Premier demands more support for GPs, as 1.5 million visit NSW emergency departments for non-urgent issues

More than 1.5 million people are presenting to NSW emergency departments each year with non-urgent problems such as migraines, sprained ankles and minor aches and pains, sparking renewed demands from state governments for better and cheaper access to GPs.

In an escalation of his call for national health system reform, which is being backed by the Victorian Labor government, NSW Premier Dominic Perrottet said there was no doubt that declining bulk-billing rates and an increasing lack of access to GPs was adding significant pressure to the state’s hospitals.

In an escalation of his call for national health system reform, NSW Premier Dominic Perrottet said there was no doubt that declining bulk-billing rates and an increasing lack of access to GPs was adding significant pressure to the state’s hospitals.Credit:

“We now need the federal government to come to the table and provide more support for GPs, as well as greater access to bulk-billing services, so that our hospitals can focus on treating the sickest patients,” Perrottet said.

Health experts supported the premier’s call for better funded GP services amid the dire state of emergency departments. However, they also said the state government had a responsibility to fix a staffing crisis in its own hospitals.

NSW emergency departments have recorded increasing presentations in the most urgent categories for more than a decade, with the number of people with potentially life-threatening conditions surging since 2012.

NSW Health emergency department data from the latest financial year shows the number of triage 2 patients has more than doubled (from 201,730 in 2011-12, to 417,960 in 2021-22) while triage 1 patients grew in number from 12,722 to 20,851.

The increase in high-need presentations means the portion of patients presenting with lower level problems has dropped over time – from making up 59 per cent of visits in 2011-12, to 51 per cent in 2021-22. However, the raw numbers are greater as the overall number of annual emergency department presentations soared by about 1 million visits.

In the latest financial year, 1.1 million people showed up at emergency departments with triage 4 issues such as a foreign body in the eye, sprained ankle, migraine or earache. This represented 37 per cent of all visits and compared with 938,510 presentations in that category 10 years ago.

A further 403,300 triage 5 patients showed up with minor illnesses or symptoms that may have been present for more than a week – such as rashes or minor aches and pains – compared with 319,825 visits 10 years ago.

“This is not just an isolated issue in NSW,” Perrottet said. “We know that other states are facing similar pressures, which is why we are also working in partnership with Victoria to expand urgent care services across both states to help take pressure off our emergency departments.”

The states are opening dozens of their own urgent care centres to deal with the problem while also pushing the federal government for increased hospital funding and higher Medicare rebates to increase access to bulk-billing GPs.

But health experts are also warning that hospital staffing – a responsibility of the state government – remains a crucial part of the problem.

Australian Medical Association NSW president Dr Michael Bonning said there was a constant battle between the state and federal governments that risked descending into finger-pointing.

He agreed there had been a sharp rise in triage 2 patients with urgent needs, due to an ageing population, and that Medicare rebates had not kept pace with the cost of GP services. He also agreed that many triage 4 and 5 patients did not require hospital care and were better served in the community.

However, Bonning said that in about a third of cases those non-urgent presentations were happening out-of-hours, when GPs were not available.

”As much as [the premier] might say this is about general practice, this is also about state government funding to deal with the case mix they have – increasing severity and number of presentations in an ageing population,” he said. “Fundamentally, the state health system may have funded significant capital works but [it] has not staffed them.

“We agree there’s more to be done [in general practice]. There is, however, also more to be done in the hospital system. The answer is somewhere in the middle.”

Australasian College for Emergency Medicine president Dr Clare Skinner said emergency departments were under increasing strain, with demand for emergency care across the country rising 14 per cent in five years despite population growth of just 5 per cent. Available hospital beds had also decreased by 4 per cent.

“If you need to be admitted to hospital, you are more likely than ever before to get stuck waiting for hours, or days, in [emergency departments] due to a lack of hospital beds, or a lack of appropriate, accessible, community-based care,” she said.

“Access to affordable, accessible, integrated primary and community-based care over time can keep people healthy so that they do not become so unwell that they present to the ED.”

Skinner welcomed any government policies to improve access to GPs and primary care. However, she said there would always be an overlap between primary care and emergency departments, and that the pressures on emergency departments were “multifactorial”.

“Healthcare workforce shortages are one of the biggest issues facing emergency departments ... Most EDs are consistently understaffed. There are marked deficits in nursing, especially senior nursing,” she said.

A spokesperson from Perrottet’s office said the state government had allocated $4.5 billion in its latest budget to recruit 10,000 new health workers over the next four years.

Health Minister Mark Butler said the federal government’s “strengthening Medicare taskforce” was identifying the best ways to boost affordability and improve access through a $750 million fund.

“The former government froze the Medicare rebate for six years, ripping billions of dollars out of primary care and causing gap fees to skyrocket. The Albanese government is committed to investing in general practice and strengthening Medicare,” he said.

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