STRUCTURAL challenges in the general practice sector have made addressing the region’s GP crisis an incredibly complex task.
A cursory glance at GP data reveals that the number of doctors in Sunraysia’s two primary health networks is the highest it’s been in more than half a decade.
The latest figures suggest the Murray Primary Health Network has 1284 practicing GPs and the Western NSW Primary Health Network has 826 practising GPs.
But the statistics alone don’t tell the full story.
Raw data of this nature can be misleading, as it doesn’t break down who is a full-time-equivalent doctor, who is working part time or how many of those GPs are doctors in training.
Nor does the headcount reveal how many GPs are close to retirement, or includes all GPs who have provided at least one service within the given areas based on the provided practice location.
Staffing across Primary Health Networks can also vary greatly as they cover vast swathes of land.
The Murray PHN sounds relatively local, but in fact covers the entirety of northern Victoria and parts of southern NSW, stretching from Mildura to Corryong, including the likes of Bendigo, Shepparton and both Albury and Wodonga, encompassing about 660,000 people.
The Western NSW PHN is even bigger geographically, taking in not only Wentworth and Euston but Broken Hill, Bourke, Forbes, Coonabarabran and Orange, and has a population of about 309,000.
When tracking GP numbers, there is no publicly available granular data about the number of GPs in any particular town or region, only anecdotal evidence of localised difficulties obtaining appointments, or increased appearances at emergency departments.
Murray PHN chief executive Matt Jones described Australia’s general practice system as being “at some level a failing model”, further hampered by the maldistribution of GPs to metropolitan areas compared to regional ones.
Mr Jones said difficulties in getting timely access to a GP in Sunraysia were due to three primary issues.
The first is an increasingly unviable bulk-billing model, coupled with the inability of the Medicare Benefits Scheme to cover the rising costs of delivering healthcare.
“We’ve got this perverse situation of many of our communities not being able to afford healthcare because of the out-of-pocket costs … whilst, perversely, the cost for the practice in providing that care is becoming unsustainable,” Mr Jones said.
“The only way (providers) can make it sustainable is increasing the out-of-pocket costs, which makes it less accessible for people.”
The second issue is the changing health needs of the community due to advances in medicine, and an aging population.
“Our health needs have changed so that we need more health care earlier and for longer, yet our system of how we structure the provision of care hasn’t been renovated and reformed to respond to these changes,” Mr Jones said.
Thirdly, the culture of health care provision is changing, as GPs seek more work life balance and less anchoring to the idea of owning a private practice through to retirement.
“People are choosing to be employees as a GP rather than being the owner of the business,” Mr Jones said.
“That’s not attractive in terms of someone that’s seeking career mobility and financial stability.”
Sustainable recruitment and retention of GPs in regional areas to meet demand has proven to be problematic, particularly the further a region is from other locations.
A Western NSW PHN spokesperson said factors that made it difficult to train GP registrars in Far West NSW included a significant workload for supervisors, a reliance on locums, an aging or retiring workforce, demand elsewhere across the nation, misconceptions about the region’s lifestyle, and substantial incentives being offered by other state governments.
Towns like Mildura, Red Cliffs, Wentworth and Gol Gol are located within what is called a Modified Monash (MM) 3 region, and do qualify for incentives and Federal Government supports to attract GPs.
Those incentives increase significantly for more rural locations including Robinvale, Ouyen and Manangatang, which are classified as MM5 regions.
Despite the packages offered, Mr Jones said the incentives failed to address the core structural challenges that had led to GP maldistribution in Australia.
“There’s been historically a reliance on people that have been willing to move to small country areas and work as a GP,” he said.
“We’ve been increasing the efforts of trying to enable that to continue, but the models aren’t actually enabling that to be an attractive pathway anymore.
“It’s actually about developing different models and different approaches, not just trying to find GPs and plug them into what is at some level a failing model.”
