Joel Fitzgibbon (Hunter, Australian Labor Party, Shadow Assistant Treasurer and Revenue) Share this | Hansard source

The member for Kingsford Smith is right to say that it is far too high. It is double the acceptable level. Twice as many people as the acceptable standard are trying to see GPs in my electorate. This is a crisis situation. People cannot get to see a doctor. I have real examples of this. Newspapers in the past have asked me whether I can give real-life examples of people who physically cannot access a doctor, and I have been able to provide those real-life examples. In some cases it has been a pretty sad story, where children have failed to secure the services of a general practitioner when they have really needed it. We often hear in this case that that forces them to wait at the local public hospital. Not only does that inconvenience the family and actually put lives at risk but it also then becomes a cost-shifting exercise between the Commonwealth and the state. If you go to the GP, the major cost is borne by the Commonwealth; if you go and line up at the public hospital, then the major cost is borne by the state government. So there is a significant cost-shifting issue here.

When will the government finally acknowledge and recognise this is a problem and do something about it? How long can communities like Cessnock and Maitland continue to soldier on without a basic right—the ability to access a general practitioner when that is the family’s requirement?

One of the big problems with the current system is this system of RRAMA classification. The RRAMA classification classifies towns on their rural remoteness. Obviously the more remote you get, the more difficult it can be to secure GPs. In the cities, where lifestyle choices are attractive, GPs are pretty easy to find. That is why bulk-billing rates are so high in Labor strongholds like some areas of Western Sydney and so low in Labor strongholds in rural Australia. It is simply is a matter of competition: if you have a doctor on every corner, there is going to be intense competition—doctors fighting for patients, in effect. In a normal market it would drive the price down, but what it does in this market is push the doctors into offering bulk-billing services. In other words, the patient does not have to pay any out-of-pocket expenses.

But in rural and regional Australia, where doctors are much more thin on the ground, there is no competition. In fact, there is a disincentive to bulk-bill because, if you are a hardworking GP—and all the GPs in my area and, I am sure, in all of Australia, are hard working—you do not want to be attracting additional patients. You cannot deal with the patient load you already have. So the response, of course, is not to bulk-bill—put a price signal in there so people do not come to the doctor. I am not imputing any bad motive upon the doctors. They can only work 24 hours a day, not 26. It is not surprising, therefore, that they would want to put that price signal in place. Again, in Western Sydney and many city areas, where the lifestyle is attractive, the competition is intense, and the best way for doctors who are undersourced to attract patients is to bulk-bill. That is why that discrepancy applies so obviously.

The RRAMA classification is wrong in its implementation and it is wrong in fact. You cannot assume that because an area is rural it is more difficult to secure a doctor. In fact, some rural areas are very attractive to doctors, for various reasons. Big regional centres can offer their attractions. Some people might want to work in a rural area because they are from rural areas themselves, and that is an attraction to them. This is why we have to get more local people to do their medical degrees in regional universities. The people most likely to practise in rural and regional areas are people who come from rural and regional areas in the first place. The more people we can get coming back to those areas, the more doctors we will have, the more competition we will have, the more demand for patients we will have and of course the more bulk-billing we will have in those regional areas.

The RRAMA classification system is full of those anomalies. I have spoken with the minister for health about this issue and I agree with him when he says it is very difficult to start pushing RRAMA boundaries around. We have RRAMA 1 for city and metropolitan areas, we have RRAMA 2 for other metropolitan areas, we have RRAMA 3 for regional areas and RRAMA 4 for, I think, rural areas. It goes on and on and on. When you use these arbitrarily drawn lines and you start moving them around, just as in the case of thresholds in tax policy, you create another problem and therefore you create another anomaly. So I agree with the minister for health that it is difficult to deal with the issues facing these so-called ‘other metropolitan’ or RRAMA 2 areas by just shifting the boundary a bit further, because just beyond that boundary there is likely to be another community with other problems just as intense as the problems of those who were previously outside the RRAMA 3 area.

Boundary adjustments will not do the trick. It only exacerbates the problem or spreads it to other places. We have to jettison this idea of drawing these arbitrary lines and having people rely on those arbitrary lines for access to basic health services. The government should have learned by now that you cannot take this one size fits all approach to public health policy, just as it should have learned that you cannot take a one size fits all approach to taxation policy as it applies to small business. That policy last year drove more than 2,000 small business operators to the wall. You have to start taking a town by town approach to these classifications to ensure that these additional initiatives governments take to help create more GPs in their local areas are applied to towns in need and not just towns that might fall within one particular boundary. Under the RRAMA 2 classification, Cessnock and Maitland cannot get access to those initiatives that are provided to try to lift GP numbers in those local areas.

I will give the minister for health his due. He visited Cessnock recently and discussed some of these issues with us. I was delighted with the time he gave to those health professionals he spoke with, the time he gave to those consumers he spoke with, but, alas, I saw no initiative in the budget whatsoever that is going to address the doctor shortage crisis in the LGAs of Cessnock and Maitland. Today, as I close this debate, I appeal to the minister for health, in his presence, to have another look at those areas and do something about that GP crisis.

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