Review of the National Rural Locum Program - Final Report - April 2011

Attachment 5: NRLP Survey Analysis

Page last updated: 04 July 2012

Introduction

An online survey addressed respondents’ awareness of and views about the National Rural Locum Program (NRLP), comprising:

  • SOLS — Specialist Obstetrician Locum Scheme
  • GPALS — General Practitioner Anaesthetist Locum Scheme
  • RGPLP — Rural General Practice Locum Program.

The survey consisted of a total of 25 questions, and was designed to gather information from both those who had participated in locum schemes (as locum or host), and those who had not.

The survey used a ‘skip logic’ function so that each respondent answered approximately 5 questions that specifically related to their situation.

It is important to note that the figures provided below in data breakdowns by question or demographic characteristics often do not tally with total number of responses. This can be because:

  • it was not compulsory for respondents to answer all questions
  • it was not compulsory for respondents to provide specific demographic information about themselves
  • multiple responses could be provided for a number of questions
  • not all respondents completed the survey.

Whilst the limited number of respondents in any one particular group means that statistically significant quantitative results cannot be drawn, the individual responses do provide a wealth of qualitative data.

A copy of the survey tool is at Attachment 9.

Summary

A total of 244 respondents started the NRLP survey. Of these, 230 specified their state of residence and role/specialty. Nearly 90% (219) completed the survey.

There were responses from both locums and hosts. Forty-four percent of respondents had either been a locum or enquired about becoming a locum. Twenty eight percent of respondents had either had a locum replace them or their staff, or had enquired about having a locum.

Analysis of the demographic characteristics of respondents by role/specialty, state and remoteness classification follows.

It should be noted that the low number of responses to many of the survey questions prevents reliable conclusions to be drawn in relation to the issue raised in those questions. In many cases, the results are no more than indicative for those questions.

Demographic characteristics

Role/specialty

Thirty-five respondents nominated some kind of anaesthetic specialty in their role description, either:

  • GP/Obstetrician and GP/Anaesthetist (11.4% or 4 respondents);
  • GP/Anaesthetist (74.3% or 26); or
  • Specialist Anaesthetist (14.3% or 5).

(No respondents described themselves as GP/Anaesthetists with another speciality.)

Ninety-one respondents nominated some kind of obstetric specialty in their role description, either:

  • GP/Obstetrician and GP/Anaesthetist (4.4% or 4 respondents);
  • GP/Obstetrician with other speciality (1.1% or 1 respondent);
  • GP/Obstetrician (53.8% or 49 respondents); or
  • Specialist Obstetrician (40.7% or 37 respondents).

Seventy-three respondents identified themselves as General Practitioners, with no specialty.

Forty respondents identified as ‘other’, including 11 practice managers and 3 health service managers.

State

Respondents from every state and territory participated in the survey, although numbers were low from the Northern Territory (1.3%), Australian Capital Territory (1.3%) and Tasmania (3.9%).

The majority of responses (67%) came from NSW, Victoria and Queensland.

Qld
NSW
ACT
Vic
Tas
SA
WA
NT
Response count
18.3% (42)
26.5% (61)
1.3% (3)
22.2% (51)
3.9% (9)
10.4% (24)
16.1% (37)
1.3% (3)
230

Table 1: Breakdown of survey respondents by state/territory

Remoteness classification

The Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system defines Remoteness Area (RA) categories in terms of ‘remoteness’ — the physical distance of a location from the nearest Urban Centre (access to goods and services) based on population size. 20

The categories are as follows:

RA1 - Major Cities of Australia
RA2 - Inner Regional Australia
RA3 - Outer Regional Australia
RA4 - Remote Australia
RA5 - Very Remote Australia

A breakdown of respondents by remoteness classification reveals nearly one third (31.8%) of survey participants were from remote and very remote RA classifications; with just over 4/10 (42.5%) from regional areas.

RA1
RA2
RA3
RA4
RA5
Don’t know/ not provided
Response count
8.8% (20)
18.6% (42)
23.9% (54)
12.8% (29)
19% (43)
16.8% (38)
226

Table 2: Breakdown of survey respondents by RA classification

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Awareness of locum programs and funding

General summary

Overall, a majority of respondents were aware of the existence of the three locum programs:

  • SOLS (75.0% or 165/220 respondents)
  • the RGPLP (72.2% or 161/223 respondents)
  • GPALS (62.0% or 132/213 respondents)

Similar proportions understood that the Australian Government funds SOLS, GPALS and the RGPLP (76.5%) and that financial subsidies are available to offset the cost of locums through these programs (73.5%). (Note that it is not clear from the data whether there were differences in awareness of funding source in relation to each of the three programs individually).

