A doctor of more than 50 years says a lack of GPs and the changes in treating patients is putting pressure on the health system.
The Small Towns Project by the Western NSW Primary Health Network - a non-government organisation that collaborates with state and federal health departments - has identified Wellington and nine others in the western area among the 45 towns in regional NSW at risk of losing GPs in the next 10 years.
"I was a doctor at Bourke in 1978, we had a shortage of doctors in rural Australia back then. What has changed is the general practice of treating sick people. We all worked in hospitals and now hospitals are quite difficult to work with," Wellington doctor Ian Spencer said.
At the Swift Street Medical Centre in Wellington, a town of a little more than 4,000 folks, Dr Spencer, 74, is among a few doctors along with the Aboriginal Medical Service, rotating their days every week to service a rural town that's mushrooming with tree-changers.
He was 72 when he quit as visiting medical officer at Wellington Public Hospital.
The reason? The 24-hour roster is grueling while working full-time at Swift Street. But often, doctors in the town are needed to do both because a GP is one profession hard to come by in rural towns as most graduates are magnetised at metropolitan centres.
"Look, I'm not blaming the health department, I'm not blaming the universities...I've seen country medicine for well over 40 years the bottom line is all of the changes that have been tried before have not worked," Dr Spencer said.
"We are really struggling just to try and maintain the sort of services that are necessary for people to be involved in complex care management, preventative care, diabetes, hypertension, obesity, and the list goes on. Being a doctor for over 50 years, the changes in medicine have required a lot of changes in primary care."
As well as Wellington, towns in regional NSW at risk of losing GPs in the next 10 years include Balnarald, Bourke, Brewarrina, Cobar, Collarenebri, Coonamble, Lightning Ridge, Walgett and Warren.
This report was submitted at an earlier NSW parliamentary inquiry into regional health services across regions.
Since the inquiry into the project, a spokesman for Western NSW Primary Health Network said the organisation has collaborated with the Western NSW and Far West health districts as well as the NSW Rural Doctors Network.
Along with declining GPs in the identified towns, they also found six percent of the 300,000 residents in those 45 towns have chronic diabetes and without primary care support, 40 percent of them would die from a treatable illness, the spokesman said.
The state government has funded the network's project with $13.7 million to roll out the Living Better and Stronger Diabetes program coordinating the care and treatment of thousands afflicted with diabetes.
Baradine is a town two hours drive northwest of Dubbo where only two doctors are available to look after nearly 800 of its residents.
The two doctors are a couple. They were about to leave town for another opportunity but have since decided to take over the Baradine medical practice.
Kerry Munns works for the doctors running the Baradine Surgery at Darling Street where she organises everything, including remote online consultations by Telehealth connecting patients to specialists in Dubbo and other hospitals in the central and far west health services.
Expecting mothers either go to Dubbo, Gunnedah and Narrabri and as far as Tamworth whichever way is closer to deliver a precious bundle, Ms Munns said.
"For chemotherapy, palliative care, and diabetes care the doctors determine where the patients can receive available care which can be done through Telehealth," Ms Munns said.
Telehealth remote services are available by video.
They can be done if a physical examination to diagnose or treat is not needed, or preventative treatment is not needed. The service has been made available through Medicare since January this year.
Ms Munns said they also referred patients to the NSW Health's multi-purpose hospital service at Baradine which has a hostel for cancer patients, acute care beds, and an emergency department.
But with only two doctors in town, caring for anyone who's sick can be tedious.
"Telehealth is a good idea, particularly for older residents, we can help them connect with remote doctors they see and talk to on video. We do it here at the surgery the patients are assisted by either our doctor or nurse," Ms Munns said.
Dr Spencer, who obtained his medical degree at Sydney University and in the United Kingdom, said he has been part of a health committee that made submissions for a "virtual model" which is similar to Telehealth but with specific features for remote towns without resident doctors.
"It would need to be very well organised central hub for doctors and administrators so to speak," the Wellington doctor said.
"They will be staffed by well-trained nursing staff who could triage patients properly so in a virtual sense those remote towns' [health service] would be run as a general practice without necessarily having the doctors actually having to live there.
"I think that is something of the past [doctors residing in the town]...The Royal Flying Doctors' Service has done it for a very long time. With modern IT and very well-put-together system, that might be the only way those remote towns would maintain primary care."
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