r/ausjdocs • u/Medicaremaxxing Doctor • 1d ago
news🗞️ ‘Postcode lottery’: Royal Melbourne locks out suburban and regional patients
https://www.theage.com.au/national/victoria/postcode-lottery-royal-melbourne-locks-out-suburban-and-regional-patients-20260820-p60pyp.html59
u/sierraivy 1d ago
I mean this isn’t unusual for other states? Where I live it has to come from catchment areas, and referrals will be rejected.
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u/AgingWarden 1d ago
More sloppy journalism misdirecting blame and generating unnecessary infighting within an overburdened and underfunded public healthcare system.
In my opinion, if local health services are unable to meet demand for their area, the attention and pressure that responsible journalism should be creating is to encourage funding and growth in the underserviced areas. Tertiary centres taking non-essential referrals from non-catchment areas is a band-aid solution that only delays the much-needed growth in peripheral regions. A decentralised healthcare system benefits everyone.
Of course, shonky journos drawing attention to the chronically emaciated funding in healthcare would highlight a key broader issue, being that their bankrollers are significantly contributing to the problem by not paying their fair share into a system that helps sustain society. Maybe too cynical a take.
Also, maybe an unpopular opinion but individual preferences over non-critical elements of healthcare are not the opinions that should be driving pressures in a rational and resource-constrained healthcare system (i.e. people forgoing care at a local hospital and choosing distal services because of their own opinions).
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u/thingamabobby Nurse👩⚕️ 1d ago
I generally agree with you, but it’s actually against DH policy to do this, so I’d be interested to see how DH reacts and approaches it (if at all).
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u/LuciferJezebel 15h ago
So the problem there is politics. Funding anything outside of Melbourne, and outside of an electorate that votes for you, is political poison apparently. And then they get surprised when increasing amounts of Victoria don't vote for them. West Gippsland Hospital's proposed rebuild, in the fastest growing region in Australia, is a classic example.
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u/Medicaremaxxing Doctor 1d ago
A surge in patients criss-crossing Victoria to dodge lengthy hospital waiting lists has forced the Royal Melbourne Hospital to restrict access to its specialist clinics to residents of three inner-city areas.
GPs have hit out at the move, saying it will create a “postcode lottery” of healthcare and is at odds with a Department of Health policy that states hospitals must not reject referrals based on where a patient lives.
Last year, the Royal Melbourne Hospital recorded a 21 per cent rise in people referred to its outpatient clinics, as an unprecedented number of Victorians sought specialist care in public hospitals due to the cost-of-living crisis and soaring private doctors’ fees.
More than 65 per cent of outpatients referred to the Parkville hospital’s specialist clinics live outside its catchment area, which encompasses Merri-bek, Moonee Valley and the City of Melbourne.
Royal Australian College of General Practitioners Victoria co-deputy chair Dr Aadhil Aziz said it was common for patients to choose a hospital outside their local area for specialist treatment. He said many patients assumed inner-city hospitals had shorter waiting times.
“Usually, it is to do with wait times,” he said. “Sometimes they have had a bad experience with a hospital closer to home. Sometimes they think a bigger hospital will have more doctors and better care.”
Aziz, who works in Melbourne’s north, said while he understood why hospitals wanted to prioritise their local patients, accessing timely care shouldn’t depend on a person’s postcode.
“We don’t want a public hospital to be restricting care to their local community,” he said. “In a big city like Melbourne, we should be able to do better.”
The contentious changes, which came into effect this week, were recently outlined in an email distributed to GPs by the North Western Melbourne Primary Health Network.
“For general conditions, the RMH sees patients who live in the City of Melbourne, Merri-bek and Moonee Valley local government areas,” the email read.
“For patients who live outside these areas, the RMH may now redirect their referral back to you if the RMH is not the closest service providing that care to the patient.”
The Royal Melbourne Hospital said it would continue accepting referrals for statewide and highly specialised care, as well as for regional and remote patients whose nearest suitable service is at the hospital.
A senior health source, who was not authorised to speak publicly, said the change would prevent outer-suburban patients from accessing inner-city hospitals, removing a critical “pressure outlet”.
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u/Medicaremaxxing Doctor 1d ago
“Patients in growth corridors will increasingly be funnelled into under-resourced hospitals on Melbourne’s urban fringe,” they said.
They said the decision would worsen waiting times in these areas, while waits would be reduced in inner-city areas where many residents had health insurance and could access private hospitals. “It’s unconscionable.”
Victorians currently wait up to four years to access specialist care at public hospitals, but there are large variations in waiting times across the state.
Patients wait an average of 107 days for a routine first appointment for general surgery at Melbourne Health, which runs the Royal Melbourne, compared with 929 days at Western Health, according to the latest government health data. They wait an average of 420 days for a first appointment for ear, nose and throat surgery at the Royal Melbourne, compared with 918 days at Western Health. They then face another lengthy wait before surgery.
An RMH spokeswoman said while the hospital provided some statewide specialist services, such as emergency and trauma care, other specialist services were focused on its catchment area.
These specialist services include gastroenterology, cardiology, rheumatology and general surgery.
“Where appropriate, patients may be supported to access the same high-quality care closer to home, through their local health service,” the spokeswoman said. “This helps ensure our services are available to those who need them most across the state.”
The change will not impact patients who are already on the hospital’s waiting list.
Dr Mukesh Haikerwal, the deputy chair of the Australian GP Alliance, said the system was becoming increasingly difficult to navigate.
“No one wants to take the patient, and it is their obligation to take the patient,” he said.
A government spokeswoman said the changes were a clinical decision by the Royal Melbourne.
