Patient aggression is by no means an unknown phenomenon for the staff at Mount Gambier’s Village Medical Centre.
 
For practice manager Jessica Bilal, the occasional hostile response is almost an inevitable part of working in healthcare ‘because we are dealing with people who aren’t necessarily at their best’.
 
‘It doesn’t mean that it’s okay, but it does happen,’ she told newsGP.
 
However, in the past 12 months, she has seen the situation worsen at the rural South Australian clinic.
 
According to the ABC, since an urgent care clinic (UCC) based in the city closed in June, all of Mount Gambier’s clinics have closed their books to new patients, with another one-GP practice also shutting its doors temporarily.
 
That has caused abuse to intensify, according to Ms Bilal, who has said there have been up to 15 incidents in a single day.
 
‘We have noticed since GP clinics in the region have closed their books that it has exacerbated the situation,’ she said.
 
‘This is obviously because people are quite distressed and they don’t know what to do, and we’re struggling to give them answers as well.’
 
Last week, the clinic posted on social media saying GPs could not take any new patients, and provided a list of alternative telehealth services.
 
It stated it had a patient base of more than 12,000 and requested ‘understanding and compassion’ as it noted a recent increase in abuse and aggression.

‘If we could accommodate more patients, we absolutely would,’ Ms Bilal said.
 
‘That’s what the GP is there to do, to service the community, but unfortunately our GPs are completely maxed out in terms of patients.
 
‘There is that distress when patients are presenting at the clinic on some occasions. They are quite upset and turning them away is very difficult, especially for our reception staff.
 
‘Everybody’s just quite stressed.’


Staff at the Village Medical Centre, including from left to right: Jess Wilkinson, Samantha Sellars, Jessica Bilal and Madi Revill.

Ms Bilal says the situation goes well beyond Mount Gambier and has affected the broader Limestone Coast region as well as spilling over the nearby Victorian border.
 
A wider issue
RACGP Rural Chair Associate Professor Michael Clements says the issues are present in other areas around the country where GPs are in short supply.
 
‘One of the things that struck me about the Mount Gambier shortage is that this is common,’ he told newsGP.  
 
‘We’re hearing this more and more of practices that are looking after small areas having to turn away new patients because they need to make sure that they can continue to look after their existing patients and provide adequate care.
 
‘This is a natural thing that happens when systems and services are stretched.
 
‘It is horrible for the doctors, and the medical teams hate turning people away. Everybody went into health because we want to help people and it’s very sad that this is a consequence of systemic underfunding.’
 
For Associate Professor Clements, the closure of the UCC – which opened in November 2023 before closing its doors in June this year – is likely to have played a significant part.
 
He queried whether the funding would have been better directed to support general practices.
 
‘It’s a market distortion, and so by putting in that town a single clinic with all of this extra funding, it diverts funding, resources, energy, time, and patients to that site, which means it becomes even more pivotal and important,’ he said.

‘And so when it fails … it actually puts the community more at risk.
 
‘This is probably not going to be the last time we hear of a town that became reliant on a UCC which falls over.’
 
Meanwhile Ms Bilal is naturally concerned about the impact on the reception staff.
 
‘They are on the frontline and [catch] the brunt of the abuse from people coming into the clinic and it definitely affects their mental health,’ she said.
 
However, she also has wider concerns about the implications for care, with the clinic directing would-be patients elsewhere.
 
‘It’s essentially referring them to the telehealth services, which not everybody is comfortable using or they may not be able to access for whatever reason, so it’s really just a band aid, it’s not a solution,’ she said.
 
She believes many factors are at play, meaning there is no easy answer. This includes the strain caused by Mount Gambier’s growing population, as well as enticing and retaining GPs in a regional area with infrastructure strains, including housing shortages.
 
‘It’s not necessarily recruiting GPs that’s an issue,’ Ms Bilal said. ‘We’ve actually got GPs waiting to join us, but we have exhausted our space.’
 
While she would like to see more consultation with regional GPs and clinics to find out what is needed and has contacted members of parliament at different levels of politics over the past 12 months, she says ‘everyone’s kind of just scratching their heads’.
 
‘When it gets to the state level, they’re saying it’s federal and it’s backwards and forwards, so nobody’s really taking accountability,’ she said.
 
‘This isn’t a new thing. It’s been brewing for quite some time, but unfortunately we have arrived at a crisis point.
 
‘We all hate calling it that but that is essentially what it is.
 
‘When you’ve got people in the community who can’t access primary healthcare and they’re ending up at the local emergency department to fill a script, that is quite problematic.’
 
For Associate Professor Clements, politicians placing blame elsewhere is unacceptable. He points to improvements in other areas where communities have previously struggled to access general practice, including a single-employer model brought into place in the Riverland area of South Australia.
 
‘For South Australian politicians saying “it’s somebody else’s responsibility” is ignoring what’s going on in the other states and territories where governments are just rolling up their sleeves – they’re not pointing the finger anymore,’ he said.

‘They’re just getting in and fixing the problems because as we know if the State Government doesn’t invest money into supporting primary care, then it’s just going to end up paying more money to fix them once the patients are broken.’
 
He believes there are incentives and solutions that could work, and having previously visited Mount Gambier, he sees no reason for that city to be any different.
 
‘Many communities are getting doctors for the first time in years,’ he said. ‘We’ve got more trainees than ever looking for positions in rural towns from next year. This is not an insolvable problem.
 
‘This is not a fait accompli, this is not a problem where the solution is going to be trying to bring in more pharmacies.

‘There are solutions – with the right funding and with the right State Government and local council involvement, working hand in hand with the stakeholders, we can solve this.’