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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”.
“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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Henrietta Cook is a senior reporter covering health for The Age. Henrietta joined The Age in 2012 and has previously covered state politics, education and consumer affairs. Email her via henrietta.cook@theage.com.au or henrietta.cook@protonmail.comConnect via X, Facebook or email.From our partners
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