Peta Murphy (Dunkley, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That this House:

(1) commends the Government for delivering on its commitment to address doctor shortages in rural, regional and outer metropolitan areas by updating the distribution priority area classification to support communities in need of general practitioners;

(2) acknowledges that practices in these areas will now be able to recruit from a larger pool of doctors, including international medical graduates and overseas trained doctors; and

(3) notes the Government's continuing support of access to quality, affordable healthcare through its commitment to establish 50 Medicare urgent care clinics across the country, making it easier to see a doctor for minor emergencies and taking pressure off hospital emergency departments.

Dunkley is a magnificent place to live. Most of my electorate is contained within the Frankston LGA, and some of my electorate, Mount Eliza, is within the Mornington Peninsula shire LGA. We're all in the South Eastern Melbourne Primary Health Network. It's a magnificent place to live, but, in Frankston, we do have some significant health issues. For example, emergency department presentations in the Frankston LGA are at just over 5½ thousand per 100,000 residents; The Victoria average is 3½ thousand. Urgent presentations are at 14,000 per 100,000; the Victorian average is just under 10½ thousand. Non-urgent presentations are at 1,500 per 100,000; for the rest of the South Eastern Melbourne Primary Health Network, it's just 1.3.

In 2019-20, Frankston had the highest number of lower urgency after-hours emergency department hospital presentations in our health network. That's almost 22 per cent per 100,000. We don't have enough GPs to service an area which has significant chronic health difficulties. We have significantly higher-than-average rates of arthritis, asthma, chronic obstructive pulmonary disease and cardiovascular disease and the associated risk factors, such as poor dietary intake, obesity and physical inactivity. They're the highest in the region.

Something that concerns me greatly—many people would know why—is that, of women aged 50 to 74, just under 50 per cent participate in breast screening, whereas the Victorian average is 53.6 per cent. We have, almost unavoidably, a higher avoidable mortality rate for breast cancer—19 per 100,000—than the average for the region, which is just 16. We have higher numbers than average for our region's circulatory systems diseases, chronic obstructive pulmonary diseases, colorectal cancer and respiratory diseases. We have significantly higher-than-average levels of obesity. And we have more residents than the rest of our region who experience cost as a barrier to accessing the healthcare system. No-one should experience cost as a barrier to accessing the universal healthcare system in this country.

For years now—almost since I was first elected—doctors, particularly in Frankston, Langwarrin and Carrum Downs, have been telling me they cannot attract enough GPs for their bulk-billing clinics. It has been a chronic problem that I lobbied the former government about over and over again, because we were not a distribution priority area for the recruitment of doctors. We kept getting told by the former government and the department that there was no problem. Yet we know there was, on the ground, and there has been until recently. It continues, but it's, hopefully, about to change. Jill, who's 80 years old, from Carrum Downs, contacted me because her preferred centre, the Ballarto Medical Centre, couldn't get her an appointment for five days, even though they wanted to, because they don't have enough bulk-billing doctors. We know that it's a problem in regional and rural areas in this country. It's talked about a lot, and more needs to be done. But it's also a big problem in the outer metropolitan areas, and before this current government, we often didn't feature in the conversation. That's why I'm so pleased that we've already delivered on the election commitment that the minister made to my electorate, which was that Frankston would be a distribution priority area, and it now is. It's not going to change overnight, but now my clinics can go and recruit not just Australian GPs—we know we need to produce many more Australian GPs—but also GPs from overseas.

The other thing that we're doing in my electorate is establishing an urgent care clinic to address the numbers of presentations at emergency rooms, to take the pressure off the hospital but also to make sure that people who have broken arms and legs, cuts and bruises, issues that they need to present urgently to get addressed but aren't as critical as many things that go to an emergency room, can get looked after immediately by a bulk-billing clinic by nurses and GPs. There'll be 50 across the country. One of them will be in Dunkley. Again, that's the difference between a government that thinks about and delivers on health care and one that doesn't.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

I appreciate the government's intentions in changing distribution priority areas, DPAs, to automatically include all Modified Monash Model level 2 and some level 1 areas, but the cost of this decision will be borne by the regions—rural people. People in regional Australia already have significantly worse health outcomes than people living in metropolitan areas, and it's vital to keep this in mind.

