Key successes of the NRLP
The literature scan undertaken as part of this review found the availability of practical support to assist rural doctors to access leave has been well established as necessary to help maintain a strong rural health workforce. The establishment of the NRLP has seen direct funding of the administering bodies who manage subsidy support for locum hosts to assist with the daily cost of the locum and subsidy/reimbursement for locums to assist in covering their travel costs and time. For those who have used these schemes this government funding is welcomed and well received.
All three programs have high levels of satisfaction from both hosts and locums.
The subsidy levels were considered by most stakeholders to be adequate in offsetting some of the cost of employing a locum. The capping of 14 days per practitioner per year was also generally considered to be adequate.
Approximately 20 respondents to the survey affirmed the value of the National Rural Locum Program. Comments included:
- ‘The system works very well, it has been seamless doing my first locum, very warmly received by the docs taking leave and all in the town.’
- ‘They are a necessity for rural practices. We rely heavily on them so that our doctors can have regular much needed breaks without the community suffering.’
- ‘Essential to continuing well being and care of doctors and patients alike.’
- ‘Essential to keep rural practice viable and to provide services to rural communities.’
- ‘A good initiative that needs development. Key is a lot of availability and reasonable cost. Locums rarely earn the same as the principal they replace.’
Key areas for improvement of NRLP
Although stakeholders have welcomed the NRLP, the review has raised questions as to whether a more efficient administrative structure would maximise the potential benefits of the program.
The appropriateness and efficiency of having separate administering bodies for these schemes has been questioned through this review. Whilst there is strong support for the backing of the professional colleges / associations by stakeholders there is no strong evidence that this is a significant benefit for either SOLS or GPALS. Similarly, the efficiency of the double layer of administration for the RGPLP has also been questioned and there are arguments both for and against the maintenance of the two layers.
Stakeholder feedback has indicated that the administering agency of a locum program should have a close relationship with the rural medical workforce and understand their needs. Bodies nominated as possessing these qualities include the RWAs, Divisions of General Practice, ACRRM and some commercial locum agencies. RANZCOG is also well regarded by SOLS stakeholders.
Stakeholders also expressed the need for the administering agency to be able to ‘tap into’ a supply of locums, but not necessarily own the locum supply. To effect this, a national approach to locum supply is needed with effective database management plus good relationships and networks between state and territory RWAs, Divisions of General Practice and medical colleges and associations. Improved locum supply remains a key success factor in any future NRLP model.
The current model of the NRLP restricts access to the subsidies to only those locums registered through the individual programs. The review has found that this is not an effective way to ensure the provision of locum relief and/or subsidies to the practitioners most in need of support. Whilst one of the aims of the program is to build a supply of locums to provide relief to the rural medical workforce, it should not be necessary to attach the locum supply to any one program.
Given the demand for RGPLP to date and the high likelihood that this demand will increase, further refinement of the eligibility criteria for RGPLP may be required in the future or an increase in funding for the program.
None of the three NRLP programs cater well for proceduralists with multiple specialties. Due to the difficulties in matching skills for this group it is acknowledged that replacement for leave often requires two or more locum placements. A simple method that enables these GP proceduralists to access the subsidies is required, along with a targeted communication strategy to inform them of the availability of the subsidy.
The NRLP has had limited reach to date. SOLS has reached approximately 25% of its target specialist obstetrician workforce, but less than 10% of GP Obstetricians and 4.3% of all GPs with an obstetric speciality (ie multi-proceduralists). GPALS targets were set at 5.7% of GPAs, yet this was not achieved. RGPLP, has exceeded its targets, however, this reach is less than 4% of eligible GPs.
It is not clear how well the NRLP is meeting previously unmet demand for locum services. The aim of the program is to address the shortfall where other locum providers are unable to provide a locum service or other subsidised locum programs are unable to provide subsidies to target hosts. It was never intended that the NRLP would meet the needs of all rural and remote medical practitioners.
The extent of current workforce shortages also means that the NRLP is operating in a very dynamic environment. Until higher overall workforce levels are achieved, locum supply will remain tenuous. Whilst there are no mandated leave requirements for medical practitioners, leave will remain at the discretion of the individual practitioner. The use of locums will also remain discretionary as one of a number of ways to support leave.
Survey respondents had a number of ideas for improvement in relation to the model:
- ‘An alternative model is to employ salaried locums rather than contractors.’
- ‘The RWAV program for training GPs to work in remote communities is absolutely fantastic. There should be more training programs designed to help urban GPs upskill to take on remote work.’
This included some support for centralisation of administration:
The need for reduction of red tape was a particular concern:
- ‘Removing red tape. Each out of 6 locum placements I have done in last 12/12 required me to submit 20-40 pages application pack — such a waste!’
- ‘Give the subsidy direct to the practice.’