Wednesday, 15 February 2023
WE are in the midst of an existential crisis. The backbone of our country health services – the humble rural GP – has now become an endangered species whose complete extinction is imminent unless the whole clunky, outdated health system is urgently turned on its head.
Over the past couple of decades our nation’s federal governments of both political persuasions have ignored the warning signs, contributing to and blithely watching the steady decline of the rural GP and the Medicare system that underpins them.
The economic viability and therefore attractiveness of the ‘Country Practice’ and family GPs here in the bush, right around Australia, has continued to be eroded.
Whether through gradual neglect or a deliberate centralisation of health services to metropolitan areas – the results are clear – there is a crisis and our hardworking rural GPs and their staff are at breaking point. There are fewer doing more for many more and, sadly, they are at their limit and leaving in droves.
I hear daily from people around the region – often elderly – distressed and anxious when they can’t see a GP, can’t be included as a patient ‘on the books’, when they can’t find the money from a tight budget to pay upfront for a consultation or a script and when they lose their own supportive GP through retirement or career change.
As a State MP, watching the Feds with its hands on the levers, this is without doubt the most frustrating, aggravating and frightening critical problem that comes across my desk.
It’s a sad fact that in our region almost 80 per cent of those who present at Emergency Departments would never have had to walk into their local hospital if they had been able to access a GP just months earlier.
While I am encouraged by the comments recently from the Prime Minister and Health Minister Butler around strengthening the Medicare system and acknowledging the current system of subsiding individual consultations is no longer fit for purpose, I believe we need to start again from the ground up, with a particular focus on improving support for those doctors choosing rural general practice.
We need incentives so that choosing to be a medical practitioner in rural and regional areas, is viable and an attractive career option. This was clear at the UNE Medical School graduation last year. I attended the graduation dinner and had a chance to speak to some of the 71 newly minted doctors celebrating their graduation. Not one of all those graduates planned to work west of the Great Divide, and the vast bulk of them were aiming to specialise.
They spoke about how becoming a rural GP was the least attractive career option for them – the message was their workloads would be huge with little reward for their efforts. We need to look at how that can be changed and what needs to be done to make ‘Country Practice’ a rewarding and fulfilling career choice.
I have spoken countless times about this in State Parliament, but the message does not seem to sink in. Maybe now, on the brink of collapse of the primary health care system and the extinction of the rural GP, it will.
There needs to be greater cohesion between the State and Federal Governments – we cannot have a workable health system in the regions without that stronger relationship, given that they control the two sides of the same health coin.
In that vein, there is still some hope. In the countless meetings, briefings and reems of paper I have read trying to learn more about possible solutions, I still cannot find anything better than the Single Employer Model, which has been successfully trialled down south in the Murrumbidgee Health District around Wagga Wagga.
Under this model, doctors are employed directly, as salaried employees, by the public health system (NSW Health) and work in the hospital on a roster on various days during a week. When not in the hospital they are able to practice as a private GP in a local clinic, accessing the Medicare Benefits Scheme. This brings the security of salaried employment and all the leave entitlements of the hospital system with the flexibility to engage in general practice. It keeps GPs in our local communities and guarantees a doctor is always in your local emergency department when you present.
As a result of the 16,000 signature petition I presented to Parliament last year on behalf of the people of the Northern Tablelands, the State Health Minister agreed to rollout the single employer model to our region to help address the current crisis.
For us this would mean having four doctors employed at Inverell Hospital, three at Glen Innes and 12 at Armidale, just as an example.
The only sticking point is that it requires the Federal Health Minister to grant exemptions under the Health Insurance Act (1973) for this to occur. Otherwise the Medicare Benefits Scheme cannot be accessed by the GPs. The request has been formally made by NSW for this to occur and we are still waiting. I’m not sure how much longer we can afford to wait though.
Lastly, I recall a discussion I had last year with a rural GP from Armidale with many decades of ‘Country Practice’ under his belt. He cut right to the heart of the matter: ‘The NSW Government is responsible for its hospitals, while the Federal Government is responsible for General Practice and Aged Care. While this division of responsibilities might work in metropolitan areas, it cannot in rural areas, and is responsible for a lot of our problems.’
The system as it currently stands is failing our rural generalists and they deserve so much more as our primary healthcare workforce. We need to put aside partisanship and be bold in trying something different, something ambitious.
I believe that is the Single Employer Model. It works and we need to implement it, before it’s too late and the humble rural GP is no more.