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Health Service Provision from the Tasman Peninsula

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Health Service Provision from the Tasman Peninsula Health Service Provision From The Tasman Peninsula Dr Stephen Ireland and Dr Pamela Ireland Nubeena, Tasmania 3rd National Rural Health Conference Mt Beauty, 3-5 February 1995 Proceedings Health Service Provision From The Tasman Peninsula Dr Stephen Ireland and Dr Pamela Ireland Nubeena, Tasmania We wish to describe, for consideration and comments, some of the problems that are at present confronting the sparsely populated, isolated and remote region of Tasmania in which we work. This provides a microcosm of the general problems which are facing those who live and work in such areas. Solutions are required now - this is what we ask - so that this community can have sustainable and high quality health services which are accessible. The Problem as perceived by present practitioners The Tasman Peninsula has a population of 1,700 residents and is 110 kms from Hobart. The nearest town of substance is Sorell, 80 kms towards Hobart and there is little in between. There is an eighteen bed nursing home with two acute care beds at Nubeena and the surgery is situated at one end of this building. Hostel beds are soon to be built. This has always been a solo general practice - by all criteria it still is. Patient load is 140 per week and the gross income is $180,000 p.a. (1993/1994). Until 1987 this was always a State-managed District Medical Officer post; however since then the practice has been privatised. There is no Visiting Medical Officer status for the practitioner and no subsidy from the State. The premises are rented at $125 per week from the Council which includes cleaning and electricity. Some of the equipment is State (eg. X-ray and Autoclave) and community owned. The present practitioners consist of a married couple who job-share a full-time equivalent situation. There are ten consulting sessions per week. The problem is that there is no other neighbouring practice to share on-call and thus, in essence, this family unit must provide seven day cover to this area. There is no economic basis to add another full-time equivalent GP to the practice. In May 1994 we approached Tasman Council about the human impossibility of being on call seven days per week. The previous doctor, who left due to the onerous situation, did have a retired GP to help him (who stopped the day we arrived) and suggested the practice could probably support another doctor. The State Southern Region is now involved with solving this problem. This may involve increasing the level of locum relief, as well as using a distant practice for on- call. 486 Weekend locum relief has been obtained by this practice since 1992 with a project grant. This was followed on via the Rural Incentives Program (RIP) and now from funds from the Tasmanian Rural Divisions Co-ordinating Unit (TRDCU). This has been an intensely frustrating exercise and, in actuality, at the present time gives (with luck) 33 hours (9 am Saturday to 6 pm Sunday) relief each month - a total of 5% genuine free time. This is apart from annual leave when we can find a locum. State Registered Nurses (SRNs) at Tasman Nursing Home are unhappy about triaging after-hours calls and actually refused to do so en-masse on the night of 22 December 1994 after a meeting which was attended by State Health, Tasman Council, ANF and the medical practitioners. The SRNs backed down the following day. At present, interim measures are in place, however we were placed in an intolerable position on the night of 22 December 1994. The community feels insecure and confused as they are well aware of the present issues taking place and it would be fair to say that some members of the community are very angry. Over the years, the community has observed a regular change of doctors. Some are asking for a public meeting to discuss the issues. This community is socio-economically disadvantaged as well as having all the other inherent rural problems. The community view the Nursing Home as a hospital and have used the facilities as such in the past. Tasman Council performed a survey of medical services in June 1994. Of the respondents which were representative of the population, 35% indicated that they attended a family doctor in Hobart or Sorell but 99% respondents indicated that a doctor should be available on the Peninsula 24 hours per day. (In many rural areas of Tasmania, the local population may attend doctors some distance away, which adds yet another dimension to the various difficulties). The State and Tasman Council are presently working towards resolution of the SRN crisis as well as taking action to retain the services of the current practitioners. We believe that the State of Tasmania should assume responsibility for provision of medical services in these communities which are difficult to staff and maintain, as surely this is one of the roles of government. There is no economy of scale in a solo practice in the bush. The Commonwealth Department of Human Services and Health has offered the “Better Practice Payments” to all Vocationally Registered GPs. We believe that this new system of part payment for GPs is probably appropriate and we are waiting for the outcome of negotiations between Government and the GP Caucus. To be eligible, however, the practice must provide 24 hour continuity of care. In the situation here at the present time, this is an impossible and unreasonable expectation. 487 The guide produced by DHSH was written for group practices and made no mention of those in difficult circumstances. Is there a position the DHSH will take on this? The RACGP have set the standards for GPs. How does the College view these special practices? The RACGP training program cannot encompass this practice and yet a trainee may solve some of the problems. RIP and the newly formed TRDCU are funding one weekend per month for weekend relief for the next six months. This is insufficient free time for anybody. We believe that any solo practitioner without a nearby practice with which to share on call, should have at least a 24-36 hour period free each week (or to be accumulated). Funds are available to retain practitioners and these must be used quickly and appropriately, not just bogged down amongst meetings and panels. Likewise the single and small practices should be absolutely prioritised (as is documented in all the RIP literature). Tasmanian Ambulance Service Volunteers provide this vital service. There is some consternation among a few of the volunteers with the recent problem at Tasman. There is no place to jeopardise the security of these volunteers or to cause division amongst their ranks. As the present practitioners, we wish to state that the work of being a GP is enough. We certainly have a right to job-share and we are not certainly not trying to hog a huge income between ourselves at the cost of obtaining another doctor. The current SRN problem has just added to the burden of this position. We also have the right to a fair and reasonable amount of time free from on-call. It appears nobody will address this issue and thus provide guidelines. This is not simply a “private practice” as we are so often told. Perhaps the Better Practice Payments (BPPs) and the Vocational Registration requirements must address this along with the State of Tasmania. A married couple - both with MBBS - have moved to this area and have asked for work. Neither are Vocationally Registered (VR) and would now have to undergo training etc. if that was their direction. Under the proposed BPPs we could not employ them, nor could we afford to do so. We agree with the reforms in this area and would prefer not to employ a non-VR GP. However, we face pressure from the community to do so. Of course, they are entitled to commence their own practice which would affect the viability of this one and further threaten the presence of a suitably qualified GP. We would appreciate comments and suggestions to obtain an actual solution. We are considering relocating at the present time unless the dilemma of free time is resolved. Who else would work under these conditions? 488.
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