Outcome 12 – Health Workforce Capacity

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Outcome Strategy

This chapter reports on the major activities undertaken by the department during the year, reporting against each of the major activities and performance indicators published in the Outcome 12 chapter of the 2010-11 Health and Ageing Portfolio Budget Statements (PB Statements) and the 2010-11 Health and Ageing Portfolio Additional Estimates Statements (PAES). It also includes a table summarising the estimated and actual expenditure for this Outcome.

Outcome 12 was managed in 2010-11 by the Health Workforce Division and the Primary and Ambulatory Care Division. The department’s state and territory offices also contributed to the achievement of this Outcome.

Program Name	Program Objectives in 2010-11
Program 12.1: Rural Workforce	Increase the number of health professionals working in regional, rural and remote Australia. Support rural teaching, training and infrastructure.
Program 12.2: Workforce	Establish Health Workforce Australia to ensure improvements in Australia’s health workforce planning capacity and ability to promote workforce innovation and reform. Support the Commonwealth’s engagement with the National Registration and Accreditation Scheme. Build the medical workforce, through targeted medical education and training programs. Support rural health practitioners (including locum support to enable health practitioners to keep their skills up to date). Build the nursing workforce supply through the provision of scholarships. Improve the education and training opportunities for Aboriginal Health Workers. Commence work to establish a voluntary dental intern program.

Major Achievements

• Successfully implemented program expansions to build Australia’s workforce through medical, nursing and allied health programs. This has included increased numbers of general practitioners in training (700 in 2010 to 900 in 2011), junior doctor training places (see Outcome 5), and 379 specialist training places in 2010 (518 in 2011).
• Supported scholarships as part of the Nursing and Allied Health Scholarship and Support Scheme, including 639 new nursing scholarships and 618 new allied health scholarships in 2010-11.
• Supported 327 scholarships as part of the Puggy Hunter Memorial Scholarship Scheme.
• Continued the delivery of rural based training options including supporting 605 graduating medical students who did long-term placements, on an average of one year, in a rural setting, and 4,609 clinical placements of at least two weeks duration for medical, nursing and allied health students.
• Supported new capital works projects through the Rural Education Infrastructure Development Pool such as rural education centres and student accommodation in all states and the Northern Territory.
• Improved access to GP services for regional, rural and remote communities through the Rural GP Locum Program. This program has exceeded expectation by achieving 265 targeted GP locum placements and 1,866 locum service days in rural and remote Australia.
• Increased incentives to retain medical practitioners in regional, rural and remote communities – 10,235 practitioners were assessed as eligible to receive a retention payment under the General Practice Rural Incentives Program.

Challenges

• There continues to be a need to monitor and evaluate the current policy levers designed to achieve an optimal workforce distribution. Current training programs are successfully delivering training in regional, rural and remote locations and overall numbers of medical practitioners working in regional, rural and remote Australia are improving. However, further work in partnership with key rural stakeholders, Health Workforce Australia and states and territories is required to continue to achieve improvements in this area.
• The department appointed a joint administrator of the Nursing Rural Locum Scheme and the Allied Health Rural Locum Scheme. The joint scheme is to be called the Rural Nursing and Allied Health Locum Scheme. The appointment was delayed due to extended negotiations to ensure the effective design and implementation of the Scheme. A marketing strategy commenced in May 2011 to gain a pool of potential locums and to gain interest from rural nurses and allied health professionals to use the scheme for professional development leave. The first placements commenced in July 2011 which failed to deliver on targets for 2010-11, however, increased target numbers over the next 3 years are expected to achieve overall targets during 2011-12 to 2013-14. The department will continue to work with the admistrator to monitor progress in the Scheme.
• Some transitional issues arose in the move to national registration under the National Registration and Accreditation Scheme, resulting in agreement by the Australian Health Workforce Ministerial Council (AHWMC) to provide additional support to AHPRA. The department negotiated with AHPRA to provide assistance in the area of information and communication technology projects to improve the alignment of AHPRA and Medicare data systems.

