‘Perilous state’: Dozens of areas across NSW at risk of critical GP shortages

Dozens of towns across the state are at risk of not having a single GP available in coming years as experts warn the exodus of hundreds of doctors from the workforce has left the system in a “perilous state”.

The Herald can reveal the locations of 60 towns and regions across NSW identified by authorities as being at risk of critical doctor shortages, including larger population centres such as Cessnock, Singleton, Moree and Gunnedah.

Suburbs on the outskirts of Sydney, including Katoomba and Blackheath in the Blue Mountains and Kurrajong in the Hawkesbury, are also in danger following an “unprecedented decline in workforce supply”.

“The reality is there isn’t a town in rural NSW that isn’t at risk of being able to sustain viable primary care right now,” said Richard Colbran, the chief executive of the NSW Rural Doctors Network.

“For every general practitioner that leaves the workforce there will need to be three to replace them to keep up with demand. After COVID-19, floods and bushfires, GPs have never felt a time when the system is in such a perilous state. They are exhausted.”

The recent NSW parliamentary inquiry into regional health heard evidence of an exodus of GPs from regional and rural areas, which is set to worsen as more than half of GPs in small towns retire within a decade and younger doctors do not step forward to replace them.

The malaise has been blamed on financial pressures on rural general practices jeopardising their sustainability, increasing specialisation of the medical workforce and generational change as thinning ranks of rural GPs struggle with increasing workload pressure, repelling young doctors seeking work-life balance.

The federal government is responsible for supporting and monitoring the quality, effectiveness and efficiency of primary health care services.

The Office of the National Rural Health Commissioner told the inquiry that the GP workforce has become concentrated in Australia’s urban centres.

“While Australia has one of the highest ratios of doctors per head of population in the world, this workforce is not distributed proportionately across the country,” it said in its submission.

The Royal Australian College of GPs also stressed the need to attract GPs working in urban centres to the bush, as well as providing additional support to those already based regionally.

Data provided by the Hunter New England and Central Coast public health network show Barraba, Wee Waa, Moree, Gunnedah, Glen Innes, Cessnock, Murrurundi/Scone, Denman/Merriwa, Muswellbrook and Singleton are at risk of current or impending shortages. The network said Maitland and the Central Coast are also “under pressure”.

Colbran described general practices as businesses that were “fundamentally critical” to regional and remote towns.

“The NSW rural health inquiry has clearly shown that the way we operate now needs to be changed. We need to be brave and show courage.”

At least 600 rural general practitioner proceduralists - who also work as doctors at local hospitals - have left their positions in the past 10 years, Colbran said. There are now fewer than 200 GP proceduralists working in rural NSW, with authorities concerned this number could dwindle to fewer than 100 within the decade.

Western NSW Primary Health Network confirmed there are at least 45 towns across the region at risk of being without a general practice within the next 10 years.

“Without intervention there will be no GPs that are willing to take the place of those that leave, and people will have limited access to essential primary care services,” a spokesperson for Western primary health network said. “Hospital admissions will increase as will the burden on the health system more broadly.”

Parts of the Blue Mountains and Hawksbury are also at risk, including Blackheath, Katoomba Kurrajong, Glossodia and Colo.

The head of the Nepean Blue Mountains primary health network, Lizz Reay, said in parts of outer metro Sydney there are two-week waits to see a doctor. Further inland, that wait can triple as some general practices close their books to new patients entirely.

“The Upper Blue Mountains has faced an unprecedented decline of workforce supply with one practice losing 10 GPs due to retirement or relocated out of the region,” Reay said.

Dubbo GP Ai-Vee Chua said three of the 12 general practices in Dubbo had closed recently.

Dr Ai-Vee Chua said three of the 12 general practices in Dubbo had closed recently.Credit: Jayde Lee

“I’ve worked in rural NSW for more than 20 years and the shortages we are seeing now are the worst they’ve ever been, especially with the increasing population.”

Dr Chua said patients were being forced to go to emergency departments because “they have no other option”.

She said there were concerns the recent announcement to recruit more than 10,000 nurses, doctors and other staff to the state’s hospitals and health services could drain supply of general practitioners from areas that were already struggling.

Dr Kerrie Stewart from Parkes told the parliamentary inquiry the town of 11,400 was experiencing a huge GP shortage and there came a time when scarcity of resources create an unsafe environment for both patients and clinicians.

“I believe we are on the precipice of this scenario in Parkes,” she said.

Numbers of general practices had remained relatively stable across the South Eastern NSW and North Coast regions, while numbers in the Murrumbidgee region had increased marginally, according to the Primary Health Networks.

Head of south-eastern NSW Primary Health Network Dianne Kitcher said while there were no areas at immediate risk there are concerns about many smaller towns and an ageing GP workforce with few options to incentivise doctors to those areas.

In response to questions, the Minister for Health Mark Butler issued a statement, saying the government “will take action to increase the number of doctors in communities that are desperate for more GPs.”

He said Labor had “committed to $146 million in initiatives to deliver more doctors in rural and regional Australia”.

Butler said the previous government “repeatedly cut and undermined Medicare, including cutting rural and regional bulk billing incentives, and in 2019 Scott Morrison cut access of outer-metro and regional Australia to bonded and overseas trained doctors, making GP shortages much worse.”

He said the government would make it easier for regions and outer suburbs to recruit overseas trained doctors and students in programs that would require them to work in regional areas upon graduation.

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