Rural generalism is ‘dying’ and small hospitals will pay price

4 minute read

The last day of testimony in Wagga saw some hard truths aired by Murrumbidgee LHD executives.

Nursing workforce challenges in rural and regional NSW are exacerbating the fragility of smaller hospitals trying to bridge gaps in access to primary care services, according to Murrumbidgee LHD chief executive Jill Ludford.

Testifying before the NSW Inquiry into healthcare funding, Ms Ludford said the growing lack of acute care nurses, along with workforce challenges in primary care, particularly rural generalism, put increasing pressure on smaller, rural hospitals.

“We’ve heard a lot about the fragility of the primary care sector over the last week, but I’m not sure that we also touched on the fragility of some of our small hospitals as well, and the main reason why they are equally as fragile is because of workforce issues,” Ms Ludford said.

“While we’ve seen and heard about the declining numbers of GPs, particularly those choosing to work in rural areas, if we extrapolate the same for nurses, my thinking is that it is going to get harder and harder for us to attract nurses who want to work in small rural hospitals, because having the skills to work in an emergency department and all the other things that we’ve heard about is very challenging.

“If we’re not training nurses to be those generalists, then we’ve got a fragile system on both sides.

“If we take primary care presentations, in [MHLD] we’ve had an 18% increase in triage 4 and 5 presentations in those small hospitals [compared to] two years ago.

“That’s an alarming rate of primary care coming into our EDs and it’s episodic [care], it’s treating the symptoms that they’re presenting with [but] not doing anything around the chronic disease management or whatever they presented with.”

According to Dr Alam Yoosuff, MPHN board director, MLHD director of primary care and a Finley-based GP, severe gaps in the rural primary care workforce, particularly GPs and rural generalists, created “significant financial burden” for rural and regional LHDs required to spend considerably more money on providing primary care services to bridge the gaps.

“Hospital systems and LHDs are not good at providing primary care. They’re meant [to provide] acute care, but when there’s service failure, they pop up and patch up things to fill the gap. But if you look at data, it will be very evident that hospitals providing primary care is going to be very expensive model.

“If I’m a GP seeing patients in my practice, I see about 25 to 30 people, that’s my routine. If I’m a GP working on a sessional contract in a hospital, I can’t see more than 12 to 15 at a time, because that’s the process. So you can see the gap, and that gap will amount to a significant cost.

“[Across] NSW health facilities such as in Murrumbidgee, we’re already providing primary health care services in the name of ED care, or hospital care in smaller towns, non-base hospital towns.

“Certain places have no other alternative other than providing primary care, through the acute care settings, in places where there is a certain market failure, because there’s no option, it becomes the last resort.”

Acute care services across NSW rural and regional hospitals were also hindered by recent trends across the GP workforce, Dr Yoosuff said, with declining numbers of rural generalist and proceduralists severely limiting the quality and availability of services across smaller rural hospitals.

“Rural generalism is dying. At the moment we’re seeing less and less people wanting to do that because of the demands that we have,” Dr Yoosuff said.

“There are towns, there are towns in our region where you have 14 GPs in town, but none of them want to come and work in us in the small integration hospital in the town. That makes it significantly harder for us to provide better care.

“I don’t think I’d want my appendix taken out in smaller hospital where there are no operating theatres or standards maintained to the level of what Wagga would be.

“If I don’t want it, then I don’t want my patients to have it too. It’s as simple as that.”

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