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Public-private model fills rural service gap
31 August 2016
Murrumbidgee, in central south New South Wales, covers more than 124 000 square kilometres. For its population of almost 250 000, accessing physiotherapy services has often been difficult. Until 2014, there was a chronic part-time physiotherapy vacancy at Finley Health Service, near the Victorian border, and alternative measures, such as outreach from a major regional hospital, weren’t meeting identified community need.
The former Hume Medicare Local (now part of
Murrumbidgee Primary Health Network
) was aware of the problem and approached
Murrumbidgee Local Health District
with a potential solution. By pooling resources as a
, a local private practitioner would be contracted to deliver physiotherapy services in a more flexible way across the region. After a scoping exercise was completed, that private practitioner turned out to be APA Sports Physiotherapist
Jeremy Carr and his team
based in Corowa.
‘For Jeremy, it was a sustainable thing to get involved in because two major local organisations were supporting the proposal and providing the funding,’ Cath Maloney, APAM, director of Allied Health, Murrumbidgee Local Health District, says.
The business case developed by the two bodies was successful and in June 2014, Jeremy began providing services with the help of Allied Health Assistants (AHAs).
During the six-month pilot phase, the service was only available at Finley Health Service but that has now been expanded to three more sites in the health district: Berrigan, Urana and Jerilderie. Prior to the project, existing funding would have provided a service two days each week at one facility.
‘Patients often mention that it’s a great service and the local health advisory committee that works with the hospital is very happy that they’ve now got these services,’ Cath says.
Last year, the service won the NSW Health Secretary’s Award for Integrated Care at the
NSW Health Awards
, highlighting this as a rare example of agencies sharing resources to address a service gap in the community.
‘So often, we’re working in parallel and trying to apply funding separately, but we can achieve far more if we pool those funds and overcome some of those issues around variations in the outcomes we’re looking for,’ Cath reflects.
In terms of achieving this, she says the willingness of a local health service to explore alternative models of providing services is critical.
‘From our perspective as a local health district, we had to overcome some reservations from managers about contracting a service rather than employing someone,’ Cath says of the process.
She believes it’s important that contracted allied health professionals are treated in a similar way to visiting medical officers, something they are working toward in Murrumbidgee. Other factors to the program’s success have been Jeremy’s enthusiasm and capacity to see the advantage in working with local health administrators, as well as Cath’s understanding as a former private practitioner of the advantages of such a model.
(L–R): Rosemary Garthwaite, Murrumbidgee Local Health District (MLHD) Rural Group Manager; APA Sports Physiotherapist Jeremy Carr, Back on Track Physiotherapy; Catherine Maloney, APAM, MLHD Director Allied Health, Subacute and Aged Care; Professor Mary Foley AM, former secretary, NSW Health, accepting the NSW Health Award.
The model’s sustainability relies heavily on the use of AHAs to carry out the physiotherapist’s care plan between their visits with each patient. Underpinning this is a strong framework that sets out responsibilities around delegation of clinical duties and who remains responsible for what.
‘A lot of the services being provided to the health service at Finley were more along the lines of slow stream rehab, so they didn’t necessarily need that high intensity, daily input from the physiotherapist. It’s a very efficient system and that goes a long way to the sustainability of the whole thing,’ Cath explains.
Significantly, the arrangement survived the phasing out of Medicare Locals in 2015, which have been replaced by Primary Health Networks.
Later this year, Cath will give an update on the program at the
Services for Australian Rural and Remote Allied Health conference
, where other rural services are likely to be listening closely for the lessons she’s learned.
‘The issue at the beginning was a service gap, so it’s quite easy to demonstrate now that we have a service for those rural communities populations.’
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