Andrew Wilkie (Clark, Independent) Share this | Hansard source

The minister paints a rosy picture, but I don't buy it and I don't think many Australians would buy it. When I go about my work in my community and travel around Tasmania, including in regional, rural and remote Tasmania, and when I talk to my wife and her colleagues—and my wife is a general practitioner—it is patently obvious that general practice in this country is in crisis. It is an undeniable fact that many Australians simply can't find a GP with open books—or at least one that might bulk-bill. It's an undeniable fact that hospital emergency departments are heavily populated with non-emergency patients. It's an undeniable fact that many Australians are financially stretched to breaking point right now, and the big and growing gap fees are just one more pressure on those family budgets.

Tasmania is particularly badly affected, as reflected in the shocking statistic that regional Tasmania has approximately one-third less general practitioners per thousand people in the population than the national average. General practice is in crisis. To be fair to the minister and to be fair to the government, there have been some positive reforms. Yes, the urgent care clinics are of some value—in particular in the cities, where they tend to be located. And, yes, I acknowledge that the tripling of the bulk-billing incentive payment has led to an uptick in the rate of bulk-billing. But again, it is undeniable that bulk-billing rates are still woeful right across the country and that GP numbers are still grossly inadequate.

The government would dispute that—in fact, as I said, the minister has just painted a very rosy picture of it. But even by the government's own numbers, the bulk-billing rate is still just 72 per cent in Tasmania, and that apparently reasonable rate—although I think it's still very low for a country as rich as ours—is actually covering up the reality. That's because when the government measures bulk-billing, it uses the number of bulked-billed services delivered and not the number of unique patient services. In other words, if a member of the public goes to see their GP and has to pay for the consultation, but gets a referral for a bulked-billed blood test and perhaps a bulked-billed x-ray, then the numbers the government uses would show those as three services, one not bulked-billed and two bulked-billed. In other words, the government's figures are grossly misleading. In fact, when I drill down into the figures and look at figures for Tasmania for the patients that are always bulked-billed across the state, it's only 36 per cent. That 36-per-cent figure was from before the introduction of the tripling of the bulk-billing incentive. But even if we apply all of the uptick seen across the country as a result of the bulk-billing incentive payment, then the figure for patients who are always bulk-billed in Tasmania is still only a bit over 40 per cent. It's barely a bit over half of what the government claims in its figures.

This can be fixed, starting with restoring the Medicare GP rebate to the value it was in 1984—when it was introduced. The fact of the matter is that due to pauses in indexation, and inadequate indexation since 1984, the real value of the Medicare GP rebate is about half what it was in 1984. This explains why doctors aren't bulk-billing; this explains why the number of unique patients in Tasmania that are always bulk-billed is just a bit over 40 per cent. It's because the rebate is so woeful that you can't run a GP practice and rely on it. That's why so many GPs are having to resort to a gap payment.

Can we afford this? Of course we can. The budget that was brought down two weeks ago forecast that the government would spend three-quarters of a trillion dollars next financial year. Heavens, it's all about priorities and working out other ways that we should be spending our money. And, very quickly, I would add that the other problem is the number of graduates. It's such an undesirable line of work now that only about 10½ per cent of medical undergraduates are considering following a career in general practice. Heavens, it used to be 70 to 80 per cent! So we have a crisis coming with the number of GPs: not enough now and certainly not enough in the future.

This can be fixed. I call on the government to fix it; I call on the government to have a better set of priorities and to invest more money in general practice.

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