Cessnock Hospital doesn't have a designated emergency department doctor but residents say GP VMO system isn't working there anymore

The hospital's emergency department relies on GPs - or "visiting medical officers" - to provide access to medical coverage 24 hours a day.

But residents say that system is "hit and miss", and are calling for the hospital to get its own permanent, dedicated doctor.

Storm-Haylee Crowe of Abermain said the "amazing" nurses were having to do the job of a doctor when she presented with both hands "completely busted" after being mauled by a ferret in June.

"They had not had a doctor there in three days," Ms Crowe said. "They didn't have a single doctor working in the emergency department at all."

Ms Crowe said the nursing staff did their best to help her as quickly as possible, but because there was no doctor on site, they needed to call Maitland Hospital to get X-rays and treatments approved by a doctor over the phone.

"Both hands were a mess," she said. "I've got no feeling in my right thumb from the knuckle upwards because it has done some nerve damage. And then the ring finger on my left hand is completely totalled with ligament damage and tendon damage, and I have a small fracture in the knuckle itself.

"The nurses were going above and beyond what they needed to do as nursing staff. There was one nurse that was basically doing all the stuff that a doctor would normally do because they just needed her to do it. But I couldn't even get an X-ray without the nurse having to pester Maitland Hospital to get the OK first."

She was offered the option of going to Maitland Hospital and waiting "hours" for further treatment, or seeing her GP the next day.

After her GP assessed her he arranged for her to arrive at Maitland Hospital for surgery at 7am the following day. But despite having "nil by mouth" from midnight, she left just before 5pm after being told it would be at least another four hours before the surgeons would get to her case.

"I lost the plot mentally and I signed myself out... I still haven't had the surgery," she said.

Local business owner Kelsey Foster said she too was disappointed there had not been a doctor on duty there when she needed one.

"I have a pre-existing spinal issue and I was working in my beauty salon in Cessnock when something just slipped in my back," she said. "I rushed up there and I explained that the last time this happened, I ended up unable to walk, I was in a back brace, and that I really needed them to have a look at it immediately, because I was already losing feeling in my legs. They said they were too busy. I'd have to wait at least six hours, and they didn't have a doctor."

She drove home.

"By the time I got home, I lost feeling in my legs and collapsed and had to call the ambulance to come and get me," she said. "They took me back up to Cessnock Hospital. They said again that they were way too busy and I'd have to either wait for six hours, or drive to John Hunter. I couldn't drive.

"You go to a hospital because it's for something more serious, something that can't wait for a doctor's appointment. There should be a doctor there."

Ms Foster said she was concerned about the safety of her three-year-old daughter - who has a medical condition - if the pre-schooler had an episode and couldn't get the appropriate care fast enough.

"I'm a local business owner, and I do things here to try to give back to my community," she said.

"To have medical services that can't give back to us in the way that we need is really disappointing."

Cessnock resident Leonard Duffie was left exasperated after his partner, Helen, was forced to wait outside the hospital in the cold in May because she had recently had COVID-19.

He said an ambulance had taken her to hospital, and she was having trouble breathing.

"They arrived at the hospital about 9.30am. I got a phone call from Helen about 10.30 asking me to bring some warm clothing up because she was sitting outside and nobody had been near her yet.

"I took the warm clothing up and gave it to Helen, then I went inside to make my feelings felt.

"When I went back out she had a blanket around her... She said a groundsman was working around there and he'd asked her if she needed one and went and got it for her."

Mr Duffie said health staff had since denied it was a groundsman that offered Helen the blanket.

He said there had been no doctors on duty during the day, but Helen was finally assessed by one at 5.30pm.

"I realise that these are not normal times," he said.

"But I think this situation should have been handled a lot better than it was."

Cessnock MP Clayton Barr said historically, the hospital had always relied on local GPs to be on call and to provide care on weekends and after hours.

"If you go back 20 or 30 years, we had 25 GPs on the roster to help cover Cessnock ED. Today, only 10 are on the roster," Mr Barr said.

"But then we managed to all work together with Hunter New England Health to figure out that actually the volume of ED presentations at Cessnock - the highest in the state without a permanent doctor - required daytime doctors Monday to Friday," Mr Barr said. "And we managed to get access to two doctors per day, Monday to Friday. But then COVID arrived and because our doctors at Cessnock ED were provided from the pool of doctors at Maitland, somewhere along the line the decision was made that those doctors needed to be recalled back to Maitland.

"And so we were left stranded without doctors again."

Mr Barr said more people were moving to the area and, understandably, they assumed the local hospital emergency department would have a doctor.

It was "just not good enough" that it didn't.

"We've just had a NSW parliamentary inquiry into rural and regional health, and the stories that were told during the course of that were just egregious," he said.

"And we regional communities are being asked, or actually being forced, to accept a much lower standard of care than our more fortunate cousins in metro areas.

"We are all entitled to care across NSW. It doesn't matter if you live in Cessnock or Sydney. You are entitled to the same care."

Mr Barr said the back up care model for Cessnock Hospital nurses when there was no doctor on site - where they called a doctor at another hospital to approve treatments, tests and scans via telehealth - was "hit and miss".

He understood there had been times nursing staff had had trouble getting hold of doctors for advice and approvals.

"The nurses can't actually go ahead with treatment until they get the sign off from a doctor," he said.

"So a patient lying in a bed in the ED can't get the treatment until the doctor online approves the medication or the X-ray or whatever. And this creates enormous stress for everyone - the patient, the family and friends of the patient, the nursing staff there that want to help the person, so it just festers.

"That is meant to be the fail-safe model, and I'm told the fail-safe model is sometimes failing."

A Hunter New England Health spokesperson said that Cessnock Hospital's emergency department was supported by GP VMOs in the hospital during the day.

She said they also provided an on-call service overnight from 11pm.

"This model of care exists across many rural and regional facilities in NSW and ensures hospitals, like Cessnock, have medical coverage 24 hours a day," she said. "When GP VMOs are unavailable and a replacement cannot be secured, our skilled nurses attend to patients with the support of emergency physicians via telehealth. Additional nursing staff can also be brought in if required.

"Patients requiring a high level of care are transferred to the most appropriate facility within the network, when necessary."

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