Rural GP agreement gridlock dragging on

The previous SA Rural Medical Fee Agreement expired on November 30 last year, with the Australian Medical Association SA and Rural Doctors Association of SA submitting a joint proposal to RSS for a new agreement in March. The proposed changes were rejected by RSS in July, on the grounds that the proposal was "unrealistic based on local health network budgets".

RSS released a revised offer on Wednesday last week, with RSS chief clinical adviser Hendrika Meyer saying the amendments were another step forward in the negotiation process.

"We are working towards an agreement that is sustainable across the whole of regional SA, recognising the equal contribution and benefiting all rural doctors," Dr Meyer said.

"We have carefully considered the points put forward by the AMASA and RDASA and have been able to incorporate a large number of their requests into our revised offer.

"We have made increases to the payments for GPs in this offer, with an overall increase of roughly 10 per cent across the whole agreement."

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But RDASA and AMASA representatives remain unsatisfied with the updated version, saying the agreement still doesn't put rural GPs on a level playing field with their city counterparts.

RDASA president and Murray Bridge GP Peter Rischbieth said the offer did not take into account suggested big-picture strategies surrounding adequate remuneration, conditions and professional development support to attract and retain rural GPs.

"The rate for working in rural hospitals is still below what GPs would get if they were working in a metro hospital, so how are we going to recruit people if the offer isn't as much as what metro GPs get?" Dr Rischbieth said.

He said some of the changes in the amended agreement - such as a sessional rate involving an all-inclusive fee for a 24-hour period when doctors were offsite but on-call - were being over-emphasised.

"There are only a few hospitals, for example the bigger obstetric and maternity hospitals and those that give anaesthetic, where the 24-hour session is applicable, so by championing that, it's exaggerating the offering seeing as it only applies to a small number of health units," he said.

Other inclusions in the amended agreement, such as a $190 per hour payment for contracted rural GPs attending regional LHN-initiated meetings, were not necessarily positives, according to Dr Rischbieth.

"Currently, the rate is $243/hr to take part in those meetings, so the rate has dropped - doctors won't be encouraged to be involved in important things if rates are dropping by $50," he said.

"Those who are involved in the system understand that with some of these offers, we're going backwards, even if they are touted as positive things."

AMASA president Michelle Atchison said the agreement needed to ensure equality between country and metro GPs, as well as equality between rural LHNs.

"We have considerable concern that if the agreement as it stands was to go through, we will end up with different LHNs bargaining with their local doctors," she said.

"Some LHNs could end up with better agreements than others, and could attempt to poach doctors from others, making shortages even more acute, and demoralising country GPs even further.

"In the end, there needs to be more money available from the government to pay rural doctors working in our hospitals. At the moment, that money isn't available, which is why the process is bogged down, so we need to see if the treasury will release more money, so what GPs deserve can be funded."

Dr Rischbieth and Dr Atchison met with Health Minister Stephen Wade today (Thursday) to discuss the latest amendments to the SA Rural Medical Fee Agreement.

Dr Rischbieth said SA was behind other states in terms of providing fair working conditions and remuneration for rural GPs, and a meeting with the minister to help rectify the situation was vital.

"Successive governments haven't recognised that we are losing doctors to other states," he said.

"We have already lost many but we are going to lose more if we aren't able to retain people or attract them to come and work for us.

"This is a scenario which has been going for 12-15 years. We need to sort this so we can get new doctors to join us in rural SA."

* More to come in next week's Stock Journal *