The DPA was set up as a measure of last resort to make a broader pool of doctors, including those trained overseas, eligible for Medicare in communities having difficulty attracting doctors. Overseas trained doctors may practise in these locations for a time before they receive an unrestricted Medicare provider number to practise anywhere in Australia. So now we're going to have a system where metropolitan Elizabeth, in the Playford council, with a population of approximately 100,000 people, is treated the same as remote Kangaroo Island, with a population of less than 5,000. Now capital city Hobart, with a population of near a quarter of a million, is going to be treated the same as my little town in Birdwood, population 1,200, and Milang, population 850—areas with no public transport or regular access to medical services. And what's happening now is that doctors are cancelling their contracts in remote and regional Australia, going and living in North Adelaide, and they'll drive out to Elizabeth.

The Rural Doctors Association of Australia and the Australian College of Rural and Remote Medicine have expressed concern about expanding the DPA to these centres and outer metropolitan areas, saying that it will erode already limited access to health care in rural Australia. The RDA reports that some overseas trained doctors have already resigned. They've cancelled their contracts. They've withdrawn their applications to practise in the regions as a result of these changes. The RDA president, Dr Megan Belot, has stated, 'We have already received very early indicators of how this policy change will wreak havoc in the bush.'

Our doctors are the backbone of primary health care in the regions. It's already hard enough to attract doctors, even in relatively inner regional areas in parts of my electorate. The RDA anticipate this move will further diminish the chances of regional, rural and remote communities attracting doctors if no other measures are put in place for those communities. Several of our communities in Mayo already experience severe difficulty in this regard. Last month, the only general practice in the town of Meadows closed its doors, leaving around 2,000 people looking for alternative care some distance away—and there's no public transport available. The city isn't just 20 kilometres down the road. Residents in Yankalilla, a DPA listed area located on the Fleurieu Peninsula, have lost one of their two GP clinics. The average age in Yankalilla is around 68. With the remaining clinic already at capacity, residents now need to travel further if they can find a doctor who is taking new patients. They can't get on a bus to do that. They have to rely on someone to drive them if they can't drive themselves. Closures will lead to older people in our communities, those who do not have access to transport and those who have need for chronic illness care deferring primary health care. This is going to dramatically affect their quality of life.

Equally dire is Kangaroo Island, which relies on sea and air transport to access medical support on the mainland. Chronic doctor shortages have resulted in the short-term closure of Kangaroo Island Health Service obstetric and theatre services. Expectant mothers have been asked to relocate off island for weeks around their due date. The flow-on effects on the island are huge. Pregnant women and their partners are not on island to care for their other children, run their farms and businesses and, in one case, to carry out their duties as a local GP.

I call on the government to urgently work with key groups to fix the mess that they have now created. Leeching doctors from our underserviced regional and remote areas, where we already know we have poorer health outcomes, is outrageous, just because they are a Labor seat. That is why this has happened. This is purely political. Doctors are being taken from areas that are in non-Labor seats, including in my electorate, and they're going to be going into these Labor seats. Quite frankly, it's outrageous, and it's a big problem that is the making of this new government. I have deep concerns for regional Australia.

Meryl Swanson (Paterson, Australian Labor Party) Share this | Link to this | Hansard source

My electorate of Paterson is home to approximately 137,000 people. The health care for those people has deteriorated over the last 10 years. That is a fact. Last year, I met with the managers of local GP practices because the doctors couldn't spare the time to come and meet with me, such is the pressure for appointments. They had to send their practice managers, and, in fact, some of those practice managers were in tears describing the stress that they, and their GPs, are under.

The largest amount of correspondence I get in my inbox, by far, is about health care. Indeed, it's about trying to get an appointment at the doctors—and let's not even talk about specialists' appointments in rural and regional Australia. It is an abomination in this day and age to think that people have to wait years in some circumstances to see a specialist. What I have been hearing time and time again is that, in Australia at the moment, of all the people who graduate from medical school, about 12 per cent of them go into general practice. In the 1970s, roughly 50 per cent of people went into general medicine. Now, people are gravitating towards specialisations.

We will do more to encourage more people to go into generalist medicine. We need that, and we need those people to come to regional and rural Australia. In a place like beautiful Port Stephens, a lot of people come to retire—they often describe it, with tongue in cheek, as God's waiting room. Well, it is a magnificent part of the world, and we do have a lot of experienced Australians. However, a lot of people also want to come to Port Stephens to holiday. And, at times, our population there is fivefold what it normally is. This puts the medical profession in Port Stephens under immense pressure. Tomaree Hospital gets absolutely inundated, and not only over the summer; we're seeing more and more people coming to enjoy our whale-watching season in the winter.

