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Outcome 12 - Health Workforce Capacity

Improved capacity, quality and mix of the health workforce to meet the requirements of health services, including through training, registration, accreditation and distribution strategies.

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Outcome Summary

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the key strategic directions and performance indicators published in the Outcome 12 chapters of the 2009-10 Health and Ageing Portfolio Budget Statements and 2009-10 Health and Ageing Portfolio Additional Estimates Statements. It also includes a table summarising the estimated and actual expenditure for this outcome.

Outcome 12 aims to ensure that Australians have access to an improved health workforce through education, training, recruitment and distribution programs for the medical workforce, particularly general practitioners (GPs); the nursing workforce and for allied health professions. The department worked to achieve this outcome by managing initiatives under the programs outlined below.

Outcome 12 was managed in 2009-10 by Health Workforce Division and Primary and Ambulatory Care Division. The department’s state and territory offices also contributed to the achievement of the outcome.

Programs Administered Under Outcome 12 and 2009-10 Objectives

Program 12.1: Rural Workforce

Increase the number of health professionals working in rural areas and ensure that they are well trained, with appropriate skills to meet health needs in these areas.
Develop, implement and monitor rural workforce programs.
Support and encourage existing rural health professionals and students of health disciplines to consider careers in rural and remote areas.

Program 12.2: Workforce

Increase the supply of workers in all health professions.
Facilitate a more even distrubution of workforce both in terms of geography and of the types of services provided.

Major Achievements

Established Health Workforce Australia (HWA) to facilitate national workforce planning and to support clinical training capacity expansion in Australia. HWA will work collaboratively with states and territories, the university sector and health professional services to deliver the training needed to produce the health workforce of the future.
Implemented required legislative changes to support a National Registration and Accreditation Scheme at the Commonwealth level. A national system of registration and accreditation will deliver improved public safety across Australia and facilitate improved flexibility for health professionals while reducing ‘red tape‘.
Streamlined administrative arrangements for a range of programs to improve consistency in program design and delivery. This has included consolidating similar programs to deliver more streamlined arrangements for scholarships through the Nursing and Allied Health Scholarship and Support Scheme and for specialist training programs through the Specialist Training Program.
Negotiated 57 infrastructure grants that increased and enhanced clinical training capacity for health students, trainees and clinicians across a range of disciplines Australia wide.
Implemented the Rural Locum Education Assistance Program by filling 30 available training placements which will improve the pool of doctors providing rural locum services.
The Rural GP Locum Program achieved 78 locum placements and 663 placement days to support rural GPs and improve access to GP services for rural and remote communities.

Challenges

Lower than expected take-up of the Bringing Nurses Back to the Workforce Program.
Lower than anticipated take-up of locum relief days under the General Practitioner Anaesthetist Locum Scheme and the Specialist Obstetrician Locum Scheme.
Difficulty in meeting the target for recruiting overseas trained doctors under the International Recruitment Strategy.

Program 12.1: Rural Workforce

Program 12.1 aims to increase the number of health professionals working in rural areas and ensure they are well trained, with appropriate skills to meet health needs in these areas.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve these aims were to:

improve the supply of all health professions in regional, rural and remote Australia; and
strengthen investment in rural teaching, training and infrastructure.

Major Activities

Improve the Supply of Health Professionals in Regional, Rural and Remote Australia

Rural GP Registrar and GP Incentives

Communities in rural and remote areas have difficulty accessing medical services due to the shortage of doctors working in these areas. In 2009-10, the department helped 2,362 GPs and 664 GP Registrars to remain in rural and remote areas through the Rural Retention Program and the Registrars Rural Incentive Payments Scheme. From 1 July 2010, these programs will be consolidated into the General Practice Rural Incentives Program. The new arrangements will provide greater financial incentives through a relocation grant to encourage doctors to move to and remain in rural and remote communities.

In 2009-10, the department worked with Medicare Australia to develop a reliable IT system to assess and deliver incentive payments under the General Practice Rural Incentives Program. From 1 July 2010, the program will provide increased incentives to encourage the retention of GPs and GP Registrars in regional, rural and remote areas of Australia. In addition, the IT system will deliver payments under the HECS Reimbursement Scheme, the Rural Locum Education Assistance Program and the Rural Procedural Grants Program. The department also consulted with Rural Workforce Agencies to support implementation and administration.

