Bandaids - do we rip them off, or pile more on top?

2025 is in full flight... Somehow we're already two months in - and I'm still saying "Happy New Year" to anyone I haven't seen since December! Come to think of it, I might have done a fair bit of this at the first sector event at which I've represented GPSA so far this year!! 

The Rural Workforce Agency of Victoria (RWAV) held their conference "Dreaming Big and Driving Change in Rural Healthcare" in the charming regional town of Bendigo from 19th through 21st February, and as always this proved a terrific platform for sharing of ideas and learning about the different challenges experienced not only in different regions and ruralities but also across all the various cohorts that make up the rural health workforce: at the heart of which is the rural GP / RG. 

What I get most from conferences like this is the opportunity to connect with all the passionate folk involved in supervising tomorrow's health professionals - generally while queuing for a barely-decent coffee! Apart from the calibre of coffee, what I reliably find disappointing at these events is the lack of connection between the separate initiatives presented and the holistic solutions the attendees are crying out for... a product of government funding structures that drive individual universities, health networks, peaks and other entities to compete for research grants that ultimately give rise to disjointed ideas rather than meaningful system-wide improvements.

The first day of presentations and keynote addresses was a bit of a challenge once that caffeine wore off... "Data and tech" seemed like something I could get my teeth into, especially the tech part, but I have to confess I found myself irritated from the very first reference to data as a basis for health policy - my irritation stemming from the fact the data referred to by a Vic government representative appeared fundamentally flawed. I now realise that for me to feel so strongly affronted by one piece of data, drawn from a one-dimensional source without context or consideration of accuracy, I must be starting to think like one of our members! In truth, while sitting in that auditorium shaking my head in frustration at back to back presentations and keynotes on the importance of data - with no mention of the importance of truth-checking this data or ensuring responsible use thereof -, I was definitely channelling some of my favourite, more outspoken, GP supervisors!

All it takes is to overlook one small thing and all the academic assumptions based on data are immediately rendered irrelevant (or maybe that's just in the eye of the beholder!). The one small thing that echoed through my head throughout that first day has two parts to it, namely that under-representative data is as good as no data for use in effective policy-making, and GPs have little to no trust when it comes to contributing to any form of data collection after so many years of having this data used against them (exhibit A: the Medicare freeze both major political parties are finally promising to address). I know I am writing this when our annual supervision survey is kicking off and we start plying the airwaves with requests for you to contribute your "data", but (a) there's a big difference between GP supervisor data being used by this representative body to shape advocacy on your behalf / develop fit-for-purposes supports for you, and GP data being used for political expediency; (b) when we choose not to contribute our data, thinking others will adequately represent our position, the squeaky wheels that get the grease are rarely reflective of our interests; and (c) policymakers are going to use even the most scant data to advance an agenda, so we're pretty much "damned if we do, damned if we don't"! (Key takeaway here = DO THE "ENGAGE" SURVEY!!!)

The suspicious nature of the GP supervisor continued to shape my response to the ensuing tech presentations. Technology has huge potential to streamline workflows, increase quality of delivery (both of clinical outcomes and of supervision as a component of training the future healthcare workforce). But again, suspicion creates a barrier to the uptake of certain tech opportunities. What nobody discusses in 2025 is the impact on health workers by the rapid introduction of new technologies throughout the very dark days of COVID. Aversion to more of the same is only natural for the people burdened to adapt to all this newness while trying to keep their communities alive and healthy through a pandemic. And again, yes, we at GPSA keep plying you with the opportunity to purchase our mobile apps and take up free membership of a community of practice which involves not one but two separate tech platforms, but these really are all designed purely for your benefit! The kind of technology discussed at the RWAV conference was varied (of course AI transcription came up, albeit briefly), but it was a presentation by a virtual ED provider that left a truly lasting impression. Unfortunately, this presenter - like several of the academics and bureaucrats with their specialised data presentations - failed to read the room! Almost every clinician at a rural conference like this is a rural GP or RG with close connections to their communities and the workforce challenges of their health services. Almost as one, these doctors challenged the purpose of this state government virtual ED initiative, declaring it a substitution at a point in time when their overwhelmed health workforce urgently needs physical, in-person reinforcements. Reading between the lines, the real sticking point for many might have been the presenter's cheeky boast that he like the majority of the clinicians contributing to this service get to do so from the comfort of their own homes in metro Melbourne - blissfully ignorant of the woeful internet and phone reception that's a staple for regional, let alone rural and remote, communities.

