The National Minimum Data Set
As part of their arrangement with the Department of Health and Ageing (DoHA), RHWA, through the Rural Workforce Agencies (RWAs) in all states and the Northern Territory collects and compiles a National Minimum Data Set for RRMA 4 to 7 locations in relation to the rural and remote general practice workforce.
In order to provide context for this report, a summary of the latest data report is provided below with more detailed data provided at Attachment 4.
GP and Specialist demographics
According to the Medical Practice in Rural and Remote Australia: National Minimum Data Set 30 November 2009, the number of medical practitioners practising in RRMA 4 to 7 locations has been steadily increasing since 2002.
Rural and remote communities generally have a relatively low ratio of General Practitioners (GPs) proportional to their population. National figures for GPs Full Time Equivalent (FTE) per 100,000 population range from 97.0 in major cities to 47.1 in very remote regions.
Overall numbers of practitioners working in RRMA 4 -7 locations (now ASGC-RA 2 to 5) have been steadily increasing since 2002 and as at 30 November 2009 there were 4753 practitioners, which represents an increase of 71 practitioners from the previous year.
NSW has the largest number of practitioners overall (1303) and RA 2 is the location with the largest number of practitioners (2662).
Rural and remote communities generally have a relatively low ratio of specialist medical practitioners proportional to their population with major cities having 122 FTE per 100,000 population, compared with remote/very remote at 16 FTE.
Numbers and targets for locum placement
The provision of support for the rural workforce through access to locum services is known to be a factor in influencing recruitment and retention. 2 3 One of the aims of this review to identify whether the number and targets for locum placement under the NRLP is appropriate.
Although the number of GPs continues to grow, the Rural Doctors Association of Australia (RDAA) state that this growth does not indicate increased availability of GPs over time, as the growth in the medical workforce has not kept pace with the rate of population growth. 4 The RDAA has calculated that rural Australia is short at least 1800 doctors. The data shows that there are 4753 medical practitioners practising in RRMA 4 to 7 locations (4559 in RA 2 to 5 locations) as at 30 November 2009. This means that there are 4559 practitioners who potentially require locum relief support.
Only Victoria and Tasmania recorded an overall drop in practitioners, with these states recording a loss of 17 and 9 practitioners respectively.
In relation to the RRMA categories, the most significant increase occurred in RRMA 7 where 24 more practitioners were noted. Most of this increase in RRMA 7 occurred in the Northern Territory and Queensland. In NSW RRMA 4 also recorded an increase of 21 practitioners.
Of the total number of practitioners, 556 or 12.1% are solo GP practices, which is a criterion for priority locum relief support. However, it is important to note that over 462 of these solo GP practices are in RRMA 4 and 5 areas so this does not necessarily mean that they are the sole GP practice in the town/location.
The data shows that the number of solo GP practices is decreasing steadily with 56 less reported in 2009 than 2008. However, the number of GPs working in group practices remained steady.
The number and proportion of known GP proceduralists5 is falling steadily, according to the data. The number of GPs practising in at least one procedural field has fallen by 72 from 934 in 2008, to 862 in 2009. The most significant drops were seen in South Australia and Victoria, which recorded losses of 23 and 22 practitioners respectively. Northern Territory dropped from 13 to 5 practitioners. NSW was the only jurisdiction which remained steady.
In relation to the RRMA categories, the most significant drop was seen in RRMA 5 which lost 51 known proceduralists. RRMA 6 and 7 remained relatively steady.
The total number of proceduralist GPs undertaking anaesthetics fell from 488 in 2008, to 438 in 2009. The largest drops were seen in Victoria and South Australia with losses of 34 and 13 practitioners respectively. NSW was the only jurisdiction where an increase of 6 practitioners was noted.
Of the total 438 known anaesthetic practitioners, 248 of these also undertake other procedures in either obstetrics and/or surgery.
Over four hundred (412) GP anaesthetists (GPAs) work in group practice but it is unknown if they work with other proceduralists who may be able to provide locum cover for them. It is known that 22 GPAs work in solo GP practices and that 66 GPAs work in group practices in RRMA 6 and 7 locations, which makes it likely they are solo proceduralists in the practice and town.
The number of GP anaesthetists/obstetricians/surgeons is an important factor when considering locum relief with the appropriate skill mix.
The number and proportion of known GP proceduralists undertaking obstetrics has fallen by 40 (from 623 in 2008, to 583 in 2009). The largest drop was noted in South Australia with a loss of 21 practitioners. Significantly for a small jurisdiction, the Northern Territory recorded a loss of 6 practitioners, falling to just 3.
Of the total 583 obstetrics practitioners, 322 of these also undertake other procedures in either anaesthetics and/or surgery.
One hundred and fourteen obstetrics practitioners work in RRMA 6 and 7 locations, making it likely that they are solo proceduralists in the practice and town.
The number of known GP proceduralists undertaking surgery has fallen by 24 from 282 in 2008, to 258 in 2009. The largest drop was noted in Victoria with a loss of 18 practitioners. Northern Territory recorded a loss of 5 practitioners, falling to just 2. Of the total of 258 surgery practitioners, 184 of these also undertake other procedures in either anaesthetics and/or obstetrics.
The number and proportion of GP proceduralists with multiple procedural specialties (obstetrics and/or anaesthetics and/or surgery) has fallen by 23 from 360 in 2008, to 337 in 2009.
2. Ian Cameron, Retaining a medical workforce in rural Australia, MJA 1998; 169: 293-294.
3. Australian Primary Health Care Research Institute Retention Strategies & Incentives for Health Workers In Rural & Remote Areas: What Works? November 2009.
4. RDAA Factsheet 1/2010 The medical workforce shortage in rural and remote Australia: The Facts.
5. Refers to non-specialist practitioners providing procedural services such as obstetrics, anaesthetics or surgery.