Victorian healthcare system is 'fundamentally broken', GP says

Victorian healthcare system 'fundamentally broken', regional doctors struggling, GP says In short: Regional GPs across Victoria say insufficient access to primary care in the community is resulting in more patients needing emergency department care in hospital. Some clinics are struggling to hire staff, while others say a lack of resourcing is impacting patient care and safety. What's next? The Royal Australian College of General Practitioners warns people will continue to get sicker if clinics and staff are not supported. When Jacqueline Altree went on maternity leave last November, her patients at Terang Medical Clinic had to wait three or four months for a routine appointment for things like a script repeat or blood pressure check. Even with Dr Altree back at work, patients at the south-west Victorian clinic still have a two-week wait for their preferred GP, and upcoming staff movements are expected to make that even longer in the future. The regional GP said she was worried patients managing long-term chronic disease would go without care and potentially end up in hospital. "That's most of what I see, and that's most of what I feel anxious about when I know there is a big waitlist to get in to see me," she said. "What are we missing, what aren't we caring for, what is going to need to go to hospital because I physically can't see any more patients? "There's only so many hours in the day — either you cut down on the time you spend with each patient, in which case you might miss stuff, or you see less patients, and you're going to worry about that." She said she believed more people were turning up at emergency departments (EDs) because they were unable to see a doctor promptly. "People are presenting to ED sicker and later, because they couldn't get appropriate care earlier," she said. Lack of GPs helping drive ED overload Insufficient access to GPs is among the key factors blamed for rising pressure on regional Victorian hospital emergency departments. The ABC previously reported emergency departments at multiple hospitals across regional Victoria have faced high demand and long wait times, with hospital staff saying they are at breaking point. Hundreds of GPs walked off the job for four hours at the Ballarat and Bendigo emergency departments yesterday to protest poor pay and working conditions. The latest Rural Workforce Association of Victoria worker census released last month found "critical workforce gaps" for GP roles across the state, except for the Baw Baw area in the state's east. Meanwhile, the Commonwealth government's most recent data showed there were fewer doctors per capita in rural and remote communities in Victoria, compared to metropolitan and regional centres. Doctors and GP advocacy groups have told the ABC that unless something is done to fix the GP shortage, the ED crisis will only get worse. Policy change needed The far south-west Victorian town of Casterton had no GP for six months in 2024 when their long-standing doctor retired, and a patchwork of locum staff failed to fully plug the gaps. Patients unable to travel an hour to the nearest clinics in Hamilton or Mount Gambier went without care. Andrea Cumming, practice manager of the Edgar House Medical in Casterton, said the situation was "absolutely dreadful". "People's health is at risk when they can't see a doctor,"Ms Cumming said. While the town now has three doctors, she said the problem was going to keep coming up due to a national policy issue. In 2022, the federal government implemented changes to Distribution Priority Area (DPA) policy, which eased the limits on where international medical graduates were allowed to work as GPs. Under the old policy, doctors who gained their training overseas either had to work in a small rural town for 10 years or in a remote location for five years. At the time, rural and regional clinics sounded the alarm, saying the change was going to make it harder to recruit doctors. Last year, the federal government further expanded the areas counted as a DPA, a move criticised by the Royal Australian College of GPs. Ms Cumming said her former workplace in Hamilton lost three doctors shortly after the 2022 change, and says the policy should be reversed so that doctors are required to do a stint in the country. "[The government] should bring that back in and give doctors a five or ten-year moratorium … so they have to come to these areas and gain that experience," she said. "That would help us quite a lot." Ms Cumming said though the Casterton clinic currently had three doctors, one had recently foreshadowed retirement, which meant the practice would be back to relying on locum staff. She said it pointed to another ongoing problem that needed solving. "[Hiring locums] costs a lot of money … sometimes we're in the negative, but we have to have the GP coverage for the patients,"Ms Cumming said. She said a solution would be to pay GPs more if they moved out of the cities. "Doctors aren't getting paid well enough to come into rural areas; they can make more money working in Melbourne," Ms Cumming said. "All of the locums tell me that." 