Susan Templeman (Macquarie, Australian Labor Party) Share this | Hansard source

Well, there is some agreement and recognition that there is a GP shortage—for electorates like mine it's a very serious shortage—and the Health Insurance Amendment (Enhancing the Bonded Medical Program and Other Measures) Bill 2021 will have our support. But it doesn't go nearly far enough to address the issue. The complex problem of the provision and retention of GPs has been a challenging issue since I first sought office in 2010, and I've advocated for changes at various times over those 11 years. We were able to secure special support to attract GPs to our area through some of that time, but in the past eight years there have been big changes. The Nepean Blue Mountains Primary Health Network and its predecessor have been active on this matter throughout that whole time as well. GPs have spoken to me about the strain of the shortages that they and their teams experience. Residents of my electorate, particularly new residents, have told me of their challenges in being accepted as a patient at a local practice. It plays out for a lot of people.

The Macquarie electorate covers all of the Blue Mountains and all of the Hawkesbury local government areas on the western edge of Sydney. So, some people think of us as Western Sydney, but in fact we have some very remote areas, and a lot of rural. We have a lot of distance between us and the major teaching hospitals. So these changes are welcome, but the bill will simply not address the difficulties that peri-urban areas like my electorate experience. The Morrison government's decision to exclude most of the Blue Mountains and the Hawkesbury from the new Distribution Priority Area classification means that doctors in the Bonded Medical Program can't meet their return-of-service obligations in my area, and that makes the local GP shortage worse. Often it's not just an issue of attracting the GPs; it's also an issue of attracting the bulk-bill incentives. That's another policy that the Morrison government took action on that makes the regional GP shortage worse. And of course there's also just the general impact of the Morrison government's six-year freeze of the Medicare rebates and the government's decision back in 2014 to abolish Health Workforce Australia—all these things at a time when we should be investing in Medicare and delivering more services to peri-urban, regional and rural areas. This government has been doing the opposite.

The COVID experience has obviously made things harder. That's why Labor established a Senate Community Affairs Reference Committee inquiry into outer-metro, rural and regional GP and other healthcare services. The inquiry will consider the performance of programs such as the Bonded Medical Program, and I was very pleased to make a submission to that inquiry. We want this inquiry to seek practical, positive solutions so that Australians have access to quality health care, regardless of where they live. You shouldn't have to live in Double Bay to get the best health services; you should be able to get those if you in Bullaburra. I encourage others who have views around this and have experienced the impact of shortages and difficulties accessing primary health care to make a submission to the inquiry. It can be as simple as an email and a letter. I want to acknowledge the efforts of the Nepean Blue Mountains Primary Health Network. They and their predecessor have worked hard on this and I'm very grateful for their ongoing interest in the issue.

I want to talk about the things we experience in the electorate. Residents in the upper Blue Mountains and parts of the Hawkesbury find that it can be difficult to get an appointment with a local GP in a timely way. Many new residents to the area are advised by multiple local general practices that their books are closed to new patients; they simply cannot become a patient. And a lot of our GP practices are relatively small. We don't have massive centres, so we have smaller practices scattered across a lot of towns and villages. The real challenge is in attracting GPs to live and work in the area. There are no financial incentives to attract GPs from inner metropolitan areas to the Blue Mountains, unlike designated rural areas. And GPs will not choose to commute on a daily basis from Sydney to Katoomba when there's local work available closer to home. Early-career GPs are increasingly reluctant to venture beyond inner-metropolitan areas, I'm told, or to relocate to regional and rural areas.

Let's put this in perspective. Katoomba is 55 kilometres from the nearest tertiary hospital and metropolitan centre, which is Penrith, and it's more than 100 kilometres from the CBD—probably closer to 150. Yet this peri-urban status is not reflected in GP workforce schemes and initiatives. It's still considered part of metropolitan Sydney. This is a place people go to for a long weekend to escape Sydney, yet we're classified as Sydney for the purposes of GPs. It makes no sense and is completely inequitable. This has to change. You have to travel to Black Heath, a bit further up the mountain, before you get to an area that is considered to be slightly outside Sydney.

The two major general practices in Katoomba have been under significant stress for several years. GP positions have remained vacant and demand for GP appointments has increased. Local residents report absolute distress at the impossibility of getting a timely appointment, and that means that they can end up having to go to an emergency department to get the medical assistance they need. All of this has been an issue for a long time but has been heightened ever since the Blue Mountains LGA was not deemed a distribution priority area in 2019. The primary health network informs me that, for example, in November 2020 one of these practices reported turning away more than 100 patient appointment requests a week. That's a lot of people who are reaching out to get medical assistance and advice, or to have their usual check-ups, but are not able to get it.

