Concerns about the NT intervention, recently raised by Central Australian medical specialists and the Australian Indigenous Doctors Association, seem to be based on some flawed thinking.

With the greatest of respect, I would suggest that perhaps both of these groups have overlooked the potential for the Intervention to result in gains for the NT medical workforce.

Australia has roughly 60,000 doctors, of whom roughly 400 live and work in NT. So it is clear that the vast majority of doctors, for a variety of reasons including family and career aspirations, are not available to provide regular services to NT communities. This is not likely to change in a hurry.

Many of these remote area communities are less than 300 people in size. This is too small for a residential medical service to ever be realistic. Hence we have utterly brilliant remote area nurses (RANs) who deal with everything from vaccinations to roadside trauma, from house calls to air retrievals.

Some critics seem to feel that if more money was given to the existing services, they could do a much better job caring for the acute, chronic, and promotional health care needs of these communities than they do currently. The problem is that more is not possible without more workforce, and there are already fully funded vacancies including those of district medical officer in Alice Springs.

Money won’t fix this, unless you are talking about a complete reworking of remote area awards and salary packages across not just NT (or you would shuffle deckchairs) but all remote areas in Australia. Even then it could not guarantee continuity of workforce.

The vast majority of doctors do care deeply about the gaps in service provision and the inequalities seen in Aboriginal life expectancy. They just don’t want to commit to working in remote areas for the long term.

When 800 doctors applied to participate in the NT Intervention, it was not about money. It was about 2-4 week work opportunities where somebody else arranged everything including the transport. It was also about working for the disadvantaged — or logically they would have already been working for the more lucrative locum agencies.

Think about that. City doctors (predominantly) willing to work outside their comfort zone because they genuinely want to help. Every one of them a potential longer-term workforce recruit.

What work can you give them so they feel useful and want to return? They can be culturally trained, but won’t be around long enough to establish the trust needed to make a serious impact on chronic disease management. They don’t know the communities or services or even the specific disease patterns well enough to run a quality acute care service, and they may not have the high level clinical skills required in a remote setting anyway.

The best work would need to be something clearly defined, and perhaps following a set protocol. Something where the majority of the skill set is already within range. Something where regular follow-up would still be done by the regular team, so as not to interfere with established therapeutic relationships.

Hmmm. Sounds a bit like a child health check to me.

We know from the research that to provide high quality disease prevention and health promotion for an average GP case mix per day takes 7.4 hours, even before they have been seen for what they presented with. The NT guys do a fabulous job, but maybe this is a task they could use help with?

There would be risks. Primary Health Teams love their work and feel ownership for their patients. They might even feel under scrutiny, or, worse, criticism by the new chums.

Ideally, RANs should never be exposed to doctors who might treat them like NSW RNs (nor should NSW RNs!).

The new teams won’t be as experienced and might over or under diagnose, and might redo some checks that had already been performed.

But maybe, if we did a whole lot of checks all at once, so that we knew on a set date how many kids needed dental care, audiometry, and other specialist referrals including cardiac ultrasound, we could arrange block bookings and block transport and get things done faster and more efficiently.

We might even be able to bulk-arrange specialists to fly in for a set time period like for the Medical Specialist Outreach Assistance Program, or to provide outreach services like a dental van to particular communities.

Hmm. That also sounds a bit like the NT Intervention.

In an ideal world we would not have workforce shortages anywhere in Australia. But we do. And just maybe the NT Intervention is an effective short term way of recruiting new blood. And just maybe, that new blood will fall in love with the red sand and the desert communities.

Peter Fray

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Peter Fray
Editor-in-chief of Crikey