Trends

Text version of this chart

Since 2002, when the Rural Clinical School Program commenced, there has been a significant increase in the number of graduating medical students who have undertaken at least one year of their clinical training in rural areas – from 115 in 2003 (first full year of operation) to 605 in 2010. An increase in participating universities from ten universities to 17 universities has contributed to this increase. Overall the universities have met or exceeded their target of 25% of Commonwealth supported medical students undertaking long term placements.

Figure 2.4.12.2: University Departments of Rural Health students undertaking two week placements

Text version of this chart

Between 2003 and 2010 there has been an overall increase in the number of University Departments of Rural Health students undertaking placements of at least two weeks duration.

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Program 12.1: Rural Workforce

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

The Medical Rural Bonded Scholarship Scheme (MRB) is a long-term initiative aimed at improving access to medical services for communities in rural and remote areas of Australia. The scheme provides more than $24,000 a year to participating medical students who commit to working in rural and remote Australia for up to six years once they have completed their medical training as a specialist. In 2010-11, an additional 98 new university medical students accepted a place in the scheme, bringing the total number of participating doctors to 1,062. Since 2010, 13 doctors supported by the scheme commenced their return of service obligation in rural and remote areas.

The Bonded Medical Places Scheme (BMP) is a long-term initiative aimed at increasing the medical workforce in districts of workforce shortage across Australia. In 2010-11, over 700 students accepted the opportunity to study medicine at university through this scheme, bringing the total number of participants to over 3,800. It is expected that doctors supported by the scheme will commence their return of service obligation in 2013, working in districts of workforce shortage for periods of up to six years. The return of service obligation can be reduced by eligible pre-vocational and vocational training and any credit obtained through Scaling.

Scaling is applied to a range of Australian Government programs that have a return of service obligation, including the MRB Scheme and the BMP Scheme. Scaling increases the attractiveness of working in rural areas by fast tracking doctors’ return of service obligation based on the location they are working in. Scaling will apply to MRB and BMP participants once they have gained Fellowship and commenced their ‘return of service period’ (which on average can be 14 years from when participants sign their contract or deed of agreement).

The department also delivered on its commitment to provide 100 additional rural allied health clinical placement scholarships in 2010-11, allowing more allied health students to experience rural based practice. The additional scholarships were fully implemented for 2010-11, with 100 scholarships being offered to students undertaking placements in rural areas.

Incentives for Rural GPs and Registrars

During 2010-11, the department assessed 10,235 doctors as eligible to receive the new retention payment, which is 7,937 more than the number of practitioners paid in 2009-10 under the previous program. The increase has occurred through the expansion of eligible locations and the introduction of a systems based assessment and payment process. The department received 87 applications for the relocation grant and of these, approved 39 applicants. The total number of approved applications was lower than anticipated due to a number of applicants that failed to meet the eligibility criteria. In 2011-12, the department will continue to monitor uptake of the program, and consider ways to expand awareness in order to increase the number of GPs in regional, rural and remote locations.

Quantitative KPI:	Number of doctors relocating to rural or remote locations.
2010-11 Target:	70	2010-11 Actual:	39
Result: Indicator not met.
The number of successful applications was lower than expected. The department will consider ways to increase uptake to the relocation component of the General Practice Rural Incentives Program in 2011-12.
Quantitative KPI:	Number of Registrars remaining in rural and remote locations.114
2010-11 Target:	100	2010-11 Actual:	303
Result: Indicator met.
The number of GP Registrars choosing to remain in a regional, rural or remote location at the end of their registrar training has exceeded expectation and provides greater access to primary medical services in these locations.

The department worked with Medicare Australia, Rural Health Workforce Australia, and the Rural Workforce agencies, to develop a database and IT system to assess applications for payments under the General Practice Rural Incentives Program. Medicare Australia’s IT system has also been used to provide incentive payments for the HECS Reimbursement Scheme and the Rural Locum Education Assistance Program. ¹¹⁴

The department’s work with the rural workforce agencies also produced a robust database which has reduced processing times and improved consistency across the states and territories. The database will also free up agency officers to provide them with more time to liaise with medical practitioners and provide individual advice. The database captures information in relation to doctors not billing Medicare.