Coupled with the difficulty for residents in accessing appointments is the fact that there is no 100 per cent bulk-billing general practice in the mid- to upper-Blue Mountains. There's no general practice open on evenings, Saturday afternoons, Sundays or public holidays. This is a contrast to other areas closer to Sydney, where bulk-bill services are available until 10 o'clock every night of the year. That has led to a strain on the emergency department at the local Blue Mountains District Anzac Memorial Hospital. The cost factor is an issue as well as the difficulty in securing a doctor's appointment. It means that residents in the area who have chronic and complex health issues frequently present at the hospital with what are probably inappropriate presentations that could be seen by a GP rather than taking up time in an emergency department. But they're thinking about the out-of-pocket, the cost of the appointments that they would have to pay.

I received similar feedback to this from GPs in the Hawkesbury. Remember that the Blue Mountains is an area of about 1,000 square kilometres and the Hawkesbury is an area of about 3,000 square kilometres, with people living up little country roads, stretching halfway up to the Hunter. Their medical services are delivered in small towns and cities like Richmond and Windsor. I raised this issue recently in a Zoom with GPs, in which I was getting an update from them around how the vaccination rollout was going in the Hawkesbury. I asked them, 'How are you feeling about GP shortages?' And there was just a complete, unanimous response of, 'Oh my goodness, it is a massive issue!' They had a totally unanimous view about it, particularly when they talked about the area across the river—not the Sydney side of the Hawkesbury River but the north and western parts of this very large LGA.

Historically, we have had a proportion of the district covered by workforce shortage provisions. In the past this has enabled GPs to recruit from a wider pool of doctors, because it allowed for overseas-trained doctors and those on the Bonded Medical Places Scheme to work in the region. Under the Commonwealth's Stronger Rural Health Strategy, and in an effort to shift inequity in the distribution of GPs, the distribution workforce system was replaced in 2019 with this new Distribution Priority Area scheme. It might have benefited some very rural and remote areas—I don't argue that—but peri-urban areas like mine are worse off as a result. The suburbs of Blackheath and Mount Victoria—and anyone who knows the Blue Mountains knows they are small areas right at the top of the mountains—are the only areas now classified as being distribution priority areas. That's in contrast to the entire Blue Mountains and most of the Hawkesbury local government area previously being considered a DWS.

A high and growing proportion of GPs who work in the broader Nepean Blue Mountains PHN are overseas trained doctors. In 2017, about half of GPs in the region had gained their qualifications overseas. The loss of the DWS-DPA status has had a detrimental effect on general practices' ability to get those GPs to work there. I will give you one example of that, Mr Deputy Speaker. When the area was ruled a DWS, under the old scheme, we were able to help at least 25 doctors, in a 4½-year period, secure work in a general practice in the region. Afterwards, that changed. The only place you can do it is Blackheath, so we're down to pretty much zero. There are a few exceptions. The establishment of the medical practice in Glossodia, in the Hawkesbury, was helped only due to the fact that it was in a DWS-DPA area and the owner of the practice was the first doctor they recruited. That has not been possible since the changes were made. These are two things that were possible before but are not possible now, and the consequences of that are really profound.

One of the really serious consequences I'm seeing is GP burnout. I think we've probably all seen GP burnout during COVID. They have been asked to administer vaccines to thousands and thousands of people. In my electorate there is no hub. The only place you can go is to a GP practice or, now, to a pharmacy. The hubs are outside the electorate, so people have leaned really heavily on their GPs. They have stepped up amazingly, but they are burning out. They are carrying a large and complex case load. I'm advised that several GPs from the upper Blue Mountains have resigned in the last 12 months because the patient complexity and workload volume were simply unsustainable.

In peri-urban areas like mine there are fewer opportunities for GPs to link patients with the types of health services and support that residents in metropolitan areas have, so they carry a big load on their own. They're coordinating far more of the care of patients with chronic conditions than are their urban counterparts, who can simply refer on. My rural and regional colleagues will know this.

My GPs also report that they feel less connected to a collegiate professional network. They draw a lot on each other, as GPs, but there's not necessarily the wider ecosystem. Interestingly, I've had a number of conversations with overseas trained GPs who aren't able to work in my electorate. They live in Sydney's west, so they live close. We're not asking them to drive long distances to get to us. They would love the opportunity to finish their Australian training and be supervised, and we have such experienced GPs within our practices that the supervision would be of a very high standard. With the right incentives it would actually be a perfect match. These are the sorts of things that should be considered to provide long-term, sustainable services to my community.

At a systemic, policy level we need to see the methodology for determining distribution priority areas reviewed; we need to see more incentives for GPs to work in lower socioeconomic, peri-urban areas; we need stronger measures to support collegiate professional networks; and we need to consider new models for funding primary health care that might support our GPs and their work. We really do need to draw on the experience of long-serving GPs to train the next generation.

There's one other thing that I think this parliament needs to push. We all accept that telehealth will be an absolutely crucial part of our Medicare system going forward. It has saved lives during COVID. The medical profession, public health experts and patients themselves all agree that it should be made permanent, but after two years of a global pandemic it still isn't a permanent thing. I cannot understand the delay. That is something that needs to be done and it's something Labor will be fighting for, to defend Medicare and improve health services.

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