First Nations healthcare access gaps laid bare

Systemic changes and increased government intervention from all levels is urgently needed to address worsening face-to-face healthcare access for Australians living remotely, according to a GP expert.
 
The call for change comes as new Australian Institute of Health and Welfare (AIHW) data reveals that, nationwide, 17% of Aboriginal and Torres Strait Islander people currently have relatively poor physical access to a GP.
 
That is compared to 5% of non-Indigenous Australians.
 
The data states that the proportion of people living in areas where physical access to GPs is relatively limited increases with remoteness.
 
It reveals that access changes from 3% of First Nations people and 1% of non-Indigenous people in major cities not having access, to 71% and 58% respectively in very remote areas.
 
RACGP Rural Council Acting Chair Dr Rod Omond said the data is not surprising, but still concerning as much of the crucial work GPs do is in preventive healthcare and allowing rural or vulnerable populations to lead healthier lives.
 
‘The issue is that people in remote areas should have access to good medical care, including medical opinions by a specialist general practitioner, as well as other providers,’ he told newsGP.
 
‘But that will need to be supported by various models through government input, otherwise, it’s just non-viable.
 
‘A lot of the population doesn’t have the ability to travel the distances that we’re talking about to access medical care, so they need some sort of medical care in the community that they’re in, or close to it, or support to get to medical care where it’s not available locally.’
 
The analysis was based on three key barriers facing different communities, the first being the estimated drive time between populations and GP locations.
 
‘The GPs are not considered accessible at all if the estimated drive time is more than one hour,’ the modelling states.
 
‘People do sometimes travel for longer periods to access GPs in Australia but one hour was chosen as the maximum time people should reasonably be expected to travel.
 
‘We have also found that the vast majority of GP visits in Australia happen within a one-hour drive.’
 
It also estimates the GPs to need-adjusted population ratio for each service, and the demand on each service relative to its capacity.
 
Telehealth options do continue to grow, with the proportion of people who had at least one virtual consultation for their own health in the last 12 months sitting at 28% in 2022–23.
 
That includes around 24% of people who had a telehealth consultation with a GP – but telehealth access is not always available.
 
But Dr Omond said for those living in regional areas access to preventive care is much harder, so many patients enter a medical centre once an illness has reached a much later stage.
 
‘There needs to be some sort of transport to either bring the person to the care required, or to take someone out to provide that care,’ he said.
 
‘A lot of care is done by registered nurses and Aboriginal health practitioners, but they need backup from a GP to help with more complex problems or presentations.
 
‘If nothing changes, people are just going to keep getting sicker and sicker … this is one area where there really needs to be a concerted effort to make a difference.’
 
The new modelling comes in the same week as new ‘deeply troubling‘ Closing the Gap data revealed several outcomes are not only remaining stagnant but going backwards.
 
The Productivity Commission analysis found the outcomes currently not on track include Aboriginal and Torres Strait Islander peoples’ early childhood development, incarceration rates, children in out-of-home care, and suicide rates.
 
In a bid to combat the gaps, Dr Omond said more options are becoming available to GPs to work in rural and remote areas - such as adopting a fly-in fly-out lifestyle.
 
‘There does need to be more done to attract doctors into that sort of work because it is quite interesting work,’ he said.
 
‘Governments are working on this, but these solutions are not easy at all because it requires a lot of effort and considerable money to provide good medical services to these populations that are so spread out.
 
‘In these areas, the geography is huge, and logistics are very difficult, and that should never be underestimated when people are talking about solutions.’
 
The RACGP’s has launched GP training campaign, ‘Become a GP’, aimed at seeking out the next generation of GPs, especially to rural and regional areas.
 
Moving forward, the AIHW said it plans to investigate whether the interaction between access and need can be calibrated in a ‘meaningful way’ with respect to its effect on health outcomes.
 
Log in below to join the conversation.

Aboriginal and Torres Strait Islander health Close the Gap rural health