for Carers Program (NRCP) • Day Therapy Centres (DTC) Program

More information about: • The CHSP www.dss.gov.au/ ageing-and-aged-care/programsservices/commonwealthhome-support-programme/ about-the-commonwealth-homesupport-programme • The NSW HACC transition to CHSP www.health.nsw.gov.au/agedcare/ Pages/HACC-transition.aspx Find a list of aged care service providers in NSW through the Human Services Network (HSN): www.hsnet.nsw.gov.au More information about Australia’s aged care services: • www.myagedcare.gov.au/ • www.adhc.nsw.gov.au/individuals/ help_at_home

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Evolution of the Australian Industrial Relations (IR) system In the early part of the twentieth century, the role of the Commonwealth Court of Conciliation and Arbitration resolved industrial disputes which extended beyond the limits of any one state.

“The establishment of special tribunals in Australia for industrial relations purposes had its origins in the major strikes of the 1890s. These bitter struggles between capital and organised labour caused widespread dislocation and distress. The damage done to the social and economic fabric of colonial society led to a growing community belief that, if employers and unions could not resolve their disputes, then they should be required in the public interest to submit their competing claims to an independent third party for arbitration: a ‘new province for law and order’ should replace what had become the law of the jungle.”

The Australian Industrial Relations Commission would also certify enterprise bargaining agreements. These agreements were negotiation collective contracts commonly between a union (as representative of the employees on the site) and an employer of a site.

The Australian Industrial Relations Commission also registered trade unions and dealt with demarcation disputes between unions.

Finally the Australian Industrial Relations Commission dealt with unfair dismissal applications.

In 2009 the AIRC became Fair Work Australia: www.fairwork.gov.au/ For a history of how the unique Industrial Relations system came about you can download a PDF document from www.airc.gov.au/about/ourhistory/ overview.pdf or view a timeline: www. fairwork.gov.au/about-us/the-fair-worksystem/australias-industrial-relationstimeline

Two main IR systems

Source: www.airc.gov.au/about/ourhistory/ overview.pdf

1. The Federal System

In practice this became a system of ‘paper disputes’ where a union or other employee organisation would write to a group of employers and demand certain terms and conditions (a log of claims or log of demand).

The Federal system is referred to as the Fair Work system – this covers all but those employed by NSW Ministry of Health funded employers e.g. those employed in NSW public hospitals and community health facilities.

The employers would then reject part or all of the demands, creating an industrial dispute. This dispute would then be arbitrated upon, with the result of the arbitration being an Industrial Award.

The Fair Work (national) system includes a number of important features, which both employers and employees must comply with, including:

Awards Throughout the years from 1904 to 2006 the Australian Industrial Relations Commission (as it became known) created Awards which set the minimum terms and conditions of employment for people who worked for certain employers. A standard Award would have approximately 20-30 conditions and would be around 40 pages in length.

The Awards were periodically reviewed.

• The 10 minimum National Employment Standards (NES).

• Modern awards for specific industries and occupations.

• A national minimum wage order (where it applies).

• Protection from unfair dismissal.

It has two main components: Modernised Awards and ten National Employment Standards (NESs). The Awards set minimum terms and conditions such as wages and allowances as well as incorporating the NESs. The NESs cover hours, leave, termination and redundancy predominantly. More information: www.fairwork.gov.au/ employee-entitlements/nationalemployment-standards Under the Fair Work system there are three bodies that have roles in the system: • Fair Work Australia.

• Fair Work Ombudsman.

• Fair Work Federal Divisions of the Federal Court and the Federal Magistrates Court.

2. The State System – NSW

Industrial Relations The state system covers the NSW public sector and local government employees.

This includes workers employed by NSW Ministry of Health funded employers.

NSW Industrial Relations (NSW IR) works in partnership with the Commonwealth’s Fair Work Ombudsman to ensure NSW private sector businesses comply with their responsibilities under the national workplace relations system. NSW IR also administers NSW laws regulating shop trading hours, public holidays and longservice leave.

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Employment arrangements for health professionals The majority of doctors in Australia are self-employed, with a small proportion being salaried employees of Commonwealth, state and local governments. Salaried specialist doctors in public hospitals often have rights to treat some patients in these hospitals as private patients, charging fees to those patients and usually contributing some of their fee income to the hospital.

For some allied health/paramedical professions, there is a significant proportion of self-employed practitioners (e.g. Physiotherapists, Podiatrists).

Others (e.g. Social Workers) are mainly employed by state and local government health organisations.

• An employee is engaged under a contract of service and is remunerated for the provision of labour. Employees are paid a wage or salary and are entitled to annual leave, sick leave, superannuation and workers’ compensation. Employers may be vicariously liable for any damage or loss resulting from work performed by an employee.

• An independent contractor acts independently and bears the risk of commercial loss or profit.

Independent contractors are not eligible for paid leave and make their own arrangements regarding insurance, income tax and superannuation. Independent contractors are generally required to invoice the practice for services provided, in accordance with their obligations under GST legislation.

Potential employers should seek independent legal advice regarding the structural, financial and insurance implications of any appointment.

Contracts Regardless of the basis of appointment, a written contract outlining the roles and responsibilities of both parties is essential. As a minimum, the contract should include:

General practitioners – basis of appointment

• A description of the position and performance expectations.

There are two main ways for GPs to be appointed to a private practice:

• The supply and maintenance of tools and provisions.

• They are employed by the practice, or

• Insurance responsibilities.

• They provide services as an independent contractor.

It is important to understand the differences between these two options and the implications of each. In brief:

• Hours and location of work.

• Details of any probationary period.

• Payment arrangements including the pay day and how any deductions from pay are made.

• Leave provisions.

• Superannuation contributions and benefits (employees only).

• The period of notice required for termination of employment/ appointment.

• Any special rules and procedures including unacceptable conduct, confidentiality, and disciplinary and grievance procedures.

Wages and conditions for health professionals The wages and conditions for salaried medical practitioners, VMOs, nurses and allied health professionals in Australia are determined by Awards and Agreements.

