GPs 'at tipping point' meet with health body after inquiry hearing

An inquiry by the Legislative Council into health in rural, regional and remote parts of the state is holding hearings throughout this year.

The first regional sitting in Deniliquin was told of a lack of paediatric services, 120-hour weekly workloads by GPs at the brink of resigning and a "broken" VMO system.

Murrumbidgee Mayor Ruth McRae said "sometimes there is not an ambulance" at the four-person station in Jerilderie.

"There have been instances of ambulances having to come out of Albury-Wodonga to meet an ambulance between Jerilderie-Berrigan on the way to Albury because it is the only ambulance that is left in the area at the time," she told the council.

"So rather than leave the whole area without an ambulance, we have to wait for somebody to come and retrieve (the patient).

"Our local member (Justin Clancy) is aware of this issue and is advocating in that space for us."

Albury MP Justin Clancy said the issues put to the inquiry, including the one referenced by the Mayor, concerned him.

"In March, I met with paramedics in Albury to catch up on general issues," he said.

"Minimum operating levels formed part of those discussions. I have taken this broader discussion to the Minister, along with the Jerilderie-Berrigan incident.

"I have had a number of conversations with communities such as Culcairn regarding GP and VMO services.

"I am preparing to lodge with Parliament a petition signed by around 700 people from Culcairn.

"I am pleased to take this forward and appreciate the effort and concerns that have motivated this."

The inquiry heard from the Deniliquin Health Action Group chair Dr Marion Magee who said GPs were at a "tipping point".

"There are 11 of us in town ... five of us provide on-call services to the hospital, which means we are doing one in five 24 hours," she said.

"I do not work 12-hour days five days a week, I work 120 hours a week.

"I provide continual anaesthetic and obstetric cover. It is rare for me to get a full night's sleep.

"We are finding that the new doctors who are arriving in town are looking at our workload and just going, 'No way in hell. I'm not doing that. I'm not joining in'. So that is why there are 11 doctors in town and five are the only ones who are participating in the on-call roster."

Dr Magee gave a statement yesterday updating on issues raised in the April 29 hearing.

"The issue of recruiting more GPs to our town is on many agendas and lots of people are working very hard in this space," she said.

"The inquiry is highlighting workforce shortages across all of NSW.

"The issues raised at the inquiry included the particular difficulties our doctors face to be able to provide ongoing services to Murrumbidgee Local Health District (MLHD) in their respective VMO roles.

"Keeping the emergency department staffed through an on-call-roster system and managing patients admitted to the ward, as well as keeping GP practices running at optimal capacity, requires significant workload from our local doctors.

"The doctors are advocating for a model that can maximise care to our community in a sustainable and safe way."

Dr Magee said local GPs in Deniliquin met with MLHD following the hearing and discussed their concerns around being able to sustain current service delivery.

"This remains an ongoing negotiation and collaboration, to look at different models of care and employment, between all parties concerned," she said.

Dr Magee said the hospital maternity ward was fully staffed with a permanent Nurse Unit Manager and midwifes rostered on 24/7.

"Our doctors who do obstetrics continue to deliver and care for babies and their mothers following birth," she said.

"DHAG continues to work actively with a range of stakeholders to ensure the highest possible level of health services are provided."

This statement followed evidence given by Shirlee Burge, whose great grandfather was a founding member of the board of the initial Deniliquin Hospital.

Committee chair Greg Donnelly felt compelled to clarify further evidence by Ms Burge, that "a midwife thought it was unsafe to give birth at the hospital", to which Ms Burge replied: "Absolutely correct".

Murrumbidgee Local Health District chief executive Jill Ludford told the inquiry there was 24-hour midwifery cover at Deniliquin Hospital.

Across the Murrumbidgee Local Health District, there is a a GP to population ratio of 1 to 1350 residents and there are 297 visiting medical officers.

Medical services executive director Len Bruce said it was "of grave concern" when doctors worked long hours.

"Apart from the well-being of themselves and their families, we risk burnout," he said.

"If we look at the emergency department presentations at Deniliquin Hospital, 75 per cent of those presentations are low-acuity presentations-category four and five.

"Those are the types of presentations that can be managed very well by nurse practitioners.

"We have employed a nurse practitioner at Deniliquin Hospital and we are in the process of expanding their hours because we thought that was extremely valuable.

"In a large hospital there is an intern, a resident and a registrar. If you are a rural GP then you are the intern, resident, registrar, consultant and sometimes the specialist."

Mr Clancy said he was concerned the Inquiry report may run the risk of losing focus "on solutions with a fair chance of success in the real world".

"To seek improvement to our health system we first need to acknowledge the issues. The Upper House Inquiry plays an important role in this," he said.

"We need to do this in an environment where it is not so much who to blame, but how we can identify solutions."

Mr Clancy said expectations of health professionals have changed over time.

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"We cannot hope to fill positions based on the traditional model of the country doctor who was always available and who was not just the local GP but also the obstetrician, surgeon, counsellor and a dozen other roles which are often highly specialised and technical," he said.

"The VMO model is not so much broken as evolving, and that is in progress. Not just here either.

"I will continue to work with health professionals, the community and government to best represent the Albury electorate."