09 May 2022

RACGP: Action needed on rural, regional, and remote healthcare in NSW

The Royal Australian College of General Practitioners (RACGP) has welcomed a New South Wales parliamentary inquiry report into health outcomes in rural, regional, and remote communities but warned that action is also needed at the federal level to ensure the future of general practice care in the bush.

The Legislative Council’s report “Health outcomes and access to health and hospital services in rural, regional and remote New South Wales” calls for a fundamental re-think of healthcare outside of major cities across the state.

RACGP President Adj. Professor Karen Price said the report was a positive step forward but warned that action at a federal level was also desperately needed.

“This report is long overdue because for too long healthcare in our rural, regional and remote communities has been overlooked,” she said.

“As the college that represents four-out-of-five rural GPs, the most of any organisation in Australia, the RACGP welcomes the focus on investment in rural, regional, and remote healthcare. In particular, I welcome the report’s focus on recruiting and, just as importantly, retaining GPs in rural, regional, and remote areas. The report should also be applauded for recommending the Government investigates incentives and new health infrastructure to attract more doctors to communities outside of major cities.

“We can’t just encourage action at the state and territory level though, we need a nation approach that gives rural, regional, and remote general practice a shot in the arm. Just a few months ago, the Community Affairs References Committee interim report recommended the federal Government investigates substantially increasing Medicare rebates for all levels of general practice consultations. This would make an enormous difference for the future viability of practices in rural, regional, and remote communities across Australia and help ensure that no patients are left behind.

“Medicare rebates for patients simply haven’t kept pace with inflation and the cost of providing high-quality general practice care and the current Medicare rebate structure devalues longer consultations because patient rebates decrease significantly the longer a person spends with their GP.  World-class general practice care requires time and when rebates are insufficient - this is particularly damaging in areas of lower socio-economic status, as well as rural, regional, and remote areas.

“No one wins when practices are forced to close their doors or patients delay or avoid seeking care and end up in a hospital bed for a condition that should have been taken care of by their usual GP.”

RACGP Rural Chair Dr Michael Clements welcomed the focus on rural, regional, and remote healthcare but warned that some of the recommendations must be approached carefully.

“It’s great news that the state of rural, regional and remote healthcare in New South Wales is front and centre,” he said.

“All patients in all corners of Australia deserve access to high-quality healthcare no matter their postcode and that is something that RACGP fights for every day. It’s important, however, that governments in New South Wales carefully consider the consequences of enacting some of the recommendations contained in this report and consider the practicalities of what would be involved in implementing them.

“The report recommends a ‘Single Employer Model’ for all GP trainees across rural, regional, and remote New South Wales, such as the Murrumbidgee Rural Generalist Training Pathway. Under this model, Local Health Districts will employ GP trainees and rotate them across hospital training positions and local practices throughout their training and then potentially employ them in the NSW Health system. This would provide GP registrars with pay and entitlements in line with their hospital-based counterparts.

“Making general practice a more attractive option is something to be welcomed; however, it’s vital to keep in mind that this will only work if there is a hospital nearby and I suspect this model has the potential to draw new GPs away from towns without a hospital acting as a ‘single employer’. When it comes to reforming rural, regional, and remote healthcare across the state, we must not only consider regional centres with a hospital but also small towns in rural and remote areas.

“Recommendation 10 calls for the establishment of a Rural Area Community Controlled Health Organisation pilot. This holds promise but would be very expensive due to the salaries involved and would potentially only be viable in some towns. So, once again we need to have rural and remote areas front of mind because we don’t want any patients missing out. We also need to be mindful of these competing with existing privately owned rural, regional, and remote practices – so location choice is key.”

The RACGP submission to the inquiry can be found here.

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