Chris Oldfield, Naracoorte Community News
The SA Government can spend up to 10 times more on each locum it employs in the Naracoorte Hospital than it pays a local GP for the same 24-hour shift.
Around the State it does the same, spending hundreds of thousands of taxpayers’ dollars on locums and fly in fly out doctors rather than finalising contracts which enable local GPs to work at their home town country hospitals.
Believing their goodwill has been betrayed, rural doctors last week pulled out of negotiations with the State Government’s health bureaucrats.
In addition to the enormous salary payments to locums, taxpayers or the Kincraig Medical Clinic (KMC), also fund their travel accommodation and agency fees.
Yet seldom do locums spend their time and money training registrars and the next generation of local rural doctors.
Nor do they play sport or contribute to the town socially or economically like local doctors and their families do.
Funded by taxpayers, more and more locums are being employed by the State Government to service country hospitals, as a domino effect from expired contracts roll on.
Contracts allow local doctors to work in hospitals with the Government stating which skills they can and can’t use as well as remuneration.
Without “fair and reasonable” contracts, medical clinics throughout country SA are finding it even harder to attract and retain rural doctors.
After three months of the Government and its health bureaucracy failing to offer workable contracts, two organisations representing rural doctors last March developed a possible solution.
The Australian Medical Association SA (AMA SA) and the Rural Doctors Association SA (RDASA) sought an agreement which they believe reflected “the high workload that rural GPs experience and the regular out-of-hours care they provide their patients and communities through regional hospitals, in addition to their general practice commitments”.
It included a package of remuneration, conditions and “professional development support” which responded to the many circumstances confronting rural doctors.
But after delaying any response for three months, last week the health bureaucracy rejected that solution.
The AMA SA and RDASA have withdrawn from all negotiations with the State Government agencies – Rural Support Services (RSS) and Local Health Care Networks.
Once the Millicent hospital operated as a key training site for rural doctors, with around 500 babies a year born there – but now there are none.
Almost 200 babies a year are born at the Naracoorte Hospital and many fear the State Government will also abolish the facility’s obstetric services by stealth.
The KMC can use the skills and expertise of 15 rural doctors, but currently it only has eight fulltime GPs – four of whom are trainees.
Yet every day three doctors are required for 24-hour shifts to fill rosters for the Naracoorte Hospital – a general practitioner, an anaesthetist and an obstetrician.
But when they are stretched to the limit, locums earning up to 10 times more, plus costs, fill the void – if they are available.
Or the emergency department is bypassed – without an accident and emergency (A&E) doctor.
For five days this month the Naracoorte Hospital is without an A&E doctor, including three days last weekend.
RDASA president Peter Rischbieth said many rural communities in the past 10 years had seen their emergency departments on bypass, their maternity units close and a mass exodus of highly skilled GPs from regional SA.
“Many practices are crying out for more GPs to support their primary care clinics and to also provide services at their local hospitals,” Dr Rischbieth said.
“We recommended to RSS a package that would reflect the care and expertise GPs provide and create an attractive environment for younger doctors looking to commit to regional South Australia, now and in the future.”
He said GPs had been working on a day-to-day basis at rural hospitals since their hospital contracts expired last November.
“But this response (from RSS) is a slap in the face for rural doctors and the communities they work for,” Dr Rischbieth said.
Dr Rischbieth said there had been a large decrease in the number of GP registrars (GPs in training) applying for rural placements, from 72 in 2021 to 26 for placements in 2022.
AMA(SA) vice-president John Williams said the RSS “knows there is a rural community health crisis across SA, yet continues to make it impossible to attract and retain GPs and GPs in training”.
“It seems the SA Government is willing to let South Australian towns wither and die as residents lose yet another essential service,” Dr Williams said.
Kincraig Medical Clinic’s Dr Brian Norcock is the SE GP representative who during the past five years has met with five other regional representatives, the RSS, and Health Minister Mr Wade, defining problems and putting forward solutions.
Dr Norcock is also on the working party with the AMA SA and RDASA which presented “a workable model that will ensure cost-effective sustainable rural generalist/GP healthcare going forward”.
“The fundamental principle remains the same as when KMC doctors were locked out of the hospital for four weeks in 2015,” he said.
“That is a contract that ensures the attraction and retention of skilled doctors so that rural communities can access timely healthcare without the need to travel and put further pressure up the line on our struggling health system.
“The solution is that the Marshall Liberal Government invest in the offer from the AMA/RDASA without further delay as this should have been resolved by (December 1, last year) on the expiration of the old contract.”
Rural Support Service (RSS) chief clinical adviser Henrika Meyer said she acknowledged the concerns raised by the AMASA and RDASA.
She said the RSS would “continue to work directly with them to address their concerns with the aim of finalising the new agreement to benefit rural GPs and the towns in which they provide such valuable services”.
The News sought comment from the Health Minister Mr Wade three times, but there was no response before the dead-line for press.
Naracoorte Area Health Advisory Council presiding member Barrie Moyle said he was unable to comment.
This article appeared in Naracoorte Community News, 21 July 2021.