In addition to this, health professionals in the public health sector and in private hospitals are usually covered by an industrial agreement, which encompasses the legal requirements of awards and legislation and other aspects of employment for that workforce. While there is some degree of consistency, wages and conditions can vary depending on the relevant State/Territory and the specific area of practice.

For Visiting Medical Officers, you can view both the NSW Health Award as well as the Rural Doctors’ Settlement Package at this link: www.health.nsw.gov.au/ careers/conditions/Pages/v.aspx This includes rates and contract information for Fee For Service, sessional and honorary appointments.

Wages and conditions for nurses working in settings other than hospitals (i.e. in general practice) are also governed by the federal system and the following is a link to this award: www.fwa.gov.au/ consolidated_awards/an/AN120385/ asframe.html Wages and conditions for allied health professionals in general practice are governed by the federal-based Modern Award: www.fwa.gov.au/documents/ modern_awards/award/ma000027/ default.htm Loadings are often used to attract allied health professionals.

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Rural Doctors RDA hospitals Association in New South of Australia Wales (RDAA) “The Rural Doctors Association of Australia (RDAA) was formed in 1991 and is a national body representing the interests of rural medical practitioners right around Australia. Their vision is for excellent medical care for rural and remote communities.

We are committed to building and maintaining a workforce of highly skilled and motivated rural medical practitioners.

This requires adequate training and proper incentives, remuneration and support (both professional and personal).

RDAA comprises the Rural Doctors Association (RDA) of each State and Territory representing rural doctors from right around the country. State RDAs are autonomous entities which negotiate with government and other bodies in their own jurisdictions. Members are typically drawn from small rural towns and remote areas.”

Source: www.rdaa.com.au/about-us

“The Rural Doctors Association and NSW Department of Health agreed on a new set of fees to be paid by rural hospitals to rural doctors for public services rendered at the hospitals. This is known as the Rural Doctors Settlement Package or the RDASP. The Rural Doctors Settlement Package primarily sets out the conditions and fees for providing care to emergency and public inpatients. There are 125 rural hospitals in New South Wales that the Rural Doctors Settlement Package currently applies too.”

Learn more about these hospitals: www.rdansw.com.au/rda-hospitals/

Superannuation Superannuation is a compulsory savings program that helps workers to have funds to live on in their retirement. Employers are required by law to contribute to a superannuation fund – this is known as the Employer Superannuation Guarantee – and is currently at 9.5% of gross salary.

Employees are unable to access these funds until retirement (age requirements vary depending on your own age and date of entry in to a fund).

The Australian Taxation Office (ATO) homepage for superannuation (www.ato.gov.au/super) contains key superannuation information such as reporting and lodgement dates and the Register of Complying Superannuation Funds. Resources and services include online services, calculators and superannuation law.

Your employer may offer you the option of a default fund or you may have the option to choose your own fund. The ATO has some advice on choosing a superannuation fund: www.ato.gov. au/individuals/super/getting-started/ employees/#Choosingasuperfund The government has established an information website to help people understand and manage their finances: www.moneysmart.gov.au/

34 > RDN / Orientation to general practice in rural NSW

Life in Australia

RDN / Orientation to general practice in rural NSW < 35

Geographical information States and Territories Australia is made up of six states and two territories.

NORTHERN TERRITORY QUEENSLAND WESTERN AUSTRALIA SOUTH AUSTRALIA

NEW SOUTH WALES

VICTORIA

TASMANIA

AUSTRALIAN CAPITAL TERRITORY

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The New South Wales (NSW) Area

NSW map used with permission from the Sydney Australia Tourist Guide, www.sydney-australia.biz/

NSW Capital: Sydney Sydney is Australia’s largest city and home to some of Australia’s most famous landmarks including Sydney Harbour, Sydney Opera House and Bondi Beach.

Sydney has a warm temperate climate and has a population of 4.63million (according to the 2011 Census).

More information about Sydney: www.sydney.com.au/ NSW Climate While NSW enjoys a temperate climate, summer temperatures can be high and can occasionally reach over 40˚C in some locations.

NSW enjoys four distinct seasons: Spring (1 Sep–30 Nov), Summer (1 Dec–28 Feb), Autumn (1 Mar–31 May) and Winter (1 Jun–31 Aug). Winters tend to be short

and mild but parts of NSW have an alpine climate and you can even snow ski in the winter months at a number of Snowy Mountains ski resorts and enjoy the delights of a cosy log fire in many parts of NSW. The north-eastern coastal areas of the state enjoy a sub-tropical climate where summers are usually wet and not too hot and winters are very mild.

Useful NSW Websites to Visit www.nsw.gov.au/about-new-southwales This site includes an overview of NSW, including the climate, history, geography, key industries and government system. www.trade.nsw.gov.au/ For those interested in establishing a business or investing in NSW.

www.visitnsw.com/ Tourism information on NSW regions and the myriad locations and things to see and do. www.evocities.com.au/ The Evocities website is designed to attract metropolitan-based people to the regional cities of Albury, Armidale, Bathurst, Dubbo, Orange, Tamworth and Wagga Wagga, highlighting the lifestyle benefits and more affordable cost of living in a regional city.

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Australian principles, values and culture

Newcomers to Australia

• Recreation, media and lifestyle.

An excellent starting point for all newcomers to Australia is the Department of Social Services website which has some excellent resources.

We encourage you to access the document as the remaining information in this guide is designed to complement it and provide NSW-specific information.

Australia is a democratic society, with governments elected by its people.

www.dss.gov.au/our-responsibilities/ settlement-services/settle-in-australia

Any person living or visiting Australia must obey the laws or face being held accountable for breaking the law.

Individuals are expected be tolerant of others and live within a harmonious social system. People are generally expected to respect Australian social customs, habits and practices. Australia is a multicultural society, valuing fairness, tolerance and individual freedom. For more information visit www.border.gov.au/Trav/Life

The following link in particular provides an excellent practical guide to settling in Australia, entitled Beginning a Life in Australia. It’s available to download in English or in 37 other languages.