Our GPs in Port Stephens are experienced, too. In fact, many of them have thought about retiring. But they just can't, because there isn't a replacement. That's why I am particularly pleased to talk about the course of action we have taken in, firstly, saying, 'You know what? A town like Kurri Kurri, in my electorate, or a town like Nelson Bay isn't the same as the CBD in Sydney. It is an area of need for medicine.' I'm pleased to say that our government has taken action to ensure that we can recruit doctors to places like beautiful Port Stephens and Kurri Kurri. The Medicare taskforce is going to review the bulk-billing rebates for local GPs. That's such an important thing, too, because we know it is now harder than ever to run a practice. And we need these practices to be able to be prosperous. We need to encourage people back into medicine.

We also know that creative recruitment and training of international and local doctors is so important in getting them to come to the bush, to seats like Paterson. The MRI licence at the Maitland Hospital is something else that I have campaigned on, and I am so delighted to say that an Albanese government is going to deliver an MRI licence for the Maitland Hospital MRI machine so that people can be bulk-billed when they need an all-important MRI for diagnosis.

Labor is always going to support Medicare, and we are always going to deliver for people when it comes to health care. We just absolutely fundamentally understand how important health care is, and we understand it in places like Paterson.

GP access is also one of the critical things that help to alleviate the pressure on emergency waiting rooms. No-one wants to sit in the ER with a sick child or relative and think, 'I'm going to be here for eight hours.' We're going to take the pressure off those ER waiting times because we know that people want that so desperately in regional and rural areas. There's a lot of work to do, but be assured, we are working with medical professionals to ensure better health for all Australians.

Anne Webster (Mallee, National Party, Shadow Assistant Minister for Regional Development) Share this | Link to this | Hansard source

When you're sick and you need a doctor, it should not be a herculean task to get an appointment. However, doctor shortages exacerbate poorer health outcomes for everyone, in particular those in regional and rural towns. I can speak for my experience in Mallee.

In the 46th Parliament I worked hard with the then Minister for Health, Greg Hunt, to work on solutions for this problem. These measures included making telehealth permanent, thanks to COVID. We funded 80 Commonwealth supported places for rural medical programs so students could study in the regions. We know that 60 per cent of those who study in the regions will stay there. We provided HECS-HELP for doctors and nurse practitioners to have their HECS-HELP reimbursed at the completion of time in the bush. We also incentivised the rural bulk-billing incentive and increased it. We permanently retained telehealth. In the last two years, there have been over 100 million telehealth services delivered to more than 17 million people with a cost of $5.1 billion. Telehealth increased access, reduced travel time, reduced the risks of sitting in waiting rooms, where others might have COVID, and reduced waiting times for patients in regional and rural areas to see a doctor.

The previous coalition government also funded $114.2 million which includes further Commonwealth supported places, so students could study medicine regionally. I recently had the pleasure of attending Charles Sturt University's new Mallee Clinical School in Swan Hill, which will benefit under this initiative. I also advocated for this program in Mildura and worked and will continue to work with La Trobe and Monash universities to see that rural secondary school students can have a closed pipeline from year 12 all the way through their postgraduate course. I have already raised this with the new Minister for Education, Jason Clare, and will be raising this with the new Minister for Health and Aged Care, Mark Butler, when I meet with him.

I have two concerns about the recent changes to health policy under the new government. The first is the expansion of the distribution priority areas classification system, as recently announced by the Minister for Health and Aged Care, which outlined the expansion of the DPA to modified Monash 2 areas. As we heard from the member for Dunkley, international and bonded medical students can now go to Frankston instead of to Mildura or Ouyen or Swan Hill or Horsham—regional areas that are desperate for doctors. It doesn't take two guesses to work out where those doctors would prefer to be; it would be somewhere there are lots and lots of patients, lots of other doctors and lots of hospitals who can support them. More needs to be done. This solution by the minister for health is not a solution at all, and it will detract from health care in our regional and rural areas.

The member for Dunkley spoke about a patient who has to wait for five days for an appointment. I can tell her and I'll tell this chamber that in my communities people are waiting four weeks to see a GP. We have older doctors who are retiring, and they need to retire. One of them is my husband. We have very few new doctors coming to our regional areas. This is a huge concern, and this government will now be held to account for the policies it is putting in place.

