Chris Bowen (McMahon, Australian Labor Party, Shadow Minister for Health) Share this | Hansard source

The Labor Party will be supporting the Health Insurance Amendment (General Practitioners and Quality Assurance) Bill 2020. It changes the registration of general practitioners—and the whole House will join me in thanking Australia's doctors and medical profession, and general practitioners in particular, for the role they are playing as we deal with the COVID-19 crisis. This bill amends the Health Insurance Act 1973 to simplify the administration of higher Medicare payments for some GPs. This is very sensible streamlining. GPs are eligible for higher Medicare rebates if they are fellows of Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine and meet ongoing, continuing professional development requirements.

The current system is quite shambolic, to be honest. It requires two different systems: the current system for determining eligibility for those higher rebates as administered by Services Australia, and it duplicates the separate requirements of the National Registration and Accreditation Scheme. So this bill removes the requirement for eligible GPs to register with Services Australia and, instead, ties eligibility for higher Medicare rebates to the existing scheme. This is how the eligibility for other specialist rebates is already determined and it will reduce red tape for general practice, colleges and Services Australia. It reduces red tape all around. It is a sensible change. Hence, Labor will support this bill.

I will, however, be moving a second reading amendment which notes the things that the Labor Party does not support and some things that the Labor Party is concerned about. I talk, in particular, of the impact of the government's changes in relation to general practice in regional Australia and outer metropolitan Australia. These are changes which the government has undertaken and, despite the Minister for Regional Health's assertion, which did not require legislation and did not have the support of the Labor Party. He misled the House at one point to assert this. These are changes which have been done administratively.

The Stronger Rural Health Strategy is one with fine ambitions, and we support those ambitions. It has been very important to me in my time as shadow health minister to highlight and focus on rural health disparities and the shortage of medical health professionals and allied health care professionals in rural Australia. It is one thing to support the intent of the strategy, but the way the government is going about it has had intended or unintended consequences in other areas.

The first is to change Medicare bulk-billing incentives. GPs are paid additional incentives when they bulk-bill children and concessional cardholders. These are higher in rural areas than cities to encourage GPs to practice in the bush. But, under government changes to how rural areas are defined, many areas have lost access to these higher incentives and have been moved to lower metropolitan incentives. The government initially claimed that there were just 14 areas that had been affected, but we know through Senate estimates that 433 areas have seen cuts. I have been in electorates and communities which have received these cuts and the local member has been unaware because the government had not been transparent about it. These general practitioners have seen a reduction of 34 per cent in their incentive payments from $9.65 to $6.40.

GPs in places like Queanbeyan have seen those incentives slashed. Queanbeyan is not a major metropolitan centre; it is a regional centre and an important centre. It is not the middle of Sydney or Melbourne, and we need incentives for GPs to work in Queanbeyan. But this government has reduced the incentives there, and I think the government might be hearing a bit more about that in the coming weeks and months. It might find that it will be held to account for its decision to do that.

The second change is to the longstanding District of Workforce Shortage system. Doctors who've trained overseas or in a bonded position in Australia can only claim Medicare benefits for a time in defined rural areas. The government's changed the system for defining those areas to a new Distribution Priority Area system. The old system wasn't perfect, and I was open to a conversation about sensible changes. I looked at the government's changes and looked at them in good faith. I welcome the fact that the new system does take into account an area's socioeconomic status. That is a good thing. It shouldn't just be based on non-economic criteria. Areas that are doing it tough do deserve special consideration. That is one element I looked at favourably. But, again, the change is having consequences which I can only assume are unintended. I can't actually bring myself to believe that the government intended the consequences that some of these changes are having.

For example, Yass struggled to attract and retain doctors even when it was under the District of Workforce Shortage, and it will be tougher now that it's not in the DPA. I suspect the government will be hearing more about the impact on Yass as well in coming weeks because they have neglected the people of Yass and the medical care of the people of Yass. It's just one of 250 regional and outer metropolitan areas around the country that have been negatively affected. This impacts regional areas and outer metropolitan areas. This is a matter that I know my friend and colleague the member for Macarthur is deeply concerned about as a medical practitioner and as representative of outer metropolitan Sydney, as I am. I have experienced difficulty in attracting general practitioners to my electorate, which is not remote. It is not really regional. It is in the western suburbs of Sydney. Even those areas have trouble attracting doctors, as does the area represented by the member for Macarthur and as do areas represented by other members in this place. We know that outer metropolitan areas need more doctors, not fewer doctors. We suffer health disparities as well, we suffer high rates of diabetes, we suffer high rates of obesity and we suffer strong levels of co-morbidity. If the government think that reducing doctors in outer metropolitan Australia is a good idea, we will beg to differ.

