‘Gut-wrenching’: Rural clinic closures taking their toll

Michelle Wisbey

20/09/2023 3:28:07 PM

An increasing number of regional towns are losing their general practices, with recruitment issues and rising costs having a devastating impact.

Patients inside a doctor's surgery holding signs.
Patients at the Cardwell Family Practice rallied to save the invaluable service. (Image: supplied)

Heart-breaking, exhausting, disappointing.
Those are the powerful words of two rural Queensland practice owners, forced to give up their beloved clinic.
The main causes are all too familiar – costs go up as GPs numbers go down.
The Cardwell Family Practice is one of 14 currently being overseen by Rural Health Management Services (RHMS), which helps struggling Queensland clinics from Childers to Mareeba.
Established in 2011 due to a growing need to manage smaller, rural practices that were facing the same problems plaguing Australia’s rural health workforce, it is also now completing health plans for towns such as Gladstone at the request of Queensland Health.
RHMS is often called when practices are on the brink of collapse, helping to arrange management services, accreditations, integrating telehealth, and working with allied health professionals.
Its Chief Executive, Trish Lisle, told newsGP recruiting and retaining GPs in smaller communities continues to be a struggle.
‘This is resulting in the utilisation of locum doctors, which is not only expensive, but also disruptive to the continuity of care of patients,’ she said.
‘The overall quality of primary healthcare is impacted, and patient health compromised.’
Earlier this year, the owners of Cardwell Family Practice found themselves in just that situation.
For almost a decade, Julie McKay and Carmen Edmondson dedicated their lives to the practice, servicing the 1600 people who call the picturesque seaside town their home.
But times have been tough on the Cassowary Coast.
Battling a global pandemic that ‘knocked our socks off’, the clinic found itself churning through a seemingly never-ending cycle of locum GPs, despite offering $500,000 a year in an effort to attract a full-time GP.
That vacancy was never filled.
‘We thought, “well we’ll just keep plodding along”, but then in the last eight months it’s just been a nightmare,’ Ms McKay, a registered nurse, told newsGP.
‘It was gut wrenching, absolutely gut wrenching.’
Soon, it all become too much.
In July, the practice announced it was closing its doors on 1 September, much to its patients’ heartbreak.
‘I never felt so grateful to be able to confide in you both and have the extra set of hands to hold one of the boys while the other had their needles done,’ one patient wrote on Facebook.
‘For letting me cry during the moments I needed too most. For always giving great service as well as great medical advice.’
Another comment lamented how sad the closure was for the Cardwell community.
‘This shows how governments are lacking to support GPs and how some community members take their GPs for granted,’ they said.
In a true display of rural medicine’s importance, patients rallied around their clinic, gathering with signs that pleaded for someone to ‘give us a doctor’ and ‘help save our practice’.
And just in time, the practice was offered a lifeline.
Last month, Queensland Health Minister Shannon Fentiman announced the practice would temporarily be transferred to the Townsville Hospital and Health Service until a longer-term solution is found.
RHMS was engaged to operate the practice in the meantime to keep the doors open and the patients healthy.
Ms McKay said knowing her much-loved patients would be taken care of brought her an immense sense of relief.
‘We’re very, very proud of our patients,’ she said. ‘They actually supported us 100% and even though they were extremely disappointed they actually knew the reasons behind it and why we did it.’
But as regional and remote towns across Australia continuously face the same problems, Ms McKay believes a longer-term solution is needed to keep practices afloat and patient care at the highest level.
‘You’ve got a rotating GP every two weeks, so every two weeks it’s retraining a new GP,’ she said.
‘Everyone is struggling to put together some form of a plan and unless the Federal and the State Government start working together around health, you’re going to have a divide.
‘This isn’t just a state problem, it’s not just a federal problem. It’s a health problem and we need to resolve it at all levels of government.’
Ms Lisle agrees, noting the long list of challenges facing rural clinics, which she describes as being ‘absolutely crucial’ to communities.
‘These practices not only allow patients access to primary and preventive healthcare, but they also reduce the number of unnecessary presentations to hospitals and calls for emergency services such as the ambulance,’ she said.
‘If these practices were to close, we would see marginalised communities and groups such as the elderly, further marginalised and not being able to access healthcare.
‘It would place further financial, emotional, and psychological strain on our patients who would have to travel to access basic healthcare.’
A recent newsGP investigation revealed at least 184 general practices have closed around Australia in just one year, with not enough new openings to fill the gap.
Ms Lisle said a lot needs to change if Australia is going to meaningfully support its regional clinics.
‘A requirement for GPs to complete a regional or rural placement would be beneficial,’ she said.
‘This would allow healthcare professionals to experience the uniqueness of rural primary healthcare provision and allow them to experience what these amazing communities have to offer them.
‘Placed-based incentives for GPs and practices could be beneficial; however, it is the long-term retention of qualified healthcare professionals that is imperative to positive health outcomes for the patients in these communities.’
For Ms McKay, she loves the beachside town she still calls home and continues to advocate for GPs to work rurally.
Her advice to GPs is to not ‘dismiss’ the idea of practising in a regional area before experiencing it first-hand, suggesting that they ‘try before you buy’.
‘What we can provide is great support systems, great family, friends, and a beautiful environment,’ she said.
‘Our patients are so welcoming. Once you get into these communities, and actually start to live within the community, you make connections, you make friends.’
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Dr Andrew John Booker   21/09/2023 7:18:20 AM

