Providing adequate support for allied health professionals in rural and remote Australia is crucial to the quality of care and health outcomes for those living in the bush. The peak body Services for Australian Rural and Remote Allied Health (SARRAH) provides such support for rural AHPs, and has been central to the rollout of the Allied Health Rural Generalist Pathway: a strategic type of AHP support with a long-term view to resolving rural health workforce issues.
I discussed this with SARRAH CEO Cath Maloney.
Could you talk a little bit about your role in SARRAH and what SARRAH does.
I have spent the majority of my career as a physiotherapist working in rural and remote settings—including owning my own practice and working in health services—where I have been managing allied health services across regions. So I come with that background of understanding some of the logistics and challenges of providing services into rural and remote communities. It was kind of a natural progression to come to an organisation like SARRAH, and I’ve now been in this role for three and a half years.
SARRAH—Services for Australian Rural and Remote Allied Health—has been around for 26 years. We started as a member-based organisation to support allied health professionals who were working in rural and remote communities, because it was recognised by those founding members that allied health professionals in these settings needed a voice. It wasn’t being heard elsewhere and there was such a need for allied health services and support for these services that SARRAH was created to provide that support. We provide advocacy to governments of all levels, state and federal, so that there are policies and programs in place that support allied health professionals and the communities that they’re serving.
Can you tell us a little bit about how SARRAH has been involved in the rollout of the Allied Health Rural Generalist Pathway?
SARRAH has been involved for a number of years—we started out as part of a stakeholder group that was overseeing some of the work that Queensland Health was doing in this area, and also the work of the former organisation called GNARTN (Greater Northern Australia Regional Training Network), who did some consultations on the shared skills and capabilities of various allied health professions that were relevant to rural and remote settings.
This set up the concept of a ‘rural generalist’ [in the allied health context], and we’ve been involved with Queensland Health since about 2013 in this work. In 2018, we were provided some seed funding from Queensland Health, to look at ways in which the [Allied Health] Rural Generalist Pathway might be expanded into private and non-government settings, so that involves talking to the various state jurisdictions, and there were a number of states who were actively looking at trialling and piloting allied health rural generalist positions within their services. So Northern Territory, South Australia, Tasmania, obviously Queensland—and, to a lesser extent, Western Australia and New South Wales—have all been active in this space over the last five years.
We were in negotiations with the federal government at this point to look at sourcing funding to do more work in this area. We were actually holding on to some unspent funds from a former grant, and we proposed that this money be used to help pilot an allied health rural generalist pathway into non-government and private settings. We were able to reach an agreement with the Commonwealth, and that was signed off in late 2019. Since then, we’ve been conducting a pilot that was completed middle of last year, and we were awarded further funding in the 2021 federal budget to continue this work over the next three years.
So that’s exciting. This investment in allied health workforce development has been the first significant investment probably in living memory.
That’s really important, given the challenges of recruiting rural and remote positions generally, but particularly for the allied health workforce.
Well, of course, and when we started we were able to recruit to the project positions.
But with the onset of the COVID pandemic, and its subsequent effect on allied health workforce development, recruitment and retention has been exceedingly challenging. The pandemic has shown how fragile this workforce is, with the loss of movement and mobility of the workforce across state borders during those lockdowns, and the reduction in migration of skilled workforce—this has all been contributing to what we’re now seeing, which is incredible workforce shortages, unprecedented in rural and remote settings.
Do you have any early results from the evaluation about the impact on recruitment and retention for allied health professions in rural and remote areas that the Allied Health Rural Generalist Pathway has had?
An example of some of the projects that we’ve seen implemented within some of these non-government organisations include a pharmacy business in Western Australia, who utilised training positions to support their graduate programs.
They had a graduate program where they were providing services across a huge footprint in WA and northern Australia in general, and created a two-year program where they rotated their trainees through these four different locations over the two-year period.
While the trainees were doing this, they were undertaking the pathway requirements, which regular listeners and readers will know includes: the training through James Cook University; workplace supports put in place by the employer to provide supervision and mentoring for that person; and then a service project that looks at particular community needs and how that service might meet those needs. The trainees undertook these projects while they were doing this two-year graduate program.
