“If I look out the window of a hospital and all I can see are 30 cows and grass...it’s a rural hospital.”

While the current stoush surrounds the non-renewal at short notice of Chris Phoon’s contract with the SERH, it perhaps has its beginnings in the removal last year of public hospital incentives for rural specialists.

The Rural Doctors Settlement Package (RDSP) was designed to encourage doctors in country areas to maintain services in small, remote communities through higher remuneration for public hospital work. That incentive was removed from the SERH last year. In October 2016, the orthopaedic department kicked up a public stink that to sign the new contract would result in a 30 per cent pay cut.

On Thursday night, the debate over Dr Phoon’s dismissal led into discussion over how a regional hospital could attract and, more importantly, retain quality medical staff. The reintroduction of the RDSP was proposed as a potential factor.

The NSW president of the Rural Doctors Association – which initially agreed to the incentive scheme with NSW Health in 1987 – said on Thursday there was no doubt Bega should qualify as “it’s in the middle of nowhere”.

That that observation came from a GP from Bombala says a lot!

At the time of media coverage over surgeon contracts, the Southern NSW LHD said the orthopaedic department had known for a while the incentive scheme was to be cut. It pointed to a growth in capacity, services and staff from the days of the Bega District Hospital and said it no longer met the criteria of a rural hospital.

There is more to this “crisis” than a pay dispute, but discontent between senior medical staff and LHD management also goes deeper than recent discussions over “core values” and bolt cutters.

While no-one from management appeared at Thursday’s meeting – can’t really blame them – there was some concession from Dr Nott the health service and the surgeons all want the same thing: provision of the best healthcare outcomes for the south east.

The question is, where to from here to continue achieving that worthy goal?