A detailed study of the availability of GP care in northern NSW* has found that while the area has high rates of chronic illness and an ageing population, there is limited access to an affordable, same-day GP appointment.
The study found that less than half of potential new patients would be able to see a doctor on the same day if they rang the practice that morning. There would be even less chance if their requirement was to access a female GP, according to the study ‘Actual availability of appointments at general practices in regional New South Wales, Australia’, published in the latest issue of the journal Australian Family Physician.
Improving the availability of primary healthcare services would benefit both patients and the public health budget by reducing the “non-urgent use of emergency department services”.
Working from a list provided by the North Coast Primary Health Network the researchers engaged a professional interviewer to contact all 184 medical practices in 12 local government areas ranging from Tweed Heads to Coffs Harbour, including inland locations such as Kyogle, Tenterfield and Bellingen.
Of these, 22 were excluded because they provided exclusively specialised services, including Aboriginal health, skin clinics, women’s health and headspace. The final sample size was 162, and these were contacted by telephone in March 2016.
The methodology followed that of a ‘secret shopper’ study conducted previously in Victoria. Here, this involved a hypothetical patient scenario designed to reflect a presentation frequently encountered in general practice. It was consistent with a category 4 or 5 classification on the Australasian Triage Scale, if the patient were to present to an ED.
If required, the interviewer posed as the relative of a woman aged 60 years who recently moved to the area, had been experiencing mild abdominal pain over the past few days and was covered by the Medicare Benefits Schedule (MBS) but not eligible for any other concessions.
The primary focus was to determine the likelihood of a same-day appointment with any of the practice’s GP. The other questions related to the availability of a female GP on the same day, the bulk billing status, and if bulk billing were not available, what would be the associated out-of-pocket costs for the appointment.
The results showed that the availability of a same-day appointment for new patients across the region was 47.5 per cent, increasing to 57.4 per cent for an appointment within 48 hours of the call, almost 60 per cent within three days, and 70 per cent within 10–15 days.
They report that one-in-five practices could not offer an appointment at all (also finding that only one-in-five practices bulk-billed). The main reasons given for no available appointments were that the practice was not taking new patients or was fully booked.
“Some of the clinics advised that new patients were required to attend a longer consultation, which may have reduced the availability of a same-day appointment and increased costs,” the researchers noted.
The location showing the least chance of a same-day appointment was Nambucca (11.1 percent), and the highest was Port Macquarie-Hastings (63 per cent).
Northern Rivers figures were highest in Byron Shire (60 per cent), with Lismore at 50 per cent likelihood, Ballina at 33.3 per cent, and Richmond Valley at 28.6 per cent.
With an average bulk-billing rate of 20.7 per cent, the North Coast fell considerably below the national average of 83.7 per cent (according to the MBS). The Northern Rivers’ highest bulk-billing rate was in Lismore (21.4 per cent), followed by Byron at 6.57 per cent. While Ballina and the Richmond Valley registered 0.0 per cent, 50 per cent of Kyogle-Tenterfield practices bulk-billed.
The average out-of-pocket payment by patients was $30.00, slightly lower than the state and national averages.
The Melbourne study that sought the same information found that 75 per cent of local practices bulk-billed.
The researchers concluded that areas of northern NSW with longer waiting times could be targeted for additional attention from policy makers, such as GP workforce enhancement or alternative healthcare models that may increase access to primary healthcare.
“Health services reform is part of the New South Wales Rural Health Plan, which aims to improve access to health services as close to home as possible. Despite the fact that the New South Wales government has increased investment in rural health services over the past few years, findings from this study suggest further improvements are required to facilitate easier access to primary healthcare for regional areas, particularly for first-time patients,” they said.
“With 80% of people who recently attended an emergency department citing the lack of GP availability when needed as the major reason for attending, there is a possibility that increasing GP availability would decrease attendance to emergency departments.
“Indeed, in 2014-15, eight of the 12 local government areas in this study had higher than state average hospitalisations rates. Further research is required to identify how patients make decisions about whether they would attend general practice or emergency department for non-urgent conditions.”
* Bradbury, J., Nancarrow, S.A., Avila, C., Pit S.W., Potts, R., Doran, F., Freed, G. (2017). Actual availability of appointments at general practices in regional New South Wales, Australia Australian Family Physician. 46(5), 2017. 321-324.