The outcomes of that to date have been that those chronically vacant positions have been filled. The service has been able to create more positions because they’ve grown this capacity and they’ve got greater level of viability. And they are now at the point where they have actually struck a private public partnership with the local health service, to deliver pharmacy services into a particular community, because the health service has been unable to recruit. So I think that’s a great example of some of the successes that we’re starting to see come through; that service is now in its third year of participation in this program. It takes time to develop those sorts of outcomes, but they’re the sorts of trends that we’re starting to see.
That’s really exciting because it also shows that when you go out to the market and let them innovate around the development of the rural generalist, they’re starting to get quite a lot of interesting and different models that may not have been the original intention of the program.
Absolutely. It also makes it hard to evaluate, because you’ve got such diversity in the service providers that we’re working with, everything from a small single discipline practice right through to your large, multi-disciplinary practices that employ more than 100 people.
So it’s difficult to discern what makes a successful workplace, and what is it about allied health trainees that make them more inclined to stay, or to move on.
Allied Health is a complex space to evaluate anyway, but you’ve got all these added layers of complexity. What level of support are the professions providing for the allied health rural generalist?
I think that the understanding of the [Allied Health] Rural Generalist Pathway by the professions is improving.
Certainly since we’ve been working on the project, we’ve had good levels of support from the associations. So that notion of ‘are you trying to produce a generic allied health worker; what is this about?’—I think that we all understand that those roles do not exist. An allied health rural generalist works within their discipline, and within their scope of practice, but retains that breadth of experience to enable them to service the community in which they are working and living. I think that there is a growing level of understanding about the importance of the [Allied Health] Rural Generalist Pathway as part of a strategy to grow [the] rural health workforce.
I know it’s early days in terms of the rollout of the allied health rural generalist role in private practice, but what trends are you seeing in private practice and non-government settings?
In terms of the training needs, we are seeing some evidence to support that this is one means to attract people to a rural position, and the growing evidence to support this is helpful in retaining those staff.
Some of the trends we’re seeing is that there is growing evidence to support that this is useful as a recruitment and retention strategy. People do move on—they’re moving on because they’re getting a promotion within their organisation, which is not a bad thing. They’re moving on because they’re being headhunted by another organisation and going to a more senior position there—also not a bad outcome. And when you think about the fragility and the thinness of this workforce—there aren’t many of them out there—they are going to be headhunted and they’re going to be targeted, particularly if they are showing interest in developing a community approach to health service development.
You’re always going to have that element of people moving on. I think what this is demonstrating is the usefulness of rural employment opportunities, because of the breadth of caseload that these people deliver, and that ability to form networks, and to establish your skills and your independence as a clinician. These are all things that are important in developing the resilience of the rural health workforce.
So that’s a little bit about the trainees. In terms of the workplace, what we’re seeing is that there’s tremendous variability in workplaces’ capacity to put the necessary supervision and support arrangements around the individual, and we haven’t been very prescriptive about that, for obvious reasons. We don’t want to stymie the innovation that we’ve seen, which has made some of these workplaces really successful.
What’s unique about this project is that it’s probably the first time where workplaces have been remunerated for putting those supervision and support arrangements around the trainee. We know that happens for the medical workforce, we have various examples of those trainees being supported—even though they might move from place to place, they are supported along the course of that pathway to completion. That level of infrastructure does not exist for the allied health workforce. This is one of the first examples of where that level of support is being funded. There’s still a lot we must learn: what is needed to help support those trainees who might remain mobile, but stay rural; and what needs to happen to support the workplace to retain those trainees.
It’s a very powerful model in a lot of ways. It sounds like the graduates of the program—or the trainees themselves—will be highly valued in the workplace because it’s actually codifying the skills that they would be learning in practice anyway, but also giving them a framework to support that. The other important point you raised about supporting trainees and graduates in practice and having a framework for that—that can become a model for practice for allied health, generally, but it will require some funding and support.
Yes, and I think that’s one of the key things: we’re talking small numbers at this point; the first cohort was for 40 places. The cohort that we’re working with now will support a further 90 workplace training packages, 60 of those in mainstream services, and 30 in Aboriginal community controlled or Aboriginal community owned practices. It’s going to take some time to build the numbers to get that recognition and to really understand the value of this. But we’re seeing some early signs, which is exciting.