Approximately 13% of respondents took the opportunity to comment on a range of issues related to this question or the programs more generally. These included comments in relation to:

  • general quality/efficiency of the programs
    • ‘Great service.’
    • ‘Good schemes but coming off a small base, and not using visiting specialists to provide ongoing procedural education to rural GPs which limits it bang for bucks spent.’
  • adequacy of funding level
    • ‘The subsidies do NOT even come close to the prohibitive cost of employing locums.’
    • ‘The subsidies have proven not to be enough to offset locum costs, but they certainly help to ease the financial burden.’

Analysis by role/specialty

The degree of awareness of the three locum programs varied depending on the role/specialty of the respondent.

Anaesthetic specialties

More than 9 out of 10 (91.4%) of the 35 respondents in this group were aware of the existence of the General Practice Anaesthetists Locum Scheme (GPALS) and nearly as many knew of the RGPLP (80% or 28 respondents) and the Specialist Obstetrician Locum Scheme (SOLS) (75.8% or 25 respondents).

Most respondents with an anaesthetic specialty in their role description knew that the programs were funded by the Australian Government (77.1%) and that financial subsidies are available to offset the cost of locums through these programs (80%).

Obstetric specialties

Similarly, there was a very high level of awareness of the various locum programs within this group (91 respondents).

Almost all (95.6%) of this group were aware of the Specialist Obstetrician Locum Scheme (SOLS); and approximately 7 out of 10 knew of GPALS (71.1%) and the RGPLP (74.7%).

Significant numbers of respondents were also aware of the funding source for these programs (91%); and that financial subsidies are available to offset the cost of locums through these programs (85.6%).

General Practitioners

Awareness of the various locum programs appears to be generally lower among GPs who do not have a specialty. While approximately three quarters (74%) are aware of the RGPLP, only about half know of SOLS (55.4%) and GPALS (43.8%).

The percentage of GPs who are aware that the Australian Government funds these programs is also lower (63.4%), as is their knowledge that financial subsidies are available to offset the cost of locums through these programs (58.6%).

Practice managers and health service managers

As noted above, eleven practice managers responded to the survey, and 3 health service managers.

Practice managers were much more aware of the RGPLP (81.8%) than they were of SOLS (36.4%) or GPALS (also 36.4%). Most were aware of the funding source for the programs (72.7%) and the existence of financial subsidies (81.8%).

All three of the health service managers were aware of SOLS. Two knew of GPALS, and only one was aware of the RGPLP. All three were aware of the funding source for the programs and the existence of financial subsidies.

Analysis by state/territory

Some differences in awareness across states/territories were also evident, although there were relatively few respondents from ACT, Tasmania and the Northern Territory.

Across the remaining states, awareness of SOLS was uniformly high, as can be seen in the table below. Fewer respondents (approximately 6 out of 10) were aware of GPALS, though awareness was slightly higher in South Australia. This was also the case for the RGPLP. Over 70% knew of the funding source for the programs, and there were high levels of awareness in relation to the existence of financial subsidies.

Qld
NSW
ACT
Vic
Tas
SA
WA
NT
SOLS
70.7% (29)
71.9% (41)
100.0% (3)
77.6% (38)
75.0% (6)
82.6% (19)
70.6% (24)
100.0% (3)
GPALS
60.0% (24)
60.7% (34)
100.0% (3)
59.6% (28)
50.0% (4)
77.3% (17)
58.1% (18)
66.7% (2)
RGPLP
67.5% (27)
64.4% (38)
66.7% (2)
72.9% (35)
88.9% (8)
100.0% (23)
71.4% (25)
66.7% (2)
That the Australian Government funds these programs
75.6% (31)
70.5% (43)
100.0% (3)
84.0% (42)
75.0% (6)
87.5% (21)
71.4% (25)
66.7% (2)
That financial subsidies are available to offset the cost of locums through these programs
75.6% (31)
66.7% (40)
100.0% (3)
76.0% (38)
75.0% (6)
83.3% (20)
67.6% (23)
100.0% (3)

Table 3: Awareness of locum program and funding by state

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Analysis by RA classification

More than 6 out of 10 respondents across all RA classifications except major cities were aware of the three locum programs, the funding source for the programs, and the availability of subsidies. Knowledge of SOLS and the RGPLP was particularly high in RA 2–5 areas.

RA1
RA2
RA3
RA4
RA5
SOLS
40.0% (8)
75.0% (30)
76.0% (38)
77.8% (21)
79.5% (31)
GPALS
31.6% (6)
63.4% (26)
62.5% (30)
73.1% (19)
67.6% (25)
RGPLP
65.0% (13)
73.2% (30)
81.1% (43)
74.1% (20)
78.0% (32)
    That the Australian Government funds these programs
70.0% (14)
66.7% (28)
83.0% (44)
79.3% (23)
80.0% (32)
    That financial subsidies are available to offset the cost of locums through these programs
55.0% (11)
66.7% (28)
83.0% (44)
65.5% (19)
77.5% (31)
No. of respondents
20
42
54
29
43

Table 4: Awareness of locum programs and funding by RA classification

‘I have not had any dealings with a locum service’

General summary

Thirteen percent (33/244 respondents) have had no dealings with a locum service. Just over half of these (17) used internal staff to cover personnel on leave; while one third (11) cover leave periods by using their own personal contacts. Another 15% were not aware of any locum services that they could access. (Note: it is often not possible from the data for this question to determine which of the three programs participants are referring to.)

