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The rural New South Wales town of Gunnedah has “no capability” to deal with a Covid outbreak, according to mayor Jamie Chaffey, as a result of a long-term decline in medical services, with many residents having to travel outside the shire for medical care.
Gunnedah is just one of many rural and regional areas struggling to attract medical staff despite a recent influx of new residents, including many in the 25-to-35 age bracket.
Gunnedah shire council commissioned the Rural Doctors Network to conduct a survey and analysis of the medical services in the town.
RDN found that the shire has a doctor-to-patient ratio of one general practitioner to 2670 residents, nearly three times the 1:905 ratio recommended by the report.
“The staffing issue is one that no tier of government seems to have an answer for,” Chaffey said.
“I think it’s the same reason right across Australia. It is the fact that you get to a low threshold of support, that you are very isolated as a doctor and expected to do superhuman things to serve your community and take a lot of personal risk.”
Many residents were shocked to find that their regular medical practices have closed as doctors retire or move.
The town has two private practices with a total of four doctors, with the only female doctor working part-time.
More attention on people, not facilities
Rebecca Ryan, a member of Gunnedah maternity network PaediatRic And Maternity Support (PRAMS), said that while they appreciate the rebuild of the hospital, it’s staff that are needed.
Ryan said doctors can get a Medicare approval to set up in a city and then determine how many patients to see a day while running a profitable business.
“At the end of the day, it’s probably not so much about bricks and mortar,” Ryan said.
“There probably needs to be an incentive for doctors to come to rural areas where they’re probably going to work longer hours.
“There may be a sacrifice of their career in terms of maybe general practices viewed as not as sexy as some of the specialties that you’d be able to do in an urban area.”
New mother Lauren Mackley, who moved to Gunnedah for her career, was able to have her daughter in Gunnedah hospital – but there are no GPs available for postnatal care.
“My pregnancy was amazing because of Dr Parsons and Dr Law, but both are looking to move to different phases of their lives,” Mackley said.
“But aftercare was one visit from the midwife. But now, I cannot get my daughter a doctor’s appointment anywhere – she’s a new patient, so there are no doctors taking on new patients. Not Manilla, not Boggabri, not Tamworth, not Narrabri.”
“Within a 100km radius I cannot get her into a doctor – we have to go to Emergency where we see a locum, so there is no ongoing care for her. Our life expectancy is dictated by our postcode, due to government funding and negligence.”
Local facilities under-utilised due to lack of staff
Like many rural towns, the hospital is staffed by locums who don’t have the Visiting Medical Officer rights to admit patients.
According to the RDN survey, emergency patients are often told it would be quicker to drive themselves 80km to Tamworth than be admitted at Gunnedah.
Overflow from surrounding towns has contributed to Tamworth’s emergency department being the busiest in the state, according to a NSW parliamentary inquiry.
Another issue is the beleaguered Rural Health Centre, an all-in-one clinic built under the GP Super Clinics program, now a symbol of Gunnedah’s health service woes.
The RHC was built in 2012 with contributions from the community, mining company Shenhua, and federal funds on state government land. It was taken over by Hunter New England Health last year after several changes of operator.
HNEH called for expressions of interest to staff it earlier this year.
Susan Heyman, HNEH’s executive director of rural and regional health services said: “Unfortunately, the three proposals we received would not deliver additional GP services, beyond what is currently provided in Gunnedah.”
Heyman said the federal government is responsible for primary health care but when the commonwealth is unable to provide GPs, “the state supports primary care providers to find alternative solutions to medical workforce shortages.”
A second round of EOIs is currently under way.
President of the Rural Doctors Association of Australia, Dr John Hall, acknowledged the problems with rural health staffing, and said some solutions are currently under consideration.
“Currently GPs are funded by feds, hospitals by the states, creating a two employer system which is very difficult for doctors to navigate and is buried in red tape,” Dr Hall said.
“A single-funded rural health system would stop the cost shifting and blame game that is rampant.”
Dr Hall called for recognition that rural medicine is different, and training, recruitment, and remuneration needs to be modified in NSW for rural GPs, citing the success of Queensland’s dedicated rural generalist pathway.
“The recognition of rural medicine as a different specialty to general practice occurred in Queensland and elevated the professional standing and remuneration of rural doctors, leading to a significant increase in the number of doctors working in QLD rural hospitals.”
“This actually stopped the downgrading and closure of many rural hospitals and birthing units.”
“The system is broken”
Mayor of Parkes Ken Keith has collected similar stories in his role as chair of the Country Mayors Association, expressing frustration at the lack of staff.
The Parkes shire hospital is still staffed by locums, with residents forced to go to Dubbo – a Covid hotspot – for treatment. Parkes had three general practitioners retire over the last five years. The council alerted the Western Local Health District ten years ago.
“Locums are an expensive way to staff a health service,” Keith said.
“The system is broken. It’s getting worse, and until you change the model where doctors are trained in the bush, work in the bush, pay them more – we’ve got to come up with a model where GPs go out and train in rural areas.”
“You can get paid more to do a three-day locum stint at a hospital than working full-time as a doctor. The system that allowed that to evolve is broken.”
Rural health minister, Dr David Gillespie, said the government is acutely aware of the maldistribution of doctors across Australia and the resulting recruitment and retention challenge.
“The focus of our initiatives ranges from enabling more kids to study medicine in rural locations, to increasing registrar training opportunities in the bush to incentivising rural GPs with higher payments.”
Chaffey remains frustrated at the lack of input from local government in determining health needs.
“I’m as frustrated today as I was 12 months ago,” Chaffey said.
“All we can do is advocate. I really don’t know that we’re actually getting anywhere. When you do speak, you wonder if anyone’s listening.”
NSW health minister, Brad Hazzard, could not be reached for comment.
Tom Plevey is a Tamworth-based journalist.
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