Quantitative Deliverable:	Number of new doctors participating in the General Practice Rural Incentives Program.
2010-11 Target:	2,200	2010-11 Actual:	7,937
Result: Indicator met.
The higher than anticipated participation by doctors on the General Practice Rural Incentives Program has occurred as a result of the automated processing of assessments and payments, and increases to the number of eligible areas.
Quantitative Deliverable:	Number of new registrars participating in the General Practice Rural Incentives Program from 1 July 2010.
2010-11 Target:	250	2010-11 Actual:	137
Result: Indicator substantially met.
As training places occur across financial years the figures do not include semester one GP Registrars who completed their training placement in August 2011.

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HECS Reimbursement Scheme

Locum services

In 2010-11, the department engaged Communio Pty Ltd to undertake an external review of the National Rural Locum Program to consider the effectiveness and efficiency of the three components. ¹¹⁷ The review found that the subsidies provided through the National Rural Locum Program are an appropriate means to provide support for rural doctors and these programs have a high level of client satisfaction.

The department also funds Rural Health Workforce Australia to administer the Rural GP Locum Program to improve the number of GP locum placements and locum services to rural and remote communities. This program has exceeded expectations by achieving 265 targeted GP locum placements and 1,866 locum service days in rural and remote Australia.

The department supports the expansion of urban GP skills for the purpose of complementing rural locum services. During 2010-11, the department reimbursed the costs for urban doctors who undertook emergency medicine training in exchange for a commitment to four weeks rural locum service. The provision of locum services to rural doctors helps to maintain and improve access to quality medical care in rural communities whilst at the same time giving rural doctors a much needed break.

Quantitative Deliverable:	Number of Allied Health Locum Placements.
2010-11 Target:	100	2010-11 Actual:	0
Result: Deliverable not met.
During 2010-11, the department appointed an administrator for the Rural Allied Health Locum Scheme and worked with that organisation to develop program guidelines for the operation of the scheme. Extended negotiations with the preferred administrator were required to ensure an effective program model was implemented. Due to the delays, the 2010-11 placements were not filled, with placements commencing in July 2011. However, increased target numbers over the next three years will ensure the overall target of 400 placements will be met during 2011-12 to 2013-14. Ongoing information activities are underway to accelerate the filling of locum placements.

In 2010-11, the department appointed an administrator to establish and manage the Nursing Rural Locum Scheme. The scheme will provide locum placements to enable nurses and midwives in rural and remote locations to take leave and undertake continuing professional development activities without adversely affecting service delivery. It will also allow interested nurses and midwives to experience rural based practice through locum placement. Locum placements were arranged during 2010-11 and commenced in July 2011.

Quantitative KPI:	Number of nurse locums under the Nursing Rural Locum Scheme.
2010-11 Target:	750	2010-11 Actual:	0
Result: Indicator not met.
During 2010-11, the department appointed an administrator for the Nursing Rural Locum Scheme and worked with that organisation to develop program guidelines for the operation of the scheme. The appointment was delayed due to extended negotiations being required to ensure an effective program was implemented. Due to the delays, the 750 locum placements for 2010-11 will be filled over future years, ensuring that a total of 3,000 placements are provided over the years 2011-12 to 2013-14.

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Rural Teaching and Training

In 2010, University Departments of Rural Health supported 4,609 clinical placements of at least two weeks duration. The Dental Training Expanding Rural Placements Program supported 191 clinical placements of three to six weeks duration. In the Rural Clinical Schools Program, 1,009 medical students did long-term placements, on an average of one year, in a rural setting. The John Flynn Placement Program provided 900 students with the opportunity to work with doctors in rural communities for two weeks. The program is expanding and in 2011, 1,050 students will be offered placements in a rural community.

The department also delivered on its commitment to provide 100 additional rural allied health clinical placement scholarships in 2010-11, allowing more allied health students to experience rural based practice. The additional scholarships were fully implemented for 2010-11, with 100 scholarships being offered to students undertaking placements in rural areas. The average placement time is four weeks.

Quantitative Deliverable:	Number of Rural Placements by University Departments of Rural Health.121
2010-11 Target:	3,300	2010-11 Actual:	4,609
Result: Deliverable met.
University Departments of Rural Health training placements are reported on a calendar year basis, rather than by financial year. In 2010, 4,609 clinical placements of at least two weeks duration were supported, exceeding the program target of 3,300.