Is there strong uptake and interest in those programs?
Yes, very much so. The Aboriginal and Torres Strait Islander sector is obviously a little more challenged in employing allied health professionals in the first place, because they’re not necessarily funded to deliver allied health services. But there are some policy priorities currently in play that are seeking to encourage Aboriginal community controlled organisations to start delivering services in disability, for example, and starting to deliver services into aged care. It’s going to be a growing area where support is needed to help those organisations put the necessary supports around those allied health professionals that they’re seeking to employ.
That’s fantastic, because we’ve seen a problem with capacity and people being able to meet the needs of the disability community and the aged care community. It’s great to hear that potential transferability into those sectors. Where do you see the Allied Health Rural Generalist Pathway in five years’ time?
There’s work in process at the moment, which we’re hoping will be well completed within the next couple of years.
One of the key pieces of work that we’re supporting is the establishment of an allied health rural generalist accrediting committee or council. This will enable universities to apply for accreditation so that they can deliver the Allied Health Rural Generalist Program within their course offerings—this is to ensure that we’ve got that consistency of delivery and program content across universities. Obviously, numbers are going to be fairly small for a while so it may be that that’s a consortium approach.
We’ve had good support from universities to date. James Cook University, as the initial deliverer of the program, up until this point has been very supportive of this process of establishing a council and bringing other universities online to deliver this course. But in addition to that, what we’d like to see is each of the allied health professions come on board and start to offer allied health rural generalist training within their CPD program. We’d like to see that level of recognition from the associations, support through professional recognition, and through titling, but that’s a whole other conversation. There are other complexities associated with a titling or specialisation process, but we would like to start to have those conversations.
We’d obviously like to see funding continue to grow the rural generalist numbers, and we would like further engagement from the state-based health services. Several of the health services are already well down that path, running pilots and programs to grow a rural generalist workforce. What we’d like to do is work with the states and maybe look at co-locating allied health rural generalist trainees, so that you’ve got some in private settings, some in public settings, doing place-based project work, helping to plug those gaps and meet the health needs of the communities that they’re working in.
Those are some of the things that I’d like to see happening over the next five years—that the rural experience generally, and the training, are seen as a really valuable parts of an allied health professional’s development and career pathway. We can map out for somebody who has an interest in rural health, that there are career pathways that will support you to develop your skills and to contribute to the health of rural communities.
This is a really important project, not just for rural health, but for allied health generally. It’s one of the first times that the allied health professions have come together to create a common model to resolve the need in the allied health workforce. Creating a valued model for a generalist workforce is not something we’ve seen before. We tend to value specialisation, and even in my own work, I can see that the rural generalist model is valued and sought after. But it’s also creating a framework for training and advancement of the allied health workforce generally, which we haven’t seen a model for. I can see a lot of opportunities to translate this more widely across the allied health workforce—that’s exciting.
Absolutely. We don’t always agree on everything, and I’m sure that the pathway is going to look different again in five years’ time. It’s not a static thing. This is going to grow and develop in response to our findings and the ongoing work that the states are doing to support this workforce. It will look different, but it is creating opportunities to come together, for the disciplines to come together to address this issue.
Who will oversee accrediting the pathway? Will SARRAH take a lead role in that governance?
The way that we’re setting it up is that this council will be independent, so it will sit within SARRAH’s corporate governance structure, but it’s an independent committee of the board, so we will be at arm’s length. Currently Queensland Health owns the education framework. We’re talking to them about how we might allow the council to hold those educational standards and continue to develop them, to fit the needs of the various settings that we will find [for] rural generalists. SARRAH doesn’t own it; we are supporting the process to establish those structures.
That’s really another interesting opportunity for allied health because we have no one with jurisdictional oversight of allied health, anywhere. So again, the fact that SARRAH as a national not for profit, non-profit organisation that’s working across boundaries and particularly in rural and remote is supporting this model is quite an innovation as well. Cath Maloney, thank you so much for your time.
To learn more about Services for Australian Rural and Remote Allied Health SARRAH, please visit their website | Connect with SARRAH CEO Catherine Maloney on LinkedIn | Learn more about the Allied Health Rural Generalist Pathway.
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