The Department of Immigration and Border Protection Life in Australia web pages contain information and publications about life in Australia, and links to government settlement services including help with learning English. These web pages also provide information about Australian values and the cultural diversity of Australia’s peoples.

Australian Language and Slang

• Help with English.

While Australia has more than 80 spoken languages, the predominant language is English. However, as with other countries, there are some distinct and sometimes colourful variations which at times make it difficult to understand.

• Emergency Services.

The True Blue Guide to Australian Slang is a general publication to help you understand Australian expressions. This can be found online or through local book stores.

• Australian Law.

www.dss.gov.au/our-responsibilities/ settlement-services/beginning-a-life-inaustralia It covers: • What to do soon after arrival.

• Where to go for help.

• Family.

• Australian Society.

• Housing.

• Employment.

• Money.

• Social Security.

• Transport.

• Education and child care.

• The health system.

• Local government and community services.

• Visas and citizenship.

www.border.gov.au/Trav/Life See, in particular, the Life in Australia booklet which provides information about Australian history, culture, society and values. It can be downloaded in English and other languages. www.border.gov.au/Trav/Life/Aust/Lifein-Australia-book RDN has more generic information online about settling into a rural location: • RDN website www.nswrdn.com.au/site/index. cfm?display=72232 • RDN YouTube channel www.youtube.com/user/nswrdn • RDN Facebook Page www.facebook.com/ NSWRuralDoctorsNetwork

38 > RDN / Orientation to general practice in rural NSW

Purchasing a Vehicle

Aboriginal Driving in and Torres country NSW Strait Islander peoples Driver Licence

• For general information on Aboriginal and Torres Strait Islander culture, please visit: australia.gov.au/aboutaustralia/australian-story/austnindigenous-cultural-heritage • The Western Australian Centre for Rural Health at Curtin University has produced a training module for Aboriginal Cultural Awareness. We encourage you to complete these modules and then obtain some localised cultural awareness training in your area.

lms.cucrh.uwa.edu.au/login/index. php

• We highly recommend the Orientation Manual for International Medical Graduates developed by the Postgraduate Medical Council of Victoria:

www.pmcv.com.au/img/orientation/ orientation-manual30

In particular, Section 2 on Communication and Cultural Safety is an excellent guide for doctors new to the Australian system. Bear in mind that this was developed for Victoria so other information is Victoriaspecific.

Refer to Appendix 3. Resource List for Aboriginal Health Information for additional links and information. This has kindly been provided by the Aboriginal Health and Medical Research Council.

Visitors driving in NSW must observe licence requirements. You must carry your licence with you when you are driving.

There is an on-the-spot fine for not having your licence with you. Additionally, if your licence is not in English you must carry an English translation when driving in Australia. If you are uncertain of any requirement or have other road safety inquiries, phone the Roads and Maritime Services (RMS) on 132 213 or visit their website: www.rms.nsw.gov.au/ International and interstate driver licence holders should visit this section: www.rms.nsw.gov.au/roads/licence/ moving-to-nsw.html Permanent visa holders and New Zealand citizens “If you’re a permanent Australian resident, or hold a permanent visa under the Commonwealth Migration Act 1958, and you intend to stay in NSW, you are not considered to be a visitor. As such, you are allowed to drive in NSW on a current overseas licence for a maximum of three months. After that, you will need to apply for a NSW licence to continue driving or riding.

New Zealand licence holders, regardless of whether you are a permanent or temporary resident, must obtain a NSW licence within three months of living in NSW or you must stop driving.”

Source: www.rms.nsw.gov.au/roads/licence/ moving-to-nsw.html

Speed Limits Drive at or below the signed speed limit.

Slow down in wet weather. The police regularly conduct speed checks using fixed cameras, radar and lasers along all types of roads. The default speed limit in a local or suburban area in NSW is 50 km/h. A speed limit of 40 km/h applies near schools in the mornings and afternoons during school terms.

The maximum speed on highways in NSW is 100 km/h. The maximum speed limit on motorways and freeways is 110 km/h. Heavy penalties apply to drivers exceeding speed limits. This can include the police suspending at the roadside your right to drive in NSW.

You can either visit a local car dealer to purchase a brand new or used vehicle or you could try one of the following sites to look at used car options: • www.drive.com.au • www.carsales.com.au • www.tradingpost.com.au • www.carsguide.com.au • www.gumtree.com.au A useful source of information and advice about the process of buying or selling a car, and make and model information, is www.mynrma.com.au/motoringservices/safety-advice/buy-sell.htm Vehicle Registration You need to establish NSW registration for a new vehicle purchased in NSW or any vehicle brought in from interstate.

Read more: www.rms.nsw.gov.au/ roads/registration/index.html Fees and charges will include some or all of these payments listed below: • Stamp duty is collected by the RMS on behalf of the Office of State Revenue when registration is issued to a different person or corporation.

Stamp duty is based on the market value of the vehicle or the price you paid, whichever is greater.

• Number plate fee.

• Compulsory Third Party (CTP) insurance premium (green slip). It is advised to shop around for price comparisons between insurers.

A comparison website for purchasing a green slip is www.greenslips.com.au – this site also provides more information about green slips.

• Vehicle Identification Inspection fees (if your vehicle requires an additional inspection).

Driver Fatigue Australia is a vast country and car trips outside major cities may take several hours or even days. Driver fatigue is a serious road safety concern involved in nearly a fifth of fatal crashed in Australia.

If you are driving long distances try to have a passenger with a current driver licence share the driving with you and rest every two hours to take at least a 15-minute break. This is important even if you are near your destination because fatigue crashes can occur near a journey’s

RDN / Orientation to general practice in rural NSW < 39

end. It is also possible for fatigue crashes to happen on short journeys or near the start of a short trip. The way to avoid this is to not drive if you feel tired or know your concentration is not at its best.

restraints must be used for all children.

More information is available at www.rms.nsw.gov.au/roads/safetyrules/road-rules/seatbelts.html Mobile phones

Alcohol Australia has strict laws about drinking alcohol and driving. Australian police are authorised to stop any vehicle and breath test the driver at any time. They perform regular roadside Random Breath Testing (RBT) of drivers in both metropolitan and rural areas. There are heavy penalties, including imprisonment, for drink driving.