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.

Quantitative KPI:	Percentage of medical students participating in the Rural Clinical Schools Program.
2010-11 Target:	≥25%	2010-11 Actual:	30%
Result: Indicator met.
Rural Clinical School placements are reported on a calendar year basis rather than by financial year. In 2010, the program target was exceeded, with 30% of Australian medical graduates (at participating universities with operational rural clinical schools) completing at least one year of rural training.

In 2010-11, the Rural Education Infrastructure Development Pool continued to support new projects such as rural education centres and student accommodation in all states and the Northern Territory. Since the establishment of the Rural Education Infrastructure Development Pool in 2009-10, a total of 30 new projects have been approved. Many of these projects will be completed during 2011-12 and the department will work to ensure these initiatives provide high quality clinical training experiences for students of medicine, nursing and allied health in rural and remote Australia.

The Rural Health Continuing Education Sub-program provides support and continuing professional development for health professionals in rural and remote communities. The program also provides a coordinated approach to issues of professional isolation. In 2010, 12 project grants and 23 individual grants were approved under Stream One for medical specialists and 15 project grants and five individual grants were approved under Stream Two for allied health professionals, nurses, general practitioners and Aboriginal and Torres Strait Islander Health Workers.

Quantitative KPI:	Number of GPs supported to maintain procedural skills under the Rural Procedural Grants program.
2010-11 Target:	1,780	2010-11 Actual:	1,633
Result: Indicator substantially met.
The figure is based on unique participants. Doctors access both the emergency training component and procedural GP up-skilling. The Rural Procedural Grants program reached 91.7% of its target and achieved a 5.2% increase in the number of unique participants from 2009-10. Activity will continue to raise the profile of this program.

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Whole of Program Performance Information

Program 12.2: Workforce

The department worked with states and territories and the Australian Health Practitioner Regulation Agency to support the introduction of the National Registration and Accreditation Scheme (NRAS) for health professions which came into effect on 1 July 2010. NRAS currently includes ten health professions: medicine, nursing and midwifery, pharmacy, physiotherapy, psychology, osteopathy, chiropractic, optometry, podiatry and dental care (including dentists, dental hygienists, dental therapists and dental prosthetists). An additional four professions (Aboriginal and Torres Strait Islander health practitioners, Chinese medicine, medical radiation practice and occupational therapy) will be included in the NRAS from 1 July 2012.

The department worked with Health Workforce Australia (HWA) on the implementation of health workforce planning and reform activities throughout 2010-11. HWA is an initiative of the Council of Australian Governments and was established to meet the future challenges of providing a health workforce that responds to the needs of the Australian community. HWA operates across the health and education sectors to address Australia’s critical health workforce planning, training and reform priorities. HWA will facilitate more effective and integrated clinical training for health professionals, provide effective and accurate information and advice to guide health workforce policy and planning, and promote, support and evaluate health workforce reform.

Build the Medical Workforce – Medical Education and Training

Training for Specialists

Training for Emergency Medicine

Support the Rural Health Professional Workforce – Recruitment and Retention of Health Professionals

Overseas trained doctors and foreign graduates of an accredited medical school are generally subject to ten years of restricted practice under Section 19AB of the Health Insurance Act 1973. Through the scaling incentive, overseas trained doctors and foreign graduates of an accredited medical school can now reduce the ten year moratorium if they practise in a regional, rural or remote location. Since the commencement of the incentive on 1 July 2010, an average 1,991 doctors are receiving the benefit each month.

In 2010-11, the department in conjunction with Medicare Australia, implemented an IT system to identify, track and scale eligible participants and apply a scaling incentive. The department has used fact sheets, conference packages, a dedicated website ¹²² and email enquiry line, to inform participants of the available incentives.

