Royal Flying Doctor Service report calls for better primary health care in rural and remote Australia

When Jareth Forrester’s three-year-old, Esme, started throwing up and had trouble staying awake, she made the hour-and-a-half trip to the Meekatharra Hospital to treat a suspected concussion. Once there, Ms Forrester said the medical staff were worried they could not treat her daughter, and they recommended that both be air-lifted to Perth via the Royal Flying Doctor Service. This resulted in two nights spent in Perth 900km away from their Mid West home. By the time they reached the Perth Children’s Hospital, Esme turned out to be fine, but Ms Forrester said the condition was hard to assess in Meekatharra. “If Esme regressed again from the head injuries, they (the Meekatharra Hospital) had nothing to help her at all,” she said. The RFDS’ Best For The Bush Rural And Remote Health Baseline 2023 report has shown the rapidly growing number of aeromedical retrievals in recent years. It has linked the cause to rural residents relying on emergency services in the place of absent or under-resourced primary health care in their local areas. The RFDS conducted 36,937 aeromedical retrievals in 2022-2023 — equivalent to 101 retrievals per day, or four per hour, according to the report. The report made recommendations to establish better financial and staffing support for rural and remote healthcare to alleviate pressures on the RFDS’ emergency services, as well as to establish an agreed definition of “reasonable access” to primary healthcare services in the bush. Another major issue raised was the high number of rural and remote people who died from potentially preventable deaths because they did not seek treatment sooner. Ms Forrester, who lives on Yarlarweelor Station with her family, said many rural people put off seeking medical help because they did not want to make the trip to Perth, which could be time-consuming and costly, especially for people who managed properties. “You feel like you can’t leave because you’ve got so many responsibilities,” she said. RFDS executive director Frank Quinlan said this problem very often led to people delaying help until it was too late, resulting in preventable emergency hospitalisations for illnesses left too long. “We need to be much more focused on preventing illness and identifying it early so people don’t end up moving outside of (primary care) into the emergency evacuation side of the service,” he said. “In the populations that we looked at, rural people were up to three times more likely than their city counterparts to be in hospital for illnesses that were preventable.” Mr Quinlan said this problem could be fixed by increasing funding for rural primary health care, as well as increasing awareness to seek medical help straight away. Ms Forrester said it was off-putting not knowing if the nearest hospital would be able to treat her or her children because of the funding issue many rural medical centres were facing. “A lot of things here just come down to the cost,” she said. CALLS FOR FUNDING MODEL OVERHAUL AND “BIGGER-PICTURE THINKING” Rural Doctors Association of Australia CEO Peta Rutherford said there needed to be a new and improved funding model for rural and remote practices. “At the moment, a lot of our members indicate the fee-for-service model in its current state is actually no longer fit for purpose for rural and remote general practice,” she said. “(We need) bigger-picture thinking that sets rural and remote general practice up for the future.” Under the fee-for-service Medicare model, government or insurance companies pay healthcare providers for services provided, which alleviates cost pressures for patients. But, according to Ms Rutherford, it can also mean funding for health services is inconsistent and not reaching the grassroots across the bush. The distribution of Medicare across Australia has been a hot topic among researchers and rural medical associations, and has sparked calls from the National Rural Health Alliance for place-based investment to rural and remote services as opposed to the current model. Ms Rutherford said while more funding was important, it had to come with a new system to provide the collaboration between the State and Commonwealth to ensure rural communities got the “total benefit” of adequate primary health care. The Best For The Bush report recommended a national compact for rural and remote health, an agreement between States and Territories and the Australian Government to oversee health services and commit necessary funding. “We need some sort of agreement together on . . . what is a reasonable expectation of those living in the Australian bush, and what can they reasonably expect to get from the health system in terms of primary health and preventive activities in particular,” Mr Quinlan said.