South Australia's Country Health Centre Plan

[A Letter to Members]

 
 
Dear CRANA Members, especially our South Australian colleagues,
 
Our SA State Reps have recently informed us about the South Australia’s Country
Health Care Plan. Unfortunately CRANA has not been consulted on this initiative
and therefore have not had an opportunity to input into its formulation. 
This appears to be a huge change to the way SA Country Health has been provided
in the past. Although CRANA congratulates the SA Government for working to
develop innovation and change, we are seriously concerned by the “medical”
focus, without consideration of the vast majority of the workforce in Country
Health (remote and rural)… NURSES! 
The CRANA CEO, Carole Taylor, and CRANA President, Christopher Cliffe, will
be meeting the CEO of Country Health SA and have requested an urgent meeting
with the Minister of Health on the matter so that we are fully informed and can
provide support and accurate advice to our members.
Prior to those meetings and advice, some of Christopher’s comments are:
 Refocusing to a Primary Health Care approach and getting the health
workforce out of hospitals and into the community is a positive initiative.
 Much of the health workforce data and issues are concerned with the medical
professions, with little explanation about the nursing, midwifery and other
health professionals. Recruiting and retaining a strong workforce didn’t
include scholarships for the nurses in the workforce… much more would be
needed and equity between the health professionals essential.
 Safety and Quality speaks about managing high risk caesarean births with 4
doctors (no mention of Midwives!), I hope this is not an excuse to remove or
reduce low risk normal births from local communities. CRANA strongly
thinks this should be enhanced by building the capacity and numbers of the
Midwifery workforce to provide safe services in the local community,
regardless of the size of its hospital!
 CRANA would not support the gradual removal and centralization of birthing
services away from the small rural hospitals (i.e. Cummins moved to Pt
Lincoln). The plan needs to be looking at strategies to support and
development Midwives to provide these services. 
 CRANA would not support the provision of antenatal care by non-midwives in
this GP centric model, would this open the door for the use of the 16400
Medicare item? Country women deserve the same standard of care as women
in urban areas.
 Why create Physician assistants, another complexity when Nurse Practitioners
are ready to take up the challenge once the beurocracy and egos allow.
 “GP Plus Emergency Hospitals” What a title for a country health service!!!
What about Primary Care Hospitals?
 “GP Plus Emergency Hospitals” The skills and knowledge of Remote Area
Nurses working in these services would benefit the communities greatly and
provide an alternative level of service provision to these communities.
 
 
Likewise Nurse Practitioners and Midwives should be considered essential
team members.
 The Centre of Excellence in Aboriginal Health in Port Augusta appears to be a
great initiative, providing a focus for developing excellence across all services.
 Huge effort would be required to ensure the PATS system is user friendly, not
blocked by a lack of any certain health professional and is expanded to include
more allied and oral health care referals.  
 The Sole GP town and the demands on them to provide emergency care is an
unnecessary burden and CRANA would be keen to see the development of
Rural Nurses to take on much of this role. Rural Nurses are the great-untapped
resource in country towns.
 The expansion and development of remote area nursing services in locations
where there are currently under-utilised remote hospitals, or no service may
improve the health of the communities. CRANA would need clarifications on:
o These should not be just when no doctor can be recruited, these are safe
and reliable services, that can work collaboratively with GP’s or other
health care professionals when they are available… not only used as a last
resort!
o Nurses are regulated health professionals who are ‘not supervised nor work
for or on behalf of’ any other health professionals. Therefore they need:
• Access to a legislative framework for the prescription of drugs,
ordering of investigations, pathology, xray etc.
• Appropriate clinical guidelines (i.e. the CARPA Manual)
• Appropriate educational preparation (REC and MEC courses, post
graduate opportunities to study, i.e. remote health practice)
• Development of a career pathway to Remote Nurse Practitioners in
each location.
• CRANA would be essential in working with the SA Government to
develop an appropriate model.
CRANA is eager to get the opinion of our members on the plan and ask that you
contact us and let us know your views on the proposed changes. The Plan can be
downloaded from the following website: 
http://www.health.sa.gov.au/Default.aspx?tabid=471
Please either ring on 08 89535244 and ask for Carole or email ceo@crana.org.au. 
 
 
Carole Taylor, 
CEO CRANA