Dick Adams (Lyons, Australian Labor Party) Share this | Hansard source

A number of issues are contained in Appropriation Bill (No. 3) 2008-2009. The bill looks at various changes in funding for a range of programs that require changes since they were first announced, including amendments to names and amounts allocated. My interest is with the superclinics in the health sector, which may be the key to commencing the changes needed in health delivery in Australia. Additional funding is being allocated amounting to $33 million to provide up front capital grants and recurrent funding for the establishment of 31 GP superclinics around Australia and to provide incentive payments to GPs and allied health providers to relocate to those clinics. So far, one of those has been allocated in the seat of Lyons in my electorate in the growing town of Sorell in south-east Tasmania.

We all know that there is a shortage of doctors in Australia. We also all know that doctors prefer to be based in the cities rather than in regional areas and that ways to attract them out of the cities usually only work for a limited time. So we have to resort to recruiting from overseas. According to one of the doctors in Lyons, Oatlands GP Dr Robert Simpson, there is a shortage of 1,500 doctors and 5,400 nurses in regional and rural Australia. Why is this so? Well, according to a well put together article in the Tasmanian Examiner, isolation, financial incentives and family issues are just some of the factors that make medical jobs in rural areas hard to swallow. Danielle Blewett has been putting in time searching out health statistics, as she knows that Tasmanians are not getting the best out of their health system. According to Danielle, in rural Tasmania there are 180 general practitioners, of which 35 per cent are overseas trained. They come mainly from Nigeria, India and Sri Lanka. Let me say, they are most welcome. They stay for a minimum of two years. In the past we have had overseas trained doctors mainly from the UK and South Africa, and they have often migrated rather than just come for a few years. There were 26,212 GPs and other medical practitioners billing Medicare in Australia in 2007-08. There were 18,613 GPs and others working full time in Australia.

Compared with their metropolitan counterparts, GPs in rural and remote areas spend more of their time working in local hospitals, for which they are not paid through Medicare. These are real barriers to the recruitment of Australian doctors to work in rural areas. The most likely person to consider rural placement is someone near retirement who wants to work part time, an overseas doctor, or locums who want to work for no more than a few months as a relief to keep their hand in or get close to the beach.

The shortages are causing huge problems. These doctors, who are still in rural areas and have been for many years, are concerned about succession planning. Janelle quoted the case of the doctor in Tasmania—in Lilydale, which is just north of Launceston—who has been in her practice for 25 years. She is concerned that, once she retires, her town would no longer have a full-time GP and, even if they moved closer to Launceston, they would not be able to get into a doctor as most have closed their books to new patients—a very common theme in Tasmania. We can only try and fill vacancies through overseas doctors, many of whom do not have complete grasp of the English language and are not used for the sorts of cases presented. Another local doctor who has been there for some time is also concerned that rural doctors are still operating their practices in an old-fashioned way, where they are responsible for all the paperwork required for the practice as well as employment and other ordinary day-to-day office procedures—record-keeping and running the business. Today’s doctors seem to want to walk into a job and just deal with patients, deal with the health issues and not have to keep the records and be on call 24/7. He is not assisting recruiting in country areas—the old-fashioned doctors approach.

One of my old doctors, a city doctor in Hobart, complained that he could not get a partner because they did not want to do the paperwork that he did. They just wanted to do the medical work, but nothing in the way of pen pushing. So, the problem is that the delivery of health services is changing, but somehow the funding models, Medicare and doctors’ training is not. In two of my small towns a succession plan is being developed to ensure that the area has doctors in the future as there are doctors on the verge of retirement. Suggestions are being made now as to how to deal with this dilemma, which is a quite sensible approach that is not being done in many areas that I can see. Dr Simpson from Oatlands asks why we cannot see a move from the urban based practices to form alliances with rural practices to broaden the depth of experience of their staff. It seems a very good idea, so we are starting to broaden out the opportunities for doctors to work in those rural and regional areas.

Difficulties face country towns where private practices are operating public hospitals. It is noted that not many doctors, town or country, want to set up in private practice these days as it reduces their options to move further down the track. The Tasmanian Farmers and Graziers Association has also pointed out that the crisis of finding doctors is further exaggerated by changes to the rules applying to overseas doctors wanting to work in Australia. They must now pass the Australian Medical Council’s examination before they arrive here, whereas in the past they had been able to sit the exam while working here. I have had my differences with the Australian Medical Council on that issue. I understand that this might be a response to some of the difficulties caused by the entrance of some doctors of dubious training, but it does not help to put more barriers in the way. It has considerably slowed down the number of overseas applications.

The development of centres that put together a number of health professionals—doctors, nurse practitioners and practising nurses along with other services—all organised by a single office makes a lot of sense. All the paperwork and all the business can be done in one corporate centre. That is behind the idea of the superclinics, which are being developed around Australia at the moment. Getting all these services together and modernising their work environments has got to be an attractive prospect for prospective doctors looking for work sites. There needs to be backup, proper rosters, simple hospital referrals, community transport to get patients to hospital quickly when needed and access to referrals to specialists et cetera. Community transport is vital in this area, especially for the aged. This means getting services together—something that has been resisted for some time. It really needs doctors working together to achieve a common goal. Working in teams in a community similar to the way hospitals are set up seems to be a logical approach for the future, but so far it has been unachievable.

I am very keen to see our superclinic up and running at Sorell. I want to see how the model works and I want to encourage others to apply for similar types of developments. I have had some other developments in my electorate of Lyons. I know the member for Hume, who is sitting opposite, would have experienced similar difficulties with doctors in his electorate, a rural electorate in New South Wales. In the St Helens area, the GP and allied health workers have come together. They are situated in a new building. I think it cost about $1.2 million—about $400,000 of federal money and the rest from loan funds. GP North, the local division of GPs, backed that, and now we have an extremely good centre where health professionals are very happy to work and practise medicine. They also have a very good home situation for training doctors who have access to the internet and modern communications. That is certainly the way forward.

It was in the old days that a suburban house that would have accommodated a family was converted into doctors’ rooms. I have several of these old places in my area that are falling to pieces and are unpainted. They are a very unpleasant workplace for anybody. If you ask a young doctor or an overseas trained doctor to go to that sort of site to practise medicine and look after the health needs of the community, I can understand why they say they are not interested in doing that. We need to make sure we are modernising health services. The new model of service delivery for rural and regional Australia has to be provided in a bigger centre where all the health professionals are together and can share their experiences, and where they have a decent workplace in which to deliver primary health services.

In the New Norfolk area, Commonwealth money will help renew and expand the GP centre, which will hopefully work along the same lines as the one at St Helens. The people of the Derwent Valley deserve no less and also of course all those who live in areas off that valley. The Derwent Valley is the big catchment area for the Derwent River, which of course opens out into Storm Bay at Hobart.

This is the way forward. The present government is endeavouring to go down that track. It is putting money into superclinics, which are certainly going to be the way forward. I do not see why we cannot renew health delivery for primary health care in a positive way through these sorts of centres. I can see that it will be much easier to deliver preventive health and preventive health programs in rural and regional areas with these sorts of centres, where we have access to health professionals working together where they can discuss and work out programs, and which the federal government will most probably be funding into the future.

I am very pleased to be able to speak on this appropriation legislation and I commend the legislation to the House.

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