Andrew Laming (Bowman, Liberal Party) Share this | Hansard source

[by video link] It's a brave member who stands up to New England MPs in a rage, but there is probably a need for some sobering information about exactly how after-hour services work and the fact that there's a broad platform of services that all residents in the Hunter and New England are able to access.

The first speaker was absolutely correct that large amounts of money, from both sides of politics, have gone into supporting after-hours GP services. It was an absolute brainchild of the Howard government, which put together this scheme. It led to significant after-hours access to GPs, and it' really important. That funding has never been cut. But, by being activity based, as Medicare is, the more the service is used, the more likely a service is to be viable. Likewise, if hours are reduced by providers then, by definition, their income will be lower. I think that's at the heart of this problem, not some malevolent hatred from a political party towards after-hours access. The rules are the same nationwide. If an individual service is noting a decline in funding then it's most likely due to a decline in activity. That's a very important point.

As a government, we don't directly fund Hunter Primary Care. Funding can and has been reduced, for instance, by the state government, which is likely to have a significant impact on the decision to close Calvary Mater hospital on, I think, 24 December. That's a state not a federal issue. I know that residents there can access one of the four other GP Access After Hours programs in the Hunter region. There's a John Hunter just a 10-minute drive away. You've got the explosion of online consultations, as well, through Medicare. We do understand the irritation and frustration, but hopefully not political opportunism, from the first speaker. She's a good MP, but I don't think she fully understands the economics behind changes in funding that are predominantly activity based.

The government spends nearly three-quarters of a billion dollars on after-hours care, and $71 million of that for the PHN After Hours Program. It's basically driven by demand, isn't it? You need to be finding your GPs. I'd say to the member: go out and promote the after-hours service and get more GPs into your area who are prepared to bulk-bill. If you're losing that battle to electorates like mine, which have lots of GPs prepared to bulk-bill, then you have a PR issue and you need to work on your marketing and on your recruitment of GPs to your area. Do better. A C-plus for the member on those grounds.

We know that after-hours investment ranges from all of the basic MBS to the Practice Incentives Program and the Healthdirect services. There are lots and lots of sources of funding. There's been a recent program evaluation of the Hunter, New England and Central Coast PHN. The PHN After Hours Program, in particular, had an independent assessment that looked at whether the program was filling critical roles, meeting after-hours needs, and they found significant areas that needed to be worked on and improved. You need to expect the government to be able to have that latitude and headroom to be able to improve services where required and to work with PHNs to redesign a service, particularly when they're not consistently prioritising the delivery of primary care services in the after-hours period. There are instances where the PHN was commissioning services that just duplicated other Commonwealth and state services. To follow the line of logic from the previous speaker, do we do nothing about that?

Of course not. You've got to do something. You've got to hold workshops. You've got to improve the focus. You've got to make sure patients are able, through this raft of providers, to get an after-hours service. Whether or not it's from that service member is not as important as ensuring that they can get the service.

We're not here to save every provider. I can see some whimsical, quizzical faces in the opposition. Well, I've been doing this for a couple of decades. I know that some services don't meet the needs of the population that others do, and we need to be making sure that there is a financial signal, and it's mostly through demand. If there are reduced operating hours at a place like Calvary Mater clinic, then that contract has to be renegotiated. It's quite simple. There are plenty of other providers out there for GPs to work for—to be redeployed. It just reflects the national trend, doesn't it? If providers are doing a good job, they attract GPs. The decision to bulk bill is one for them to make, and them alone.

I know this is a very good member moving the motion, but I've got to be honest. I've been doing this for a long time; I know exactly how after-hours services work. Some do it better than others. Some meet community needs; some don't. Some deliver after hours in a genuine sense, and others are sometimes duplicating services and sometimes not getting the activity and the customer base that they should be from patients, and funding must reflect that. I think having these workshops at PHN level is an important step in that direction. I hope these service providers get through it, but there's no malevolence from the government. These are local issues, and these GPs need the support from their local MPs.

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