I have a question about the 50 urgent care clinics that this government is putting in place—one in Dunkley. That's excellent. Mallee is 83½ thousand square kilometres. Will there be one in Mallee at all? That is my question to the minister for health. It is a reasonable question. A lot of patients prefer to be bulk-billed, especially if there are plenty of doctors who are bulk-billing. The bulk-billing fees need to increase. Urgent care clinics—they are a great idea—need to be more than a platitude. They need to help us in regional settings. I'm concerned that, despite the health inequity in my electorate, the dire need for more government funding and the fact that Mildura is in the top 50 cities in Australia by population, my electorate will not see one of these urgent care clinics.

Louise Miller-Frost (Boothby, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak to the motion moved by the member for Dunkley regarding Labor's plan to improve access to high-quality, affordable health care, specifically the establishment of 50 Medicare urgent care clinics across Australia. During the election campaign, I spoke to literally hundreds of Boothby residents, who told me it had become harder—and more expensive—under the previous government to see a doctor or access the health care they needed. I also spoke to a surprisingly large number of people who told me of their personal experience of ambulance ramping—of long delays for an ambulance. People would stop me in shopping centres to tell me about their mother's experience, their neighbour's experience, their own experience or their child's. These stories only confirmed what was obvious in South Australia under the previous state and federal Liberal governments—that ours was a health system in crisis, one with record levels of ramping and hospital overcrowding. That's why I was so keen during the campaign to ensure that federal Labor delivered better health services for the people of Boothby. It's why I'm so proud to be able to say, as we announced during the campaign, that the Albanese Labor government will be delivering a new Medicare urgent care clinic in Boothby at Bedford Park to support the Flinders Medical Centre.

The urgent care clinic at Bedford Park will complement the joint initiative between the Malinauskas state Labor government and the Albanese federal government to deliver a $400 million expansion of Flinders Medical Centre. This will equip the centre with the ability to deliver high-quality services to all of southern Adelaide and will complement the urgent care clinic being set up in Adelaide's south, at Noarlunga. Together, these will address the needs of those using Flinders Medical Centre, which are not only the residents from Boothby but also those from Kingston and many parts of Mayo, for whom Flinders Medical Centre is the nearest tertiary hospital. This redevelopment will deliver 160 more desperately needed hospital beds, an expanded intensive care unit, a redeveloped inpatient mental health unit and improved care for older South Australians, including a new 24-bed ward at the Repat Health Precinct as a hub for older people to access health care.

But, importantly, the urgent care clinic at Bedford Park, the one at Noarlunga and the three others like it to be established across South Australia will help take the pressure off the front end of our tertiary health system—our extremely stressed emergency departments. They will be a diversion for the emergency departments, ensuring that doctors and nurses in ED can focus on the true emergencies. It will also make it easier for families in Boothby to see a doctor or a nurse when they have an urgent, but not life-threatening, need for care.

Those of us in this place who have raised or helped care for young children know all too well that blurred decision line, usually in the middle of the night, when you're up with a sick child, wondering to yourself: 'Are they sick enough for the emergency department? Is there another option that would work better? I really don't want to be waiting with my child for eight hours.' I know that Australians and the people of Boothby don't want to add to the pressures on our hospital system and its emergency departments unnecessarily. That's what will make this Medicare urgent care clinic so valuable and so vital for the people in Boothby. It will provide time-critical and, crucially, bulk-billed treatments to Boothby residents who don't need a hospital emergency department. This will include injuries such as sprains, broken bones, minor burns and ear and eye problems. These clinics are a practical, real example of Labor's commitment to strengthen Medicare and take the pressure off families in Boothby.

By comparison, when we look at the record under the previous government, out-of-pocket costs to see a GP in Boothby went up by 35 per cent, and now they want to lecture us, as a new government, on cost of living. In my previous working life, I have run health services across the state. I know what the pressure is, I know how difficult it is, and I know that people make decisions based on whether they think they can actually afford to get health care. That's why I have advocated so strongly for this urgent care clinic in Boothby—because it's so important for people to have access to urgent care, without what are often prohibitive out-of-pocket costs.

Russell Broadbent (Monash, Liberal Party) Share this | Link to this | Hansard source

I want to talk about sugar. The member for Barker has just come in on duty. I wish he'd been here to hear the member for Mayo's address and the member for Mallee's address. If you put the two together you have a description of the whole sugar-coated mess that, within two weeks of the parliament, you have created for regional people in Australia. Just like that. It is one decision that is going to have huge ramifications for every regional area.