For fully licensed car drivers the legal limit is 0.05g/100ml. For special licence categories the legal limit is 0.02. Learner and Provisional drivers (or motorbike riders) must not exceed zero blood alcohol.

There is no absolute safe level of alcohol consumption for competent driving.

Seatbelts It is a requirement for everyone, including visitors to NSW, to use seatbelts at all times. Baby capsules or child car seats/

It is illegal to touch a mobile phone while driving (except to hand it to a passenger).

A mobile phone can only be used to make or receive calls while driving if it is securely mounted to the vehicle and you are using an automated audio device.

More information is available at roadsafety.transport.nsw.gov.au/ stayingsafe/mobilephones/know-therules

Hazards/Caution Warnings signs usually alert drivers to dangers ahead. Scan to the limit of forward visibility for dangerous situations and drive at a speed that suits the conditions. Some of the most commonly seen warning signs are demonstrated below.

When driving in rural areas, be extremely careful of: • Potholes, rough surfaces and soft or broken road edges • Single lane bridges • Road surfaces changing without notice

Motorways and freeways

• Livestock or wildlife crossing the road

Because traffic travels at high speed on motorways and freeways, you must be especially alert. Do not stop on a motorway or freeway except in an emergency. If you must stop, move off the road completely. Do not make a ‘U’ turn or reverse on a freeway. Keep to the left unless overtaking.

• Very large trucks (sometimes called road trains).

More information: Call the RMS on 132 213 or visit the website at www.rms.nsw.gov.au

Road is slippery when wet

Roadworks Ahead

Winding Road

Kangaroos Ahead

Loose Stones

Railway Level Crossing

40 > RDN / Orientation to general practice in rural NSW

Furniture and White Goods

Opening a bank Housing and account accommodation In Australia most income, including salary or wages, and government benefits are paid directly into a bank account. The bank or financial institution will then issue you a debit card with your own Personal Identification Number (PIN) to allow you to withdraw funds from either an Automatic Teller Machine (ATM) or directly from the bank.

A widely used system in Australia is EFTPOS (Electronic Funds Transfer at Point of Sale). Most retail outlets, food outlets, petrol stations, etc. utilise EFTPOS where you can use either your debit card or credit card to pay for goods and, in some instances, withdraw small amounts of cash.

You should open a bank account as soon as possible. You will require identification to do this, under the 100 points system of identification. More information: www.australianaustralia.com/page/ Opening_a_Bank_Account_in_ Australia/190 The government established a website aimed at improving Australian’s financial literacy: www.moneysmart.gov.au/ A further point to remember is that with most electronic transactions you will be asked if your account is “Cheque, Savings or Credit” before you enter in your PIN so make sure you are aware which account type you have when you set it up. It’s also useful to understand what bank fees may be applied based on your selection of account type when using EFTPOS.

General Information Housing in Australia can sometimes be difficult to find and rent can be expensive, depending on the location. It may be particularly difficult for large families to find long-term accommodation that suits all their family and cultural needs so you may need to compromise.

There are many options to find accommodation. Many rental properties are advertised in the local newspaper, with local real estate agents, and can also be found through online real estate sites.

The local Yellow Pages is a good place to find real estate agencies (and other services) in your locality: www.yellowpages.com.au/nsw/ localities.html

Furnished houses/apartments are a rarity in Australia and are usually quite expensive. Therefore, unless you are shipping in your own furniture, you will need to factor in the cost of some basic furniture and white goods, such as fridge and washing machine.

Try the Yellow Pages for furniture stores and electrical stores in your locality – www.yellowpages.com.au/nsw/ localities.html – many offer flexible payment options so you don’t have to pay the whole amount up-front.

Larger towns usually have second-hand furniture stores or check the classified ads in your local paper. You can often secure good quality second hand furniture at an excellent price. Websites such as www.ebay.com.au and www.gumtree. com.au are other popular options.

For short-term arrangements you may find that renting furniture or white goods is a better option. Radio Rentals is the major store offering this option: www.radio-rentals.com.au

Two of the major online sites are:

Utilities

• www.domain.com.au

When you move into your new accommodation you will need to get the utilities, such as water, gas, electricity and telephone, connected or transferred in your name. A fee is usually charged for this.

• www.realestate.com.au To secure a rental property you will have to pay a bond, which usually is the equivalent of four weeks rent and then you will have to pay two weeks rent in advance. The bond is refundable once you vacate the premises, provided you have left the property clean and in the condition in which you found it, and that your rent is paid up-to-date. The landlord is required to lodge the bond with the Residential Tenancies Board Authority.

A written record of the condition of the house is recorded before you sign the lease and then checked again when you move out.

Leases are usually for a minimum of six months and the real estate agent may conduct inspections of the property (with prior notice) during the rental period.

Prices of rental properties in rural NSW are generally considerably cheaper than equivalent housing in the Sydney and metropolitan areas. The occasional exception may be some of the mining towns.

Local water utilities are responsible for providing water supply and sewerage services to NSW communities. Visit the NSW Water website to locate a water supplier in your area: www.water.nsw.gov.au/Urban-water/ Local-water-utilities/Local-waterutilities/default.aspx There are several electricity suppliers in NSW and it is useful to compare prices. See the NSW Government Trade and Investment site for an overview of electricity and gas suppliers in NSW: www.resourcesandenergy.nsw.gov.au/ energy-consumers/energy-providers/ choosing-providers There are a number of commercial websites to identify a company and make a price comparison. If you do a web search for “electricity suppliers nsw” there are several options.

Read the fine print on the contract before you sign up to anything!

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Phone and Internet Connections There are numerous phone and telecommunications providers and it is highly recommended that you shop around to get the best deal. Do a web search for “phone service providers nsw” to locate companies offering comparisons.

