Remote Australians Matter delivers five point plan for rural health

The five point plan is the result of a day-and-a-half of 120 people from around Australia networking and sharing stories of success in the primary health care field in remote and very remote Australia, and resolving to seize opportunities to make a difference.

The outcome has been driven by the Remote Australians Matter or RAM group, set up to drive the conversation about rural health rather than take what others decide is best.

Its chair, Annabelle Brayley, based in Morven in south west Queensland, told participants that RAM was a grassroots group wanting to start a national conversation.

"Clearly what we've been doing up until now hasn't worked because the whole health system is in a crisis, but I also think that in a whole broad health concept, remote gets lost," she said.

"The geography and demography mean that it's probably too hard, even though it's only 3 per cent of the population - because it's in 80pc of the geography, the logistics are difficult.

"Decisions about remote have been made in glass towers in big cities by people who have no idea what it's like to live there, ad infinitum.

"What we're saying is - we're capable of being involved in the design and delivery, you just need to give us the opportunity.

"Given that you haven't until now, then we're going to create a forum that enables them to come and be a part of the process."

Five broad areas for attention - community involvement and leadership, universal health obligation, workforce, place-based community primary healthcare models, and service standards - were identified for action, and working groups for each are being established.

Ms Brayley said they would identify solutions for the issues, for a delegation to Canberra to take forward.

"If we can take a delegation to Canberra that says, these are the things that are wrong, and we say here are the solutions, it should make it really easy for (the government) to come on board," she said.

One of RAM's directors, Stan Stavros said the model whereby whoever lived in the most marginal seats got the most assistance, had to stop.

"Also silos, playing us off against each other, funding announcements that evaporate before money hits the ground - there needs to be a lot more listening and doing," he said. "I hope we've made the first step to doing that - I really hope RAM is the start of communities driving conversations forward for change."

Three successful models of primary health care, from Charleville in western Queensland, from Mallacoota in north east Victoria, and from Port Hedland in Western Australia's Pilbara, were shared during the conference, so that participants could see that it was possible for excellent comprehensive primary health care to be provided in remote areas of Australia.

Dr Sara Renwick-Lau had been working in north east Arnhem Land as the sole doctor but didn't stay because funding agencies couldn't provide a fence around her home, meaning her children couldn't spend any time outside.

"No funds were allocated - the grant to build the house was fully exhausted," she said.

She's now in Mallacoota with a population of 1000 and where hospital radiology is two hours away.

She said the government had pushed the practice into existing health models, where they were a square peg in a round hole.

"There was an assumption of funding streams that don't exist," she said.

"We tried everything, business analysts, that met with market failure.

"Their solutions don't work for small populations because they don't have a large volume of low-hanging fruit."

On the verge of closure in 2016, Dr Renwick-Lau went to her community, which adopted a shared approach, pooling resources with the similarly struggling aged care centre, and making a decision to stop providing non-GP services that had been dragging them under.

A community fund was born, with DGR status, and the community took up stands at conferences to search for other doctors.

"The community advocated for me," Dr Renwick-Lau said. "They purchased a seat at the table, competing with big recruitment companies."

She said keys to success were goodwill, a shared vision, and an understanding that you weren't just recruiting doctors, but were giving them a place to live out their own vision.