We already have a massive shortage of doctors, which I've talked about so many times. My beautiful township of Moe hasn't been able to get doctors for years. It struggles to get doctors. People have to travel to Traralgon and to Trafalgar for any doctors' services. We spend weeks waiting. In Moe it takes six weeks to get in. You're pretty firmly damaged by the time you have to wait for a doctor for six weeks. So what do you do? You go straight to the emergency department in Traralgon or in Morwell, don't you? You have to. What alternative have you got?

Under COVID, and for other reasons when I talk about sugar, the Australian population is becoming more unwell, because our policies don't talk about caring for those people prior to them getting ill. We're quite happy that people are consuming more and more fast food and more and more sugar. People are becoming unwell because of their lifestyle and then expect to go in and get a pill from the doctor to fix it. But things that we should be promoting to make a difference to health care are not being promoted. Many years ago we did. 'Life. Be in it.' was the program, and there have been others since.

But this small change, which they thought would be politically wonderful, really damages the opportunities for our regions. The new Labor government made all its promises on health care, and what did the promoter of this particular scheme say? 'We deliver.'

What was the sugar-coating 12 years ago? It was called: we're going to have 50 super clinics, and they are going to alleviate the hospitals. Fifty of them right across Australia. What did we get in the term of the government? Was it five or nine? And then it was completely forgotten about. By the way, the five, which have probably been being taken over by private organisations, were all in—well, Labor-held seats were the first ones to get up at those times. I'm pretty sure Mildura didn't get one. There were parts of Adelaide that didn't get one. Parts of mostly regional Australia never heard of one, because there was no money to be made in regional Australia.

We have had incentive after incentive for doctors to come. In my time we created a medical school for doctors at Monash University in Latrobe Valley. John Howard gave us 40 places for doctors to be trained. We still have a medical training centre in Warrigal because we know, and we knew then, that if you can train a medical person in an area they're likely to, hopefully, fall in love with someone and stay. But that's the only way you're going to get them. You've got to train them in the country so they accept the opportunities in the regions.

This change in policy actually turns its back on the regions and destroys opportunities for people to grow their country communities, because who's going to go to a country community if they can't get a doctor? Who? Who's going to go to Parkes? Who's going to come to my electorate of Monash? No, they're not. It's a typical new government making a crazy mistake. It's a sugar-coated disaster, and that is how it will be seen. The people of my electorate will know exactly how they've been dudded by this government. They've been dudded at the most crucial part of their families' being: the health care by their GP, which they can't find.

Fiona Phillips (Gilmore, Australian Labor Party) Share this | Link to this | Hansard source

In my electorate of Gilmore on the New South Wales South Coast, we have been experiencing a worsening GP shortage for years. It's no secret by now that regional and rural Australia have more trouble getting and retaining GPs than our cities. Our GPs are overworked and struggling to keep up with the growing demand from COVID, a hospital system that is broken and not coping, and an ageing population that needs increasingly more time and more care.

In the Eurobodalla part of my electorate, the community have been waiting an incredibly long time for a new hospital. I have been right there with them, fighting to make sure this is a level 4 hospital that can give local people the services that they need now and into the future. What we don't want and cannot afford is a new hospital that may work for right now but isn't equipped to deal with the growing needs of our community. The current hospital system is just not fit for purpose, and we don't want just a new version of this model; we need a better one.

If you combine the GP shortage with an inadequate hospital system and an ageing population, what you get is a community whose health needs cannot possibly be met. The end result of this is twofold. Firstly, people are forced to travel to where they can get the right services. This is problematic for so many reasons: it sees increased medical costs, it sees delays in critical care and it sees patients put through harrowing ordeals just to get help. The second result is that people simply move away. I have heard this all too often from local people who want to stay, but, as they get older or their health needs become more complicated, it becomes impossible. They just can't get the help they need, so they have to live somewhere else. It isn't just those who are ageing whom this is a problem for; it is families, young people and cancer sufferers. Any time a health issue arises, this is a problem and it just isn't good enough.