In 2009-10, the department delivered a range of communication activities and developed tools to inform doctors of the new arrangements. These tools include fact sheets, conference materials and updating of the DoctorConnect website. The department engaged Woolcott Research to undertake qualitative research to inform the communication strategy. The research determined the most appropriate method of distributing information to medical practitioners and medical students. The communication strategy was developed to comply with the Department of Finance and Deregulation’s Guidelines on Information and Advertising Campaigns by Australian Government Departments and Agencies.

Locum Support for Rural Doctors

In 2009-10, the department implemented the National Rural Locum Program to improve access to general practitioners in rural and remote communities. There are two components of this program; the Rural GP Locum Program and the General Practitioner Anaesthetist Locum Scheme. These new programs, along with the Specialist Obstetricians Locum Program, provide support to rural specialists and GPs to ensure they are able to obtain adequate time for rest and professional development. The locum programs are delivered through a brokerage arrangement to connect and link GPs and specialists with suitable locums. The programs also provide a subsidy to assist with the cost of employing locums.

The department funds the Royal Australian and New Zealand College of Obstetricians and Gynaecologists to deliver the Specialist Obstetricians Locum Scheme. The scheme aims to improve access to quality obstetrician care for rural women through subsidised locum placements. In 2009-10, the department funded 77 rural specialist obstetricians and 29 GP obstetricians through this program. The department also funded the Australian Society of Anaesthetists to administer the General Practitioner Anaesthetist Locum Scheme to improve the access of rural communities to quality local GP anaesthetist care through subsidised locum placements. This scheme experienced a lower than expected take-up. The department commenced an evaluation during 2009-10 and will consider options to improve future take-up of the scheme. The department entered into an agreement with Rural Health Workforce Australia to administer the new Rural GP Locum Program. This program exceeded expectation in its first year, achieving 185 per cent of its target.

A major achievement for the department in 2009-10 was the implementation of the Rural Locum Education Assistance Program – an expansion to the Rural Procedural Grants Program. The Rural Locum Education Assistance Program will increase and improve the pool of doctors who are willing to provide rural locum services. The program provides financial assistance to urban GPs who undertake emergency medicine training and commit to a four week locum placement in a rural locality within a two year period. The demand for this program exceeded initial estimates, with the allocated 30 training places filled within the first month of the pilot. The department manages contracts with the Australian Centre for Rural and Remote Medicine and the Royal Australian College of General Practitioners to administer the new program as an extension to their existing role in administering the Rural Procedural Grants Program. In 2010-11, the department will provide an additional 70 places to meet the demand for the program.
doctors receiving training

Rural Teaching and Training

In 2009-10, the department supported existing and new undergraduate training in rural areas for medical, nursing and allied health students. Training health students in rural areas has been shown to increase the likelihood that they will choose to work in a rural area after graduation.

The department also supported rural health training through management of the Rural Health Multidisciplinary Training Program, a consolidated program established as part of the 2009-10 Budget. To manage this program, the department worked in partnership with universities to support 17 Rural Clinical Schools and 11 University Departments of Rural Health. This includes three new Rural Clinical Schools currently under development. The department also worked in partnership with six dental schools participating in the Dental Training Expanding Rural Placements Program. Complementary initiatives that supported this training included programs to encourage clubs and associations for students interested in rural health in universities, provide assistance to students from rural areas, and introduce students to the lifestyle of a rural health professional through theJohn Flynn Placement Program.

In 2009, University Departments of Rural Health supported 4,229 clinical placements of at least two weeks duration. In the Rural Clinical Schools Program, 923 medical students did long-term placements, one year on average, in a rural setting. The John Flynn Placement Program provided 750 students with the opportunity to work with doctors in rural communities for two weeks. The program is expanding and in 2010, 900 students will be offered placements in a rural community.

