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The end of rural generalist procedural practice in SA


by S Lowe for 5THE FM’s newsonline wattlerangenow

Country Health SA (CHSA) will actively seek alternative service providers for the Naracoorte Hospital. Kincraig Medical Clinic has provided services at the Naracoorte Hospital for many years, until contract negotiations stalled late on Friday. The announcement brought a concerned response from Millicent GP Dr Stephan VanEeden about the overall future of GP’s in rural hospitals and the impact on patient care.
Dr VanEeden said:-
“ The end of rural generalist procedural practice in SA. “
“It fractures the seamless transition between primary and secondary care for patients in medium sized country towns in SA.”
“The savings achieved by this move will be more than nullified by duplication and inefficiencies that occur when primary and secondary care is provided by different organisations and a different work force.”
“Unfortunately because of the split between Federal and State funding the true monetary and health cost of such a move will never be quantifiable.”
“The real losers are the Naracoorte patients. They have been served by a group of doctors that have been answerable to their primary and secondary care needs for a long time. They will now be served by locum doctors with variable conviction to health outcomes in the town or if permanent staff, primarily answerable to CHSA KPI’s.”(Key performance indicators)
“And sadly there is significant difference between serving a boss in Adelaide, serving a community for a week or being a long serving doctor dependent on the same service for your own health.”
Acting Chief Executive Officer Rebecca Graham said Country Health SA had spent considerable time working with the Kincraig Medical Clinic to understand their concerns but in the end they have refused to agree to Country Health SA’s fair and reasonable offer.
“The clinic’s decision to continually reject the standard GP contract, which has been accepted by 99 per cent of rural doctors, means we will now look at new ways of delivering these services.”
We, 5THE FM/wattlerangenow quoted the Rural Doctors Association of SA earlier this year who said while the 99% quoted by CHSA may be correct, many had signed under duress so they could continue to work in CHSA owned hospitals and many had not signed for the full 3 years; some having only signed for 1 year to allow more time to negotiate .
Ms Graham said, “We are committed to continuing all current services at Naracoorte Hospital, including emergency, inpatient, obstetrics and anaesthetics services.”“We understand this is a significant change for the Naracoorte community and will continue to keep residents updated about temporary measures until new service providers are in place.

“A locum provider will remain in place until a permanent alternative has been finalised.”
CHSA has given no indication of how long this will take or how long it will be before obstetric and anaesthetic services and accident and emergency will re-instated.
Kincraig Medical Clinic Dr Geoff Taylor has said publicly the level of care is the sticking point in the contract negotiations.
Member for McKillop Mitch Williams told 5THE FM today he is disturbed that prima facie it is apparent there is a differing health standard for country than Adelaide.
“ The Minister for Health (Jack Snelling) needs to explain why we are expected to accept a lower standard of care than in the city.”



2 thoughts on “The end of rural generalist procedural practice in SA

  1. Wow. just wow.

    I do wonder where CHSA will find anaesthetic and obstetric cover from, given the current recruitment crisis in SA

    And perhaps MP Mitch Mackillop could address the other glaring inequity for rural patients – the fact that rural patients have to pay to be seen in ED, whereas the same service is provided for free in metro

    …that CHSA can do this is amazing – they claim that provision of emergency services is a ‘private arrangement’ between GP and patient – even though the patient may have never met the GP, and even when the service could not be delivered in a GP clinic and mandates referral to an ED

    All I can see is the implosion of rural health in SA as disenfranchised doctors take their skills interstate. We’re not talking about ‘just GPs’ here – we’re talking about doctors with skills in emergency medicine, obstetrics, anaesthetics – they are in high demand interstate on the locum circuit

    SA’s loss, another States gain – all because CHSA fails to negotiate for reasonable requests for local variations to the standard contract….unanimously rejected by the Rural Doctors Association in SA and forced upon many who only signed so as to ensure continuity of service to their community

    It’s not negotiation with CHSA. It’s an ultimatum. And of course, the people who make these decisions arent the ones affected – they arent the ones who need a doctor skilled in emergency airway at 3am after a vehicle rollover; they are not the young mum who has to travel hundreds of km from family to birth, at a time when she needs family most. Nor are they the rural patient who has to pay private fees to be seen in ED, when metro patients are seen for free.

    It’s a shambles.

    • Thankyou KI doc – so true!
      None of the doctors are asking for anything that the contract doesn’t allow in the local variation condition and yes you are so right RDASA do not endorse the current CHSA contract.