The Collarenebri community is fearful for its town's future if the local hospital is unable to secure a doctor for more than one day a week.
One day a week was outlined under the minimum requirements of a new contract which was put out to tender last month.
"It's ridiculous to think they're going to cut us back to one doctor a week," Walgett Shire councillor Kelly Smith, who lives in Collarenebri, said.
The Western NSW Local Health District (WNSWLHD) has failed to renew the contract of Rural and Remote Medical Services (RARMS), which currently provides doctors to hospitals at Bourke, Brewarrina, Coonamable, Collarenebri, Lightning Ridge and Walgett.
The contract was put to tender last month, with the health district revealing it would involve a mix of face-to-face doctors and telehealth video conferencing.
"The tender sets a minimum requirement for face-to-face medical services in each of the MPS [Multi-Purpose Service] facilities and for access to medical officer coverage 24/7," WNSWLHD acting chief executive Mark Spittal said in a press release at the time.
Under the new minimum requirements, a doctor will have to be present at least one day a week in Collarenebri, two days a week in Brewarrina, three days a week in Lightning Ridge and Coonamble, and five days a week in Bourke and Walgett.
Video conferencing can be offered at all other times.
'Nobody wants to go without a doctor'
Walgett Shire Council general manager Michael Urquhart said relying on telehealth services to replace a physical doctor "just doesn't work", as was the case in Gulgong recently when a woman died while being treated by a doctor over teleconference as there were no doctors available at the MPS after hours.
"Collarenebri will have to have all their accidents and illnesses on that day of the week," Mr Urquhart said.
Walgett Shire Council covers the western NSW towns of Walgett, Lightning Ridge and Collarenebri, as well as a number of remote villages.
Not only are these towns and villages a long way from their nearest big centre - Collarenebri is an hour and a half to Moree, Lightning Ridge is an hour and 45 minutes to Moree and Walgett is two hours to Narrabri, two and a half to Moree or three to Dubbo - but Mr Urquhart said internet connections were not reliable enough to be used as a substitute for a doctor.
"Our connectivity is not 100 per cent," he said.
"This is what's frightening everybody - we all know what our connectivity is like. It's not reliable."
Mr Urquhart said having doctors contracted to hospitals only on certain days, between 8am and 6pm, has "huge ramifications" for the whole area.
"We've got people in that area that have chronic disease, we have children with heart problems in Collarenebri," he said.
"Once again they're taking the guts out of remote NSW. It's just not on. We can't allow it. There can't be any decrease in services in our area, particularly health-wise.
"What price does the government put on a life?
"The part that is very frustrating is the pressure they must put on the frontline nurses that have to deal with a patient bleeding out if there's no doctor. Are they all going to get pay rises?
"It is not fair at all."
Meanwhile, Mr Smith, who had cancer in 2006, believes he wouldn't be alive today if it wasn't for the doctor in Collarenebri who found the 70 centimetre tumour in his lung.
"I wouldn't have been saved in 2006 if it wasn't for a doctor being here," he said.
"If you had a TV screen, they're not going to pick that up.
"It's just wrong."
Collarenebri has a population of just 650 people, many elderly, and a third of which are Aboriginal.
Mr Smith said the whole town are concerned about what will happen if there's only a doctor at the hospital one day a week.
"They're devastated," he said.
"Nobody wants to go without a doctor.
"We've got five diagnosed cases of Aboriginal children with congenital heart defects and we're only a small town. We've also got a lot of older people. My wife's had open heart surgery and needs regular check-ups."
Mr Smith's wife Carol said the population of the town should not play a part in whether they have a permanent doctor or not.
"It is peace of mind knowing we have a doctor on board when community members are not well," she said.
"Nurses and telehealth do not cut it. Patients deserve to have a sense of security having a doctor on board when they or their loved ones are ill."
Mr Smith also has grave concerns for his town's future if they are left without a face-to-face doctor, as people will need to travel out of town for medical services which has a detrimental affect on local businesses.
"We will lose our chemist over this," he said.
"Eric will shut his doors up if we don't have a doctor because he won't survive.
"That's just another roly poly blown down the street of Collarenebri.
"We're worried about every little business in the town.
"We've got one of everything in Collarenebri ... one supermarket, one butcher shop, one chemist, one pub ... but we can't afford to lose any of them.
"The water buyback scheme wrecked Collarenebri."
Mr Smith said the town will "fight tooth and nail" to ensure they don't end up with a doctor just one day a week, and is encouraging all local residents to write to their local MP, Member for Barwon Roy Butler.
Butler shares Collarenebri's concerns
Mr Butler said he shares the concerns of the people in his electorate about the section of the tender concerning the minimum number of hours required by a doctor on-site.
"Most of these towns have 24/7 coverage by a doctor, except Collarenebri which currently has 157 hours a week," he said.
"It wouldn't be acceptable to have a doctor for one day a week in Collarenebri. These are people who cannot afford to have any reduction in coverage.
"Across those six sites, there has been a 36.2 per cent increase in presentations [to hospital], so decisions should not be made on population, they should be based on health needs.
"These are people with significant health issues and comorbidities who should be getting more health services, not less."
Mr Butler said telehealth should never be a substitute for a doctor.
"It's a great addition or supplement for a doctor but it's no replacement," he said.
Mr Butler has been campaigning for limits to be placed on the number of doctors who can establish a medicare provider number on the eastern seaboard of the state, to encourage more to move to areas less saturated.
He's also been in regular contact with Mr Spittal since the contract went out to tender, who has assured him that the actual service delivery of the contract won't be based on those minimum number requirements, and NSW Health Minister Brad Hazzard.
"I'll be asking, 'even if it's not the intent of the health district to go with the tender with those minimum numbers, why would you put it in the tender?'" Mr Butler said.
When contacted for further details about the contract for Collarenebri Hospital and what it would mean for the community, WNSWLHD referred ACM to a press release dating back to early August.
In the press release, Mr Spittal said virtual services would not replace medical staff.
"As has been the case to date, virtual services can be made available to support local nursing staff and MPS medical practitioners, but they are not a replacement for our staff," he said.
The existing contract for RARMS expires in February next year.
A spokesperson for WNSLHD said the Request for Tender has now closed and all responses will be assessed by a panel, and with the oversight of an independent probity adviser.
There is currently a public inquiry into the health outcomes and access to health and hospital services in rural, regional and remote NSW.