Rural and regional GPs in SA are resisting health funders’ attempts to standardise after-hours agreements, saying it will force them to work long, unsafe hours.
Under new contracts, Country Health SA is providing funding to regional GP clinics in exchange for guarantees they will provide formal after-hours services in country hospitals.
At the moment, after-hours services in some areas are partly staffed by locums - an arrangement that some GPs are pushing for to continue.
Among them are Kangaroo Island GPs, who provide a 24-hour on-call service but have had a locum provide relief for one week a month.
Under the new contract, that locum relief would end.
RDASA president Dr Tim Wood said while his organisation generally supported the removal of “sweetheart deals”, the current Kangaroo Island contract was what made the on-call emergency service sustainable.
“Part of [rural doctors’] work is to staff country hospitals after hours. But with Kangaroo Island, it is an island and we think that does have specific needs.
“That [locum] service has been working and we would want it to continue.”
Other doctors holding out against the new contracts include more than 30 GPs in Victor Harbor, an outer-regional area.
They say the new contract could see them working on-call for 36 hours straight.
Currently, GPs in the town provide informal 24-hour on-call obstetric and anaesthetic cover, as well as day-time emergency medicine services at South Coast District Hospital.
A locum currently works the overnight shift in the emergency department, where presentations have doubled in a decade.
However, Country Health SA wants GPs to take on the overnight emergency shift and formalise the obstetric and anaesthetic overnight cover.
It has offered the clinics $450,000 between them to fund the on-call and after-hours rosters.
GPs will lose their hospital visiting rights unless they sign the new agreement by 30 November.
Dr David Batt, a GP at Victor Medical Centre, said the new system was “simply unworkable”.
“In some cases it will mean we will be working for 36 straight hours and that’s just dangerous for the patients and the doctors.”
AMA SA president Dr Peter Sharley said the agreement was unsustainable and the organisation was negotiating on the GPs’ behalf.
However, Dr Wood said the current arrangement was “ad hoc” and it was fair for CHSA to demand a formal arrangement.
Adjunct Professor Belinda Moyes, Country Health SA chief executive, said the new agreement would bring after-hours services in Victor Harbor in line with the rest of the state.
“If the Victor Harbor GPs decide not to sign the new agreement, other options for providing this service will be explored,” she said.