Rural medical workforce maldistribution and shortage remain key problems for Australia and other large countries with dispersed populations. This comes as no surprise given its population density of just three people per square kilometre. Australians living in regional areas need to wait on average twice as long as city dwellers to see their preferred doctors. The New England region has the longest GP wait times in the country, an average of 13.8 days.
Programs designed to combat health workforce pressures and boost medical services in rural and regional Australia include the Medical Specialist Outreach program, the National Rural and Remote Health Infrastructure Program and the Rural Flying Doctors 24 hour emergency service.
In order to combat the clinical workforce shortage and other challenges such as an ageing population and changing public expectations, new innovative clinical delivery models are required. We know digital innovations have the potential to improve primary care accessibility for patients. The government funded Health Direct organisation provides telehealth services 24hrs a day and an on-line symptom checker, however this does not integrate with existing records or liaise with ongoing practitioners.
It might be time for us to start looking at some bolder initiatives, like Babylon GP at Hand (BGPaH).
BGPaH is a primary care practice in London that incorporated a ‘digital-first’ service model into existing practice in 2017 through use of a mobile app and video consultations. The app includes a triage system based on a symptom-checker and a recommended course of action but does not provide a suggested diagnosis to the patient. Video or telephone consultations are available 24/7, 365 days of the year, usually within two hours of request.
This model represents a significant departure from the ‘usual’ model of primary care but similar models are already being used widely throughout the NHS and beyond, such as Push Doctor and Docly. These kinds of telehealth models do yield high patient satisfaction largely due to their convenience factor.
While there are still concerns over some details of the Babylon GP model – in terms of cost effectiveness, patient safety and privacy and dealing with more complex clinical issues – overall teleconsultations show great potential for solving rural access issues. They bring doctors and patients together regardless of distance. There’s a decrease in demand on professional time, improved access, convenience and flexibility for patients, and simplicity brought to straightforward health issues. Trialling such a digital first approach in rural Australian general practice should be considered without delay.