The third change is the abolition of the Rural Other Medical Practitioners, or ROMPs, program. This is having a severe impact as well. Just before we stopped travelling and started to stay closer to home in recent times, the last interstate trip I undertook was to Maryborough in Queensland. It's a fine place. It's the birthplace of the author of Mary Poppins, who's justly and quite properly celebrated in Maryborough. I visited a general practice and I visited a former general practice where the sign on the door doesn't have the opening hours of the general practice; it says 'for lease'. 'The practice closed due to changes made by the federal government' is what the sign says on the door at Maryborough. That is the impact of this government's changes. Again, Maryborough is not a thriving metropolis. It is a great place, a lovely town and an important home for many people. It was home to an important children's author. But it is not the centre of Sydney or Melbourne. Yet the government's changes—and this isn't a tweak; this isn't an adjustment; this isn't a policy criteria change—have abolished the ROMPs program completely. Under the ROMPs program, less-qualified GPs were paid higher rebates if they practised in rural or regional Australia. It was a popular program because it had the objective of providing incentives to attract doctors to places like Maryborough, and the government have simply abolished the program in an attempt, they say, to improve rural and regional GP quality.

We all want to see highly qualified doctors in rural and regional Australia, but I would also just like to see some doctors in rural and regional Australia. If the impact of their change is not to attract more highly qualified doctors into places like Maryborough but to see doctor's surgeries close then I say to the government: 'Have a rethink, because the evidence is in. We know how your scheme is working, and it's not working well.' The impact on places like Maryborough has been duplicated across the country. We've seen that time and time again, and I'm not talking from a briefing note and I'm not talking from some sort of study; I'm talking from having been to Maryborough and sat down with the doctors in Maryborough and surrounding areas. I've been to the clinics which have closed. I've looked at the waiting rooms in Maryborough and seen them overflowing. I asked one of the doctors, 'If I were a Maryborough resident and I rang up and asked for an appointment to see a doctor today, how long would it be before I could see that doctor?' You would hope that the doctor would have said to me, 'Well, you could be seen later in the day, or maybe tomorrow.' The answer was two weeks! A two-week waiting period to see a doctor!

Dr Freelander interjecting—

As the member for Macarthur points out—I think I heard him correctly—they aren't ringing for fun! They're not ringing because they want to have a chat! They're ringing because they are sick. And in two weeks time either they'll have got better, just through the effluxion of time, or they will have got a lot worse—and often the latter. That's why you need to see a doctor and, usually, you need to see a doctor more quickly than in two weeks time. Occasionally that might be okay—you might just have their annual check-up or there might be something which is not an urgent matter—but on most occasions people want to see their doctor that day, or certainly in a matter of days. Not two weeks away. The problem is not that the doctors aren't willing to work; I saw that firsthand—their waiting rooms were full. The problem is they simply don't have enough time to see everyone because there are so few doctors compared to the population.

These are the real-life impacts of the changes the government is making in Queanbeyan, in Yass, in Maryborough and in Campbelltown—all across Australia. In Werribee, we're seeing the impact of the various changes the government is making. As I said, I will not have the government tell us that they care more about rural health than we do. I spend a lot of time in rural Australia as shadow minister for health. I've travelled through rural New South Wales with Senator O'Neill. I've been to rural and regional Queensland, I've been through remote Western Australia and I've been through the remote Northern Territory. I care about getting more doctors and allied healthcare professionals into remote Australia. But I do not want to see places which aren't in metropolitan Sydney or Melbourne—or, indeed, Brisbane—negatively impacted.

These changes impact, for example, on the electorate of Paterson. As the member for Paterson has pointed out to me, Kurri Kurri is treated the same as Mosman under the government's changes. Again, Kurri Kurri is a perfectly nice place, but it's not Mosman. It's not Mosman, which is one of the most affluent areas of Sydney, but there are the same incentives to work as a doctor in Kurri Kurri as we have in Mosman. This is an indication of just how cack-handed the government's approach has been when it comes to rural and regional health in Australia.

I will move the second reading amendment, which will give other honourable members the opportunity to point out the impacts of these changes on their electorates—how their electorates have been adversely impacted by the government's changes. The government says, 'Nothing to see here.' Honourable members might recall that I asked the Minister for Regional Health about some of these matters a little while ago. His answers, I dare say, were found by this side of the House to be highly unsatisfactory. He claimed that the Labor Party had supported legislation to do these things. There is no legislation; it's all done by ministerial regulation. So the minister wasn't even aware of how he'd implemented the changes, let alone the impact those changes have had on rural and regional Australia and outer metropolitan Australia.

If the government wants to have a debate about who is better for Australia's regions then we're happy to have that debate, because, when it comes to health, it's not that side of the House. When it comes to health it's not the Liberal and National Party members who are standing up for their communities, it's the Labor Party members. It's not the regional Liberals; I haven't seen them protesting about the impact of these changes on their communities. No; they cop it. They cop it—they go along with these changes. Well, Labor members are a lot more vocal about the impact of the changes.

I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House expresses its concern at the Government’s cuts and changes to Medicare, particularly those changes that have made access to medical practitioners more difficult in the regions, including:

(1) cuts to rural bulk billing incentives;

(2) changes to the District of Workforce Shortage and Distribution Priority Area health workforce classifications; and

(3) abolition of the Rural Other Medical Practitioners program".

We will support the legislation and we will ask the House and the government to take into account the matters that are raised in the second reading amendment.

See this speech in context