Better Health for the Bush

The Better Health for the Bush (BHFTB) Framework

The Better Health for the Bush (BHFTB) Framework was developed by the Hunter New England Central Coast PHN (HNECC PHN or the PHN) in partnership with the Hunter New England Local Health District (LHD) and the University of New England (UNE). Its aim is to pursue the vision of Healthy People and Healthy Communities by designing and implementing localised community-based models to improve the delivery of primary health care services. The framework also seeks to enhance the attraction and retention of primary healthcare professionals, utilising sustainable solutions that are tailored to and effective within the local context.

In the short term, BHFTB will continue to pursue the goals of:

• Establishing rural multidisciplinary health teams across PHN's rural footprint.
• Incorporating digitally enabled solutions (where appropriate) to increase equity of access to primary care services.
• Supporting localised recruitment packages that attract primary healthcare workers to roles in targeted locations.
• Using evidence through piloting programs and initiatives to address equity of access.

Why is a new model needed?

Communities in the New England region experience poorer health outcomes and limited access to healthcare compared with New South Wales and Australia. On average, Australians living in rural and remote areas have shorter lives and higher levels of disease and injury. They also face challenges related to poorer access to, and use of, health services compared with people living in metropolitan areas.

Small Town Engagement Model (STEM)

The Small Town Engagement Model (STEM) aims to support small rural towns with populations of less than 1000 people. This model is where an existing allied health business hosts another primary care provider that creates a Multidisciplinary Team and provides a broader scope of services to the small community.

The allied health business has a room that meets Health Hub requirements, and the visiting primary care provider uses it for face to face consults. Visiting primary care providers will provide face to face appointments for new and existing patients every 3 to 6 weeks and telehealth services to existing patients at all other times.

Allied health businesses can range from Pharmacy to Physiotherapy, this will be determined by the businesses that are available, level of interest to partner with a primary care provider and who have a space available for a Health Hub. The primary care provider can range from GP, nurse practitioner, specialists and other allied health providers.

Comprehensive Approach Rural Engagement Model (CARE)

The Comprehensive Approach Rural Engagement Model (CARE) aims to support communities as well as surrounding towns. This model involves a rural multidisciplinary health team (RMHT) comprising General Practitioner(s), Allied Health Clinician(s), Nurses, and Care Navigator(s) working together in a patient-centered approach. Delivery of primary health services could be either face-to-face or a hybrid of face-to-face and telehealth services.

Features of the approach include:

• Primary Care Coordination - A registered nurse develops a care plan and supports the coordination of treatment for people with multiple chronic conditions.
• Medical and Allied Health Students - University of New England’s Medical and Allied Health students will be connected to this model to deliver services under appropriate supervision. Structured remote supervision models will be used to allow students to provide care to the patients while being monitored remotely.
• Clinical Assistants - Allied Health Assistants and Medical Practice Assistants could be employed to further support the Health Hub. Student placements may be made available to train Allied Health and Medical Practice Assistants.
• Care Navigation – Care delivery enabler to connect the patient with external health services like specialists, hospitals, pharmacies, aged care services, and social services.
• Digitally Enabled Care – Technology will be progressively integrated into the model to allow clinicians and patients time to learn and adopt innovative technologies into their healthcare. Technologies integrated into the model may include a self-diagnostic booth where patients can take basic health measurements which can then be supplied to the Health Hub’s data cloud.

Rural multidisciplinary health teams reduce burnout and isolation in rural health professionals, improving the attraction and retention of a health workforce in a rural setting. A diverse health team that collaborates creates capacity for individual health professionals to incorporate other fulfilling roles like education and training, supervision, telehealth, and multi-site practice. Diverse teams foster a supportive, culturally responsive, and safe environment for early career health professionals, improving succession and sustainability of rural health service delivery.

This model will include all team members and the patient in decision-making to enable continuity of care. The team could also scale up support in times of natural disasters or other events that place high demand on the health system. A network can be established for professional development and to foster collaboration between the team and surrounding external primary health professionals. An agreement between providers may be used to outline how the team will operate, for example, team structure, collaboration process, as well as facility usage.