What better proof the college needs to start meaningfully advocating for our practitioners while there still is General Parctice! . This reflects the start of the real demise of GP - oh but wait - my bad - patients are fine - there’s pharmacy plans to step up and fill the gaps and the college is on those working bodies - and acute care centres are proliferating !!!!

Dr Gardiyawasam Lindamulage Chaminda De Silva   21/09/2023 7:24:40 AM

This one side of the story . Other side of the story is that I tried to bring experience doctors from Sri Lanka to work in this communities for last few months . These doctors have passed AMC part one and have over 5 years experience in General practice . Tried to talked to health authorities but every one rejected in fact I was told that there is enough doctors in Queensland and also cannot arrange supervision for them . I could have easily got doctors to fill most of vacancies for the half of the cost that they are paying
if some one can direct me to the right person or to the health minister , I can help these communities

A.Prof Christopher David Hogan   21/09/2023 10:09:07 AM

I have been witness over the years to enormous efforts both in public & behind the scenes by College individuals & groups to advocate for General Practice.
Advocacy needs not only words by a few but actions by many.The members need to actively support their advocates.

A.Prof Christopher David Hogan   21/09/2023 10:18:32 AM

And so it starts.
In spite of so much advocacy by so many people , governments are not acting and rural health services are starting to fail in a catastrophic cascade.
Instead of system reforms, governments try multiple quick fixes- a total waste of time & money.
GPs feel frustrated to be correct in their predictions but to be ignored

Dr Gonasagaran Ruthnam   23/09/2023 9:58:17 AM

Can we as professionals take responsibility for the fire and avoidable state of affairs?
General Practitioners need to ask themselves how much effort they put in to rectify decades of neglect under our noses by not participating in changes- we were always too busy or someone else should sort it out- professional jealousy exists or plainly don’t want to be told by an equal practitioner unless a specialist
Then, our representatives in AMA as well Colleges have been impotent as they always lose debate or effectiveness against politicians as getting cosy became priority
Government irrespective of colour repeatedly ran GP down and gave too much abusive power unsupervised to bureaucrats with lies, distortion etc and created a monster now they don’t acknowledge- and unwanted birth and don’t have the expertise or will to rectify it- too far down the track now and it looks miserable
Patients and expectations are to blame as well- in that equation doctors did the right thing .

Dr Swapna Bhaskar   23/09/2023 11:02:28 AM

I am an IMG who is working in a rural practice and see the struggle of patients here. In my past few years, I have realized that local graduates are not much interested in going rural for reasons unknown to me. IMGs will be more committed to establishing a rapport with the community and building up a great career. They are can be a great resource if the government bodies and college become slightly lenient from the strict policies, exorbitant documentation, pre- requisites and offer good benefits for rural GPs. Isn't is better to have some doctors than none - does the quality of healthcare suffer by having non VR doctors who still do their best for the health of their patients ?

Dr Leonie Fromberg   30/09/2023 10:24:53 AM

RHMS… Don’t get me started. Find me a Doctor who has had a good working relationship with this so called ‘not for profit’. The Devil is in the detail there. The HHS will quite literally pay for everything…..would they do that for a GP? Probably not.

Dr Paresh Chandra Halder   23/10/2023 12:15:19 PM

My wife and my application/appeal in a rural position were found ineligible for FSP in this intake as the submitted practice was not approved on my registration. There appeared to be some contradictions/discrepancies per the eligibility criteria set by the RACGP & approved sites under medical registration, as the practice area can be changed by requesting a change in circumstances to Ahpra before the FSP commencement date. Suppose this needed to be confirmed and approved by the FSP application deadline; in that case, a letter of recommendation/evidence from RACGP stating that it is suitable to practice as a general Practitioner in the limited registration (Fellowship Support Program) position at ('the name of the medical centre') is enough to apply for changes in circumstances.

I hope RACGP will be able to make such a great initiative more straightforward to keep the door open in rural areas where many of those are closing due to doctor shortages.