Extending a Rural Generalism model across the Coast

14 June 2021

By former Acting Chief Executive Dr Andrew Brant and Chief Medical Officer Dr Graham Roper, was originally published as an opinion piece in the Greymouth Star in December 2020

Over the past year, the West Coast District Health Board (WCDHB) has taken several steps towards implementing a Rural Generalist (RG) model, an internationally proven way of working that is designed to create a more integrated and sustainable workforce in remote rural health systems like ours here on the Coast.

Our approach is to maintain and retain services on the Coast where it is safe and appropriate to do so. This is not a sudden introduction of a ‘new model’; this is building on and improving our current person-focused ways of delivering health care and the way we work in order to achieve this. There has been significant progress over the past ten years. Patient safety and the retention of health care services for whānau and Coast communities is at the heart of everything we do.

Rural Generalists are experienced clinicians with specialist and general skills who can work flexibly across the rural health system. They offer a wide range of experience working in primary/community care as well as providing hospital-level care. Depending on their specialist skills and additional scopes of practice, this could mean they work in obstetrics, the emergency department, unplanned care clinic, hospital inpatient wards and in general practice.

Having a workforce of generalists who offer a wide range of skills and who undergo additional training so they can provide high quality care in a variety of settings is the logical solution for the Coast and we acknowledge the important role they play in our health system. Hospital-based specialty clinicians (specialist Senior Medical Officers), working alongside Rural Generalists, will provide a supportive and collegial framework that promotes a sustainable and robust clinical service.

Over time we envisage that the Rural Generalist way of working will reduce the use of locum GPs and locum specialist Senior Medical Officers. As our Rural Generalist workforce grows, we will have more senior doctors based on the Coast working in general practice and community areas, which will strengthen continuity of care throughout the whole of the West Coast.

Developing a core workforce of Rural Generalists will not only provide continuity of care for our population, it will also improve the long-term sustainability of services and support a more integrated model of care. By improving service access, it will help us support people to stay well, reduce health inequities and improve health outcomes – all key goals for our health system. It also means more people will be able to receive the care they need closer to home.

Importantly, we aren’t completely moving away from a specialist model. We are moving to a mixed model which involves all professions – medical, nursing, midwifery and allied health – working to the full extent of their scope of practice as members of a multi-disciplinary team and supporting each other to maintain high standards. One that includes both speciality specific Senior Medical Officers and Rural Generalist/Rural Hospital Medicine Specialists. Our maternity team of Midwives, Obstetricians and obstetric Rural Generalists will continue to provide birthing and emergency care for women on the Coast, working as a team that support one another.

The international evidence from decades of safety data from both Australia and Canada demonstrates that clinical outcomes under this model are as safe as a traditional urban speciality-specific model. Rural Generalism also addresses our current challenge in primary care of being reliant on locums and it will mean Coasters gain good access to primary care provided by permanent GPs, which is paramount to improving patient care and outcomes.

Primary care/general practice sits at the heart of the Rural Generalist skill set and model and the majority of Rural Generalist Senior Medical Officers are skilled in primary care. The Rural Generalist role has flexibility in that these same practitioners can work in both primary care settings (including rural GP practices) and other hospital environments, like the emergency department.

A Rural Generalist doctor, for example, may be qualified to work in both general practice and hospital settings with a speciality in obstetrics or general practice. They would also be supported by local and Christchurch-based specialists, enhancing the capacity, capability and resilience of our health system.

With a population of 33,000 people, the reality is that the West Coast DHB will always need to refer people to larger centres for highly specialised care, such as neurosurgery, some cardiac care, cancer treatments, specialised burns treatments and neonatal intensive care. These services will continue as they always have. 

Coasters can be reassured that our Rural Generalist model supports our goal of ensuring that Coast communities receive the right care in the right place, from the right people, at the right time.