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Regionally based private ophthalmologists in NSW under increasing pressure – RANZCO

RANZCO has highlighted the intensifying pressure on regionally based private ophthalmologists in NSW – potentially sending some into early retirement – due to a lack of state government funding for outpatient services in most communities.

On Friday 3 December, the college lodged a submission to the NSW Government parliamentary inquiry into health outcomes and access to health and hospital services in rural, regional and remote New South Wales. RANZCO is advocating for better service provision for people living in these areas.

In its submission, the college stated NSW Health provided minimal public eye clinic services in regional NSW, despite being eligible for public hospital funding. This means patients are more likely to have delayed treatment, travel for treatment, and prolonged poor vision before accessing care. In some instances, some may have permanent vision impairment or loss as a result.

“The capacity of publicly funded ophthalmology services across NSW has stagnated, resulting in increasing inequity of access to these vital services. The long-term consequences for workforce stability, and therefore patient access to services, is of great concern,” RANZCO stated.

The submission points out the current model of ophthalmology care in regional NSW does not allow for access to public ophthalmology outpatient services because NSW Health does not routinely fund outpatient services in regional NSW. There are some exceptions such as in Dubbo and Broken Hill that both have public clinics and no resident ophthalmologists. Services in these areas are supplied by regular outreach.

As a result, the burden of supplying outpatient services in regional NSW largely falls upon regionally based private ophthalmology practices.

Many regional private practices generally provide for the entire community – often bulk-billing patients that can’t afford to pay a gap. The onus is on the patient to disclose a financial need for bulk-billing, and in some cases this comes at significant cost to the practice. Many services, such as intravitreal injections and the ongoing treatment of established glaucoma, are provided regularly to patients with chronic ophthalmic conditions and without these services, irreversible loss of vision could occur.

A/Prof Ashish Agar.

Regionally based ophthalmologists in NSW are typically working under severe workforce pressure with many significantly fewer ophthalmologists per 100,000 people than their city counterparts, RANZCO stated.

With increasing workforce pressure regionally, an ageing regional workforce, an ageing population and ongoing population growth regionally, the college is concerned regionally based private ophthalmologists are under increasing pressure and this may result in some being forced into early retirement if their workload became unsustainable.

To address this, the RANZCO has called on the NSW Government to:

  • Mandate eye outpatient delivery in all districts with public reporting of waitlist data
  • Develop a centrally administered e-referral portal
  • Develop KPIs and increase funding for public ophthalmology workforce
  • Invest and support the RANZCO Regionally Enhanced Training Network, which has federal funding
  • Establish an agency of telehealth, in-reach and outreach services to support the regional workforce
  • Fund equitable delivery of cataract surgery across NSW that meets community demand
  • Fund established NSW ophthalmology outreach services
  • Urgently implement Indigeneity as a comorbidity for wait list categorisation purposes.

Associate Professor Ashish Agar, director of ophthalmology in Broken Hill and part of the Outback Eye Service, said this was an opportunity to fix the system that the sector cannot afford to miss.

“We’ve been advocating about these issues for ages, but hopefully this time government will engage with us to make real progress,” he said.

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