Doctors live in fear of an avoidable death of a mother or a baby as maternity services struggle, with the ailing NSW rural health system declared the worst it's been in years.
There are dire staff shortages across rural maternity care, general practice is "in crisis" and staff are burning out, according to a parliamentary committee report.
The committee has been examining progress on rural health reform since a damning 2022 inquiry found country NSW patients had far worse outcomes than their city peers.
Though there have been improvements in staff retention and better engagement from the NSW health minister, essential changes in other areas are slow or non-existent, its report said.
"There is still much work to be done ... regarding workforce, culture and funding," said the report, tabled in NSW parliament.
"In a number of ways regional healthcare in NSW is the worst it's been for many years.
"In particular primary health care and rural general practice are in crisis."
The report highlighted the depth of staff shortages in maternity and obstetrics, leaving some birthing services barely viable.
Large regional hospitals designated to provide high-level care in the state's north are being bypassed for days at a time, leaving expectant parents to travel hundreds of kilometres.
"Our great fear is that if we have a couple of larger services that need to be on bypass sequentially with long retrieval times, sooner or later we're going to potentially see an avoidable death of a mother or baby," Australian College of Rural and Remote Medicine's Rod Martin told the committee.
The earlier inquiry's major recommendation was a review of funding across all local health districts to identify service gaps.
But the committee found it was unclear whether that review took place, with evidence there was even less certainty about funding in some regions.
The shortage of GPs is placing immense pressure on hospitals, as 72 doctors left rural and remote areas for larger regional centres in the last half of 2022.
"The GP workforce, especially in relation to supporting hospital care, is in dire need of support," the report said, calling for greater collaboration between the federal and state governments.
Workplace culture remains problematic, with reports of bullying, psychological injuries, harassment and racism among both doctors and nurses.
The committee recommended NSW Health's culture framework be urgently completed and rolled out, while managers need access to leadership training.
Despite the concerns, the report praised the NSW government for introducing staff incentive payments, which helped retain 9000 positions.
It recommended the incentives be broadened and reviewed because the extra payments inadvertently created staff schisms.
Committee chair and Wagga Wagga independent MP Joe McGirr said NSW Health had worked hard on reforms and its "dedicated efforts" were clear, but progress must continue.
The government's response is due by February 2025.