The dual issues of a GP crisis and a hospital system at breaking point put each other in a negative feedback loop. The fewer GPs there are, the more people need to turn to the hospital. The more strain the hospital is under, the more people need good GPs to turn to. This is exactly why Labor has come up with the urgent care clinic model. The aim is to support our GPs while helping to take pressure off the hospital system so it can cope with the really critical cases. That's why I fought for and committed to a Medicare urgent care clinic for Batemans Bay as well as a radiotherapy centre in Moruya: because I am tired of hearing stories of local people having to seek care so far away. I'm tired of hearing from local GPs who are under too much pressure. I want to see our community getting the help they need when and where they need it.

The medical urgent care clinics will be there when someone has an urgent but not life-threatening need for care. Things like broken bones, cuts, minor burns, and wound care can all be done by GPs and nurses at the urgent care clinic. They will be bulk-billed to make sure the services are affordable and local people won't be out of pocket. Each clinic will be based on what the community needs in local GP clinics or community health centres and will provide funding support to local doctors to stay open longer, increase doctors and nurses and upgrade their equipment.

I know how critical this infrastructure is for the South Coast, but I also know it isn't enough. I'm committed to doing everything I can to support local health workers to provide high-quality services without sending them to breaking point. One policy alone is not going to solve the health crisis facing regional communities. There is a lot that still needs to be done, and I know lots of local people working in these fields have fantastic ideas to share. Recently I met with our Primary Health Network and local doctors to talk about the health challenges facing the South Coast community. I plan to continue these discussions so I can feed that knowledge back to the minister. There's no one-size-fits-all when it comes to regional health, so I'm excited to keep working with our community so we can get the mix right for us all.

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

I can't believe we are debating this matter so soon in the term of a new government. If you went to the dictionary and looked up the word 'irony', it would point you to the member for Gilmore's speech. The towns that she spoke about, where she's having the problems, would have already been DPA. Now, to get the doctors needed to those smaller, more remote towns, she is going to have compete with peri-urban and larger regional centres. You have a responsibility, when you're in your party room, to understand what's being put up. And regional Labor MPs—even though there aren't many—should be taking notice of this, because this is bad policy.

When I was minister for regional health I had delegations and I visited clinics where you could actually see the skyline of the city, and they were telling me how they needed more doctors, because, obviously, overseas trained doctors are helping those clinics and the profitability of those clinics. Members from capital cities are talking about this. If you're a woman in Bourke and you want to have a baby, the nearest birthing centre is Dubbo. That's four hours drive one way. If you haven't got a doctor in Bourke so you can have prenatal care and care for your young child, that is a serious concern. We had these distribution priority areas so that towns like Bourke and Brewarrina and Nyngan could give doctors an incentive. When I was regional health minister we graduated the payments under Medicare. If you are in an MM 5 area, you get a higher rebate for bulk-billing than you do in an MM 1 or MM 2 area. That came in on 1 January and was a positive step.

We are training country people to do medicine. In Dubbo, 500 students applied for 24 positions in the Murray-Darling medical school. They are brilliant young local people from the bush who are going to overcome this shortage. When I was minister we doubled the number of training places for junior doctors to spend time in regional areas. We increased the number of doctors doing the generalist pathway so that, when doctors are coming out and are trained, they've got a broader set of skills. They've got the confidence to go to a country town where they might have to deal with general medicine all day and then a horrible event where a car load of teenagers hits a tree on a Friday night. They've got the skill set to have the confidence to go to these places.

When I was regional health minister we set up five trial sites looking at innovative models of primary care, combining the resources of the state government, through the local health district, and the federal government, to address the reasons why people aren't taking up general practice training. We had a model that was comparable to that for staff working in the cities—there's maternity leave, holiday pay and a whole range of other things. It is about making general practice more attractive for people to take it up.

There's no doubt there's a shortage of doctors in this country. There's no doubt about that. We are looking at all practical measures, and I'll support the current government on all the practical measures they take to improve that pool of doctors. But taking doctors from the most remote and disadvantaged communities as a sop to larger peri-urban areas and regional centres is not the answer to health care in the bush.

Seriously. We have been done over.

You are not the bush, mate.

Pat Conroy (Shortland, Australian Labor Party, Minister for Defence Industry) Share this | Link to this | Hansard source

I'm a region.

Mark Coulton (Parkes, Deputy-Speaker) Share this | Link to this | Hansard source

I'll take you out to Brewarrina, Bourke, Warialda, Broken Hill. I'll show you what the bush is. For the member for Shortland, it's 10 minutes in a taxi and he's in Newcastle. Seriously, we are talking about really regional areas, and now they are competing with peri-urban and regional centres for doctors.

