Health care services

In 2021-22, 94% of people living in the North Coast used general practice (GP) services. This is slightly higher than the Australia wide rate of people using GPs at 90%. This indicates access to GP services is relatively high on the North Coast. A total of 30% of survey respondents reported only visiting a GP when feeling unwell, suggesting a tendency towards reactive healthcare seeking. This behaviour is associated with factors such as high costs and difficulty getting appointments, according to survey participants.

For every 100 people, there were 781 visits to GPs on the North Coast, more than the 735 visits Australia wide. There are differences within the region with Clarence Valley statistical area level 3 (SA3) consistently showing lower levels of access and visits to GPs for people of all ages compared to other SA3s in the region. The rate of visits to GP generally increases with age, reflecting higher healthcare needs among older populations (Australian Institute of Health and Welfare, 2022).

There are local challenges with availability and accessibility to GPs with a need for more after-hours GP services across the region. In 2021-22, only 6% of the North Coast population accessed after-hours GP services compared to 17% Australia wide. This has contributed to increased presentations to emergency departments, especially for lower urgency care. To address this, 2 Medicare Urgent Care Clinics were opened in November 2023 in Coffs Harbour and Lismore. These clinics show promising early results in managing urgent but non-life-threatening conditions.

The rate of GPs equates to 1 full-time GP for every 800 residents on the North Coast, compared to 1 per 900 residents in NSW and Australia. Despite the high rate, the GP workforce distribution is unequal within the region, with Kyogle and Clarence Valley having considerably less GP workforce rates compared to other Local Government Areas on the North Coast. The GP workforce is ageing faster in the region compared to state and national averages. On the North Coast 15% of GPs are aged 65 and older and 16% are planning to work only 4 more years or less.

Consultations with communities and service providers highlighted significant challenges in the local health workforce. Key issues identified included high staff turnover and difficulty attracting, recruiting and retaining staff. A need for capacity building in specific areas was reported. This included LGBTQ+ health, neurodiversity and care for women and children. The ageing workforce was identified as a challenge, with many practitioners nearing retirement and experiencing burnout due to understaffing and high community expectations (Department of Health and Aged Care, 2022).

In 2021-22, 36% of people on the North Coast used medical specialist services. This is more than Australia as a whole at 31% of people. Port Macquarie SA3 had the highest population accessing medical specialist services in the region at 41%. The SA3s of Richmond Valley-Hinterland and Richmond Valley-Coastal had the lowest proportion people seeing a specialist, these areas have some of the lowest number of specialists in the region. The North Coast region had a slight decrease in specialist attendance over the past 2 years while Australia had an increase. The proportion of the population accessing specialist services on the North Coast was consistently higher than the Australian average for people of all ages. Access increased with age.

The North Coast has a lower specialist workforce rate at 1 full-time specialist for every 830 residents compared to Australia wide at 1 full-time specialist for every 630 people. Projections indicate a 29% growth in medical specialist workforce on the North Coast region by 2030. This is larger than the projected growth in NSW and Australia.

The ageing of the specialist workforce, particularly in Clarence Valley, may present future challenges in maintaining adequate access to medical specialists. Findings from community consultations and the survey echoed the concerns of having adequate access to specialist services across the region. A total of 14% of respondents reported that they were unable to see a medical specialist when needed. Challenges identified by survey respondents to access specialist care include long wait times and costs.

North Coast residents access Medicare-subsidised allied health services at 41% compared to people Australia wide at 37%. Access to allied health services varied slightly across the SA3s. Tweed Valley (45%) and Port Macquarie (44%) had the highest rates and Richmond Valley-Hinterland (35%) had the lowest rate. Most areas on the North Coast region experienced a slight decline in allied health service use in the last year and only Port Macquarie and Tweed had a slight increase during that period.

For every 100 people on the North Coast, there were 116 allied health attendances. This is higher than the Australian average of 99 visits. Service use increases with age and is highest among residents aged 65 years and over (204 services per 100 people). The SA3s of Richmond Valley-Hinterland, Clarence Valley, Kempsey-Nambucca and Port Macquarie experienced a decrease in attendance rates since 2019-20. This might be due to reduced access to services and barriers identified in the survey such as cost and difficulty getting an appointment.

The allied health workforce on the North Coast region is growing, with a projected increase of 28% by 2030. In 2022 there was 1 full-time allied health professional per 275 people in the region, the same as NSW but less than Australia wide at 1 per 255 people. The distribution of the allied health workforce varies across local government areas (LGAs). Kyogle and Richmond Valley face workforce shortages while areas such as Byron and Coffs Harbour have a higher workforce rates than the national average. The allied health workforce is ageing, with 7% aged 65 years and over, highlighting the need for planning and recruitment strategies to maintain and improve service availability across the region (Department of Health and Aged Care, 2022).

Nurses on the North Coast region are employed in various healthcare settings, with 58% of the workforce working in hospitals. Other employment areas include residential health care facilities with 13% of the workforce, community healthcare services with 11%, GP practices with 4% and outpatient services with 3%. The remaining nurse workforce is employed across diverse settings such as private practice, correctional services, Aboriginal Community Controlled Health Services and educational institutions.

The North Coast has 1 full-time nurse for every 85 people, which is similar to Australia wide but larger workforce than NSW wide with 1 nurse per 97 people (Department of Health and Aged Care, 2022). Projections indicate a growth of 13% in the nurse workforce on the North Coast by 2030. This is below the projected growth rates for NSW at 18% and Australia wide at 19%. The nursing workforce rates vary across LGAs in the region. Richmond Valley has the lowest rate at 1 nurse per 192 people while Lismore has an exceptionally high rate of 1 nurse per 43 people, more than double the North Coast, NSW and Australia wide rates (Department of Health and Aged Care, 2022). The high concentration of nurses in Lismore is likely due to Lismore Base Hospital being a training hospital and its proximity to Southern Cross University.

