Healthcare in New England is at breaking point.
It can take weeks to see a GP, hospitals are regularly on bypass and if you need to see a specialist, you’re often forced to make an expensive trip to Newcastle or Sydney.
Armidale Rural Generalist Dr Rod Martin has lived in the region since 2010. The new president of the Australian College of Rural and Remote Medicine (ACRRM) has noticed a dramatic shift during this time.
“We’ve seen a lot of retraction of, certainly specialist services, but also generalist services right across the New England footprint, to the point of being precarious at times.
“We’re kind of kind of just hanging on there by fingernails at different times of the year. And it’s not just one hospital here and one hospital there. It can be the whole district. Even from Tamworth up, it can really be sitting on a knife’s edge in terms of services just not being available,” he said.
However, is this problem unique to New England? Well, yes and no.
Dr Martin said partly it’s a size issue.
“The size of the district is a real challenge, with headquarters right down in Newcastle. It’s certainly difficult to know if we’re heard down in Newcastle from up here.”
New England also suffers because it’s close to Queensland, where nurses and midwives earn significantly more. According to the Escaping NSW Treasury’s Curse report by the NSW Nurse and Midwives Association, “entry level nurses and midwives in Queensland earn $82,753 compared to just $70,050 in NSW. This is an 18 percent difference,” they wrote.
Dr Martin said this is noticeable on the ground.
“At the moment, everyone goes to Queensland because they’re being paid more and their conditions are typically better out there because the Queensland Government put more money towards it.
“People are going where those opportunities exist and they’ve probably rebuilt their critical mass, certainly from a medical perspective. Queensland’s had at least a decade of rebuilding in rural communities,” he said.
General Practice in the region
Everyone agrees that the fundamental problem is that there simply aren’t enough health workers in rural areas, particularly GPs.
According to Chair of the New England Division of General Practice, Dr Alex Draney, your chance of finding a GP depends on where you live.
“In the New England area, there are 77 GPS. But those GPs are focused mainly in the more populated areas like Armidale. Places like Inverell, Uralla, Glen Innes, Tenterfield are suffering from low GP numbers. Places like Bingara, Tingha, they don’t have anyone,” she said.
Part of the problem is there is a shortage of GP across Australia. A report from the Australian Medical Association showed Australia will face a shortage of 10,600 GPs by 2031-32. The number of students choosing general practice continues to drop, particularly those wanting to practice rurally.
Associate Professor at the University of New England’s School of Rural Medicine, Dr Maree Puxty told New England Times the challenges are multifactorial.
“We have an ageing general practice workforce. That’s not just unique to the New England region. That’s rural general practice generally in New South Wales, and the average age of GPs are over 55.
“I think that general practice is not seen as attractive by the junior doctors and the recent graduates, and I presume that’s both a financial and work life balance kind of issue.
“I think it’s the locum-isation of the workforce. Locums (temporary doctors who fill in when there are shortages) are now paid extraordinarily high rates of pay, and it’s hard to find people who are willing to work for a lesser amount. From a young doctor’s perspective, they can go and work in an emergency department and do three or four 12 hours shifts a week, and they get paid heaps more than if they were in general practice training.
“To become a general practice trainee at the moment, you take a substantial pay cut and lose all of your entitlements, like parental leave, sick leave, etc. Medicare doesn’t cover the actual costs associated with running a practice and it is not adequately remunerated,” she said.
The way GPs view work is also changing. Dr Martin highlighted the previous generation of doctors would work 70 or 80 hours a week because that’s what the town needed.
“Now there’s a better focus on self-care and making sure that you’re getting good sleep. And the younger doctors that are coming out are expressing they don’t want to work six or seven days a week,” he said.
How to attract more healthcare workers
The debate of how to attract more doctors to general practice is complicated and includes suggestions such as increasing Medicare rebates and providing more incentive payments.
One initiative that’s getting traction is the NSW Rural Generalist Single Employer Pathway (RGSEP) to help make training as a GP more appealing.
“(Currently), when you decide to leave the hospital system and go into general practice training, you take a massive pay cut and lose all your benefits, so you lose sick leave, lose any maternity parental leave… You basically end up working as a contractor,” Dr Draney explained.
With the Single Employer Pathway, trainees are employed for up to four years by the regional local health district and keep their NSW Health Award entitlements.
“I think we need to be selecting more rural undergraduate medical students, training them for extended periods of time in a rural environment, and then we will grow our own workforce,” Dr Puxty suggested.