Quantitative Deliverable:	Number of overseas trained doctors to reduce ‘return of service’ obligations through the Scaling of Rural Workforce programs incentive.
2010-11 Target:	6,450		2010-11 Actual:	2,147123
Result: Indicator not met.
Service records are assessed each month and scaling benefits applied for doctors who were eligible for the incentive during that period. In 2010-11, 100% of eligible doctors received an incentive for their work in regional or remote Australia. Scaling is not applied for overseas trained doctors who practise in major cities or who do not meet the eligibility criteria.
Quantitative KPI:	Increased number of suitably qualified overseas trained doctors.124
2010-11 Target:	104	2010-11 Actual:			98
Result: Indicator substantially met.
In 2010-11, 98 overseas trained doctors were recruited under the International Recruitment Strategy. The program reached 94% of its target which was an increase of 92% on the previous year.

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Support Outreach Workers

Quantitative Deliverable:	Percentage of Aboriginal and Torres Strait Islander outreach workers who have commenced orientation or training programs.125
2010-11 Target:	90%	2010-11 Actual:	79%
Result: Deliverable substantially met.
Eighty-four of 107 Outreach Workers received orientation. This was due to some Outreach Workers being recruited later in the financial year and therefore not all were in a position to receive orientation by 30 June 2011.

Whole of Program Performance Information

Outcome 12 – Financial Resources Summary

	(A) Budget Estimate1 2010-11 $’000	(B) Actual 2010-11 $’000	Variation (Column B minus Column A) $’000
Program 12.1: Rural Workforce
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	250,090	255,418	5,328
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	12,047	11,944	(103)
Revenues from other sources (s31)	240	213	(27)
Unfunded depreciation expense	325	387	62
Operating loss / (surplus)	-	1	1
Total for Program 12.1	262,702	267,963	5,261
Program 12.2: Workforce
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	451,829	449,298	(2,531)
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	13,086	12,974	(112)
Revenues from other sources (s31)	261	231	(30)
Unfunded depreciation expense	353	421	68
Operating loss / (surplus)	-	1	1
Total for Program 12.2	465,529	462,925	(2,604)
Outcome 12 Totals by appropriation type
Administered Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	701,919	704,716	2,797
Departmental Expenses
Ordinary Annual Services (Annual Appropriation Bill 1)	25,133	24,918	(215)
Revenues from other sources (s31)	501	444	(57)
Unfunded depreciation expense	678	808	130
Operating loss / (surplus)	-	2	2
Total expenses for Outcome 12	728,231	730,888	2,657
Average Staffing Level (Number)	184	187	3
1 Budgeted appropriations taken from the 2011-12 Health and Ageing Portfolio Budget Statements and re-aligned to the 2010-11 outcome structure.

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¹¹⁴ By transitioning to the GP component under the General Practice Rural Incentives Program.
¹¹⁵ The ‘number of days per year locum relief’ for rural obstetricians includes multi-site placements.
¹¹⁶ The ‘number of days per year locum relief’ for rural specialist obstetricians, GP obstetricians and GP anaesthetists includes multi-site placements.
¹¹⁷ The three components are: the Specialist Obstetrician Locum Scheme; the GP Anaesthetist Locum Scheme; and the Rural GP Locum Scheme.
¹¹⁸ Australian National University, Deakin University, Flinders University, James Cook University, Monash University, University of Adelaide, University of Melbourne, University of Notre Dame Australia, University of Newcastle, University of New South Wales, University of Queensland, University of Sydney, University of Tasmania, University of Western Sydney, University of Wollongong.
¹¹⁹ Flinders University (Alice Springs and Warrnambool), James Cook University, Monash University, University of Melbourne, University of Newcastle, University of South Australia, University of Sydney (Broken Hill and Lismore), University of Tasmania, University of Western Australia.
¹²⁰ University of Melbourne, University of Sydney, University of Western Australia, University of Queensland, Griffith University, University of Adelaide.
¹²¹ The average placement time is four weeks.
¹²² Available at: www.doctorconnect.gov.au
¹²³ This figure is an estimate and is based on the month (March 2011) when the highest number of doctors received a benefit. Scaling is applied for each month of eligible services. Therefore, doctors may be eligible one month and not the next. In 2010-11, an average 1,991 doctors received the benefit each month. It is not possible to show a yearly figure.
¹²⁴ Overseas trained doctors working in outer metropolitan, rural and remote districts of workforce shortage.

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