Mobile phone coverage can be sporadic in the more remote areas of NSW and you should check with the provider about which areas they cover. There are safety considerations if you are on a road in a more remote area and your car breaks down–you need to be sure that your phone service provides coverage for your region. Telstra is often the best option in the more remote areas.

You can usually bundle your services together and negotiate a better rate e.g. you could have your home phone, mobile and internet connection on the one plan and receive a discount.

Read the fine print on the contract before you sign up to anything!

Finding employment for your spouse or partner There is a range of options for finding work in Australia.

Job Advertisements Online The most popular job websites are:

RDN also has a jobs search service for GP, nursing, dental and allied health vacancies in rural NSW: • GPs www.nswrdn.com.au/site/ index.cfm?display=287352 • Nurses/Dentists/Allied Health www.nswrdn.com.au/site/index. cfm?display=583172 Job Advertisements in Newspapers It is recommended that you also check your local newspaper for opportunities. Most local papers have a job advertisements day (most often Saturday). Many jobs are only advertised in the local paper and not online.

National newspapers are also an option– again, Saturday seems to be the main job advertisements day while trade and professional journals and magazines are another avenue to consider.

Recruitment Agencies and Networking Look for recruitment agencies in your area, usually located in your nearest regional town. You could check the local Yellow Pages for agencies in your area.

Often, an avenue into finding full-time work is to start with temporary or casual work. This gives you the opportunity to look at a few different options and some may turn into more permanent work.

Ask local people in the community about potential opportunities. It’s a great way to start a conversation with your new townsfolk and you may find out about a job before it’s even advertised.

Federal Government’s Job Connection Service For assistance in finding a job, take a look at this website for some useful resources: www.humanservices.gov.au/customer/ subjects/looking-for-work

• www.careerone.com.au

You can also register with jobactive, the Australian Government’s national network of organisations dedicated to helping job seekers to find and sustain employment.

• www.jobsearch.gov.au

jobactive.gov.au

• www.seek.com.au • www.adzuna.com.au

You can usually search by employment type and geographical location.

If your partner is also seeking healthrelated work, a good place to start is on the NSW Health jobs site: nswhealth. erecruit.com.au/Default.aspx

The service is free to both employers and job hunters. More information: www.employment.gov.au/jobactive

Assistance with English Language It is important that you have translated your qualifications into English and to find out whether these qualifications are recognised in Australia. These can be translated at no charge at any Adult Migrant English Program (AMEP) provider by the Translating and Interpreting Service. Your nearest Migrant Resources Centre can assist you with this process.

You should also access the NSW AMES (Adult Migrant English Service) website which has a wealth of information for new migrants along with useful links. NSW AMES provides leadership in the field of quality language and literacy education through its course provision and resource and curriculum development. ames.edu.au There is even an ‘English for Health Professionals’ online course you can access, with specific modules for nurses and doctors: • Doctors ames.edu.au/courses/onlineenglish-courses?courseId=1356 • Nurses ames.edu.au/courses/onlineenglish-courses?courseId=1488

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Schools General Information For general information on schooling in Australia, please refer to the Department of Social Services booklet Beginning a Life in Australia at www.dss.gov.au/ourresponsibilities/settlement-services/ beginning-a-life-in-australia Public School Options in NSW Visit online.det.nsw.edu.au/schoolfind/ locator/ to find a public school in your location of choice. This site also provides information on how to enrol your child.

Education Options There are a range of education options for your child although these will be limited depending on the location you choose. See the following link for the options: www.schools.nsw.edu.au/ gotoschool/types/index.php

While education is ‘free’ in NSW, there are many costs associated with schooling. Many schools ask for a small fee or voluntary contribution to enhance the school’s education and sporting programs. Other expenses will include stationery items, school excursions and school uniforms, which are generally available either from the school or a local, designated store.

Temporary Visa Holders Children of parents holding temporary visas will usually be required to pay full school fees. You should check with your individual school for details as exemptions sometimes apply.

More details about fees: www.schools.nsw.edu.au/gotoschool/ intnl_students/index.php Non-government Schools Often referred to as private schools, there is a range of non-government fee-charging schools, many of whom

have a religious affiliation or a particular educational philosophy. To enrol in one of these schools, you should contact the school directly.

More details on private schooling options in your chosen locality: www.privateschoolsdirectory.com.au/ educationinformation.php?region=29

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Other relocation considerations Backing-up Personal Documents It is advisable to consider scanning and saving electronic copies of all your personal documents before relocating so they are in a secure online location where you can easily access them if required.

Being Prepared Financially While you may be one of the lucky ones to receive some limited financial support to assist you to relocate, you will have seen from the previous sections in this resource that there are a number of setup costs which you will have to consider.

Even if you can secure some financial assistance, you will still incur costs on arrival. Australia is not a cheap country in which to live, although wages do compare favourably with other parts of the world.

Pets and wildlife Many households have pets such as cats and dogs. There are laws regarding which domestic pets can be kept at home.

Most LGA websites have a section on their websites specifically catering to pets, including registration requirements.

You should also check with them about keeping other animals at home, such as poultry.

There are laws on traveling with animals in vehicles. Visit the RMS website for details: www.rms.nsw.gov.au/roads/ safety-rules/road-rules/animals.html Native wildlife, including animals, birds, snakes, reptiles, fish and shellfish are protected by law, as are native plants, including trees and ferns. You shouldnâ&#x20AC;&#x2122;t hunt, fish or collect plants before checking with your local council to see whether a permit is required.

RDN recommends that you have a contingency fund for emergencies and to have a reasonable idea of how much cash you will need to establish yourself and your family â&#x20AC;&#x201C; much of which is likely to be incurred before you earn your first pay packet.

Remember, life is unpredictable and there is a chance you may fall ill or have an accident and be out of work for a few weeks with no pay. It might also be worth considering taking out Income Protection Insurance and/or seeking financial advice.

Relocating Successfully People who tend to make the most successful transition are those who connect with their community. Country towns in Australia are generally friendly and welcoming places and Australians are excellent at developing communitybased organisations around sport, hobbies and cultural activities. Most towns have a whole host of sporting, hobby and cultural clubs which you can join to meet like-minded people.

