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Australia: Rural hospitals share strain

By Ruth Pollard
Sydney Morning Herald, June 9, 2003

Australia - Pressures on the health system differ from region to region, city to country.

For the Hunter region, north of Sydney, one of the major strains comes from the decline in the number of doctors who bulk-bill, which has fallen to between 40 and 50 per cent.

To solve the problem, which not only affects access to GP services but puts pressure on emergency departments, Hunter Health will open four after-hours, bulk-billing GP clinics around Newcastle next month.

Nigel Lyons, the general manager of the greater Newcastle sector at Hunter Health, says the aim is to improve treatment access for patients.

"We looked at the emergency department of our busiest hospital, John Hunter, and found three-quarters who attend that ED get cared for and then go home," Dr Lyons said.

One of the main reasons: bulk-billing rates in the area had dropped well below the national average of 69 per cent.

In the Hunter region, bulk-billed services fell from 66 per cent to between 40 and 52 per cent in the past two years, while in metropolitan Sydney the rates fell from 90 per cent to 84 per cent, according to the Health Insurance Commission.

The other big issue for the region was the lack of nursing home and hostel accommodation, he said.

There were now about 30 elderly people in the acute hospital beds because there weree not enough nursing home beds - and that could create another treatment access block, Lyons said.

Again, more access to after-hours GPs was seen as a solution, because often the elderly were in hospital because that was the only way they could get to see a doctor.

A joint Hunter Health, Commonwealth Government, Hunter Urban Divisions of General Practice program, the after-hours clinics will be located at John Hunter and Belmont hospitals, and community health centres at Toronto and Newcastle.

The initiative also includes a GP on call for visits to homes or nursing homes, along with a telephone triage line.

Dr Mark Foster, of the Hunter Urban Division of General Practice, said the service would provide access to comprehensive GP services after hours, but did not address access block.

And clinicians warn that the co-located GP services are not a solution for every hospital, particularly those in metropolitan areas with high rates of bulk-billing.