As we inch towards kick-off on the Central-West Orana Renewable Energy Zone (REZ), state government and local councils are considering the services Dubbo and surrounding towns need to accommodate the extra 5,000 workers. Alongside housing, roads, and waste management - healthcare is one of the key services being considered.
I head up a medical centre in Dubbo - the epicentre of the state's first REZ - and I'm worried that, if we don't stop talking and start acting, we'll have left our run too late to do anything meaningful on healthcare.
Dubbo's primary health system is already at crisis point. As I write this, dozens of residents are sitting at home wondering whether their headache/ rash/ sore knee is severe enough to justify a trip to the Base Hospital's Emergency Department.
They should see a GP, but they can't. Either they're new to town, or they're one of the lucky few who haven't needed a doctor until now. Regardless, every clinic across town is telling them the same thing: "We're sorry, but our books are closed to new patients."
That scenario is already playing out across Dubbo and the region. So imagine when we add the estimated 5,000 workers which the REZ is expected to bring - plus their families. It's not an overstatement to say that the health of everyone in our community is on the line.
It's not just a Dubbo problem. Australia-wide, we just don't have enough general practitioners. And it's expected to worsen over the next 5 to 10 years as our ageing population of GPs retire, and fewer medical graduates choose general practice in favour of specialty pathways that offer that same work: life balance - but pay far more.
A friend of mine called general practice "the sinking ship" of medicine. Harsh, but probably fair.
- It's more expensive than ever to run a clinic, as we battle skyrocketing power bills, rents, and interest rates alongside our community.
- The Medicare rebate hasn't kept pace with cost-of-living pressures (the pitiable 20c increase in last year's Federal "Health Budget" speaks to how undervalued our primary health carers are.)
- At $41.40 for a standard consultation, most GPs can't afford to bulk bill anymore. But the move to private billing is an agonising decision for regional GPs, especially: active members of their communities who entered the profession because they care about people, and now are faced with the reality of either denying care, or appearing greedy by asking patients - i.e. the people they'll see around town each day - to pay.
It's no wonder medical graduates aren't rushing to jump aboard. But unless we do something drastic to overhaul the system, the GP ship will end up at the bottom of the Macquarie River.
A well supported general practice is our greatest asset in keeping the population well. Generalism as a medical speciality treats a person's physical, mental, social, and cultural health and wellbeing across their lifespan. And it's well documented that proactive GP care keeps the community healthy, and healthcare costs low.
Snowy Hydro I taught decision-makers that future developments of that ilk must secure a primary health workforce to support the project workforce. And while it might be tempting to take the COVID-enabled telehealth route, 'walk in' virtual clinics won't cut it for developments the size of REZ.
We need tried and tested face-to-face care models: GPs who get to know the patient, their history, their family, and who create a safe space to discuss sensitive issues like drugs and alcohol, or mental health. Where continuity of care is important for continuity of employment.
I want to keep running a primary health clinic in the Dubbo community that I hold so dear. But I don't want to be the only one left. So how do we fix the problem?
Perversely, I think the biggest threat to our already stretched healthcare system could also be its biggest saviour. REZ is a once in a generation opportunity to bring together government, industry, and the community to trial innovative solutions that overhaul primary care in the region.
It might mean incentivising doctors to move from the city, trialling funding models that make the generalism pathway attractive to new doctors or shifting the language around general practice so it's less, "sinking ship" and more, "cornerstone care."
Developments the size of REZ can act as a test case for decision-makers brave enough to stop tinkering around the edges, and deliver transformative solutions at scale.
We've got bright minds and bold ideas in our regions. The time to start engaging them is now.
- Tanya Forster is a registered psychologist and Director of Macquarie Health Collective, Dubbo
