Rural GP shortage takes its toll on Murrumbidgee's small hospitals

In the Murrumbidgee Local Health District, 29 of the 33 hospitals rely on GPs. When there are no GPs, patients from these communities face long journeys to larger hospitals.

Jill Ludford, the chief executive of the Murrumbidgee Local Health District, says the problem is about workforce distribution.

"We have more Australian medical graduates coming into our system. We are training more doctors. The issue is that less and less each year of those new medical graduates choose to become general practitioners and even less, again, of those are interested in working in rural areas," she said.

"So we do know what we need to recruit and retain doctors in rural areas. And that actually is appropriate training and professional colleague support. And also a system that protects doctors from burnout. Those unsung heroes that were on call frequently for their hospital and found it hard to take annual leave.

"Our hospitals are made up of on call doctors who work in general practice because most of the hospitals are somewhere between 15 and 30 beds maximum in small hospitals.

"So to have a doctor there 24-7, there's actually not enough work to keep them going all day. So that's why we've got the blended model where they work some of the time in general practice and some of the time at the hospital. But I think that historical way of working has put a lot of pressure on the GPs who are now running backwards and forwards between their practice, which is busy, and the hospital. And we need to reorganise how we do that.

"Communities need to unite with us. We are going to have to do things differently, but I'm quite confident that if we rearrange how we can attract GPs and actually employ them part-time in hospitals so that they get that remuneration working in the hospital and then they can work part-time in a practice."

Ms Ludford said a secondary issue arose when GPs set up practices in small communities, but did not want to work at the local hospital.

"So if there's not enough GPs, we need to use technology to help us in the bush. It's not the whole answer, but it can be part of the answer," she said.

"So let's just imagine you've got some GPs who are dedicated in a town, but they want to have time off. We need to give them away to have time off. So we're setting up a virtual care centre where we'll put GPs who can treat and admit their patients to their local hospital, but we'll cohort them together in group so that they can then use telehealth to assess the patient.

"And that then gives us a model for when doctors need to have time off. It is not a whole solution, it's just part of the big picture. And so we have at the moment a remote medical service where we do that, but we don't have GPs working there. We've got specialist emergency department doctors."

Ms Ludford said the introduction of more nurse practitioners was also an option.

"Nurses who have got those advanced skills can order pathology tests, X-rays, they can diagnose low acuity things. They're not for emergency critical patients, but they can suture, they can talk to the local GPs, and the talk about if the patient needs admission," she said.

Jodie Godfrey, a delegate of the NSW Nurses and Midwives Association's Wagga Base Hospital branch, says her fellow members see daily how Wagga Base is affected, when smaller hospitals go to what is called Critical Operations Standard Operating Procedures (COSOP) to run when there is no doctor available.

"What's happening is we're hearing reports that the [Wagga] hospital is running at 110 per cent and sometimes 115 per cent capacity each day," Ms Godfrey said.

"It has an impact on the smaller community, it has an impact on ambulance and patient transport vehicles, it has an impact on our hospital because people are sick and are seeking medical attention and help and they can't be treated at their local hospital, so they have to transferred into Wagga Base."

Ms Godfrey said the shortage of rural GPs affects not nursing staff in smaller hospitals in a different way, by reducing the opportunities they have to flex their professional skills.

"What you're seeing - and I'm hearing from my fellow nursing colleagues - is that the little hospitals are struggling with their staffing. What happens is that over time, nurses lose their skills by not using them. That is very worrying and it is concern for the association," she said.

"It's about finding the right kind of doctor to live and be part of the rural community. You're better off to have a permanency with your GPs because when they're permanent they're part of the community and they have more ownership of the service."

Tumut-based John Larter, from the Australian Paramedics Association, warns his colleagues are spending long hours on the road to transfer patients from smaller doctor-less hospitals to larger facilities.

"It's only a matter of time before somebody has an accident at work, because of the fatiguing hours. It's only a matter of time, and how do you measure where there's been an adverse outcome?" he said.

"You've got paramedics in the back of ambulances that are tired, so you're not only driving around fatigued, but you're also treating patients fatigued. It's just so frustrating. You're not in a good mind space."

Mr Larter believes rural GPs are shouldering heavy workloads.

"There is some solutions, and the solutions are the first thing that they need to do, and I've said this for some time, they need to employ a specialist in the emergency area to basically triage what needs to go at night and what doesn't. Because after we've been on shift for 12 hours, the last thing we need to be doing is transferring someone with an abscess on their gum at two o'clock in the morning."