Addressing the Issues in Rural General Practice by Offering a ’Total Package’ Solution

• Kaitaia
• Kaikohe
• Kerikeri
• Kaeo
• Kawakawa
• Hokianga
• Dargaville
• Wellsford
• Warkworth
• Helensville.

In recognition of the value and importance of the overall medical "team" within the rural general practice environment, both GPs and PNs are eligible for membership. Both groups are represented on the management committee of the NRGPC, thus ensuring a balanced approach to delivery of services and the development of solutions to rural general practice’s unique problems.

The NRGPC is the conduit by which one can gain access to all northern rural general practices, which have, traditionally, been fragmented and inaccessible. It is a "One Stop" point of access for any individual, group or professional organisation wishing to transmit or share information or to make an approach to the rural GPs and PNs.

How Does the NRGPC Work?

Ownership
The issue of ownership is paramount in directing the NRGPC to respond to the education and support needs and to the issues affecting rural GPs and PNs.

The ownership of the organisation is in the hands of the people it serves – being the members themselves – the GPs and PNs of rural Northland. This is the basic premise on which the Consortium was established and on which the Consortium can boast its success.

This allows the Consortium to be driven from the "grass roots" level, ensuring that the right people at the right level address issues and changes that affect rural general practice.

The Total Package
The "Total Package" concept is the key component in the Consortium’s success, because each part is intrinsic to the other. The "Total Package" is the provision of CME, Locum Management and Support Services.

Continuing medical education
The NRGPC CME programmes have been developed based on the direct contribution of the members themselves. GPs and PNs were approached individually and/or in groups for their opinions on the draft CME programme and subsequent alterations until the final programmes were agreed upon.

A key success factor is the NRGPC members’ ownership of these programmes; the delivery mechanisms, where they are held, and certainty of regular monthly educational opportunities. The Consortium remains flexible to the needs of its members and regularly alters programmes to include new topics, alters existing subjects to suit specific regional needs and/or offer various seminars or education on topics that are of specific interest to sub-groups within the membership.


Locum programme
The NRGPC Locum Programme is successful because it takes account of the needs of both parties involved. The NRGPC views the issues of the GP and the locum as being equally valid and important. Locums require security of income, access to training programmes, educational opportunities, a support network such as access to Peer Review Groups, mentors, etc. Some locums want to remain within a geographic area close to their families, whilst others are keen to rove.

Rural GPs require easy access to quality locums, who, preferably, understand northern rural patients and issues of isolation and deprivation. The GP can then take advantage of continuing education programmes, have relief from burnout or take a well-earned break. The key success factor with the NRGPC Locum Scheme is the Consortium itself, acting as the administrative foundation block.

The Consortium sources high quality locums, co-ordinates access, maintains levels of locum availability relative to GP requirements, calendars and sets an equitable fee structure and accommodation allowance regionally. An understanding of each region’s issues is essential in being able to offer a comprehensive locum programme.

It has been vital to ensure that the NRGPC addresses the issue of locum cover from both the GP’s and the locum’s stand point. With this in mind, the Consortium has structured its support packages to be attractive to locums, and hence ensure their recruitment to and retention in rural Northland. At the same time, the Consortium works to ensure that GPs are well catered for and utilise the Consortium as their first port of call. The NRGPC has formed strategic alliances with locums to ensure continuity of cover. It also has a Probationer Programme, which means that it can start to utilise the landed expertise of international GPs who have been trained overseas and are now domiciled in NZ.

The Consortium’s Locum Programme allows it to offer greater degrees of support to the more isolated and/or smaller northern rural general practices.


International locums
The NRGPC recently employed two locums from Ireland to cover one of the practices within its membership group. From reviewing the process that led to this successful recruitment it was obvious that the vital factors which swayed the foreign locums to accept the position were that the NRGPC maintained regular lines of communication with the locums once they had been placed in a practice and that the NRGPC considered the placement from the viewpoint of both the practice and the individual locums.

The NRGPC is currently seeking applications from foreign GPs interested in short- and long-term assignments within a rural New Zealand environment. The NRGPC has developed extensive professional health care links, which means that it can assist in making placements for locums throughout New Zealand.


Probationer programme
The NRGPC has developed a "Probationer" programme, approved by the Medical Council of New Zealand, which consists of a two-year contract with the first year involving varying degrees of supervision. At the end of the first year, the probationer will hopefully sit and pass Primary Membership Examination (PRIMEX) of The Royal New Zealand College of General Practitioners (RNZCGP). PRIMEX is a prerequisite to the final phase of the General Practice Vocational Training Programme (GPVTP, provided by the RNZCGP) – Advanced Vocational Education leading to Accreditation and culminating in Fellowship of the College. The probationer should then progress to being a floating locum for the NRGPC during the second year of the contract.

