Bogan Shire’s only GP clinic would be the perfect rural clinic success story, if it wasn’t for the One Big Problem.
A local council in central western New South Wales that is spending up to 20% of the money it raises from property rates on keeping its general practice operating is calling on the federal government to deliver block funding for rural practices.
The Bogan Shire Medical Centre – located just a stone’s throw from the Nyngan ‘Big Bogan’ – is a relatively large, modern practice.
Opened in 2017, it boasts two locum GPs at any one time, as well as registered nurses, an Aboriginal health practitioner, a physiotherapist, a podiatrist, pathology services and even a sonographer.
The practice is entirely owned by the council, a fact which Bogan Shire Council general manager Derek Francis said has kept it accountable to the local community.
“Our sonographer, podiatrist, physio and allied health worker are all local people who probably would have had to move away if they wanted to practice in their chosen field,” Mr Francis told The Medical Republic.
The council has been managing general practice since 2015, when the region’s two former GPs flagged that they would be entering retirement.
Nyngan, the shire’s main town, is roughly two hours’ drive from Dubbo.
“Health is one of the first things people ask about when thinking about relocating,” Mr Francis said.
“We have an active copper mine in the area that employs about 600 people.
“As a shire, we … want to grow our population.
“We want Nyngan to be an attractive destination and having a GP clinic is a part of that whole puzzle.”
In many respects, Mr Francis said, the council-owned GP clinic was a “wonderful success story for [this] little remote community”.
“Everything runs really, really well,” he said.
“The twist in the tail is the financial side of things.
“Purely and simply, we can’t make ends meet with our Medicare billings, even with the increased billings that we’ve had and are expecting [from November].
“As a council, it means that our community has to put $500,000 or $600,000 a year into subsidising the medical centre.”
There are several factors that make raising gap payments difficult.
Bogan Shire has a higher Aboriginal and Torres Strait Islander population and a lower average income than the rest of the country.
Around 60% of the clinic’s patients are Commonwealth concession card holders or pensioners and are bulk billed.
The council has identified GPs as the largest cost to the clinic.
Having now relied on locums for several years, the cost of securing two full-time GPs (including travel and accommodation) is about $1.2 million per year.
“The sticking point is GPs, and we all know the difficulties in attracting and retaining GPs in remote areas,” Mr Francis said.
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“We’ve been reliant on locums for a couple of years now, which obviously adds to the cost.”
If the medical centre continues to run at the same cost, Mr Francis said the community would need to forego new road works, infrastructure maintenance and the construction of new public facilities.
“My own personal view is that the government needs to have a look at MM5-7 [areas] and say, ‘well, clinics in those remote and very remote areas … get block grant funding to help them along the way,’” Mr Francis said.
“I mean, if we got half a million dollars from the federal government as a block grant every year, we would be able to relieve that pressure on our community, who would continue to have – even if I say so myself – a very, very good quality service.”
This is a model of funding that has been pushed for years by groups like the National Rural Health Alliance.
The NHRA is making a renewed call for block funding to go toward supporting rural communities to build and maintain their own health services in a manner similar to the Aboriginal Community Controlled Health Organisation sector, following revelations that the funding gap between rural and metropolitan Australia is rising.
“Increased billings aren’t really a solution, and we’ve had a couple of financial reviews from experts in the area,” Mr Francis said.
“We are raising as much revenue, in accounting terms, as we could.
“Really, the pressure is on the expenditure side of the business, in financial terms, and in the absence of increased funding from government I really just can’t see a solution.
“But as I started saying, aside from that, it’s a great success story.”