Before I had time to process whether all this data and tech content was offering a bandaid or a lasting solution, the lens shifted to attracting medical students and junior doctors to rural locations. And again, my head was shaking like I was one of the grumpy old men on the Muppet Show!

The cited numbers of students lacked any real substance through the failure to present these against a wider context, ie the actual outcomes of these students' education for the community, particularly the rural communities now offering end-to-end training. The disregard for these outcomes came into focus when a little known fact was revealed about paramedics. Repeatedly throughout the conference, paramedics were referred to as being in "oversupply" in Victoria; meanwhile, ambulance branches all over the state struggle to fill rosters, leaving hundreds of emergency calls unattended for extended periods every day of the year. Apparently, after devoting three years to qualify, the average length of time a paramedic works in this role is just five years (my take on this being that maybe if they stopped renewing their registration once they resign from Ambulance Victoria, the data would resolve itself and be more accurately interpreted as an "under-supply", prompting an investigation into how paramedics could be better supported to continue working in the field for longer). Regardless of the chosen profession, what happens - and why - after students qualify as health professionals seems to be far less significant than the numbers of students being fed into the sausage machine. A major problem with this is that success is measured in terms of a point-in-time headcount rather than a sustainable long-term increase in skills and healthcare quality: which for rural, regional and remote communities must surely be considered in terms of continuity and longevity in place as much as ongoing access to numbers of medical, nursing and allied health staff? To secure the longer term solution means unpacking the barriers the sector currently faces in response to diminishing interest in a forever (or at least a decent length of time) full-time career in medicine.

Long story short, I've left the first conference of 2025 armed with a new perspective on already-fermenting ideas that I'm sure will shape key elements of our advocacy this year:

• What is it about general practice that drives even trainees to commit to only part time hours in this specialty? Surely gaining an understanding of this should be a priority so that we can focus on creating a model of community healthcare that serves the needs of clinicians now and into the future to optimise the workforce growth in which the Commonwealth invests at a per capita cost? The Prime Minister's pre-election announcement about proposed increases to current AGPT places (our media release from February 24th outlines the points of relevance to GP training) highlights the investment calculated on a headcount (physical numbers of trainees) with no relationship to the outputs in terms of actual FTE hours these trainees will work in general practice during their training let alone once Fellowed. 
• A lot of additional Commonwealth investment has been focused on attracting medical students and junior doctors to rural healthcare. By contrast, there has been negligible investment in retaining today's - and attracting tomorrow's - medical supervisors. As a career destination in its own right, the medical supervisor should represent a leader of the training site and the community. To make this role attractive enough to perpetuate the apprenticeship model of healthcare training means enhancing the perception of all it means to be a supervisor through visible and measurable supports, respect, reward and recognition.
• A much-quoted area of need for rural health requiring infrastructure and investment - one that's spoken of a lot but remains stuck at the bottom of the too-hard basket - is the often lamented absence of suitable accommodation options across regional, rural and remote Australia. One water-cooler conversation I was privy to involved the billions of dollars of real estate owned by the universities represented at the conference, and whether these universities' commitment to rural health would extend to disposing of some of their blue chip (inner-city metro) investments in order to fund the purchase or building of the much needed accommodation for rural and remote health students, supervisors and practitioners. 

Rounding out February, I have travelled to pleasantly-muggy Newcastle to meet with the JCTS team, cementing a relationship that will ensure ongoing access to high quality cultural safety training for our supervisors and practice team members, new ACCHO and JCTS groups on GPSA Community, and the introduction of a brand new Indigenous Health category on the Scenario app.

Already so much underway, and it's only the start of the year (which I'll keep telling myself!!). So now I leave you to reflect on the title of this little blog post in the context of new incentives and old issues finally being tackled through pre-election promises (conditional of course on bulk billing for every consultation no matter the duration or type - not an issue GPSA has much of a role in addressing), policies being built on flawed data, data that takes a life of its own when used to suit an agenda, technologies created with little reference to end-user needs and perspectives, a distinct absence of holistic solutions but an eclectic range of innovations and place-based initiatives... Many of these might be seen as bandaids. Which should be ripped off in one short sharp action, and which should be piled on top of existing stop-gap measures? But most importantly, how do we get to the point of actually healing the underlying problem? I genuinely welcome your response to these questions - please email me at [email protected] with your thoughts. And please, block off less than a half hour so you can complete our annual survey!