These initiatives provide a long-term solution to rural health workforce development, while also offering an immediate benefit to people living in rural Australia. Access to health care in communities with a Rural Clinical School or a University Department of Rural Health has generally improved, due to the retention of existing health professionals and the recruitment of new health professionals to these regions due to the presence of a major training provider.

In 2009-10, the department established the Rural Education Infrastructure Development Pool, which supported new projects such as rural education centres and student accommodation. A total of 22 new projects were approved and rural communities in all states and the Northern Territory will benefit from these projects. The department will work in 2010-11 to ensure these initiatives continue to provide high quality clinical training experiences for students of medicine, nursing and allied health in rural and remote Australia.

In 2009-10, the department consolidated four programs under the Consolidation of Continuing Education and Training Support for Rural Health initiative. Under the initiative, four programs providing support and continuing professional development for health professionals in rural and remote communities were consolidated into the Rural Health Continuing Education Sub-program. The first stream of the program will focus on medical specialists and the second stream will focus on allied health professionals, nurses, general practitioners and Aboriginal and Torres Strait Islander health workers. The program provides a coordinated approach to issues of professional isolation and access to continuing professional development.

The supply of doctors working in areas of workforce need will increase in the longer term, through the provision of medical school places in universities under the Bonded Medical Places scheme. In 2009-10, the department provided 653 places, bringing the total number since the scheme’s inception in 2004 to 3,142. It is expected that the first cohort of doctors from the scheme will commence their return of service obligation in 2013, working in areas of need for at least four to six years (less any credit obtained through scaling).

The department also administered the Medical Rural Bonded Scholarship scheme, which provides more than $24,000 a year to students who commit to working for up to six continuous years (less any credit obtained through scaling) in a rural or remote area after completing their medical training as a specialist. In 2009-10, the department supported 97 new students under the scheme, with a current total of 977 participants. The first doctors supported by the scheme commenced their return of service obligation in rural and remote areas in 2010.

The Scaling Initiative was announced in the 2009-10 Budget as part of the Rural Health Workforce Strategy, and provides a non-cash incentive for doctors with a return of service obligation to work in more remote communities whereby participating doctor’s return of service period is scaled such that the more remotely a participating doctor chooses to practice the shorter their bonding period is. Scaling has been included in the agreements for all 2010 Bonded Medical Places and Medical Rural Bonded Scholarship students.

Performance Information for Outcome 12

Program 12.1: Deliverables

Qualitative Deliverable

Qualitative Deliverable:	Regular stakeholder participation in program development through a range of avenues, conferences, meetings and consultation mechanisms.
Result: Deliverable met.
In 2009-10, the department consulted with stakeholders in relation to the findings of the 2008 external evaluation of the Rural Clinic Schools and University Departments of Rural Health Programs. Copies of the final evaluation report were distributed to 73 stakeholders including participating universities, professional bodies, peak groups and state, territory and Australian Government departments. Written feedback was requested to inform program development. The department’s work in response to stakeholder feedback from the evaluation implementation process continued in 2009-10. This included revision of program funding parameters for the next funding period (from 2011-12) and efforts to streamline administrative arrangements to reduce the reporting burden for participating universities. Discussions on the implementation of recommendations were also held with the Australian Rural Health Education Network, Medical Deans of Australia and New Zealand and the Federation of Rural Australian Medical Educators. In 2009-10, the department also worked with stakeholders from the Rural Doctors Association of Australia, Rural Health Workforce Australia, General Practice Education and Training, General Practice Registrars Australia, the Australian Indigenous Doctors Association and the Royal Australian College of General Practitioners to develop rural health workforce programs such as the General Practice Rural Incentives Program and the Rural Locum Education Assistance Program.

Quantitative Deliverables

Improving the Supply of Health Professionals in Regional, Rural and Remote Australia
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-0.5%
Result: Deliverable met.
The administered expenses for Program 12.1 were underspent by 0.5 per cent.
Quantitative Deliverable:	Number of University Departments of Rural Health multidisciplinary rural placements, with an average duration of 4 weeks.
2009-10 Target:	3,300	2009-10 Actual:	4,229 (2009 academic year)
Result: Deliverable met (for 2009 academic year).
University Departments of Rural Health training placements are reported on a calendar year basis, rather than by financial year. In 2009, the program target of 3,300 placements was exceeded. Support was provided for 4,229 placements, with an average placement duration of five weeks.