Those with children may find it easier to meet people through their kids, but we have observed that those who embrace the community wholeheartedly tend to have the best and most rewarding experiences.

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Appendix 1

acronyms

RDN / Orientation to general practice in rural NSW < 45

AHPRA

Australian Health Practitioner Regulation Agency

AMA

Australian Medical Association

AMC

Australian Medical Council

ASGC-RA

Australian Standard Geographical Classification - Remoteness Area

CPD

Continuing Professional Development

COAG

Council of Australian Governments

DoH

Australian Government Department of Health

GP

General Practitioner

GPRIP

General Practice Rural Incentives Program

HCCC

Health Care Complaints Commission

IELTS

International English Language Testing System

IMG

International Medical Graduate

LEAP

Rural Locum Education Assistance Program

LGA

Local Government Authority

MBS

Medicare Benefits Schedule

MMM

Modified Monash Model

NSW

New South Wales

PHC

Primary Health Care

PHN

Primary Health Network

PIP

Practice Incentives Program

RA

Remoteness Area

RACGP

Royal Australian College of General Practitioners

RDN

NSW Rural Doctors Network

REST

Rural Emergency Skills Training

ROMPS

Rural Other Medical Practitioners

RRGPP

Rural and Remote General Practice Program

RRIG

Rural Relocation Incentive Grant

RRMA

Rural, Remote and Metropolitan Area

RWA

Rural (Health) Workforce Agency

SIP

Service Incentive Payment

VMO

Visiting Medical Officer

VR

Vocationally Recognised

46 > RDN / Orientation to general practice in rural NSW

Appendix 2

Glossary

RDN / Orientation to general practice in rural NSW < 47

TERM/TITLE

MEANING

Australian General Practice Training

Australian General Practice Training (AGPT) is run by the Australian Government and “provides vocational training for medical graduates wishing to specialise in general practice. The two endpoints of the AGPT program are the Fellowship of the Australian College of Rural and Remote Medicine (FACRRM) and the Fellowship of the Royal Australian College of General Practitioners (FRACGP).”

Source: www.agpt.com.au/About-Us/About-Us

The AGPT program is a three or four year full-time training program delivered through Regional Training Organisations (RTOs) across Australia. In NSW the program is administered by one organisation, GP Synergy.

More information.

Australian Medical Council

The Australian Medical Council (AMC) accredits medical schools in Australia and New Zealand and administers the national examination of overseas trained medical practitioners seeking to practise medicine in Australia.

Australian Standard Geographical Classification – Remoteness Area

The Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) is a classification system measuring remoteness of different geographical regions. There are five RA categories: • RA1: Major cities of Australia • RA2: Inner regional Australia • RA3: Outer regional Australia • RA4: Remote Australia • RA5: Very remote Australia RA categories are used by the Australian Government to determine eligibility for many government programs for rural doctors. More information about ASGC-RA. For information about the RA classification for a location, search the map on the DoctorConnect website.

This classification was replaced by the Modified Monash Model from 1 July 2015.

However, it is still used for some services and programs.

Area of Consideration

Areas of Consideration (AoC) were developed as a short term measure to address the anomalies in the RRMA classification system – especially in RRMAs 1 to 3.

Areas of Consideration can access certain Commonwealth workforce initiatives such as the Rural Locum Relief Program and the Rural Other Medical Practitioners Program.

Area of Need

Area of Need (AoN) is a determination by NSW Ministry of Health. It provides formal recognition that an additional doctor is required to fill a specific position in a specific practice, and permits the NSW Medical Board to assess an overseastrained doctor for specific registration to fill that position. An AoN determination applies only to the particular position for which it was granted – it does not apply to a town in general or to a specific doctor.

Bulk billing

Bulk billing is when a healthcare provider bills Medicare directly for a service provided to a patient. The patient does not make any payment directly to the provider and the provider accepts the payment from Medicare as full payment for the service.

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District of Workforce Shortage

The Australian Government defines District of Workforce Shortage (DWS) as a geographic area in which the general population need for healthcare is not met.

Population needs for healthcare are considered to be unmet if a district has significantly less access to medical professional services than the national average. A Delegate of the Minister in the Department of Health applies this determination. It applies to the whole town but is reviewed on a quarterly basis.

Doctors affected by the 10 Year Moratorium on provider numbers must work in a DWS location in order to obtain a Medicare Provider Number. More information on District of Workforce Shortage is available on the DoctorConnect website under Search the map. You can check the DWS status of a location/locality on the DoctorConnect website by entering the name and address of the location into the Locator Map and then selecting the ‘District of Workforce Shortage’ layer.

DoctorConnect

Australian Government Department of Health website about working as a medical practitioner in Australia; it includes a map for identifying geographic classifications, which relate to program funding and financial incentives.

Five Year Scheme

The Five Year Scheme for Overseas-Trained Doctors (Five Year Scheme) is available to eligible overseas-trained doctors who are seeking permanent Australian residency, and/or are subject to the ten-year moratorium on provider numbers.

To be eligible for this scheme, the doctor must be willing and able to obtain Fellowship of the RACGP or ACRRM within two years of joining, and must commit to working in an eligible inland community for an agreed period. On completing the program, and obtaining permanent Australian residency, the Australian Government Department of Health will offer a non-location specific exemption of the doctor’s moratorium in relation to provider numbers.

More information on the RDN website.

General Practice Rural Incentives Program

The General Practice Rural Incentives Program (GPRIP) is an Australian Government initiative that aims to promote careers in rural medicine as well as increase, recognise and retain medical practitioners in rural and remote Australia.

To be eligible, Medical practitioners must provide primary healthcare services and/ or undertake GP registrar placements in regional and remote New South Wales.

More information on the RDN website.

Intern

An intern is a medical graduate undertaking the compulsory year of supervised postgraduate practice required by Australian Medical Boards to qualify for full registration as an independent medical practitioner. The year of internship is also referred to as PGY1.

