Doctors call for 'fairer' reform package to help address rural crisis

REFORM: Rural Doctors Association of South Australia president Dr Peter Rischbieth is calling for a reform package for rural GP visiting medical officers to be finalised or risk the further loss of healthcare services in rural South Australia. Photo: File
REFORM: Rural Doctors Association of South Australia president Dr Peter Rischbieth is calling for a reform package for rural GP visiting medical officers to be finalised or risk the further loss of healthcare services in rural South Australia. Photo: File

South Australia's leading doctors' group is urging SA Health to provide a 'fairer' reform package for rural GP visiting medical officers (VMO) or risk the further loss of healthcare services in rural South Australia, as negotiations continue.

A member forum held by the Rural Doctors Association of South Australia (RDASA) last weekend raised significant concerns held by rural doctors relating to medical workforce shortages across rural parts of the state.

A survey of the state's rural doctors showed a critical shortage of doctors is threatening the future of hospital and GP services in rural South Australia.

The survey indicated that:

  • 77 per cent of respondents say the number of doctors is near or already below critical mass in their areas
  • 55 per cent say there is tension between the available doctor workforce and the health services needed in their local community
  • 79 per cent say there are long-term vacancies for doctors in their community, or that they are experiencing difficulties in recruiting doctors
  • 49 per cent say access to locum relief for doctors in their community is either unreliable, not available or not clinically suitable
  • 59 per cent say they have been asked to help out colleagues in other locations or provide backfill, showing the SA rural doctor workforce is under significant pressure.

The Australian Medical Association of SA (AMA(SA)) and RDASA have been engaging with the state government to develop a long-term reform package to better support rural GP VMOs, but were disappointed with a response from SA Health to the reform offer provided in March.

"AMA(SA) and RDASA subsequently were looking forward to receiving and discussing a more acceptable offer from SA Health at a meeting last Thursday, but unfortunately SA Health cancelled the meeting," RDASA president Dr Peter Rischbieth of Murray Bridge said.

"We are hopeful that SA Health will move quickly to organise a new meeting, as we need to move forward on the reform package as soon as possible.

"Rural GP VMOs not only provide general practice services in their communities, but also provide crucial services at their local hospitals, including accident and emergency care, critical inpatient, surgical and post-operative care, and obstetrics support."

Dr Rischbieth said much of this work included being on-call for significant periods, and being called to the hospital at any time of the day or night.

In the Eyre Peninsula town of Kimba, the Kimba District Council is applying for a grant through the Rural Health Workforce Strategy Steering Committee to provide financial incentive to draw GP's to the region, while also contributing $200,000 for the upgrade of the council-owned medical clinic.

The town has had long-term issues in trying to secure a permanent GP.

Meanwhile, in July, the three current associate doctors of the Kangaroo Island Medical Clinic took the extraordinary step of publishing a half page letter in The Islander newspaper calling for action to address the rural health crisis.

"It has become clear that the medical workforce across rural and remote Australia is in crisis, and Kangaroo Island is no different; the situation here is only part of a wider problem," the letter reads.

"It is becoming harder and harder to recruit doctors to rural areas like ours and we must be realistic: it is only going to get harder."

Dr Rischbieth said the reform package was developed to "better support South Australia's rural GP VMOs and rebuild the rural doctor workforce in the state", but called SA Health's initial response "unacceptable and woefully inadequate".

He said they welcomed the opportunity to speak briefly to Minister Stephen Wade about their concerns at the conference in Adelaide.

"At the moment, however, SA's country doctors are being left out on a limb by SA Health - and that limb is close to snapping," Dr Rischbieth said.

LETTER: The letter which appeared in 'The Islander' in July. Photo: The Islander

LETTER: The letter which appeared in 'The Islander' in July. Photo: The Islander

The SA Rural Medical Fee Agreement (SARMFA) specifies terms and conditions for contracted GPs delivering services in South Australia's rural public hospitals and provides the framework for individual contracts between regional local health networks (LHN) and GPs/GP clinics.

The Rural Support Service (RSS) has been coordinating negotiations with the associations on behalf of the state's six regional LHNs.

SA Health's Rural Support Service chief clinical advisor Dr Hendrika Meyer said the LHNs were eager to see a successful resolution of the negotiations to ensure that high-quality medical services could continue to be provided in rural hospitals.

She said a proposal for the SARMFA presented in March was "unrealistic based on the regional LHN budgets".

"Since then the RSS has been developing an offer to put to the associations that is reasonable for the regional LHNs while also providing appropriate recognition, remuneration and support for contracted GPs," she said.

An offer, which included a range of benefits for contracted GPs, was presented in July and contained details of two payment models to be offered based on each regional LHN's service delivery requirements.

A revised SARMFA offer was sent to the associations on Wednesday, which includes:

  • A new sign-on payment of $2000 for all GPs currently engaged under the 2017 SARMFA who accept a new contract within three months of it being offered.
  • The offsite sessional rate has been increased to $2000 for 24 hours (an increase of more than 9 per cent on the 2017 rate).
  • The new onsite sessional rate ranges from $190/hour to $220/hour.
  • The on-call allowance under the FFS payment model is $440 from Monday to Thursday (an increase of 34 per cent for small hospitals and 40 per cent for large hospitals compared to 2017) and $880 on weekends and public holidays (an increase of 17 per cent for small hospitals and 25 per cent for large hospitals compared to 2017).
  • There are new provisions enabling contracted GPs to claim $200/hour to undertake mandatory training required by the regional LHN, and $190/hour for attending regional LHN initiated meetings.All time spent in preparation, attendance and follow up work is claimable.

"We hope that contracted GPs accept the offer as fair and capable of providing a robust and sustainable GP-led health service in our rural hospitals," Dr Meyer said.

AMA(SA) vice president, and Port Lincoln general practitioner, Dr John Williams said more doctors were needed in rural communities.

"It is way past time for SA Health to put forward a support package that is fair, recognises the enormous commitment that SA's rural doctors make, and is competitive with those being offered in other states," he said.

Shadow Health Minister Chris Picton said the state government was "ignoring desperate pleas for help" from country doctors in cancelling its meeting last week.

"The Liberals were elected promising they would improve regional health, but instead they are ignoring the growing pleas for help from our state's regional medical professionals," he said.