Program 12.1: Key Performance Indicators

Quantitative Key Performance Indicators

Improving the Supply of Health Professionals in Regional, Rural and Remote Australia
Quantitative Indicator:	Number of GP obstetrician and specialist obstetrician locum placements filled.
2009-10 Target:	100	2009-10 Actual:	106
Result: Indicator met.
The Specialist Obstetrician Locum Scheme supported 77 specialist obstetrician and 29 GP obstetrician placements in rural locations during 2009-10. An average of 6.25 days was provided per placement. In 2008-09, a total of 97 specialist and GP obstetrician locum placements were supported under the Specialist Obstetrician Locum Scheme and in 2007-08, 38 specialist obstetrician locum placements were supported during a pilot year.
Quantitative Indicator:	Number of days per year locum relief is provided to rural obstetricians (these figures include multi-site placements).
2009-10 Target:	799	2009-10 Actual:	434
Result: Indicator not met.
Following contract negotiations with the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, a more realistic target was agreed for the provision of 478 locum days. The 2009-10 outcome achieved 59.8 per cent of the original target and 91 per cent of the revised target. The original target for this program was considered to be an overestimation of take-up rate of the program. In 2010-11, the department will review the program to consider the reasons for the lower than expected take-up. In 2008-09, 636 locum days were provided to rural obstetricians under the scheme. 2007-08 figures are not available.
Quantitative Indicator:	Number of days per year locum relief is provided to rural GP obstetricians and GP anaesthetists (these figures include multi-site placements).
2009-10 Target:	1,025	2009-10 Actual:	295
Result: Indicator not met.
The target was established prior to the negotiation of funding agreements with the Royal Australian and New Zealand College for Obstetricians and Gynaecologists for the Specialist Obstetricians Locum Scheme and with the Australian Society of Anaesthetists for the General Practitioner Anaesthetists Locum Scheme. The target was unrealistic due to the exclusion of specialist obstetrician placements. In 2010-11, the department will review both programs to consider the reasons for the lower than expected take-up.
Rural Teaching and Training
Quantitative Indicator:	Percentage of medical students supported (at participating universities) to complete one year of rural training through the Rural Clinical Schools program prior to graduation.
2009-10 Target:	≥25%	2009-10 Actual:	29.7%
Result: Indicator met.
Rural Clinical School placements are reported on a calendar year basis rather than by financial year. In 2009, the program target was exceeded, with 29.7 per cent of Australian medical graduates (at participating universities with operational rural clinical schools) completing at least one year of rural training.

Program 12.2: Workforce

Program 12.2 aims to increase the supply of workers in all health professions, to take into account the changing demographics of the Australian population, and to facilitate a more even distribution both in terms of geography and of the types of services provided.

Key Strategic Directions for 2009-10

In 2009-10, the department’s strategies to achieve these aims were to:

implement the Council of Australian Governments National Partnership Agreement on Hospital and Health Workforce Reform announced on 29 November 2008;
implement scaled incentives to support the recruitment and retention of overseas and Australian-trained doctors to rural and remote locations, and to facilitate improved access to medical services;
implement the National Registration and Accreditation Scheme with the states and territories to facilitate workforce mobility, enhance patient safety and reduce ‘red tape’; and
consolidate and improve the effectiveness of health workforce programs, including those which support nursing and allied health training and mentoring, into simpler, more uniform and efficient program arrangements that are easier to navigate and access.

Major Activities

COAG Health Workforce National Partnership Agreement

In 2009-10, the department continued work to ensure a sustainable health workforce. A major achievement for the department was the implementation of the Council of Australian Governments Health Workforce National Partnership Agreement, through collaboration with states and territories. The aim of this agreement is to increase the supply of health professionals, providing them with individual support and assisting them to work together, and improve the care people receive. The focus for delivering the national workforce agenda is the new agency, Health Workforce Australia. This agency was established as a Statutory Authority under the Commonwealth Authorities and Companies Act 1997 and commenced operations in January 2010 under Mr Mark Cormack, the Chief Executive Officer.

