Liam Cormican is a journalism graduate who has taken up employment at the South Coast Register. This is part three of a series called Living Regionally.
The federal government's $4.6 million 'Move to More' regional immigration campaign misses the mark with health system considerations such as the need for more regional GPs.
Regional Australia Institute, the think-tank which created the awareness campaign, has released a 'toolkit' to help regional communities "capitalise" on population growth.
The toolkit is a 42-page report about the think tank's research to go alongside the 'move to more' campaign's launch.
The report seems to suggest young families can make do with a GP and pharmacist, ignoring the maternity services, mental health and drug and alcohol services that would need to be addressed for regional community expansion.
GP practices are the "canary in the goldmine" when it comes to a choked health care system, according to Dr Vicki McCartney, GP Principal at Moss Street Medical Practice and the newly opened Cottage Medical in Berry.
"It doesn't take much to overwhelm the medical system and we have to keep up because right now it's at all levels. If we start to become overwhelmed, we know the hospitals are going to be also backed up with patients," she said.
Areas in need of more general practitioners are Berry, Gerringong, Robertson, Kangaroo Valley, Sussex Inlet, Ulladulla and areas west of Burrier, according to the NSW Department of Health's Distribution Priority Area classifications.
Dr McCartney also sits on the board of COORDINAIRE , which is the South Eastern NSW Primary Health Network (PHN) so she has "a slightly more overview of health" because she deals with both primary health (general practitioners) and the public health system.
COORDINAIRE covers an area of 50,000km and is one of 31 PHNs established across Australia by the Department of Health. Its objectives are to support GPs, nurses and allied health practitioners improve patient care and improve coordination between different parts of the health system.
With the sort of growth of population occurring in Berry and along other parts of the coastal villages, "we are going to run out of GPs quite quickly", said Dr McCartney.
"For many practices there are a lot of GPs who are over the ages of 50 and 60 and there is going to be a real need to support that next group of GPs coming through.
"At the present time there has been a lot of good effort by local practices to be ahead of the game but it doesn't take much to find that you're overwhelmed."
She said her network of practices was well positioned to deal with increased demand in the short term having just opened a new practice in Berry.
"[Our practices] are in a little bit of a different situation because having recognised that there was a growing population and a need for more medical services, we went looking about two years ago into where we could set up a second practice.
The Cottage Medical practice in Berry opened on February 1 this year.
"Our ability to receive patients and have accessibility is actually extremely good at the moment but we know from past history that it doesn't take long to find you have filled your books."
She said other considerations like housing and public health needed to be addressed with the federal government's 'move to more' regional immigration campaign.
"We know if we don't provide housing and support for people, and opportunities for jobs, then that group of people will suffer with higher levels of chronic disease and other illnesses like mental health and drug and alcohol addiction," she said.
"Those services are often very easily overrun. We know that with psychological services. They are really pressured with space to deal with people.
"You can create a real second class if you don't have the appropriate social housing and certainly Nowra has a history of having quite a large social housing cohort."
She said GP practices benefit from being nimble small businesses who can better adapt to changes in population growth compared to other areas of the health system like hospitals.
"It's a slower process for community and public hospitals to adapt and in the Shoalhaven, we're well behind having adequate services if we had a significant move of population to our region.
"In my point of view, as one of many practices in town, most of the local practices have done a great job of adapting and accommodating the increased population. And you know we're not particularly the best or anything, we are just one of many that are doing a great job.
She said although overall there is a growing population of GPs, there is a benefit to having the University of Wollongong's medical school nearby because it has meant there has been an increased interest of people wanting to move back to the Shoalhaven as medical practitioners.
"The hard work of it is that many of us as GPs are training the next cohort of GP specialists as well as the medical students.
"I think we have to be grateful for a large cohort of GPs who have put a lot of time and energy into the training of new GPs.
"If you train them locally, they often want to stay locally and that's what we've seen in the last 10 years," she said.
She said councils have archaic rules and regulations around size of practices and availability of parking which limits the number of practitioners you can have.
"It's set up when GP practices had a single doctor who just plowed through patients.
"We just don't do that anymore because we've got such complex patients and we see them for longer.
She said although the throughput (the rate at which patients can be processed) was much less due to telehealth, the requirements of parking were still high.
Gail Lloyd, practice manager at Junction Street Medical Centre in Nowra, said you won't hear a lot of complaining from practices nearby as regions further south and inland are doing it tougher.
"There are never enough GPs but our region is much better off than places further south or inland, so you won't hear a lot of complaining. If people keep coming in the numbers they seem to be currently this will become a much larger problem," she said.
"I have worked in this practice for almost 24 years and have watched there be a lot of new practices and much bigger practices so we have a lot more capacity to see people. General Practice has changed an enormous amount and we've had to adapt and do things differently to cope with demand."
Fifteen local practices were called in relation to this story with most unwilling to comment. One receptionist said off the record that they were having to turn people away because of a shortage of doctors.