19 September 2019

Rural and regional GPs shouldering huge load

The Royal Australian College of General Practitioners (RACGP) has launched its annual health check-up on general practice, General Practice: Health of the Nation.

RACGP President Dr Harry Nespolon presented the report to Australia’s key decision makers including Health Minister Greg Hunt, Shadow Health Minister Chris Bowen and Greens leader Richard Di Natale this morning at Parliament House.

The report reveals that there are many rural and remote areas where the nation’s primary healthcare system continues to thrive. However, it also found that GPs working outside of major cities face unique challenges.

“Cardiovascular and endocrine disorders such as diabetes are more common in remote and very remote areas than in major cities,” Dr Nespolon said.

President Dr Harry Nespolon said that a troubling number of patients outside of metropolitan areas were not accessing GP care when they should.

“One in three patients living in outer-regional, remote and very remote areas are waiting 24 hours or more to see a GP for urgent care, compared to one in four in our metropolitan areas.

“This is a serious problem because if health issues aren’t taken care of quickly they can lead to a steep decline in patient health and greater costs for the health system.”

The report found that one of the obstacles for people outside of cities seeing their doctor is cost.

“The number of general practices services being bulk billed has marginally increased over the last four years but the increase is slower than ever before,” Dr Nespolon said.

“Unless this trend changes, this presents a ticking time bomb – by 2019-20 the bulk-billing rate will decrease.

“The most significant development is that for the first time all areas outside of our major cities have seen a decline in the proportion of services bulk-billed. This affects over seven million Australians.”

Dr Nespolon said that it was also harder for people living outside of metropolitan areas to find a GP.

“Despite GPs being one of the best distributed health professions in Australia, there just aren’t enough GPs working outside of our cities. There are more than 103 GPs per 100,000 people in major cities but this drops to 83 in outer-regional areas.

“The percentage of GPs choosing to work in rural and remote Australia is declining year on year too.”

The problem of general practice access is particularly pronounced in remote areas.

“In the 10 years prior to 2013-14, we actually saw an increase in the percentage of GPs living and working in remote and very remote areas of Australia,” Dr Nespolon said.

“But since 2014-15 that trend has reversed. As things stand there are just over 81 GPs per 100,000 people in remote areas and just over 70 in very remote areas.”

Dr Nespolon said that workloads in remote areas pose particular challenges.

“In our cities 15 per cent of GPs reported that their working hours were ‘unpredictable’ but this rises to 33 per cent in remote areas.

“It means GPs have to be responsive to change, adding extra pressure to their already challenging role.”

Chair of RACGP Rural Ayman Shenouda Dr Ayman Shenouda said that GPs working outside of metropolitan areas often worked in areas where other health services were lacking.

“More than one third of GPs in regional and rural areas report that accessing medical specialists is a challenge. We can’t just attribute this to geographical access, it’s possible that there are having more difficulties building professional networks.”

The RACGP President warned that there were no quick fixes.

Dr Shenouda said that vocational training location did make a difference but wasn’t a one-size-fits-all solution.

“The research shows that somewhere between 74 to 91 per cent of GPs who trained in rural areas or who originated from these areas stayed there for their first five years post training.

“So having medical graduates from the bush and having them complete their training there does make an important difference.

“But it’s still not going to solve all workforce challenges, the rate for metropolitan GP trainees is between 87 to 95 per cent.”

However, the head of RACGP Rural did note that GPs in rural areas were more satisfied with their remuneration compared to GPs in the nation’s cities.

“72 per cent of inner-regional, 69 per cent of outer-regional and a massive 79 per cent of remote GPs are satisfied or very satisfied with remuneration compared to just 64 per cent in metropolitan areas.

“This tells us that there are opportunities outside of cities to run successful practices, the challenge can be attracting doctors to these areas in the first place.”

Other key highlights of the report reveal that:

  • patients talk to their GP about mental health more than any other issue
  • GPs are avoiding or delaying seeking their own healthcare for a range of issues, in part due to concerns about being reported to regulatory bodies
  • out-of-pocket costs are increasing at double the consumer price index, with the average patient cost now higher than the rebate for a standard GP consultation.
  • 14% of those delaying a GP visit do so because of cost concerns
  • there is a decline in the proportion of services bulk billed outside of major cities
  • more and more medical graduates are choosing other medical specialities over general practice, in part because a large amount of GP work is unfunded
  • the costs of providing care are increasing year on year and not being matched through appropriate health funding. Medicare rebates remain the top priority health policy issue for GPs.

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