'Exceptionally difficult' to hire GP Birregurra, a small country town less than an hour's drive west of Geelong, is attracting a growing population, but can not get a second GP to go with its population boom. Despite a promise of free haircuts and coffee from the community, Birregurra Medical Clinic's 18-month search has been fruitless, leaving Jared Kilday as the town's sole GP. "It's just been exceptionally difficult, despite advertising through all the right channels and generating a bit of media interest,"Dr Kilday said. He said he was only taking on new patients who lived directly in the town, meaning he turned away multiple prospective patients from the surrounding area every week. "If I take on more patients than I can service, then ultimately it's not going to be good for my patients and good for me, my mental health, and job satisfaction," Dr Kilday said. "Although it's disappointing, especially for the new people that are moving to the area, it's a decision I've made for the time being until we can recruit someone else. "There's plenty of demand but not enough me." He said the answer was to put more funding into primary care to bolster the GP workforce. Not only would it help lure doctors to places like Birregurra, but it would also ease the pressure on EDs. "If you come and see the local GP, it's potentially costing the government $80 or $90 to fix a lot of stuff," Dr Kilday said. "[But] as soon as they land in an emergency department, the bill starts ticking at $500-plus, and then a hospital admission is priced at $1,000-plus per 24-hour period." 'System is fundamentally broken' Michael Veal is a country GP in Avoca and Creswick in the state's west, and said many of his patients who need hospital treatment refuse to travel to the EDs in Ballarat or Bendigo. "No one wants to sit in ED or an ambulance trolley for 12 hours, and the outpatient wait time for many of the clinics, including things like vascular surgery, is stretching to three years," Dr Veal said. "So the pressure is right back on the GPs. "The system is fundamentally broken — I don't think it's actually repairable." Dr Veal said that instead of investing in telehealth, governments should return to the days when GPs were made to work in rural and remote areas. "I saw a lady yesterday [who] came in with cold and flu symptoms [and] whilst listening to her chest, I noticed a dark melanoma spot on her back," he said. "So that can't be done over [telehealth]." A multi-decade proposition Rob Phair is a hospital-based rural generalist doctor in East Gippsland. He said the pressures in regional emergency departments are felt more acutely because of fewer health resources. "We have fewer GP options, less access to primary health care, fewer aged care facilities and an aging population," Dr Phair said. He said those latter issues meant older patients were clogging up hospitals and EDs because "we don't have safe destinations we can discharge them to, we don't have carers at home to help support, and we don't have enough aged care beds for them to go to either". Dr Phair said all levels of government needed to look at better solutions for primary healthcare and aged care in the regions, which he said is a multi-decade proposition. "We have to have a greater commitment to supporting the doctors, the health services that are under most pressure, which are almost all beyond the fringes of outer suburban Melbourne,"he said. "That's where the greatest vulnerabilities are, and those are the health services that need to be prioritised." More pressure on hospitals The Royal Australian College of General Practitioners (RACGP) co-deputy chair Christie Rodda said GPs were a vital link in the healthcare chain. "We're seeing far more patients with comorbidities … they have heart disease, lung disease, diabetes, and mental health [issues],"Dr Rodda said. "If they delay that care through not being able to access GPs who care for those complex needs, they will end up being sicker and presenting to an emergency department when they're more unwell. "That means they're more likely to be hospitalised." Dr Rodda said that if GP shortages were not addressed, the ED crisis would worsen, and people would get sicker. "We're going to see that pressure flow onto the hospital system, so more crowding in emergency departments, more backlog of beds, more demand for residential aged care facility beds that don't exist," she said. She said there were several solutions to help provide more GP care in regional communities. These included more government funding in Medicare rebates for longer consultations, along with an exemption from payroll tax to help clinics stay financially viable. She said practices and supervisors also needed ongoing support to help train students as rural GPs. In 2026, the RACGP had 363 future GPs in training, with 149 of those in rural and regional Victoria. "We've got to make sure that both levels of government are supporting training those doctors coming through the pipeline as well," she said. The federal health department was approached for comment, while the Victorian government said more needed to be done to make GP care more accessible, noting it had established 29 urgent care clinics in the state to help meet demand.