Evidence and timing: The keys to good policy.

Abstract

As the peak body for rural health, the National Rural Health Alliance (the Alliance) has a key role in highlighting the issues and challenges confronting rural health. However, if it is to be truly effective, the Alliance must be prepared to go to government with well-developed, evidence-informed policy solutions. How does an advocacy body like the Alliance develop policy and how does it get traction on proposed policy responses? Like most things, the genesis and promotion of policy are about timing and context. The policy development process has been much analysed across academic and government circles. Like most considered and meaningful policy development, Alliance policy development involves analysis, research, observation, experience, consultation and validation, particularly with Alliance members and other key stakeholders. It is often framed within the broader administrative and political context, with the ‘what’ and the ‘when’ frequently driven by these imperatives. Fundamental to Alliance policy development is a strong commitment to evidence-informed policy. Ensuring all policy solutions are evidence-informed provides a critical level of credibility and rigour which complements broader policy imperatives such as stakeholder support and the social, economic and political context. An example of this is the Alliance's proposal for a new model of place-based care, Rural Area Community Controlled Health Organisations or RACCHOs. The RACCHO model is the right policy for the right time. The culmination of the extensive process for the development of the Primary Health Care 10 Year Plan, with its identified action area of improving access to primary health care in rural areas, has seen the RACCHO model included as a key policy solution to address this action area. As the Australian Government looks to develop primary health policy priorities for the next decade, RACCHOs are firmly on the policy agenda. Underpinning the RACCHO model is a strong foundation of evidence. The Alliance has classified the barriers to attracting and retaining a rural health workforce, which will be addressed by RACCHOs, into 3 categories: professional, financial and social; each informed by research and experience. There is a perception that working rurally has negative professional implications including limited networking opportunities; limited clinical experience and supervision; professional isolation; lack of support from peers; and work-life balance challenges. RACCHOs have been structured to overcome these perceptions, building on a broad spectrum of supporting evidence. A systematic review by Wakerman et al1 shows that RACCHO-style integrated services, delivered by multidisciplinary teams, provide a single point of access to a range of services and ensure sufficient health professionals to provide mutual professional support. This is important for all primary healthcare professionals, including allied health, because smaller rural communities cannot usually sustain a range of health services provided through individual practices. Multidisciplinary practice also supports innovative funding models, holistic and integrated care, and interprofessional education.2 This has benefits for both communities and practitioners. The RACCHO employment model provides secure, ongoing employment with a single or primary employer, providing competitive conditions of service including leave provisions, superannuation and professional development. A lack of these employment conditions is a significant barrier to attracting health professionals to primary care roles in rural Australia.3 The Wakerman et al study also identifies financial barriers to establishing and running a stand-alone rural health practice, as well as the associated administrative burden. This research indicates that models of care in rural and remote communities must differ from those in metropolitan communities, to address thin markets and lack of economies of scale.1 Further evidence suggests that the common perception of the solo rural general practitioner (GP) model is no longer supported, as the pattern of practice ownership in Australia has changed.4 Fewer GPs want the management responsibility, financial burden or lack of work-life balance associated with practice ownership.4, 5 The RACCHO employment model embraces this pattern of change in GP practice ownership, removing the need for GPs or other primary care providers to make the significant financial, professional and personal commitment of establishing a stand-alone practice. Social and familial challenges are also identified as significant barriers to recruiting and retaining a rural health workforce. Leaving family and friendship networks, fear of social isolation, perceptions of cultural and recreational limitations, as well as concerns about partners' careers and children's education, are often cited as reasons not to work rurally.6 Even for health professionals from a rural background, the major barriers to rural recruitment are family-unit considerations for partners and children.7 The RACCHO model, with its multidisciplinary teams and connections to the local community, provides an immediate support network which will assist in overcoming social and familial reservations, as well as provide the capacity to tap into local knowledge. The Alliance works to ensure that our policies are rigorous, evidence-informed and validated through extensive consultation and, while we have no control over the policy environment, we strive to advocate for the right policy at the right time.