The nursing workforce on the North Coast is facing challenges related to ageing. In 2022, 6% of nurses were aged 65 years and older, representing a 1% increase since 2019. The number of nurses on the North Coast who indicated plans to work for only up to 4 more years was 13%, higher than the nursing workforce intentions in NSW at 10% and Australia wide at 9%. This trend is particularly pronounced in certain areas, with Richmond Valley and Kyogle LGAs having the highest level at 21% of nurses planning to work for only up to 4 more years, followed by Ballina, Nambucca Valley, Byron and Bellingen at 17-19%.

The midwifery workforce on the North Coast region is experiencing difficulties with recruitment and retention of professionals. Projections indicate a 43% decrease in midwives by 2030 on the North Coast. This is larger than the expected reductions in NSW at 39% and Australia wide at 27%. Notably, 23% of midwives on the North Coast intend to leave the profession within the next 4 years which is higher than both NSW at17% and Australia wide at 18%. The ageing workforce compounds these challenges with 8% of midwives aged 65 years and older in 2022. This is a 3% increase since 2019. This ageing profile combined with the projected decline in midwives raises concerns about the sustainability of the workforce and capacity to meet future population demands (Department of Health and Aged Care, 2022).

Emergency department (ED) presentations triaged as category 4 (semi-urgent) or category 5 (non-urgent) are classified as ‘lower urgency’ presentations. These cases, which require treatment within 60 and 120 minutes respectively in ED, could often be appropriately managed in primary care. Seeking care in primary care settings for these cases, where possible, could potentially reduce pressure on hospital EDs and improve care for higher urgency cases (AIHW, 2024).

On the North Coast, ED presentations have increased substantially over the past 11 years. In 2022-23, 52% of presentations were classified as lower urgency, higher than NSW at 48% and Australia wide at 42%. This has remained relatively stable on the North Coast while it has reduced considerably in NSW and Australia. Some LGAs on the North Coast, such as Bellingen (75%) and Kyogle (74%), have particularly high rates of lower urgency presentations, suggesting limited access to local non-urgent care options (AIHW, 2024).

The rate of lower urgency presentations to ED on the North Coast is more than double the Australian rate, both for all-hours and after-hours care. The SA3s of Kempsey-Nambucca, Clarence Valley and Richmond Valley-Hinterland have the highest rates within the region. The North Coast ranks as the second-highest PHN in Australia for age-standardised rates of lower urgency care in ED.

On the North Coast region, the rate of lower urgency presentations to ED are highest among people aged 15-44 years. This differs to the national pattern, where younger people aged 0-14 years show the highest rate of attendances to ED for lower urgency care. This pattern for middle-aged people on the North Coast may be related to difficulties in accessing GP services, including after-hours, as reported in the community consultations and the survey (AIHW, 2024).

Digital health services, including telehealth, have become widespread in recent years, particularly during and after the COVID-19 pandemic. However, people continue to face barriers to accessing telehealth, including technological challenges, digital literacy issues and personal preferences for face-to-face appointments.

Community consultations revealed differing opinions on telehealth acceptance. While some participants expressed comfort with using these services, others reported difficulties due to technology issues, lack of service or discomfort with phone appointments. Many participants acknowledged the benefits of telehealth for follow-up appointments, repeat prescriptions and situations where physical access is challenging. Most participants maintained a preference for in-person consultations, especially for young children or complex health issues.

In 2021-22, only 0.2% of people in the North Coast region used GP telehealth (patient-end support) services. This is slightly above the Australian wide average of 0.1%. Fewer specialists in the region and a greater need for digital-based appointments may explain the higher use. The North Coast Health Connect (NCHC) service was launched in May 2023, providing 24 hour – 7 day access to nurse triage services and GP appointments. In its first full year of operation (2023-24), NCHC triaged 8,678 patients, with the highest volume of activity for patients from Coffs Harbour and Port Macquarie SA3s (Healthy North Coast, 2024).

NCHC has shown promising results in diverting patients intending to go to emergency departments to either primary care or self-care where clinically appropriate. Of all contacts where consumers initially intended to seek emergency care, 30% were redirected to primary care or self-care options. This service has been particularly effective in areas like Nambucca Valley where 53% of callers who intended to go to emergency department were diverted. These findings highlight the potential of digital health services in improving healthcare access and reducing pressure on emergency services on the North Coast region (North Coast Health Connect, 2024).

A series of challenges and barriers exist for people to access and use digital health services on the North Coast. The NSW Digital Connectivity Index considers access (coverage, performance and choice), affordability and demographics (social factors) to determine a score out of 100. Scores are calculated for both mobile and at home/stationary access. Higher scores indicate communities are more likely to be able to effectively engage in digital activities such as working, video conferencing and accessing digital and telehealth. Scores across the North Coast vary greatly due to multiple factors including the regions diverse demographic and geographic landscape (NSW Government – NSW Telco Authority, 2025):

• for mobile access, LGA scores range from 42 in Kyogle and 44 in Richmond Valley to 71 in Byron
• for home access, LGA scores range from 20 in Kyogle and 27 in Richmond Valley to 68 in Byron and 67 in Ballina.

These findings indicate a need for local, place-based understanding and innovative community-based initiatives to support access and use of digital health services.

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