Violence towards GPs and staff a growing problem

Morgan Liotta

19/05/2021 4:00:53 PM

Increased threats of physical harm have been attributed to workforce maldistribution and a rise in mental health conditions.

Patient talking to reception staff
Some practices are being faced with frustrated patients unable to secure a GP appointment.

Medical workforce shortages in rural and remote Australia is not a novel concept.
Longstanding issues regarding the recruitment and retention of GPs and non-specialist GPs to these areas have plagued the healthcare system, with the RACGP remaining steadfast in its advocacy to help improve care for people living in these areas.
However, recent reports of patients in Queensland threatening general practices after being turned away due to capacity issues show the strain on regional and remote practices dealing with a growing population that is not as well serviced as many metropolitan areas.
GPs and practice staff in parts of Queensland are regularly being abused and threatened by frustrated patients unable to get an appointment, with practice manager Carri Norval writing on Facebook that patients have threatened to burn the clinic down and ‘come for our families’.
‘A particularly frightening incident was when a patient with … a recorded history of fantasising of chopping up people and keeping them in the bathtub lost control and was very intimidating,’ she said.

‘He asked me to write my name down on a piece of paper and for a long time after I was scared stiff for myself, my children and my family.’
RACGP Vice-President and Queensland Chair Dr Bruce Willett told newsGP that violence and ‘bad behaviour’ are on the rise, with unemployment, a growing drug problem, and societal change resulting from COVID 19 fuelling the problem – particularly in rural, remote and regional areas.
‘This sort of behaviour is never acceptable under any circumstance,’ he said.
‘In my working life I have seen a move from sedating drugs of abuse like heroin, which simply put people to sleep, to stimulating drugs like ice, which tend to fuel psychosis and violent behaviour.’
Dr Willett also said the problem of healthcare workers being threatened and abused is not restricted to general practice.
‘It is a problem in the whole health sector,’ he said ‘Emergency services and hospitals have similar problems, but general practice is not exempt.’ 
These issues are expected to increase nationwide due to the effects of the pandemic, but Dr Willett says it will be particularly prevalent in underserviced areas.
‘Areas with more financial stress and problems with drugs are disproportionally affected. It is a nationwide problem, but rural areas are harder hit,’ he said.
Regional areas without Distribution Priority Area status are unable to employ international medical graduates (IMGs) eligible for Medicare, contributing to the workforce shortages.
Last year, in a move welcomed by the RACGP, the Federal Government announced a plan to fast-track visa applications for IMGs in a bid to address the issue
‘IMGs will continue to play a crucial role in our rural workforce,’ RACGP Rural Chair Dr Michael Clements told newsGP of the announcement.
‘The RACGP is supportive of speeding up visas for IMGs as an important part of the solution,’ he said.
‘Long term, we will grow our own GPs through rural generalism and similar programs. But it will not solve all our problems and certainly not in the near future.’
COVID-19 travel bans have since prevented many IMGs from coming to Australia, but Rural Doctors Association of Australia President Dr John Hall has argued that maldistribution, rather than a doctor shortage, is the larger issue.
‘We have plenty of our own doctors, the problem is that we have very poor distribution of them,’ he said.
‘There needs to be some innovative thinking on how all areas of the country can be properly serviced.’
One potential solution that may help ease the situation is the impending transition to community-based, profession-led training.
Dr Clements recently wrote of the RACGP’s important role in supporting GPs in training to meet existing workforce needs, and stated the college will be central to finding new workforce solutions.
The RACGP has also long been calling for the Government to increase funding for longer consultations that would support GPs to better deal with the increase in mental health issues.
‘[We need] recognition that health services have to deal with emergencies from time to time, and cannot always run on time,’ Dr Willett said.
‘Better mental health and drug and alcohol services are essential.
‘Patience and kindness go a long way in this world. People can help us to avoid waiting times if they book a long appointment if they have a couple of things to talk about or have an emotional problem.’
The RACGP’s General practice – A safe place offers guidance on preventing and managing patient-initiated violence.
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GP shortage IMGs mental health rural and remote workforce distribution

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Dr Jeanine Suzanne McMullan   20/05/2021 8:05:37 AM

Should we be taking doctors from their home countries in the midst of a pandemic ?

A.Prof Christopher David Hogan   20/05/2021 5:17:53 PM

A few points
* There has been minimal migration of international medical graduates into Australia since Covid.
* There is a maldistribution of doctors not only in place but in time- there are issues with provision of after hours services as well.
* With the Covid encouraged tree change & sea change esp of the 65+ group (my cohort) there is an increased demand on services. We can only hope ( younger) health professionals shift as well
* Another issue with disgruntled patients is their inappropriate expectations & their low level of health literacy.
* Violence against doctors is increasing

Dr Wynand Fourie Norval   22/05/2021 6:49:46 AM

We turn away 80 patients a day in a MM2. No DPA here and I’ve begged DOH and Racgp to assist by helping us put our message out that we are drowning but the same statistic comes out “you have an over supply of Drs in your statistical area” - really? Where are they ? I am principle GP and Skin Dr and have a 7 month wait for an appointment but there is no “shortage issue” here. Something has to change because burnout is a real concern and after servicing a rural area for 10 years without rural incentive payments or being DPA and having the cost of a BB non corporate practice to run if they don’t change to DPA then I say “if you can’t beat them join them” and we shut down our service and do the CBD bolt too.