Western NSW PHN is targeting general practices struggling to stay viable with a new program designed to give support where it’s needed.
When Andrew Coe, the CEO of Western NSW PHN, can’t sleep at night, it’s a fair bet he knows exactly what it is gnawing away in the back of his mind.
“Sustainability of general practice,” he says, without hesitation.
Diving into the numbers it’s not hard to see why.
Western NSW PHN is huge: 433,379sq km, the largest PHN in NSW. The population of about 310,000 is spread far and wide, older than the national average with about 19% over the age of 65, and with 10.5% of First Nations descent. The PHN covers two local health districts: Western NSW LHD and Far West LHD.
There are 113 general practices in the region, according to the PHN’s website.
“We think 41 of those practices are in danger of closing in the next five years,” Mr Coe told TMR.
“I’ll often talk to small communities and they’ll tell me that it’s 300km to see a GP, and then they get there and there’ll be no appointments available. Part of the problem is that if you want to see your regular GP, it’s a 12-week wait. If you want to see any GP, it’s still a number of weeks.
“It’s about capacity. A number of them have got closed books, and a number of them have moved to mixed billing. So part of the challenge is that if you want bulk billing, you used to have this many practices to choose from and now you’ve got less practices to choose from.
“So if your financial contribution is an issue, that becomes another access problem.”
Add to that the cost of locums – “$2000 to $3000 a day” – and the limited pipeline of GPs coming from overseas and the small number of students opting to go bush after graduation, the challenge is a hefty one.
“[Students] have got too many options. Why would you go to Broken Hill or Dubbo when you could go into central Sydney?”
Mr Coe and his team at Western PHN are not sitting on their hands, however.
Using a 12-minute survey, the PHN has assessed the needs of the general practices in their region and developed a support mechanism tailored to each practice’s needs.
“We’ve upskilled our practice support team to do more intensive support, particularly around financial viability,” said Mr Coe.
“We triaged the practices based on the survey results and we’re working with the practices that need the most help first, which is probably a different way of working.
“Historically, it’s been the squeaky wheel or the politician getting involved. Now we’re focusing on the ones that need the help most.”
The biggest area of need, or at least the one where a solution is visible, is what Mr Coe calls “back-office functionality”.
Most GP practices were still operating as small businesses, he said, but that model was not working.
“We’re about to establish a new company which is going to offer practice management services that they would benefit from. This option is to allow the practice owners and the principal GPs continuing to be doctors and for the new entity to provide a bit of a back office function that enhances that clinical interaction.
“What we intend to do is support the practices with whatever they would like. At one end it might be providing an IT solution to a practice that is currently running on a server in the practice, and just wants to move to the cloud, but doesn’t have the infrastructure or the knowledge to do that.
“And right at the other end, it could be that the practice manager’s left and they can’t recruit, so we put somebody in there to help them, or we do it remotely.”
The Western NSW PHN board approved the establishment of the service last week, and Mr Coe hopes to have it up and running by the end of August.
“We think it’s probably something that can be useful for about a third of practices,” he said.
“That doesn’t mean that we don’t need a different way of doing primary care delivery. But we’re buying [those practices] a bit more time to enable us to test out new models of care, new funding mechanisms.”