Modified Monash Model

The Modified Monash Model (MMM) is a classification system implemented 1 July 2015 for some Commonwealth Government programs. MMM “better categorises metropolitan, regional, rural and remote areas according to both geographical remoteness and town size. The system was developed to recognise the challenges in attracting health workers to more remote and smaller communities.”

Source and more information.

Medicare provider number

A provider number that enables the doctor’s patients to access Medicare rebates for the services provided. Also see Provider number in this glossary.

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NSW Rural Doctors Network

The NSW Rural Doctors Network (RDN) is the Australian Government-designated Rural Workforce Agency for New South Wales. It receives funding from the Australian Government Department of Health and the NSW Ministry of Health.

The prime role of RDN is to assist in attracting, recruiting and retaining medical and health practitioners to, and in, remote, rural and regional New South Wales.

It does this through a range of programs including General Practitioner (GP) recruitment, recruitment of nurses and allied health professionals, provision of medical and health outreach services, medical workforce planning, community support and student activities. RDN provides a single point of contact for policy makers, academics, health service organisations, rural communities, practices and GPs for issues relating to the recruitment and retention of medical and health professionals in rural New South Wales.

Office of Local Government

“The Office of Local Government is responsible for local government across NSW… and is the key adviser to the NSW Government on Local Government matters.” Source: www.olg.nsw.gov.au/about-us Local government refers collectively to administrative authorities over geographical areas that are smaller than a single state. Each one is referred to as a Local Government Authority (LGA).

Local government generally acts within powers delegated to it by legislation or directives of the higher level of government. Local governments usually have similar powers to national governments and they usually have some power to raise taxes, though these may be limited by central legislation.

The LGA is most commonly referred to as the local council. LGAs provide a wealth of practical information for newcomers settling into their areas, from recreational pursuits and schooling to which day your waste bins will be collected. Visit the following websites to search for your LGA: • www.olg.nsw.gov.au/ • www.olg.nsw.gov.au/public/my-local-council/find-my-council

Other Medical Practitioner

An Other Medical Practitioner (OMP) is a non-specialist medical practitioner who provides non-referred services but is not a vocationally registered GP, a Fellow of the RACGP or ACRRM, or undertaking an approved placement in general practice as part of a training program for general practice.

Overseas-Trained Doctor

An overseas-trained doctor (OTD) is a doctor with primary medical qualifications from outside Australia. ‘OTD’ is often interchanged with ‘IMG’ (International Medical Graduate).

Prescriber number

For a pharmacist to be able to provide prescription medications through the Pharmaceutical Benefits Scheme (PBS), i.e. at a subsidised price, the prescribing doctor must have a valid PBS prescriber number and quote this on the prescription. Prescriber numbers are issued by Medicare Australia. All doctors registered in Australia are eligible for a prescriber number. For more information about prescriber numbers and to download a Prescriber Number form, visit the Department of Human Services Medicare website.

Primary Health Networks

Primary Health Networks replaced Medicare Locals on 1 July 2015. Their key objectives are: increasing efficiency and effectiveness of medical services and improving coordination of care. Visit the Department of Health website for more information.

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Provider number

For a patientâ&#x20AC;&#x2122;s medical care to be subsidised by Medicare the treating health professional must have a current Medicare provider number appropriate for the location in which the service is provided. The service must be one that is subsidised by Medicare. Doctors also require a provider number to refer patients to specialist medical practitioners so that the patient can claim a Medicare rebate for the specialist service. Medicare provider numbers are issued by the Department of Human Services (Medicare Australia). Some restrictions apply to doctorsâ&#x20AC;&#x2122; eligibility for a Medicare provider number. More information.

Regional Training Organisation

The Department of Health contracts with nine regional training organisations (RTOs) across 11 training regions throughout Australia to deliver general practice training in urban, regional and rural areas. In NSW this training is delivered by GP Synergy.

Rural Locum Relief Program

The Rural Locum Relief Program (RLRP) is an Australian Government program that allows doctors affected by provider number restrictions to obtain a Medicare provider number and attract Medicare benefits while providing general practice services in approved placements in rural and remote Australia.

Australian citizens and permanent Australian residents must be vocationally registered or have Fellowship of an Australian College of General Practice in order to obtain a Medicare provider number. Doctors who face provider number restrictions because of this requirement may apply to join the RLRP. Note: OTDs may also be affected by additional restrictions; more information about the 10 Year Moratorium and District of Workforce Shortage is available on the RDN website.

In New South Wales the RLRP is administered by RDN. More information.

Rural Other Medical Practitioners Program

The Rural Other Medical Practitioners Program (ROMPs) extends the full Medicare rebate to all GP services provided by OMPs in designated rural and remote areas of Australia. Doctors enrolled on this program are able to bill A1 Medicare Benefits Schedule items.

Rural, Remote, Metropolitan Areas

Rural, Remote, Metropolitan Areas (RRMA) is a geographic classification system used to determine eligibility for some Commonwealth Government programs.

RRMA categorises all statistical local areas (SLAs) in Australia according to their remoteness. Categories range from 1 (capital cities) to 7 (other remote areas).

Categories were determined in 1994 on the basis of 1991 census data and were based on population density and distance to large population centres. An updated classification system was implemented in 2001 using ASGC-RA and in 2015 MMM was introduced; however, some programs still use the former RRMA classification system.

Settlement Package

The Rural Doctors Association (RDA) Settlement Package establishes payment rates for medical services provided by General Practitioner Visiting Medical Officers (GP VMOs) at 125 small (RDA Settlement Package) hospitals in rural New South Wales. These payment rates are only available to RDA (NSW) members and are substantially higher than the Medicare rebates otherwise payable.

The RDA Settlement Package schedule of fees is indexed annually. The package ensures that GP VMOs providing on-call and after hours services in areas with minimal specialist backup are remunerated appropriately for the services they provide. For more information about the RDA Settlement Package and a list of hospitals, visit the RDA (NSW) website.

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Ten-year moratorium

The 10 Year Moratorium is the common name for the provider number restrictions imposed by Section 19AB of the Health Insurance Act 1973 (the Act). The Act states that medical services provided by OTDs (including New Zealand doctors) and overseas doctors trained in Australia will not attract Medicare benefits for a period of ten years from the time they become registered as a medical practitioner in Australia.