In December 2009, as part of the National Partnership Agreement, the department managed the initial clinical training funding round. Funding was open to proposals in public and private settings which could demonstrate an ability to increase clinical training potential for entry level health profession students undertaking studies in eligible disciplines. A total of 204 applications were received, with total bids of over $197 million – well in excess of the $67.5 million available. Additionally, the department advertised grant funding totalling $90 million over four years (2009-10 to 2012-13) for infrastructure projects to increase the capacity and improve the distribution of clinical teaching and training. A total of 400 applications were received, with total bids in excess of $900 million. Thirty five projects were successful under this round.

Recruitment and Retention of Overseas and Australian-trained Doctors

There is currently a shortage of GPs in Australia. There are several reasons for this shortage, including a growing and ageing population and changes in the composition of the medical workforce. Programs supporting the recruitment and retention of overseas and Australian-trained doctors are important for all communities, particularly those in regional, rural and remote areas of Australia where access to doctors is low to very poor.

The department assesses applications from overseas-trained GPs and specialists, and provides eligible doctors exemptions under Section 19AB of the Health Insurance Act 1973. The exemption allows doctors to provide services which attract Medicare benefits. In 2009-10, 6,576 overseas-trained GPs and specialists held exemptions. These initiatives will be continued in 2010-11 to ensure communities in areas of workforce shortage can attract and retain medical practitioners.

From 1 July 2010, the department will introduce greater incentives to attract overseas and Australian-trained doctors to work in rural and remote areas and encourage them to remain in these locations for longer. These incentives include the scaling of return of service obligations for overseas-trained doctors and bonded doctors who choose to work in rural and remote areas of Australia. The scaling initiative will provide the greatest benefit to GPs who work in the most remote locations. During 2009-10, the department worked with Medicare Australia to develop an IT system to identify and scale return of service obligations for doctors who meet the program’s eligibility requirements. The department provided fact sheets for the DoctorConnect website to communicate the benefits of the scaling initiative and developed an email box to respond to doctors’ queries. In addition, the department notified all doctors by mail about the scaling incentive and the benefits provided.

Simplifying Australian Government Support for Medical Specialist Education and Training

In 2009-10, several medical specialist training programs were consolidated to form the Specialist Training program. The department developed new Specialist Training Program Guidelines, which provide clear advice to stakeholders on the priorities and the eligibility requirements of this program.

The program provides a simpler and easier way for health care providers to participate in specialist training. These new arrangements will enhance program uptake and integration in medical specialist training pathways across Australia. The Specialist Training program will provide a consistent approach to better match training of specialists to where services are delivered. This will increase the number of vocational clinical training places available outside traditional public teaching hospitals and provide a broader experience benefiting specialist trainees once they complete their Fellowship.

Figure 1: Overseas-trained doctors with Section 19AB exemptions

National Registration and Accreditation Scheme

The National Registration and Accreditation Scheme for health professions overcame the previous inconsistencies in registration standards between states and territories. The scheme enables health professionals to move around the country more easily, reduces ‘red tape’, and promotes a more flexible, responsive and sustainable health workforce. Under the scheme, health professionals are registered with one national board, providing greater safeguards to the public against negligent practitioners.

The department, through collaboration with states and territories, facilitated the Council of Australian Governments’ commitment to a single national registration and accreditation scheme by 1 July 2010. The department worked in conjunction with states and territories to develop the legislative policy and standards to support the scheme’s establishment through the Health Practitioner Regulation National Law Act 2009. In addition, the department developed the Commonwealth Health Practitioner Regulation (Consequential Amendments) Act 2010, which supports transitional arrangements under the National Registration and Accreditation Scheme. This Act received Royal Assent on 31 May 2010.

