The state's biggest charitable provider of primary health care services to rural communities has announced it will pull out of medical clinics in Bingara and Tenterfield.
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Residents may be forced to pay more for healthcare, after the Rural and Remote Medical Services (RARMS) program ends after two decades, from September 30.
In a statement, the RARMS charity cited the "chronic shortage of permanent rural GPs, and the escalating cost of locum coverage" to explain their withdrawal.
"We are now simply unable as a charity to afford to continue the RARMS Program," the statement read.
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The organisation denied that the move would mean any practice would close, because RARMS only supports them, and doesn't own them.
Services affected include the Naas St Medical Centre in Tenterfield and the Bingara Medical Centre.
Gwydir Shire Council Mayor John Coulton said the council didn't want to operate the clinic in Bingara, and speculated the service would have to end bulk-billing to avoid making a loss.
The council is currently negotiating for another organisation to operate the clinic, though it's unlikely anything will have been sorted out by the time the clinic is transferred, he said.
"We're doing everything we can to keep it going," he said.
"We don't want to run it ourselves ... we've got very little time to organise this, but hopefully we'll get something in place."
Cr Coulton said the community had been devastated by RARMS withdrawing from Warialda last year, and Bingara was another devastating blow.
"We're very disappointed with RARMS, very disappointed with their attitude. We just have to walk away from them now," he said.
"I mean, we haven't been given a lot of notice. They pulled out Warialda last year and it wasn't a pretty sight when that happened... we didn't want them to leave Bingara as well."
He said the change in operator would probably mean major price-hikes for locals.
"I think if we get away from bulk billing it's going to be difficult for people," he said.
"[Doctors] are barely breaking even, and if you put the price of a locum onto it I believe that the community are going to have to be charged whatever it costs for the locum."
Rural Doctors' Association secretary Ian Kamerman blamed the decision on government changes to a program that requires overseas trained doctors who move to Australia to spend time caring for rural and remote communities, before receiving an unrestricted Medicare provider number.
"I think it just is a reflection of the struggle that rural communities have in recruiting doctors to the bush," he said.
"I think what might have been the straw that broke the proverbial camel's back is the change in district priority areas, such that now areas such as the Central Coast and Newcastle are rated as the same priority as Bourke, as Brewarina - or you could say Tenterfield and Bingara."
Dr Kamerman, who is based in Tamworth, said the changes would likely make it more difficult for residents to see a doctor.
He said the medical retreat was a reflection of the need for significant changes to primary health care and medical recruitment more generally in rural Australia.
"It's going to mean reduced Medicare expenditure per head of pop in rural areas given lack of access," he said.
"And continued worse health outcomes. Already our expenditure is less in rural areas and our health outcomes are worse in rural areas, we know that."
In a statement, RARMS said it was simply too expensive to continue the rural medical aid program.
"Growing GP shortages has seen the daily rate for locums who fill in vacancies in rural GP practices soar to unaffordable levels," a spokesperson said.
"As a charity, we are simply no longer able to absorb the rapid increases in these costs."
Tenterfield's clinic will be owned and operated by a local permanent GP, Bingara is set to be managed by the Gwydir Shire Council.
"In Armidale, we are working with our local GPs and staff to explore how we might get support to retain this practice as an overseas doctor training centre to help rural and remote towns get doctors in the future," the charity said.
The charity claimed that all its community GP practices are financially sustainable as standalone services and will remain so with appropriate local community support, while they have permanent or regular GP.
The charity acknowledges that the change will mean communities are exposed to a higher risk of closure in case of a vacancy, or a loss of staff.
It has asked governments to consider how they can financially support rural and remote general practices to remain open while the government fixes rural GP workforce programs over the next few years.
"This has not been an easy decision and something we have been trying to avoid for two years," he said.
"Over the last two years, RARMS has provided more than $3 million from our charitable reserves to subsidise the RARMS Program in rural and remote towns, and strengthen rural GP practices. This is simply no longer possible."
*Editor's note: This story originally made reference to RARMS pulling out of the West Armidale Medical clinic, but the plan is to continue operating the centre for the forseeable future.
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