Australia Avoca fought hard to keep medical services in town, but now it's facing another GP shortage
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Less than a decade ago, a rural community in western Victoria fought to keep a medical centre in town, but now it is a case of deja vu with a sudden shortage of general practitioners.
Until a few weeks ago, three doctors worked out of the one full-time clinic in Avoca, a few hours north-west of Melbourne.
Now it is down to just one, and the remaining GP is only available for face-to-face appointments one day each week.
The ABC understands the change at Tristar Medical Group occurred in the past few weeks.
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The one mental health social worker in town, Melissa Murdoch, said the information provided to the community and other health professionals about the change had been limited.
Ms Murdoch said there had been confusion around what was happening with doctors appointments being cancelled.
"People have the right to know what's happening with their care … what's happening with a major service," she said.
"What seems to be happening is that the community are trying to piece things together by talking to each other and sharing stories of appointments being cancelled."
It is understood that until recently a second doctor was available for in-person appointments at Tristar Medical four days a week.
A third doctor, under his supervision, had provided face-to-face appointments three days a week.
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Taren Gill, who owns a pharmacy that has an outlet in Avoca, said a number of customers had come to her with concerns about how they would access prescriptions.
"Our first heads up was actually a patient query … asking us if we knew what was going on, and to be frank we didn't," she said.
Ms Gill's main pharmacy is in Maryborough, nearly half an hour a way, and she said people were anxious about finding a new clinic.
"Some of them were worried trying to find themselves a new GP and finding all the Maryborough GPs have their books full," she said.
Tristar Medical Group runs 31 clinics across Australia and in a statement said it was busy actively recruiting for a GP.
"[Tristar] remain committed to providing services to the community of Avoca and are focussed on changing the current circumstances quickly," the statement read.
Clinic made 'a hell of a difference'
A shortage of GPs in a rural area is a story regularly told, and for the Avoca community it is one it has dealt with before.
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Ron Eason owns the newsagent in town and is a councillor with the Pyrenees Shire.
He said a number of people had approached him about the issue over the last few weeks.
Cr Eason was part of a group in the community who fought for a new medical practice to be established after the Nightingale clinic reduced its services to two half days per week.
"A number of years ago, five or six years ago, we were having these problems and the town got together as a community and sourced Tristar Medical Group," he said.
The community found a clinic space for them in town and raised around $40,000 for its upgrades.
"It made a hell of a difference to the town," Mr Eason said.
"We started to attract people from other towns to come here because other towns were having problems, but Avoca went out of its way to do something about it.
"Now we seem to be falling back into that issue."
Pharmacist Ms Gill said it was vital for towns like Avoca to have the health services to treat its community and the surrounding Pyrenees Shire.
"For lots of those things, that could be a really, really big deal and have flow on effects to people's co-morbidities and just reduce their overall quality of life and health," she said.
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Ms Gill said people were also presenting to pharmacies for health issues that were not in the scope of their practice.
Effects on mental health
Ms Murdoch said she was concerned it would become more difficult for people in the region to access mental health care plans.
She said the lack of GPs would also make it difficult for her to give feedback to the referring doctor.
"If I see a client, and there's some health concerns, or some mental health concerns, that need addressing with medication or a doctor's input, then I'm not sure who I refer back to," she said.
"Obviously, I'll refer back to the clinic, but who takes care of that?"
Ms Murdoch said 95 per cent of her clients were on mental health plans funded under Medicare.
"The community is quite reliant on the GPs, for one, identifying mental health and two, making referrals so they can get support," she said.
She said clients were dealing with a range of limitations of accessing health care already, with limited transport options to nearby towns.
Reduction in rural doctors
Rural Doctors Association of Australia president-elect Megan Belot said the availability of GPs in regional areas was an ongoing issue across Australia.
"GPs are finding it hard to either maintain numbers or recruit new doctors," she said.
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Dr Belot said there would have been a reduction in international doctors coming to Australia due to the pandemic and issues with visas, leading to flow-on effects in rural communities.
She said while there had been a push for doctors training in Australia to work regionally, there had been a drop in the number of junior doctors wanting to start their GP training.
"Over the last two to three years I'd say practices have struggled to get GP registrars," she said.
"The main issues around that are the flexibility of training. It's very much regimented in how many minimum hours you have to do per week with your training and there's only so many times you can have maternity leave as well," she said.
"There's a significant reduction in not only pay [in GP training] but also in entitlements, so a lot of junior doctors are looking to stay in the hospital system while having their families."
Dr Belot said single GP practices were no longer viable in regional areas.
"There needs to be at least two GPs working together to support each other and provide an ongoing service to their community," she said.
"What we find is that a lot of our rural doctors are also doing on-call commitments to the local hospital, so to be that one doctor … is a really massive ask."
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