As we come to the end of 2020 and look to the start of our 20th year of serving rural and remote communities, there is much to reflect on as an organisation and as individuals.
Every day, our staff deal with some of the most consequential health and social issues facing rural, remote and Indigenous communities that have long-term impacts on their lives and the future of whole communities.
More than any other thing our health status is determined by the places we are born, grow, live, work and age. That is why we are committed to place-based approach to community health and well-being.
It is why RARMS is committed to ensuring that we retain our physical presence through our medical centres in rural and remote Australia to ensure our decisions and strategies are informed by what is happening on the ground.
Our doctors and health staff live and work in rural and remote communities building knowledge of the local context and establishing the relationships with local residents that are essential for good primary care and better health outcomes.
And it works. Over the last 5 years the number of low acuity presentations (T5) at local hospitals in towns with a RARMS practice has fallen by 65.5 percent. Put plainly, fewer people need to go to the ED for care because they have had access to high quality care in our rural Medical Centres.
Between 2001 and 2018 the rate of Potentially Preventable Hospitalisations (PPH) in remote NSW communities has declined from 2.9 times the city average to 1.5 times. In rural communities it has declined from 1.8 times to 1.2 times.
This is a big deal. PPH is a nationally accepted measure of the effectiveness of primary care in reducing illness which results in fewer people getting sick and needing to be admitted to hospital for conditions that are entirely preventable.
There is no doubt that the struggle to attract doctors to work in rural and remote communities remains.
RARMS was established in collaboration with Walgett Shire in 2001 to address this problem by delivering a new model of care. A 2019 Wharton Consulting review of different models of rural medical service delivery concluded that the model implemented by RARMS is the “most sustainable typology of rural and remote” primary health care provision in Australia.
What made us different, and continues to do so today, is our simple acknowledgment that doctors will come and go. What RARMS was established to do was to ensure that our medical centres remained open and delivering healthcare while we searched for a new permanent doctor.
Before RARMS, if the local GP moved out of rural practice the town would lose their doctor, highly skilled nursing and practice staff, the building and equipment, and the patient records. This made it almost impossible to attract a new doctor to start again.
The real success of RARMS has been our ability to maintain continuity of care through a team-based approach involving our nurses, allied health and practice staff, and using Telehealth when appropriate, if a permanent doctor was not available for a short time.
That is why RARMS has succeeded – our communities understand that RARMS is committed to the continuity of the local health services ensuring that regardless of workforce the community would always have access to primary care.
I believe that only a charity can do this because we are driven exclusively by our commitment to the health and wellbeing of our communities.
I have been working in rural and remote health for a long time trying to work out ways to encourage investment in the things that are proven to work. I have always found that our communities are the greatest source of insight into what works and are critical partners in finding solutions.
I took the role of CEO of RARMS because, after 20 years in rural and remote health, I formed the view that RARMS was one of the only models that would ensure continuity of care in rural and remote towns.
As a taxpayer I hate it when I see huge amounts of money spent on rural health that do not close the gap in outcomes on the ground. As a human being, I am saddened by how many lives are lost each week in rural and remote Australia because we seem at times more interested in the next big thing rather than the things that work.
Twenty years ago we sat down with the Walgett Shire communities to find a new way of sustaining primary care in rural and remote communities. In our 20th year, we began a new conversation and partnership with our communities to design a new model of care fit for the future.
Significant work has been done over the last 12 months in preparation. I am looking forward to working with our communities to design a model that makes our communities more self-reliant in access to primary care services which delivers a measurable impact on health and social outcomes.
We take comfort from the fact that for 20 years RARMS has been growing health services and improving health outcomes in our communities, as other health services have been withdrawn and declined.
The RARMS Board is excited about our new plans for expansion of primary health services, and we are actively investing in new revenue sources to underpin a new community-led model of care into the future (more on this exciting new development in 2021!).
I would like to wish you a very happy and peaceful Christmas season and look forward to continuing to work with you in the new year to continue delivering sustainable care to our communities.