Rural and Remote Medical Services Statement: Rural health care is changing, and we must too


After 20 successful years of helping rural and remote communities to manage on-site local community GP practices, and recruiting permanent GPs to vulnerable towns, we regretfully announce that we are discontinuing the RARMS Program on 30 September 2022.




Background

RARMS was established as a charity in 2001 to help communities to operate on-site local GP practices sustainably in rural and remote towns. We have done this successfully for more than twenty years by providing rural and remote towns with access to the “Rural and Remote Medical Services Program” (RARMS Program).


The RARMS Program was designed around a simple principle - “rural people helping rural people”.


The Program supported multiple communities around NSW to come together and share the costs of access to specialist practice management expertise that was often not available in the local community. Communities were able to work together to reduce the cost of health services for everyone and achieve a common vision of “health for all, regardless of where you live”.


Most importantly, the Program enabled communities to lend a helping hand to their neighbours. Under the Program, communities pooled surplus income as a rainy-day fund that could be drawn down in times of difficulty.


This ensured our communities could keep their local health services going, even if they lost their local GP or a key member of staff.


Unlike the many programs that have been designed to improve access to rural health services, the RARMS Program was designed by rural people and for rural people and focused on sustaining and growing jobs and economic activity in rural and remote towns.


Over 20 years of working together, our communities have been able to ensure ongoing local access to 24/7 GP/VMO services for vulnerable rural and remote people.


In that time, hundreds of dedicated rural GPs, nurses, allied health professionals, and practice staff have delivered millions of health services to more than 25,000 sick and vulnerable people.


They have worked with passion and commitment to ensure all Australians could exercise their human right to access health services, regardless of where they live in the country. We acknowledge their dedication and service to Australia’s most vulnerable people.


We are proud that multiple research papers have recognised the RARMS Program as one of the most cost-effective and sustainable solutions to address the health needs of vulnerable rural and remote people.


Changing Environment

Unfortunately, due to the chronic shortage of permanent rural GPs, and the escalating cost of Locum coverage, we are now simply unable as a charity to afford to continue the RARMS Program.


Growing GP shortages has seen the daily rate for Locums who fill in vacancies in rural GP practices soar to unaffordable levels. As a charity, we are simply no longer able to absorb the rapid increases in these costs.


That is why we are announcing today that we are discontinuing the RARMS Program with effect from 30 September 2022.


This has not been an easy decision and something we have been trying to avoid for 2 years. Over the last 2 years, RARMS has provided more than $3 million from our charitable reserves to subsidise the RARMS Program in rural and remote towns and strengthen rural GP practices. This is simply no longer possible.


This decision will mean that effective from 30 September 2022 the RARMS Program will be discontinued in the towns of Bingara, Braidwood, Gilgandra, Tenterfield, and Warren.


Will the rural GP practices have to close?

No. RARMS does not own practices, but rather supports the operation of the practices on behalf of local councils and communities. These practices remain an essential local asset and our decision to discontinue the RARMS Program does not mean that these practices will close.


Recognising the continuing problems associated with rural and remote GP supply, RARMS invested over the last 2 years in practice improvement capabilities to ensure that the local GP practice could operate as a standalone service in the worst-case scenario that RARMS was not able to fund the Program. That is regrettably the situation we find ourselves in today.


It is critical for our communities to know that none of the community GP practices in Bingara, Braidwood, Gilgandra, Tenterfield, and Warren need to close as a result of the discontinuation of the RARMS Program.

As a result of our work, all the community GP practices are now financially sustainable as standalone services and will remain so with appropriate local community support while they have permanent or regular GP. Any decision about the future of community GP practices is ultimately a decision for the local council and community.


The discontinuation of the RARMS Program does however mean that these communities will be exposed to significantly higher risks if there is a long vacancy in the role of a permanent GP, or if there is a loss of staff with specialist practice management skills leave, due to the rapidly escalating cost of rural and remote general practice.


We have asked governments to consider how they can financially support rural and remote general practices to remain open while the government fixes rural GP workforce programs over the next few years.


What happens now?

We have been meeting with our local councils and/or staff to discuss options.


Following discussions with our permanent rural GPs and staff we are very pleased to be able to report as follows:


In Braidwood and Tenterfield, RARMS has talked to the local permanent GPs that we recruited for these towns under the RARMS Program and reached an agreement for the local GPs to take full ownership responsibility for the practices. RARMS will make a significant donation of medical equipment and technology to support these new local GPs to thrive. We are confident that these practices will continue with a strong future under the ownership of a permanent local GP.


In Bingara, the local council has requested to take back responsibility for the management of the Bingara Medical Centre which it previously operated. All GPs and staff will be transferred to the employment of the council with effect from midnight on 30 September 2022. RARMS will make a significant donation of medical equipment and technology to support the practice.


In Gilgandra and Warren, we are in discussions with the local councils and staff about the process for handing back practice management to the councils, or a community-controlled charity, on 30 September 2022 and looking at how we can best support the practices in the future. Once again, RARMS will donate medical equipment and technology as part of this process.

The Collarenebri practice is in one of the most socioeconomically vulnerable communities in Australia. RARMS has recently secured several new grants and is working with private health providers to deliver a program of GP-Led integrated care to the community. Over the coming months, RARMS will work with Murdi Paaki, the government, and the local community on a new plan for the future of health services in the town.

In Armidale, we are working with our local GPs and staff to explore how we might get support to retain this practice as an overseas doctor training centre to help rural and remote towns get doctors in the future.


What does the future look like for RARMS?

RARMS will continue to support and advocate for rural health and workforce reform, and for rural people to have a seat at the table in decisions about the future of Medicare and their rural hospital system.


The right to health is a fundamental human right necessary for the realisation of all other rights. As a nation, we have a solemn duty to ensure that all people in rural and remote Australia have access to a local GP within reasonable reach of their homes.


We will continue our work with our university and research partners, health organisations, and rural and remote communities to develop and advocate for new policy approaches and investments that better suit and support today’s circumstances.


RARMS will continue to strongly support and grow its HealthAccess Program to specifically focus on those rural and remote communities, and aged care residents, that no longer have access to a local GP or health service. We are working with several partners to build an innovative new model of care that ensures continuity of care with a regular GP remains at the core of good quality primary health care and hospital avoidance.


We thank the numerous organisations and people who have supported the RARMS Program over many years including the NSW Rural Doctors Network, Western NSW Local Health District, Western NSW Primary Health Network, Hunter New England Local Health District, Southern NSW Local Health District, Murrumbidgee Local Health District, Royal Flying Doctors Service, Aboriginal Community Controlled Health sector, Outback Division of General Practice, Local Aboriginal Land Corporations, Murdi Paaki, InterHealthCare, Marathon Health, LiveBetter and the many other organisations too numerous to mention.


These challenging times call for new and creative approaches to the health and care of rural and remote communities that ensures and protects the right of all Australians to be able to access primary health care in the future. As we evolve our work in rural and remote Australia, we remain committed to our vision of “Health for all, regardless of where you live”.



Mark Burdack

Chief Executive Officer



A downloadable version of this statement or the media release is available below.


RARMS_Statement_3August22
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RARMS_Media Release_3August22
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