An action plan to solve the country GP crisis
Dr Paddy Glackin
AMA (WA) Rural Doctors Group Chair
- Rural Health West has more than 100 job vacancies for GPs in regional, rural and remote WA on its website.
- The PaRIS report on Australia stated that 18% of patients surveyed said they did not always seek healthcare due to difficulty travelling to their GP, and access was worse for patients outside metropolitan areas. Patients who could not access a GP were not surveyed.
- The Commonwealth Government’s urgent care clinics in WA are all in the Perth metropolitan area, except for one in Broome and one in Bunbury.
With more than 100 GP vacancies in rural WA, it’s time for all three levels of government to collaborate on fixing the problem.
The charter of patient rights published by the Australian Commission on Safety and Quality in Healthcare, part of the Commonwealth Department of Health, says all people have the right to access healthcare, and the right to access medical services and the treatment you need, regardless of where you live in Australia. However, some healthcare may not be available in all places, and you may need to travel or wait to receive the services.
That’s kind of reasonable as an overall statement. We don’t think anybody expects a coronary care unit at every crossroad, or that small country hospitals would have a neurosurgical unit.
But what about people who don’t really have any reasonable access to general practice? And I’m talking here about truly remote and rural areas, where there is an actual problem with access to any form of medical care in parts of Australia.
According to the OECD’s PaRIS international healthcare survey, published in July, a key area for quality improvement in Australia is access: 18% of respondents said they did not always seek healthcare due to difficulty travelling to their GP, and the report noted this barrier is worse for patients whose doctors are based outside the metropolitan area.
We know it’s a particular problem in states like WA because of the size, the distances and geography. And it’s not just the barriers of travel and cost that prevent people from getting the primary healthcare they need. Some people simply don’t have access to a GP.
“ What we need is a system in which working as a country doctor is a viable and attractive option for Australian medical graduates.
So whose job is it to do something about solving that problem?
The Commonwealth is investing hundreds of millions of dollars in rolling out urgent care clinics across the country, and one of the things the Government trumpets is that 80% of Australians will live within 20 minutes of a centre. However, if you look at the official online map, most of those clinics are in metropolitan areas or a major regional centre.
I would suggest that those “80% of Australians” probably already have a GP within 20 minutes of where they are, so what these clinics are doing is really providing more access to people who already have some access.
What about the 20% of people who don’t have access?
What about people who don’t have any doctor within 20 minutes, or even any doctor within an hour?
What’s the plan for them?
There doesn’t appear to be one.
What we are seeing, particularly in WA, is “GP deserts”, where people cannot access any form of primary healthcare, in breach of their stated human rights.
What we’ve got in all these small country towns is a market failure. The current market system hasn’t resulted in doctors going to work in those places. It has forced country shires to band together to spend millions on incentives to attract doctors to their towns; and even that doesn’t always work.
In reality, we’re not dealing with what is a crisis, so I think what we need is a joint responsibility framework where Commonwealth, State and local governments say, “Yes, this is our collective problem, and we’re each going to bring the bit we can to the table.”
For the Commonwealth, it’s funding structures that would support the workforce in these places where market failure has happened – and that would include funding that could be accessed by the State Government.
For the State, which has a huge workforce, it’s saying, “Yes, we have a workforce we can deploy; and if we can get funding to do it, then we’ll do it” – by employing doctors on permanent contracts and placing them into these “GP deserts”, similar to how the WA Country Health Service already provides such services in Carnarvon, Halls Creek and Fitzroy Crossing.
“ I suggest we need a pilot project where the three levels of government come together to get primary care into rural and remote communities.
For local government, it would be taking care of the things they can handle, such as providing housing, medical offices and vehicles, or facilitating the way in which the general practice services are delivered.
We already know there are many places where this is a problem. So I suggest we need a pilot project where the three levels of government come together to get primary care into rural and remote communities that currently don’t have it, to demonstrate that it actually can be done.
Through this joint responsibility framework, the Commonwealth and State governments across the country can put their collective hands up and acknowledge that they have a duty to ensure every Australian has reasonable access to a GP, and that they will work together in partnership with local communities to help ensure it really happens.
What we need is a system in which working as a country doctor – a tremendously professionally rewarding pathway – is a viable and attractive option for Australian medical graduates.
We can’t just depend on an unending stream of international medical graduates whom we force to go to the country, and who are simply counting down the days until they can move to the city. That’s not the way to run a sustainable health service.