A workforce for Closing the GapA perspective from the ground

Dr Tim SeniorGP Tharawal Aboriginal Corporation

Medical Advisor RACGP National Faculty for Aboriginal and Torres Strait Islander Health

Senior Lecturer UWS School of Medicine

References can be found athttp://www.citeulike.org/user/timsenior/tag/hwa2013

Number Average hours per week

GPs in Private Practice 33,596 40.9

Doctors in an AMS 532 37.8

Consultations in ACCHO and GP

• Younger patients• Longer consultations• More health care providers involved• More problems managed each consultation

Larkins SL, Geia LK, Panaretto KS. Consultations in general practice and at an Aboriginal community controlled health service: do they differ? Rural and remote health. 2006;6(3).

Thomas DP, Heller RF, Hunt JM. Clinical consultations in an Aboriginal community-controlled health service: a comparison with general practice. Australian and New Zealand Journal of Public Health. 1998;22(1):86-91.

Figure 2 Prevalence of multimorbidity by age and socioeconomic status On socioeconomic status scale, 1=most affluent and 10=most deprived.

Karen Barnett , Stewart W Mercer , Michael Norbury , Graham Watt , Sally Wyke , Bruce GuthrieEpidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional studyThe Lancet Volume 380, Issue 9836 2012 37 - 43 http://dx.doi.org/10.1016/S0140-6736(12)60240-2

What keeps doctors in challenging areas?

• Respect for patients

• A sense of control

• Intellectual interest

Stevenson AD, Phillips CB, Anderson KJ. Resilience among doctors who work in challenging areas: a qualitative study. British Journal of General Practice. 2011 Jul;61(588):e404-e410.

Factors that keep GPs in a rural area

• Business ownership• Income source,• Registrar status• Hospital work• No restrictions on practice location

Russell DJ, McGrail MR, Humphreys JS, Wakerman J. What factors contribute most to the retention of general practitioners in rural and remote areas? Australian Journal of Primary Health. 2004

Indigenous health - a role for private general practiceR Paul Johanson and Peter Hill, Australian family physician 40, no. 1-2 (2011): 16-19

How did they do this?

Negotiation with Elders resulted in 3 key strategies:

• bulk billing for all indigenous patients (by agreeable doctors)

• one session each week (‘the clinic’) specifically for indigenous patients

• a bus to the clinic

“Conclusions: For Aboriginal patients the focus on interpersonal relationships between themselves and health practitioners is paramount. Creating comforting physical environments and systems that are easier to navigate do assist in overcoming cultural barriers, but are often seen as little more than token gestures if trusting interpersonal relationships are not formed between patient and practitioner.”

Breaking down the barriers?Cultural barriers to health care for Aboriginal and Torres Strait Islanders in Mount Isa, Kristin E. McBain-Rigg and Craig Veitch, The Australian journal of rural health 19, no. 2 (April 2011

Interviews with community and health professionals in Mt Isa about barriers to care for Aboriginal people.

What do you think they found?

Solutions will involve

• A workforce willing and able to work with Aboriginal and Torres Strait Islander communities

• A workforce supported in sticking around in challenging circumstances

• A workforce able to navigate complexity