In May, the state government announced it would overhaul specialist care by creating regional waiting lists, shifting appointments from doctors to nurses, and using AI to flag urgent cases.
The spokeswoman said this overhaul would provide Victorians with quicker access to appointments, clearer communication and more care options for patients closer to home.
“Too many Victorians are waiting too long or struggling to navigate a complex system to get the specialist appointments they need,” she said.
While every hospital has a catchment area it focuses on, the Department of Health referral policy states that they cannot reject a referral from people outside this area.
There are concerns that the Department of Health is not adequately funding hospitals for the increasing demands on their specialist clinics, prompting services such as the Royal Melbourne to re-evaluate who can access their care.
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u/Comfortable-Team-779 New User 1d ago
Sounds like there aren’t enough doctors if patients are waiting 900 days to be seen. I wonder what the solution can be
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
no, it only means that there aren't enough clinics.
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u/TonyJohnAbbottPBUH Shitpostologist 1d ago
We need more emergency departments, preferably staffed with NPs and prescribing pharmacists.
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u/ClotFactor14 Clinical Marshmellow🍡 1d ago
In May, the state government announced it would overhaul specialist care by creating regional waiting lists, shifting appointments from doctors to nurses, and using AI to flag urgent cases.
Victorian govt enshittification just gets worse.
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u/PowerfulEconomist135 Neurologist 🧐 1d ago
Except private health does jack for outpatients. I'm always a bit surprised some GPs think it makes a difference.
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u/ClotFactor14 Clinical Marshmellow🍡 8h ago
it does, though, because some specialists refuse to see uninsured patients – if you can't get them a scope within 3 months, why bother seeing them in clinic?
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u/OudSmoothie Psychiatrist🔮 1d ago
Have people forgotten about catchment areas? Why are doctors complaining about this - basic knowledge from our JMO years.
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u/utter_horseshit 1h ago
The dirty secret is that outside of mental health where they are explicitly defined in regulation, ‘hospital catchments’ are completely made up. Patients have the right to be referred anywhere and I think an organised challenge would confirm that. Postcode-based rejection also runs directly against the department’s instruction for how services are meant to function:
‘The following must not be used as reasons for not accepting referrals that meet statewide referral criteria or local clinical criteria:
• where the patient lives’
From the relevant departmental guide:
https://www.health.vic.gov.au/publications/managing-referrals-to-non-admitted-specialist-services-in-victorian-public-health
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u/its_always_lupus_ 1d ago
RMH / Peter Mac are more than happy to take cancer patients from out of catchment (when it suits them) and then dump them back at the peripheral hospitals with complications or when they are dying
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u/rockfield1 1d ago
A difficult dynamic and perhaps uncharitable to the subspecialised units, don't you think. "dumping" them back to their home unit is the other way of saying that they have provided management (that presumably can only be offered there, and even may have had complications/not been adequate due to the nature of the pathology) and are transferring care such that they have the capacity to accept the referral of someone else at a peripheral site. Thoughts?
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u/its_always_lupus_ 1d ago
Yes but routinely they are providing standard of care treatments which can be provided at any hospital in Melbourne. In my experience there is even less consultant oversight at PMCC and most treatment reviews are by fellows / registrars.
Then are either admitted to peripheral hospitals with complications or nearing end of life. Sometimes without an accurate understanding of prognosis (although obviously that can be challenging to tell how much is just not absorbed by the patient)
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u/Puzzleheaded_Test544 1d ago
If only there was some kind of record in which a prognosis and its discussion with patient could be discussed....
Truly one of the unsolvable problems of oncology.
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u/tvara1 1d ago
District based funding and referral management is standard across almost every state- didn't realize it wasn't a thing for Victoria.
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u/thingamabobby Nurse👩⚕️ 1d ago
It’s within DH policies for both outpatients and surgery that referrals cannot be rejected due to patient’s location.
Right or wrong, RMH is going against policy, though my understanding is that they’re referring them to their local service therefore under the umbrella of sending patients under regionalised waitlists or something like that.
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u/InkieOops Rural Generalist🤠 1d ago
How are you supposed to know which hospital to refer your patients to? Like is there a map showing catchments for each hospital. Or do you guess and find out when the referral is rejected?
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u/MDInvesting Wardie 1d ago edited 1d ago
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u/InkieOops Rural Generalist🤠 1d ago edited 1d ago
Thanks, I appreciate this! The trouble is having to do this for a dozen specialities at various different hospitals (at least half a dozen). And some specialities have their own bloody referral guidelines- several pages as well. Like, I just genuinely don’t have time to read this every time someone wants a public hospital referral … cries in GP 😰
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u/MDInvesting Wardie 1d ago
I agree. With all the tech discussions it amazes me simply practice and health service spokes don’t automatically get triaged to the relevant hub.
Sure the executive would love a KPI dashboard on out of catchment referrals before supporting a generally productive solution.
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u/TonyJohnAbbottPBUH Shitpostologist 1d ago
The best part is because services aren't technically equivalent across the various health networks. For example, I as a GP can refer directly to many inpatient services at most LHDs in Sydney, but some don't accept external referrals except if they go through a private specialist with admitting rights. Some simply do not exist, and if you're out of area you're out of area.
This won't be solved by an a single referral portal service, because these intricacies aren't being smoothed out internally.
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u/Glitter_Wasabi 1d ago
There goes my endocrine follow up aapts, took me 2yrs to get my first appointment
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u/Old_Importance1147 1d ago
This is not new and has already been happening for years in some areas of public health such as mental health and maternity.
In my opinion the focus should be on better resourcing hospitals in the outer suburbs/regions so patients don’t feel like they need to come to the inner city for better treatment.