Consolidate and Enhance Health Workforce Programs

On 12 April 2010, the Health Legislation Amendments (Midwives and Nurse Practitioners) Act 2009 received Royal Assent. From 1 November 2010, eligible nurse practitioners will be given access to the Medicare Benefits Schedule and the Pharmaceutical Benefits Scheme. This initiative is aimed at supporting nurse practitioners in non-acute settings, including primary care, aged care and rural and remote settings by providing access to certain Medicare Benefits Schedule and Pharmaceutical Benefits Scheme subsidised services. The measure allows the nurse practitioner role to be more efficiently used and will help improve the efficiency and capacity of Australia’s health workforce.

In 2009-10, the department consolidated and built on a range of existing and new initiatives to create the Nursing and Allied Health Scholarship and Support Scheme to ensure better alignment with, and responsiveness to, the needs of health professionals to train and practise, especially in areas and locations of particular need. The consolidation of the Nursing and Allied Health Scholarship and Support Scheme was completed in 2009-10, enabling the new scholarship arrangements to take full effect from July 2010. Under existing arrangements: 631 people were awarded a nursing scholarship for either continuing professional development, undergraduate or postgraduate studies in 2009-10; and 355 allied health scholarships were awarded for rural and remote clinical placements, undergraduate and postgraduate study or continuing professional development opportunities.

In 2009-10, the department worked with the Aboriginal and Torres Strait Islander community health sector, Divisions of General Practice and the education sector to provide specially tailored vocational education and training for Aboriginal and Torres Strait Islander outreach workers under the Council of Australian Governments Indigenous Health National Partnership initiative. In consultation with the medical and nursing professions, the department also established additional registrar training posts, new professional development scholarships and clinical placements for nurses working in Indigenous health services. These initiatives mean that a greater number of health professionals from a range of disciplines will gain exposure, and receive training and other development support, while working to improve Indigenous health. The department is also supporting Aboriginal and Torres Strait Islander health workers to receive practical training in the use of audiometry equipment to improve ear health in Indigenous people.

Performance Information for Outcome 12

Program 12.2: Deliverables

Qualitative Deliverables

COAG Health Workforce National Partnership Agreement
Qualitative Deliverable:	Establishment of a new agency, Health Workforce Australia, by January 2010.
Result: Deliverable met.
Health Workforce Australia was established by the department as a Statutory Authority under the Commonwealth Authorities and Companies Act 1997, and commenced operation in January 2010 under Mr Mark Cormack as its first Chief Executive Officer. Health Workforce Australia’s board, with the Hon Jim McGinty as Chair, was appointed in February 2010.
National Registration and Accreditation Scheme
Qualitative Deliverable:	Introduction into Parliament, by the end of 2009, of the Bill to make consequential amendments to existing Commonwealth legislation to support the introduction of the National Registration and Accreditation Scheme.
Result: Deliverable met.
The Health Practitioner Regulation (Consequential Amendments) Act 2010 (the Act) was passed on 13 May 2010 and provides for consequential amendments to the Crimes Act 1914 and the Health Insurance Act 1973 to recognise and support the implementation of the National Registration and Accreditation Scheme; and provide for transitional arrangements. The Act will streamline the processes involved in the recognition of general practitioners, specialists and consultant physicians for Medicare purposes under the Health Insurance Act 1973.
Recruitment and Retention of Overseas and Australian-trained Doctors
Qualitative Deliverable:	The delivery of the Scaling of Rural Health Workforce program.
Result: Deliverable met.
During 2009-10, the department worked with Medicare Australia to develop an IT system to assess and administer incentives under the Scaling of Rural Health Workforce program. The department, through Medicare Australia, commenced the incentive payments from 1 July 2010.
Qualitative Deliverable:	Implementation of the COAG International Recruitment Strategy during 2009-10.
Result: Deliverable substantially met.
COAG agreed that Health Workforce Australia would have responsibility for implementation of the International Recruitment Program. Health Workforce Australia was established in 2010 and the funding and responsibility for the International Recruitment Program transferred from the department to Health Workforce Australia in 2010.