At present the NRGPC is seeking two new probationers, who have a desire to work in rural general practice, to join the programme and become members of its team. They will be supported with access to ongoing CME, peer review groups, seminars, cultural induction programmes, etc, to assist them to acclimatise to their new rural surroundings. The key to the success of this programme is a thorough and careful candidate selection process, which involves matching the successful candidate with an appropriate, vocationally trained GP in the "right" practice environment.

The Consortium’s primary goal is to relieve the pressure on northern rural GPs by providing greater access to locum cover. The spin-off effect is that there may well be some probationers who decide to either remain, or return to, the northern rural region.


Promotion of rural practice as a career choice
The NRGPC is focussed on developing programmes that will serve to provide a "pathway" into rural general practice. It believes these initiatives could be replicated to suit rural environments New Zealand wide. The NRGPC is keen to develop strategies with the Auckland School of Medicine, and other educational institutions, which will assist in the promotion of the rural environment as a choice for trainees and the promotion of trainees and graduates into northern rural general practices as a training environment.

It is unfortunate that many medical students and GPs have the idea that rural medicine is limited, when in fact the exact opposite is true. Rural GPs have, out of necessity, become "Jacks of all trades", with an extensive knowledge base covering a wide variety of conditions. Rural general practice is a great place for GPs to expand their learning and thus gain greater confidence and competence in "across the board" medicine.

NRGPC Achievements

The achievements of the NRGPC can be summarised as follows:

• The buy-in of 100% of rural GPs and PNs
• The establishment of a successful high quality Locum Programme – involving New Zealand and international locums
• The establishment of a Probationer Programme – to utilise "landed" medical expertise (doctors from outside New Zealand who are currently domiciled in New Zealand and seeking employment)
• The ability to offer assistance to other rural areas throughout New Zealand with locum cover
• Helping to alleviate stress on rural general practice, (GPs and PNs) which can now access locums and CME and have a support network to rely on
• The placement of MOSS (Medical Officers Special Scale) into all northern rural hospitals: Kaitaia, Kawakawa, Whangaroa and Hokianga
• The establishment of quality, accessible CME programmes delivered into surgeries throughout rural Northland
• Stronger relationships between rural general practices throughout the northern region, bringing GPs and PNs closer together.
• Acting as a one-stop information conduit for organisations wishing to reach all northern rural GPs and PNs
• Providing representation for NRGPC members on the following projects:
  

1. Draft Rural Health Policy – Ministry of Health
2. HFA Contracting Rounds
3. Healthline – HFA, Northland Health, MAPO
4. Hepatitis B Project – Northland Health
5. Rural Health Institute Project – University of Auckland, Goodfellow Unit
6. Rural Health Director – HFA
7. Waiting Times Project – Northland Health
8. Cost of Compliance Committee – Ministry of Health
   

• Strategic Alliances with other health care providers such as First Health, the Goodfellow Unit, DMC IPA, Broadway Health IPA, Hauora Whanui, etc
• The holding of the inaugural Practice Nurse Conference in February 1999
• Enabling rural GPs and PNs to access national medical education and/or conferences that were previously inaccessible
• National recognition as the credible provider of support to northern rural general practice by other health care professionals, educational institutions, IPAs, media and government agencies.
  

Critical Success Factors

Key factors in the success of the NRGPC include:

• Sound management skills
• Key executive personnel who are the "leading lights" in the area. They have an in-depth working knowledge of rural health issues and a desire and passion to effect positive change
• "Grass roots" level leadership
• 100% "buy in" by rural health professionals – GPs and PNs
• Sound locum management scheme
• Quality education programmes developed in response to rural member GP and PN requirements
• Constructive network links
• Sound relationships with relevant government agencies, health professionals and educational organisations
• Adequate funding to ensure ability to deliver.
  

Where to in the Future?

The NRGPC is a strong vehicle from which to launch similar support initiatives around New Zealand. The NRGPC is delivering to rural general practice a "Total Package", where no other one organisation has been successful before.

It has a successful management, administrative, educational and network structure already in place and a proven track record in terms of delivering a range of services and locum support to its members.

The NRGPC has also supported other isolated rural areas. For example, it has placed a locum in the Chatham Islands for three weeks, has offered locum assistance to the South Island and continues to assist other rural areas and rural hospitals.

The NRGPC’s future goal is to assist with the establishment of similar initiatives throughout New Zealand, in support of rural general practice, which will ultimately benefit rural communities as a whole.