Inequitable treatment of rural patients in Victorian hospitals was a hot topic at the recent Victorian Rural Health Conference (VRHC) in Wodonga.

Doctors from across Victoria put the pivotal issue of conversion of rural Emergency Departments (EDs) to Urgent Care Facilities front and centre at the conference.

President of the Rural Doctors Association of Victoria (RDAV), Dr Louise Manning, said that Victorian doctors remain outraged at these unfair arrangement for rural patients.

“In a nutshell, if you have an emergency in rural Victoria you have to pay for your own care,” she said.

“If it happens in the city then it is covered by the state.

“Worse, not only are metro EDs fully funded, they are also fully staffed but if you are in a rural town and have to go to your rebranded ‘Urgent Care Facility’, after you pay, you may or may not have access to nursing staff or investigations such as blood testing or imaging.

“While in some cases patients are bulk billed (which is still a patient fee, just paid for by the Commonwealth) in others facilities patients are required to pay substantial out-of-pocket fees.

“Not only does this seem to be a violation of the National Health Reform Agreement (NHRA) but also of the social contract between the state and its people.

“That this glaring disparity between how rural and metro patients has occurred at all, let alone for a number of years now, is simply outrageous.”

“While some of these facilities have an arrangement where ambulances don’t deliver patients needing lifesaving care to them, for the community they are indistinguishable from a regular ED,” Dr Manning said.

“While these renamed EDs are located in the same place they always were – the hospital – and remain using hospital facilities, equipment, staff and consumables, they are no longer staffed as part of the hospital’s standard operations.

“So when patients present to the Urgent Care Facility the doctor on-call is often forced to attempt to pull nurses to help provide care from other areas of the hospital, taking them away from the wards where they are also needed.

“This calls into question the safety of this model for patients, doctors and nurses, both in the chronically under-staffed Urgent Care Facilities, but also across the entire hospital.

“If you have someone at home experiencing, say, cardiac symptoms, you will simply drive them to the ED and reasonably, expect life-saving care. That this is not a funded ED but rather an Urgent Care Facility, with skeleton staffing would be completely unknown to you.

“There are also industrial issues that are currently being ignored by the Victorian government,” Dr Manning added.

“The doctors staffing these facilities are credentialed to provide emergency life-saving care and there is an expectation that they can provide that care when a patient presents but they are not provided the right support because they are, technically, not working in an emergency department.

“This puts the patient, and the doctor at risk.

“More technically, in some services the doctors receive the bulk billing rebate from the Commonwealth and then also a fee from the hospital for providing the care, which is in direct violation of the NHRA.”

Doctors attending the conference were also unanimous in their position that the solution was not Victorian Virtual Emergency Departments (VVED).

“A virtual emergency department for rural hospitals is not an acceptable alternative to in-person medical care,” Dr Manning said, “and should only ever be supplementary to support rural doctors.

“The VVED also needs some enhancements so that they are not creating issues for small rural health services. For example it is not helpful to send a patient to a hospital for an x-ray after 5pm, if there is not radiography on-call rostered.

“With the Federal election now settled, the states will be coming back to renegotiate the next NHRA.

“There were recommendations around these issues from the Mid- Term Review and, with the next meeting scheduled to deal with hospital funding, Victoria, South Australia and Tasmania are in the firing line to find a solution to this issue.”

We need the Victorian government to accept that what we have now is not a fair, safe or viable model of emergency care for rural Victorians, and come to the NHRA table ready to make some changes.” 

This article appeared in the Corryong Courier, 29 May 2025.