Other reasons provided for why respondents had had no dealings with locum services included:

  • ‘Work through RDWA and they haven't had locums to provide.’
  • ‘They are too expensive and paperwork burden is immense.’
  • ‘I use locum agencies not services such as SOLS.’

Respondents noted a number of difficulties with using internal staff or personal contacts to cover leave periods. These included:

  • cost of travel
    • ‘The problem is that the staff are located nearly 1800km away at a coastal based branch of our practice. We have been told we are ineligible to claim any subsidy to cover air fares!’
  • the challenges associated with covering long periods of time for training/professional development purposes:
    • ‘With reducing numbers of some proceduralists, we will need to look at locum cover, but we consider this to be very expensive and to be the hospital’s role, not ours’
    • ‘I need to be covered for 6 months next year so I can learn obstetrics. Any chance of someone covering that?’

Others had been able to tap into local or internal availability:

  • ‘We have enough workforce to cover holiday leave.’
  • ‘Was able to organise locum using previous employed doctor.’
  • ‘Currently excellent local locum availability.’
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Analysis by role/specialty

The data suggests that clinicians with an anaesthetic or obstetric specialty rely more heavily on their own networks to find locum cover than generalist GPs. Internal staff cover is the most common strategy across all role/specialty groups.

General practitioners
Anaesthetic specialties
Obstetric specialties
Health service manager
Practice manager
I manage leave myself, using my own contacts
62.5% (5)
50.0% (4)
100.0% (2)
I don't use a replacement
10% (1)
12.5% (1)
I am / we are not aware of any locum services
30% (3)
I / we can't afford a locum service
10% (1)
We use internal staff to cover staff on leave
50% (5)
50.0% (4)
50.0% (4)
50.0% (1)
No. of respondents
(Multiple responses could be provided.)

10
10
10
0
2

Table 5: Lack of dealings with a locum service by role/specialty

Analysis by state

The data implies that the two main reasons for not having had dealings with a locum service -‘I manage leave myself, using my own contacts’ and ‘We use internal staff to cover staff on leave’- are common across states/territories.

Qld
NSW
ACT
Vic
Tas
SA
WA
NT
I manage leave myself, using my own contacts
60% (3)
33.3% (4)
12.5% (1)
40% (2)
I don't use a replacement
12.5% (1)
20% (1)
I don't take leave
100% (1)
I am / we are not aware of any locum services
41.7% (5)
I / we can't afford a locum service
12.5% (1)
We use internal staff to cover staff on leave
20% (2)
41.7% (5)
87.5% (7)
100% (1)
40% (2)
No. of respondents (Multiple responses could be provided.)
5
12
0
8
1
1
5
0

Table 6: Lack of dealings with a locum service by state

Analysis by RA classification

The two main reasons for not having had dealings with a locum service - ‘I manage leave myself, using my own contacts’ and ‘We use internal staff to cover staff on leave’ - also appear to hold true across remoteness area classification.

RA1
RA2
RA3
RA4
RA5
I manage leave myself, using my own contacts
18.2% (2)
25% (2)
40% (2)
60% (3)
I don't use a replacement
18.2% (2)
I don't take leave
20% (1)
I am / we are not aware of any locum services
18.2% (2)
12.5%(1)
20% (1)
I / we can't afford a locum service
12.5% (1)
We use internal staff to cover staff on leave
100% (2)
63.6% (7)
50% (4)
40% (2)
20% (1)
No. of respondents
(Multiple responses could be provided.)
2
11
8
5
5

Table 7: Lack of dealings with a locum service by RA classification

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‘I enquired requesting a locum to replace me / my staff but did not proceed’

Locum services approached

Three respondents responded to this statement. The locum services approached were:

  1. SOLS
  2. Both RGPLP and Queensland Health
  3. Both RGPLP and Rural Workforce Agency

The respondents were:

  • a very remote Queensland practice manager (RA5)
  • a General Practitioner from an outer regional area of South Australia (RA3)
  • a Specialist Obstetrician from an inner regional area in Victoria (RA2).

Factors influencing decision not to proceed

The factors that most strongly influenced respondents in choosing not to proceed with a locum were as follows, in this order (multiple selections could be made):

  • the availability of a locum for the required dates
  • the availability of a locum with the right clinical skills
  • insufficient subsidy
  • too much paperwork.

http://www.health.gov.au/internet/otd/Publishing.nsf/Content/RA-intro