Rural workforce focus

About 20% of New Zealanders live in rural areas. Providing quality healthcare in these regions is more challenging due to our geography. Rural areas often have fewer healthcare workers than cities, and several factors contribute to this.

• Most health training happens in cities, so rural students must move to study. People are more likely to work in rural areas if they have lived or trained there.
• Health professions often value specialisation as a source of prestige, progression and pay, which is more common in urban settings. Rural jobs usually need generalist skills, making them less appealing despite their importance. Though rural generalism is itself a vital, specialist area of practice.
• Many healthcare workers are migrants who tend to settle in cities, so fewer end up working in rural areas.

Getting our rural health workforce right is essential for the sustainability of our health system. We need to:

• make our whole health system more responsive to rural communities and needs
• create targeted solutions that support rural communities.

A stronger rural health workforce relies on more health professionals who want to work in rural areas. To achieve this:

• training needs to be available in rural areas or online, so people can study close to home
• we need to encourage more students from rural communities to enter health training
• barriers like job opportunities for health workers’ whānau need to be addressed
• pay and working conditions should be fair across regions, so rural jobs are as attractive as urban ones
• rural training should be easier to navigate, since they often have to move a lot to get experience in many communities and settings.

We also need to adapt healthcare models for rural settings. This might mean we use different specialists than those in urban settings.

• Generalist doctors with extra skills can handle high-demand services like maternity and anaesthetics. This reduces the need for traditional specialists. We already use this model on the West Coast.
• Instead of fixed clinics, mobile clinics supported by paramedics and nurses could deliver care to people in their homes or community settings. This may need different funding than urban practices.

The biggest short-term challenge for rural healthcare is having enough staff. As rural populations grow and age, we need our workforce numbers to keep up and stay in these areas.

To build a sustainable rural workforce our approach will need to:

• support tertiary providers to create more rural-based training programmes for professions with low staff
• support students from rural communities to train into health careers
• give students hands-on experience in rural settings to encourage them to stay
• invest in roles suited to rural care, like rural hospital doctors and paramedics
• make rural training easier, such as by employing rural doctors, to reduce attrition and average time to complete training
• partner with rural communities to make healthcare jobs more rewarding
• share staff across hospitals and community services to improve coverage.

Long-term, the goal is to shift to 'by-rural, for-rural' healthcare models. This means we need to:

• develop training pathways tailored to rural needs, starting with rural training hubs
• use flexible care models like mobile clinics and telehealth, supported by fair funding
• expand generalist-specialist roles to meet rural demands, which we already know work
• empower Iwi Māori partnership boards to shape workforce and healthcare needs for their communities.

Over the next 3 years, we will focus on workforce planning and broader system changes to support these goals.

Workforce plan priorities over the next 3 years

3.5 Grow our GP and community medical workforce

Move to publicly employ public health medicine and rural hospital medicine specialists to smooth their employment pathways and reduce attrition.

5.7 Establish rural training hubs

Establish 3 rural training hubs at sites across Aotearoa New Zealand, employing long-term rural placements for students.

5.8 Support workforce into rural settings

Develop a supported entry to rural practice programme to acclimate professionals across the health system to rural settings when they first start work rurally.

5.9 Increase and hospital specialist training and support

Grow the number of rural hospital medical specialists we train across the system, and improve support available to trainees to bolster retention in rural settings.