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Single-practice model delivers in the west

30 August 2022

Things came full circle for GP supervisors Dr Clare and Dr David Walker this year when JCU graduates Dr Tom Currie and Dr Samantha Campbell returned to Longreach as rural generalist trainees.

“It's the first time in our careers that we’ve mentored students who became junior doctors who have done their training at the bigger facilities and returned to work with us. It's really nice,” says Clare, a former Rural Doctors Association of Queensland president.

“Samantha came to Longreach as a fourth-year and sixth-year student, while Tom was placed here in sixth year.  They were both keen and engaged students whom we stayed in contact with the during their junior doctor and advanced skill training years.”

The Walkers are helping to shape medical services in Central West Queensland, David as Executive Director of Medical Services for Central West Hospital and Health Service (CWHHS), and Clare as a board member.

The couple did their junior doctor training in Cairns and on the Tablelands, settling in Longreach with one-year-old daughter Elsie after trying Outback life as GP registrars. “We did one year of GP training in Longreach in 2006 as a bit of a test run to see if we liked it, knowing we still had to do some advanced skills training, but with a plan that we would eventually come back here,” Clare says.

“We really liked the work and the community. We returned to Cairns to do our respective advanced skills training – David did mental health as his advanced skill, and I did obstetrics and anaesthetics. We travelled for a little bit and returned to Longreach in 2010. We’ve been here ever since.”

As their professional roles have grown, so, too, has their family – Elsie is now in Year 8 at boarding school, and has three siblings, Oscar, 10, Maeve, 8, and Arthur, 5. “Longreach is a great community and a good place to raise a family,” Clare says. “This town is very agriculturally orientated so there is a very stable long-term population.”

Operating under an innovative model of care called the CWHHS single-practice model, the hospital and health service employs salaried Senior Medical Officers who provide primary care at a privately owned GP clinic during the day and share the hospital after-hours call load.

“It solved a couple of problems,” Clare says. “Medicare billings in general practice are just not fit-for-purpose in remote areas. You can’t attract and retain doctors for the salaries that they would earn through Medicare billing alone in most remote areas. There are a lot of areas in remote Queensland and, more broadly, a lot of remote areas across Australia where there are just no GPs anymore. So, if this is the model that works and we can recruit to it easily and allow the patients to have access to GPs, it’s certainly one of the models that should be looked at more broadly.

“In this town, there’s that appreciation that even during a day when you’re at the general practice, looking after patients, you might have to leave with a minute’s notice to attend a delivery or respond to an emergency and then come back. You’re on call and you are providing the higher level of care that’s required in remote areas.”

While most of David’s time is spent overseeing recruitment, governance and system processes in his executive role, much of his clinical work remains in mental health, through the GP practice and Longreach Hospital’s multidisciplinary mental health team.

Both doctors enjoy their roles as GP supervisors. “I think there’s no better way of keeping up to date,” Clare says. “When you have new doctors, who come with a new perspective on medical conditions, it allows two-way education. One of the main roles is not to just impart knowledge, but to show and to model to registrars how to find information and how to create a network of health professionals who can give you advice.”

As GP supervisors, we’re teaching the art of general practice, but our registrars are often coming from hospital rotations and they're informing us of changes within hospital systems and some of the new practices with regards to different advanced skills.

“They also ask questions that often probe some of the deficiencies in your own knowledge, so it's a bit of a shared education experience sometimes. One of the main roles is not to just impart knowledge, but to show and to model to registrars how to find information and how to create a network of health professionals who can give you advice.

“Rural medicine is so vast, and it covers pretty much every aspect of health care, so you can't know everything yourself, but a good rural doctor has a good network of other health professionals that they access, or literature and places to find the information they need.”

She says the best thing about general practice is being able to work a problem out, generally without extreme time pressure, and to get to the source of the problem. “The thing that's hardest for new doctors to learn when they start as GPs is that you don't have to have all the answers right there and then at the first consultation,” she says. “You can work your way methodically through problems and find answers and then hopefully find treatments. The rewards you get with that are far greater than any other area of medicine.”

“General practice is more of a long game. I think the most reward you get from general practice is staying within a community for a long-ish period of time. Doctors do move and change practices, but the big rewards are from long-term care for a community.”

She says while medical administration is not for everyone, it’s been a progression for her. “It naturally comes when you work within a system for some time and can see ways in which things might be able to be improved. Being part of the conversation and hopefully part of some of the solutions in the larger context of how a health organisation runs is often a natural stepping stone when you've been a clinician for some time.

“I find the work very different and rewarding in a different way than the clinical work, but they go hand in hand in my books.”

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