Opening statement: NSW Parliamentary Inquiry into health outcomes and access to the health and hospital services in Regional, Remote and Rural New South Wales

The AMA (NSW) thanks you all for the opportunity to provide a submission and appear at this Parliamentary Inquiry into health outcomes and access to health and hospital services in rural, regional and remote NSW.

The AMA (NSW) supports the aims of this inquiry, to examine health outcomes, patient experiences, wait-times and quality of care for people who live in rural, regional and remote NSW.

We acknowledge the range of issues that will be addressed over the coming months, and we place importance on each aspect of the service issues that have been identified and will be examined and placed under scrutiny.

We are aware of the shortcomings of health services, particularly in the more rural and remote communities; as well as the inadequate, or absence of, service delivery that have resulted in some very poor outcomes and very sad circumstances for individuals and their families.

Our place in this inquiry, we believe, is to focus on what improvements can be made to prevent these scenarios and, as the peak representative organisation for medical professionals in NSW, what can be done to ensure the regional, rural, and remote communities of NSW have access to the adequate and reliable medical services.

We prepared our written submissions with the input of our members who have experience working in rural, regional, and remote facilities. The input covered experiences from doctors in training to senior practitioners. We have relied upon anecdotal evidence and their feedback, as well as observations as we are of the view this is invaluable when it comes to improving health services in our regions. We believe this is the most reliable and contemporaneous evidence of the status of the provision of medical services available.

By collating that feedback, together with work we undertake on a day-to-day basis, we formed the view that there are initiatives that could be developed to improve services. We acknowledge that those improvements may require collaboration with many organisations and will also require coordination with Federal organisations – private and government, as healthcare in NSW is delivered as a collaborative service that relies upon various funding, training and education and facility models.

In our submission, we set out our summary of recommendations. These cover recommendations going primarily to recruiting and retaining a well-trained, resourced and supported medical workforce. I summarise those recommendations as follows:

1. Doctors-in-Training (DITs)

(a) Provision of allowances and incentives for DITs to rotate to regional hospitals

(b) Provision of allowances and incentives to allow those DITs based in regional areas to return to the city to undertake necessary rotations

(c) Require Colleges to support regional training or explain why regional training is not appropriate

(d) Review the accreditation of Rural and Regional hospitals to allow for further College training programs across more specialties

2. Visiting Medical Officers (VMOs)

(a) Greater flexibility in relation to on-call commitments

(b) Access to Professional Support Payment to VMOs in regional areas in accordance with the terms of the Determination and to give effect to the policy behind the payment – namely, to attract and retain VMOs in regional communities

(c) Greater flexibility with recruitment processes so that LHDs can commit to doctors interested in working in a regional and rural centre in a timely fashion

(d) Ensure doctors are offered appropriate contracts which also encourage the doctor to establish and maintain a private service to support the community

3. Career Medical Officers (CMOs) – An increase in CMO roles to attract those medical practitioners who are seeking to establish themselves and their families in a regional or rural location but not seeking to practice as a specialist.

4. Renumeration 

(a) An increase for locum rates

(b) Review of VMO Fee-for-Service rates and allowance to access additional payments, such as claiming sessional rates in circumstances where the CMBS prevents payment for service

(c) With the Commonwealth Government, review of CMBS for General Practice item numbers for rural and regional GPs

5. Relocation Grants – An extension of relocation grants to specialists, for those specialities in shortage, including but not limited to psychiatry, cardiology, neurology, and oncology.

6. Oncology – Decentralisation of radiotherapy and chemotherapy services to reduce travel time for cancer patients, particularly in the Western NSW and North Coast NSW Local Health districts.