The Rural Doctors Association of NSW (RDA NSW) says tomorrow's reluctant withdrawal by local doctors from providing after-hours services at Pambula Hospital, on the NSW Far South Coast, is symptomatic of the crisis now facing after-hours care in hundreds of rural communities across NSW. Dr Frank Simonson and his colleagues have been providing after-hours care at Pambula Hospital for years, but service cuts-including closure of the maternity unit-have led to the loss of experienced nursing staff, particularly those managing the emergency department, and consequently local doctors have been receiving significantly more calls from the hospital for advice or attendance after-hours.

"Unfortunately, we are simply not able to keep up the pace of providing increased after-hours care as well as meeting our general practice workload during the day, so if we are to remain working at the hospital there needs to be a change in the work arrangements" Dr Simonson said.

"We wrote to the Greater Southern Area Health Service (GSAHS) in October to advise that we could no longer work the night shift and asked for Career Medical Officer cover at the hospital. It took the GSAHS two months to reply...and then they simply told us that it couldn't be done and nights would continue to have to be covered by us.

"In January, our Medical Staff Council resolved that from 1 March 2011 we would work no later than 10pm at night, and we advised the GSAHS of this decision shortly thereafter in order to provide plenty of time for them to revisit their decision. They have not done so, and consequently our new arrangement must take effect from tomorrow.

After 10pm, critical patients presenting at Pambula Hospital will be triaged by nurses and sent to Bega. "We believe the Area Health Service needs to keep Pambula Hospital's emergency department open after 10pm. Reluctantly, however, we have decided that if we are to be involved long-term with the hospital and the benefits that has for continuity of care for our patients, we cannot continue to work the enormous hours we have been doing. At Bega Hospital there are now no local GPs working as VMOs providing general care-the hospital has to work constantly to source locums. This is the alternative for Pambula Hospital if we don't change things."

RDANSW President, Dr Tilak Dissanayake, said "It is critical that the NSW Government and NSW Health sit up and take notice of the looming collapse in after-hours services at rural hospitals across the state, due to increased workloads for existing doctors, the ageing rural doctor workforce, less experienced nursing staff, service cuts, and doctors and nurses who are completely disgruntled with their treatment by the system.

"As an example, why do rural doctors have to fight tooth and nail for an increase in on-call rates from the current rate of around $11 an hour to just $15 an hour? This is a staggeringly small amount when you consider that the doctor has to put their life on hold while they are on-call-they can't be out of phone range and they must remain within easy reach of the hospital at all times. This is fine if it is just for one night a month, but once it becomes 5 or 7 days a week year round, then it becomes a significant impost.

"We need a commitment by the NSW Government to maintain existing hospital services, like the maternity unit at Pambula, so these hospitals can retain experienced nursing staff and thereby relieve after-hours pressure on local doctors. And doctors providing after-hours services at least once a week or greater should be receiving an annual grant to support and encourage them to continue to provide after-hours services-such a grant would help compensate them for the rest time they need to take away from their practices the day immediately following a busy night on-call, and the lost practice income that entails.

"It is high time the NSW Government and NSW Health recognise that rural doctors and nurses are the stitches holding rural health services together in country NSW. Once they begin to fray, the whole system falls apart. Now is the time to invest in some running repairs, before that situation occurs."

Source:
Rural Doctors Association of NSW