Why is our general practitioner system broken, and how do we fix it?

Rural communities in the South East continue to face GP shortages, and the closure of many small-town medical clinics because of our failure to attract and retain specialist doctors is putting rural patients at risk.

With the Limestone Coast having a catchment population of about 60,000, many stakeholders say the closures are putting enormous pressure on services in populated centres, with practices facing increased demands.

Newly elected Australian Medical Association (AMA) SA president John Williams says the rural GP crisis is fuelled by a lack of recognition in governments and the health system that GPs are the backbone of a solid health system.

The [Naracoorte Community] News caught up with Dr Williams, asking him what was needed to fix this problem and what his plans were.

The [Naracoorte Community] News: Major South East towns like Naracoorte, Robe, Millicent, Penola, and Bordertown continue to face doctor shortages. Why?

Dr Williams: There are many factors. The main ones are that Medicare funding for GPs remains extremely low, the very small rural incentive payments for general practice, and poor support from Local Health Networks (LHNs) for GPs, including poor communication from LHNs to GPs. On a broader scale, there is a lack of recognition in governments and the health system that GPs are the backbone of a solid health system.

The [Naracoorte Community] News: Why is it difficult to attract specialist rural doctors or trainee GPs to our country towns?

Dr Williams: We want junior doctors to choose general practice or rural general practice because it’s a fantastic and rewarding career. But we don’t have enough GPs in Australia now, and especially rural GPs, because of poor Medicare funding from the federal government, insufficient rural incentive payments from the federal government, and the lack of a supportive and cooperative approach from the LHNs towards GP trainees.

The [Naracoorte Community] News: What are current state government initiatives to help train and retain specialist rural GPs?

Dr Williams: The Single Employer Model supports trainee doctors moving from the hospital system into GP training. Traditionally, and still the case in most places, it has been a disincentive for young doctors to move into general practice. The single-employer model would help level the playing field.

This needs to be supported by funding to assist the junior doctor with support and training and to adequately fund and pay their supervisors.

The [Naracoorte Community] News: Do you think these initiatives are working in our quest to attract and retain doctors?

Dr Williams: The Single Employer Model has been implemented in the Riverland and is helping the situation there. AMA (SA) is advocating strongly for it to be rolled out into different areas, and we’re talking to the government about how that can and should happen.

The [Naracoorte Community] News: In your opinion, what do you think is the solution to the doctor crisis we are facing?

Dr Williams: Better Medicare funding from the federal government is the key. Junior doctors look at the pros and cons of going into general practice in a rural area and the hours worked, and they question why they would do that when there are other options for a rewarding career. It’s not all about money, but in some cases, it’s about whether you can actually operate a practice that is financially viable.

The [Naracoorte Community] News: The SA Government is paying locums up to $3000 a day, which is 10 times more than its offer to local GPs. Will the government sign viable contracts for local doctors so they can help train a new generation of specialist rural GPs?

Dr Williams: It’s better for everyone if LHNs fund rural doctors who will live and work in communities and offer patients consistent care. It’s better for health, and it’s better economically.

The contract implemented two years ago for rural GPs that was negotiated by AMA (SA) and the Rural Doctors’ Association of South Australia improved payments for rural GPs in hospitals by more than 20 percent on average across the state. We are negotiating the next contract early next year to support the single employer model, fund teaching and training, and increase pay rates according to CPI.

The [Naracoorte Community] News: Do you think private health insurance needs to be reviewed to make healthcare more accessible and affordable?

Dr Williams: Yes, the private health care system needs reform, and the federal AMA is lobbying for a national private health care regulator to protect patients’ interests.

The [Naracoorte Community] News: What is AMA (SA) doing to ensure these challenges are spotlighted and brought to the government’s attention?

Dr Williams: AMA (SA) works tirelessly to address the current issues affecting health but also to look ahead and work towards a health system that is fit for the future. We have different forums to discuss or raise the challenges of delivering health on the ground. We take those issues where they will be best dealt with – it may be to the South Australian Health Minister, the Federal Health Minister, the Chief Medical Officer, or LHNs, or it may be something to discuss directly with other bodies such as the Medical Board of Australia or ReturnToWorkSA. Part of that work is formulating a strong argument by talking to peak medical bodies and experts. Data is gathered to support our suggestions. Key partnerships are formed to help deliver to the government a strong and unified voice, such as with the medical colleges or the law society. The AMA has a unique position in that it can speak for all doctors across specialties. The AMA is known by politicians and journalists to be an ethical and powerful voice that can be trusted. As AMA (SA) president, I can confidently state that when it comes to delivering quality health care to their patients, South Australia’s doctors are united.

The AMA (SA) acts as a voice on health matters for doctors, trainee doctors and the community in South Australia.

It brings doctors together to work towards better health outcomes for the community and promotes ethics, standards, and wellbeing in the medical profession and advocates for its members in reviewing new policy, legislation, regulations and guidelines and monitors performance in the state’s health system and challenges governments where necessary to improve outcomes for patients, doctors, and trainees.

It also focuses on the health policy debate with informed, expert medical commentary on health issues.

This article appeared in the Naracoorte Community News.