1.1

 Acknowledge that doctors often find it difficult to treat their colleagues.  Support a ‘doctors for doctors’ program by developing, and distributing to all members, a register of general practitioners with expertise in treating doctors.  The register should be regularly promoted in newsletters of Rural Divisions.  A 'doctors for doctors' program should include a training program for doctors interested in caring for doctors and the development of protocols for the treatment of doctors.

Ensure all general practitioners are aware of the services provided by the NSW Doctors' Health Advisory Service and the Medical Benevolent Association of NSW.  These services should be regularly promoted in newsletters of Rural Divisions.

Develop a register of other health professionals, such as psychologists, social workers, rehabilitation counsellors and paediatricians who may be of assistance to general practitioners and their families.  The register should be regularly promoted in newsletters of Rural Divisions.

Encourage general practitioners not to treat their immediate family as this can lead to conflict between work and

Provide forums for general practitioners to liaise socially.  Social functions are as important as educational programs in providing opportunities for general practitioners to network with colleagues.

Assist with the development of peer support groups, run by an appropriately trained facilitator.  These groups would provide general practitioners with the opportunity to discuss any personal or professional issues.

Assist with the further development of peer review groups.  These groups provide general Practitioners with the opportunity to discuss the management of complex or difficult patients and patients with negative outcomes.  All discussions at these meetings must be considered confidential. 

Facilitate the inclusion of doctors' health as a legitimate component of all educational programs. 

Provide forums for general practitioners to discuss issues associated with practice management, time management, risk management and financial management. 

Facilitate the availability of a counselling service for general practitioners who have been the subject of a complaint or legal action.  Counselling in this situation should be promoted as standard practice and seen to be as important as obtaining legal advice.  Counselling is also available through medical defence organisations under these circumstances.

Provide training on stress management, self-esteem and confidence building.

Provide training on communication, conflict resolution and public relations skills with the aim of enhancing relationships with patients and colleagues of all disciplines.  These sessions should stress the importance of doctors working in collaboration with their colleagues.

Provide practical training about ways to approach a colleague who appears to have mental health or stress related problems.

Provide training sessions on dealing with abusive and aggressive patients.

Assist with the recruitment of general practitioners to rural and remote areas.

Assist with the retention of general practitioners in rural and remote areas by organising reliable locum services, especially in areas with few general practitioners, and training programs.

Provide weekend or full day Continuing Medical Education (CME), rather than evening meetings, to minimise travel.  The program should include activities for partners (male and female) and children and be conducted in a family friendly venue at a reasonable cost.  The topics covered in 1.12 to 1.17 above could be included in CME weekends.  Many of these topics are suitable for both doctors and their partners.

Develop a program aimed at assisting general practitioners in rural and remote areas with career planning.

Assist with ‘succession planning’ for general practitioners in rural and remote areas and continue activities such as production of the NSW Rural Medical Vacancy Booklet. 

Continue the development of rural streams for general practitioner trainees.

Ensure continuing personal and professional development of RACGP and ACRRM training program supervisors.

Organise talks for RACGP and ACRRM training program registrars and supervisors about the nature of general practice in rural and remote areas.

Identify role models and mentors for new graduates and general practice registrars. 

Develop rural health streams for medical students.

Identify role models and mentors for medical students.

Ensure continuing personal and professional development of rural general practitioner supervisors for

Assist with the development of a range of collaborative relationships between general practitioners and Area

Negotiation of contracts between general practitioners and the local Area Health Service.

Encourage all general practitioners to have their own general practitioner.  It is recognised that in rural and remote areas with a limited number of general practitioners, this may mean that a doctor's general practitioner is located in a different area to the doctor.  If a doctor's general practitioner is also a practice partner, it is essential that appropriate formal consultations take place.  ‘Corridor consultations’ will deny the doctor the same level of care that is provided to other patients.  All doctors need to receive a minimum of training in providing medical care to other practitioners.

Encourage all general practitioners to have regular medical check ups.  It should be recognised that poor physical health can also lead to mental health and stress related problems.

Liaise with all medical and allied health services in the area to ensure confidentiality in relation to diagnoses and treatment of doctors and their families.  Issues related to privacy must be carefully addressed at all times.

Provide education programs for all doctors about the importance of recognition of early warning signs and the value of early intervention for mental health and stress related problems.

Provide education programs about general practitioners' responsibility to monitor their own emotions and behaviour and to seek help if they suspect mental health or stress related problems.  Doctors need to overcome their hesitancy in acknowledging problems and seek help early.

Provide education programs about general practitioners' role in 'looking out for colleagues' and encouraging them to seek assistance or treatment if required. 

Provide education programs about stigma and discrimination in relation to mental health problems and the promotion of psychiatry as a discipline possessing effective tools for the treatment of mental health problems.

Ensure support for doctors and their families during periods of bereavement.

Develop procedures that ensure the confidentiality of all matters related to a general practitioner's mental health or stress related problem.  For example it is advisable that doctors access services that are not associated with their employment or training.  Issues related to privacy must be carefully addressed at all times.

Encourage and assist general practitioners to seek treatment when required.  If a doctor does not have their own general practitioner they should be encouraged to contact the Doctors' Health Advisory Service.  A confidential referral can also be made to this service.

Assist with the organisation of locum relief for general practitioners who are unwell and need to take leave from

Develop procedures for the confidential referral of doctors displaying impairment (as defined in the NSW Medical Practice Act, 1992) to the NSW Medical Board.  Ensure all doctors have received information about the NSW Medical Board's non-punitive approach to impaired doctors and its emphasis on support and rehabilitation.

Ensure follow up and support for families, friends and colleagues of general practitioners who are impaired or have suicided.

Assess the re-skilling and rehabilitation requirements of general practitioners returning to the work force following a mental health problem or an impairment and assist with the identification of supervised practice posts.

Support research into factors affecting the mental health of general practitioners in rural and remote areas and the development of effective health promotion and treatment programs.