Quantitative Deliverables

Consolidate and Enhance Workforce Programs
Quantitative Deliverable:	Percentage of variance between actual and budgeted expenses.
2009-10 Target:	≤0.5%	2009-10 Actual:	-1.6%
Result: Deliverable not met.
The administered expenses for Program 12.2 were underspent by 1.6 per cent. In 2009-10, a number of factors contributed to this underspend, including the International Recruitment Strategy program which had targets to recruit 95 overseas trained doctors and provide additional assistance to 100 Australian and overseas trained doctors. The program did not meet its recruitment targets in 2009-10. As a result the program’s budget was underspent. The department will continue to work with Rural Health Workforce Australia to address this issue.
Quantitative Deliverable:	Number of nurses accepted as eligible to receive Bringing Nurses Back to the Workforce program assistance by returning to work under the measure.
2009-10 Target:	1,250	2009-10 Actual:	999
Result: Deliverable not met.
The target of 1,250 nurses returning to work under the Bringing Nurses Back into the Workforce Program related to the 2009 calendar year. As at 30 June 2010, 841 nurses returned to the general hospital and community sector and a further 158 to the aged care workforce under this initiative. As part of the 2010‑11 Budget, funding for this initiative has been redirected to other strategic nursing workforce measures.
Quantitative Deliverable:	Percentage of Aboriginal and Torres Strait Islander outreach workers working in Aboriginal Medical Services and Divisions of General Practice who have commenced education and/or training programs.
2009-10 Target:	90%	2009-10 Actual:	90%
Result: Deliverable met.
In 2009-10, the department worked with stakeholders to develop orientation and training programs for Aboriginal and Torres Strait Islander outreach workers. This involved extensive consultations and joint workshop presentations with the Divisions of General Practice to develop a comprehensive and flexible orientation package. Forty four Aboriginal and Torres Strait Islander outreach workers were employed in Divisions of General Practice and Aboriginal Medical Services during 2009-10.

Program 12.2: Key Performance Indicators

Quantitative Key Performance Indicator

Recruitment and Retention of Overseas and Australian-trained Doctors
Quantitative Indicator:	Increased number of suitably qualified overseas-trained doctors in outer metropolitan, rural and remote districts of workforce shortage.
2009-10 Target:	100	2009-10 Actual:	51
Result: Indicator not met.
During 2009-10, the recruitment of overseas trained doctors under the International Recruitment Strategy failed to meet expectations. This is due to the reduced number of suitably qualified overseas-trained doctors currently entering Australia and changed registration and accreditation arrangements. Since October 2008, the International Recruitment Strategy has been administered by a single provider - Rural Health Workforce Australia. From October 2008 to 30 June 2009, Rural Health Workforce Australia recruited 49 overseas-trained doctors under the strategy. In 2010-11, the department will conduct an evaluation to consider options to increase the recruitment of overseas-trained doctors.

Outcome 12 – Financial Resources Summary

	(A) Budget Estimate 2009-10 $’000	(B) Actual 2009-10 $’000	Variation (Column B minus Column A) $’000	Budget Estimate 2010-11 $’000
Program 12.1: Rural Workforce
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	160,125	159,285	( 840)	255,220
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	11,577	11,698	121	11,278
Revenues from other sources	201	140	( 61)	210
Unfunded depreciation expense¹	-	-	-	290
Operating loss / (surplus)	-	6	6	-
Total for Program 12.1	171,903	171,129	( 774)	266,998
Program 12.2: Workforce
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	217,819	214,320	( 3,499)	470,703
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	13,292	12,932	( 360)	12,949
Revenues from other sources	230	1,122	892	241
Unfunded depreciation expense¹	-	-	-	333
Operating loss / (surplus)	-	7	7	-
Total for Program 12.2	231,341	228,381	( 2,960)	484,226
Outcome 12 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	377,944	373,605	( 4,339)	725,923
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	24,869	24,630	( 239)	24,227
Revenues from other sources	431	1,262	831	451
Unfunded depreciation expense¹	-	-	-	623
Operating loss / (surplus)	-	13	13	-
Total Expenses for Outcome 12	403,244	399,510	( 3,734)	751,224
Average Staffing Level (Number)	179	181	2	168

¹ Reflects the change to net cash appropriation framework implemented from 2010-11.

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