There was also a recent announcement to fast track doctors from Ireland, UK and New Zealand into Australian rural locations. Groups such as the Royal Australian College of General Practitioners (RACGP) were concerned but Dr Puxty is in favour of the announcement.
“I see that as a very good thing. I think anything that decreases the bureaucracy to make it easier for international medical graduates to come to Australia. But they also require appropriate supervision to work within the Australian health service as well,” she said.
Ultimately, she thinks there needs to be more incentives for Australia doctors to live and work rurally.
“We just have to make rural general practice more attractive to the Australian medical graduates, and that’s by decreasing locum payments and Medicare increases,” she said.
Another popular way to encourage more healthcare workers to the region is through incentive payments.
The Hunter New England and Primary Health Network have offered a series of Bush GP Relocation Grants. The NSW Government’s Rural Health Workforce Incentive Scheme provides incentive payments of up to $20,000 for the hardest to fill roles.
However, according to GP and Secretary New England Division of General Practice, Professor Michelle Guppy, one barrier is that people don’t know what it’s like to work in a rural town.
“Making the leap can be a step of faith. So we need to work out how to break that down. Recruiting people who have already lived in a rural area (or done their medical studies) is a great start. Making things easy to move here (housing, childcare, work for a partner) is also really critical,” she said.
The Local Connect Program in Glen Innes is one such program that is making it easier.
It’s powered by the Attract Connect Stay program and provides a ‘Welcome Experience Community Connector’ value-add for government and non-government agencies who are trying to recruit workers to the region.
According to Executive Manager Margot Davis, the Community Connector can help with anything from relocation to finding a home and getting them settled with all their essential services, like healthcare, schools for their children and employment for their partner.
“Really critically… it supports them to make social connections, because that’s what has the biggest impact on retention beyond a year. We connect them with sporting clubs or social groups or community organisations,” she explained.
Similar programs under the Welcome Experience have also recently started in Moree, Armidale and Inverell.
Changing the way we view healthcare
Many Australians have become accustomed to accessing healthcare services through telehealth or virtual care, particularly since the COVID-19 pandemic.
While it gives people access to specialist services they previously had to travel for, Dr Martin urged caution.
“The camera cannot cannulate, the camera cannot resuscitate…
“Rural people don’t deserve to have their doctor substituted by technology. We can’t have it that the government’s acquiesced to the fact that it’s just too hard to get doctors and just replace them with digital services instead,” he said.
We need to be innovative though, according to Dr Alison Koschel, Executive Manager of Populations, Access and Performance from Hunter New England and Central Coast Primary Health Network (PHN).
“I guess communities have to come to terms with services being maybe delivered differently. We would all love to keep status quo and have a general practice the way we’ve always had general practice and have our hospitals functioning the way we had them in the past. But we don’t live in a day and age where that can occur anymore.
“I think the only thing communities can do is to be more proactive in prevention so that we don’t require them. Wouldn’t that be utopia to not require them because we’re all living well?” she said.
One way the PHN are trialling delivery of services aligned with better prevention is through a pilot called the Glen Innes Health Hub. It aims to integrate digital solutions with a hub of doctors, nurses and allied health professionals.
The goal is for patients to navigate healthcare more effectively and also learn to be more proactive with their health.
“We have a point of difference where we really want community buy in and ownership of this health hub so we’re looking at different governance models to make it a sustainable thing for the community,” Dr Koschel said.
Rural Fit, an allied health organisation dedicated to improving the health outcomes of rural communities, was announced this week as the operator for the Glen Innes Health Hub.
“We are committed to improving lives in Glen Innes. We understand the challenges faced by General Practitioners and Allied Health Professionals in regional and rural areas,” Andrew Mahony, Managing Director of Rural Fit, said.
“As the operator of a Glen Innes Health Hub, we will bring together a multidisciplinary team to provide comprehensive care and support to the local community.”
Dr Draney told NE Times that the NEDGP supports the Glen Innes Health hub as an innovative way to deliver primary care to Glen Innes.
“We hope that initiatives like this will attract GPs and other health care workers to our region,” she said.
Being more innovative and finding new models of blended care are key to improving healthcare in the region, Dr Martin believes.
“In towns where it used to be predominantly specialists, it’s going to need to move to having some good rural generalists that are supported by specialists. Either resident specialists that live in town or come in and visit. That to me is one of the key models for the future,” he said.
There aren’t any silver bullets. But experts are hopeful with increased government funding and the innovative ideas being proposed, healthcare access will improve.
“I think what we have to do is try a lot of different strategies… We have to be hopeful about the future,” Dr Draney concluded.
This article is part of a series on Health Care in Crisis. See our other stories on this topic here.
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