Violence towards GPs and staff a growing problem

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