NSW Rural Doctors Network respectfully acknowledges the traditional custodians of the land

on which we learn and work together, and commits to building collaborative relationships,

respect and opportunities with Aboriginal Peoples to deliver their aspirations.

Collaborative Planning

for Primary Health

Services, RICH Forum24th March 2021

1. The Collaborative Care program

2. Theoretical Underpinnings

3. An emerging Framework

4. Experiences in the 4Ts through the lens of the

Collaborative Care Framework

5. Summary of learnings so far

Contents

Collaborative Care

The Collaborative Care Program aims:

• to work with small connected rural and remote communities to develop, run

and evaluate new ways of delivering primary healthcare services that are

specific to each community’s needs (5 sub-regions);

• The 4Ts – Trangie, Tottenham, Tullamore and Trundle

• Canola Fields - Canowindra and its surrounding communities

• Wentworth Shire

• Lachlan Health Region – Parkes / Forbes

• Snowy Valleys – Tumut, Batlow, Tumbarumba and Adelong

• to determine the applicability of these new ways of delivering primary

healthcare services in similar rural and remote communities nationally and

to use the outcomes to inform options for broader primary care reform

Theoretical Underpinnings (1)

• Community-based development

• Advocates for community participation in decision-making and

management of projects

• Empowers people with knowledge and means to decide their own

priorities, improve capacities and take action in addressing their own

needs

• Town-based planning for health

• Grounded in community-based development principles

• Town-level PHC workforce consultations, local evidence base and

problem solving

Theoretical Underpinnings (2)

• Western NSW Primary Health Workforce Planning Framework 2030

• Broad consultation 2018 on factors contributing to attracting and

retaining primary health workforce in rural areas

• Six action areas with identified priority actions: recruitment; retention;

needs assessment; strong partnerships; professional development;

training and strengthening coordination

• Health workforce literacy & Health system literacy

• Improving understanding both health workforce in the community and

understanding of the complexities of how the health system functions

to either support or disincentivise health workforce, will support the

development and acceptance of innovative solutions to provide

sustainable models of care

Collaborative Care – Emerging Framework

The 4Ts Sub-Regional Project

4T’s Sustaining Small Rural Communities Project: A place-based

approach to healthcare delivery in Tottenham, Trundle, Tullamore & Trangie

Objective:

• To pilot a place-based model in the 4T’s communities for sustainably

providing integrated, multidisciplinary health care that is high quality and

accessible

Key Features:

• Collaborative Regional Governance

• Single employer model for four part time primary health care clinics co-

located with 4’T’s MPS’s

• Towns of <1500 approx. people and all have MultiPurpose Services

The 4Ts – Assessment / Needs

Market Failure where General Practice closed or left town in all

four communities

▪ Primary care challenges – gaps in private practice GP services, allied

health and pharmacy services

▪ Community challenges- wanted easy access to quality primary health

care services including GPs, allied health, emergency care and

pharmaceuticals. Communities felt a full time GP in their own town was

central to addressing their health needs.

▪ Service delivery challenges - LHDs usually not involved in GP primary

care service provision and no model existed to design, implement and

fund this. Towns were also too small to individually sustain a full-time GP

in each location.

The 4Ts – Engagement / Goals

Engaged with community on ‘Options Analysis’ – requested by

the community to step in and provide primary care services

• Engagement with Community – on health workforce literacy to understand

service delivery implications and constraints (via public meetings, Local

Health Advisory Council & community group meetings, newsletters)

• Chosen Provider - WNSWLHD as the default provider of healthcare

services already present in 4T’s communities to test a single-employer

model with opportunities to partner with for additional services

• Agreement on project objective and timeframes (2 years)

• Three part-time GP’s shared across 4 communities

The 4Ts – Connect & Empower / Planning

Established collaborative regional governance, co-

contributions, strategic & operational priorities, agile project

management methodology

• Collaborative Regional Governance – Project Governance Committee;

Project Working Group; SME’s; Community stakeholders including

Health Councils and Local Government

• Reviewed primary care services, Health Needs Assessment, & identified

strategic and operational priorities for development (Service Backlog)

• Co-contributions – (in kind) secured from project partners, local

government and local community groups

• Whole-of-government approach

• Project Manager engaged

The 4Ts – Deliver / Implementation

Incremental implementation of Strategic and Operational priorities,

developed and tested with SME’s & Community stakeholders

• Agile approach – brought together SME’s to develop unproven solutions for

iterative and incremental implementation, developing solutions in ‘sprints’.

• Community Co-Design – as part of the agile approach, solutions were tested

with community stakeholders via regular feedback loops building trust driving

improvement to reach “small wins”

• Operational Milestones – infrastructure upgrades (grant secured by Parkes

Shire Council), partnerships with co-located community pharmacy at Tullamore

MPS, IT upgrades, single medical software solution, policies and procedures

alignment across MPS and primary care clinics, staffing and recruitment

(management, nursing, admin), working toward financial sustainability and

telehealth support where required

• Strategic Milestones (in progress) – new models of funding, as well as non-

standard approaches to medical recruitment and retention with NSW Health

The 4Ts – Reflect & Learn / Maintenance

Importance of Evaluation – especially formative evaluations to

inform program improvements and return to implementation

• Formative (process) Evaluations – provide valuable insights into program

level adjustments for further implementation and improvement

• Summative (outcome) Evaluation - yet to occur as implementation still

ongoing

• Reflections – important to invest in operational and change management

resources upfront for the benefits to flow, and collaboration has driven

success of the project to date

• Ongoing - Sustainability of the 4T’s model is still yet to be realised, and

further work to be done to review available funding models and project

impact over time

Summary of Key Learnings

• Collaborative Care is a way of working at a sub-

regional level - an emerging framework being

developed (rooted in community based development)

• Success story of rural communities partnering in

service model design which impacts on their health

• Combination of SME expertise and community as co-

design partners was critical to landing sustainable

solutions

• Health workforce literacy improves community

capability to engage

• Iterative not linear approach

• Potential for 4T’s project replicability, scalability and

sustainability if resourced and well supported

NSW Rural Doctors Network respectfully acknowledges the traditional custodians of the land

on which we learn and work together, and commits to building collaborative relationships,

respect and opportunities with Aboriginal Peoples to deliver their aspirations.

THANK YOU