Exemptions to the moratorium can be granted by the Australian Government if the doctor works in a designated DWS location. A reduction on the moratorium may be given if a doctor works in nominated rural or remote locations.

Visiting Medical Officer

A Visiting Medical Officer (VMO) is a medical practitioner in private practice who also provides medical services in a public hospital. VMOs are not hospital employees but are contracted by the Local Health District (LHD) to provide specific medical services in nominated health facilities. For a GP to be granted VMO rights in a hospital, their core skills must be ‘credentialed’ by the relevant LHD and they must be granted ‘clinical privileges’ to provide services in nominated health facilities.

Vocational Recognition

To qualify for vocational recognition (VR) a doctor must be working predominantly in general practice and have obtained Fellowship of the RACGP or ACRRM, or been registered by a Vocational Registration Eligibility or Appeal Committee.

Many GPs obtained vocational recognition through a grandfathering clause that ceased in 1995. This satisfies the requirements of 19AA of the Health Insurance Act to allow medical practitioners to attract the higher Medicare rebate.

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Appendix 3

Resource List for Aboriginal Health Information

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WEBSITES 1. Australian Indigenous HealthInfoNet: A ‘one-stop’ shop for information about all aspects of Aboriginal and Torres Strait Islander health. www.healthinfonet.ecu.edu.au/ 2. Aboriginal Health & Medical Research Council of NSW (AH&MRC) ahmrc.org.au and the National Aboriginal Community Controlled Health Organisation (NACCHO) www.naccho.org.au and other State and Territory affiliates for information about the history, philosophy and activities of Aboriginal Community Controlled Health Organisations.

3. NSW Health: provides information on Aboriginal Health Priority areas. www.health.nsw.gov.au/ publichealth/aboriginal/hpa.asp 4. Royal Australian College of General Practitioners: By understanding the cultural context, the faculty advocates for culturally appropriate health delivery systems that will improve health outcomes for Indigenous Australians. www.racgp.org.au/yourracgp/ faculties/aboriginal/ 5. Useful general media content about Aboriginal issues:

ABC Indigenous portal, giving links to news, information and details of ABC radio and TV coverage of Indigenous issues. www.abc.net.au/indigenous/

The First Australians website, SBS, including Aboriginal history and stories as well as episodes and segments of this documentary series. www.sbs.com.au/firstaustralians/

National Indigenous Television (NITV) is a channel made by, for and about Aboriginal and Torres Strait Islander people. ‘Through us, you will discover a channel for all Australians’ www.nitv.org.au/

Gadigal presents the inherent and multi-faceted story telling of Aboriginal Australians and other First Nations peoples through their own broadcasting, online and physical spaces. gadigal.org.au/

6. Medical Journal of Australia collection of Aboriginal health papers: www.mja.com.au/ 7. Link-Up (NSW): works with Aboriginal people who were separated from their families when they were children, known as the “Stolen Generation”. www.linkupnsw.org.au/ 8. Human Rights & Equal Opportunity Commission: provides information on Aboriginal social justice. Includes information sheets and publications such as Bringing them Home – ‘Stolen Generation’ report. www.humanrights.gov.au/ publications/bringing-them-homestolen-children-report-1997 9. Australians for Native Title and Reconciliation (ANTar): is the preeminent non-Indigenous national advocacy organisation dedicated specifically to the rights-and overcoming the disadvantage-of Aboriginal and Torres Strait Islander people. antar.org.au/ 10. A range of health statistical information for Aboriginal people from NSW Health. www.healthstats. nsw.gov.au/ BOOKS/TEXTBOOKS 11. Communicating positively - A guide to appropriate Aboriginal terminology. A small booklet developed by NSW Health and the AH&MRC about using the correct terminology when talking with or about Aboriginal people in NSW. Also includes a discussion of terminology issues with relevance in other settings. www.health.nsw.gov. au/aboriginal/Publications/pubterminology.pdf 12. 10 Out of 10 Deadly Health Stories: Nutrition & Physical Activity Successful Programs from NSW Aboriginal Community Controlled Health Services. Read 10 Out of 10 Deadly Health Stories): www.ahmrc. org.au/index.php?option=com_ content&view=article&id=63:10out-of-10-deadly-health-stories&cat id=57:chronicdisease&Itemid=61

13. Couzos S and Murray R (editors).

Aboriginal Primary Health Care-An Evidence Based Approach 3rd Ed. Oxford University Press, 2007: A text book collating comprehensively researched information about a range of specific topics in Aboriginal health. Available from libraries or for purchase from on-line bookshops.

14. Eckermann A-K, Dowd T, Chong E, Nixon L, Gray R, Johnson S. BinanGoonj: Bridging cultures in Aboriginal health; Churchill Livingstone, 2005. A classic text book about Aboriginal cross cultural issues when working in health. Available from libraries or for purchase from on-line bookshops.

NEWSPAPERS Koori Mail is a fortnightly national Aboriginal newspaper available at most newsagents providing comprehensive and informative stories about Aboriginal issues, community news and programs, employment and sport. For information on current news and/or subscribing go to www.koorimail.com/ National Indigenous Times is a national Aboriginal newspaper featuring up-to-the-minute news, politics, sports and art. It is available at most newsagents. For information on current news and/or subscribing go to www.nit.com.au/

This information has kindly been provided by the Aboriginal Health and Medical Research Council. www.ahmrc.org.au

054 > RDN / Orientation to general practice in rural NSW Š NSW Rural Doctors Network 2016. All rights reserved.

An Orientation to General Practice in Rural New South Wales is funded by the NSW Ministry of Health.

Enquiries about this guide can be directed to the NSW Rural Doctors Network Medical Recruitment Team: NSW Rural Doctors Network Level 3, 133 King Street, Newcastle NSW 2300 T 02 4924 8000 INT +612 4924 8000 E recruit@nswrdn.com.au W nswrdn.com.au

PHOTO: Rural green meadow, Australia.