This is a backwards step. This shows—I'd like to say it's not disregard—lack of understanding of the issues of delivering health service in the bush. I think we are going to overcome this by following on with positive measures—not these kneejerk, quick responses that actually have negative impacts on the people that need it the most.

Pat Conroy (Shortland, Australian Labor Party, Minister for Defence Industry) Share this | Link to this | Hansard source

I rise very proudly to speak on the motion moved by my colleague and friend the member for Dunkley and to thank her for recognising that the Albanese government is delivering on our commitments in health policy at a lightning pace. It's clear from the last government's policies but also the last member's contributions that the one thing that the last government cared less about than Medicare was large regional areas like my home, the Hunter, which has a right to representation and a right to services. The last government seemed to think that you only had the bush and large capital cities but nothing in between, and it showed a blatant disregard for communities like mine.

That's why I was very pleased to right that wrong a couple of weeks ago when I joined with my colleagues on the Central Coast and in the Hunter and we announced our regions were now classified as distribution priority areas to help combat the dire GP shortages across our regions. I'm proud to represent a regional electorate in this place. The truth is that changes made by the Liberals in 2015 reclassifying my home region as not being a priority area for GPs hurt my region most grievously. To classify suburbs in Shortland such as Cardiff and Windale—which is the poorest postcode and the most disadvantaged community in all of New South Wales—as having the same access to medical services as Vaucluse and Mosman was insulting and showed a great misunderstanding of my region. That's why my Labor colleagues and I have been lobbying over the past 2½ years to get this reversed, and that's why I was so pleased that we delivered on one of our election commitments so fast two weeks ago.

I want to recognise the efforts and the lobbying of the Hunter General Practitioners Association, led by Dr Fiona van Leeuwen and Dr Lee Fong. They've been passionate advocates for this reclassification, and they are working to improve all areas of primary health care, because the truth is that we need a multipronged approach to fix the challenges around general practice. The reclassification of our area is essential to that, because what happened in 2015 was a sledgehammer to my local general practices. The sledgehammer, which removed the ability of overseas trained doctors and doctors under Commonwealth bonded scholarships to practise in my area, made a massive negative impact in my electorate.

Bulk-billing is one of the most cherished cornerstones of our Medicare system, and the Liberals' changes to Medicare and the GP classification made it more difficult for people in my community to see a doctor and, if they do see a doctor, to see a doctor who bulk-bills. When I meet regularly with the Hunter GPs Association, I hear of practice after practice that has being forced to change its level of bulk billing because of the last government's neglect and wilful attacks in our region. You just have to see practices that have gone from 80 per cent bulk-billing to 20 per cent bulk-billing overnight. In this particular case, the changes in the distribution priority access area meant that we lost access to so many doctors.

I will give you an example of the practical impact of this, Madam Deputy Speaker. I attended the opening of new premises for the Swansea Medical Centre, with great consulting rooms. Because of the change made by the last government, they had a consulting room completely empty every day of the week. They weren't open on Saturday or Sunday, and their books were closed despite the huge demand, because of the lack of distribution priority area access.

So this change will make a meaningful impact in large regional areas like mine, where a very significant number of Australians live. That's why I've fought for this change and I welcome it. It's part of a broader process of restoring Medicare to what it once was. The truth is that the last government learned from the example of Prime Minister Howard, who lost an election on a platform of abolishing Medicare. Instead they were a bit smarter and they tried to kill Medicare slice by slice, with co-payment charges, distribution area changes and all the other changes that are just making it a bit harder to see a doctor and, if you do see a doctor, to see a doctor who bulk bills.

This is a down payment on restoring universal health care in this country and on making healthcare access based on need rather than credit card and wealth. So I welcome this change. I also welcome our election commitment on the GP after-hours access service. That will make a huge impact in my area. I want to thank the Minister for Health and Aged Care for his vision in this area, and I want to thank him for again putting priority on regional areas such as mine who so clearly deserve it.

Andrew Gee (Calare, National Party, Shadow Minister for Regional Education) Share this | Link to this | Hansard source

In many ways there is still a great divide between city and country. There is a divide and an inequality in income. If you live in a country area, your income will not be as high as it would be if you lived in a city area. There is still a great divide in education, educational opportunities and educational outcomes. And there is definitely still a great divide in health outcomes. The cold, hard truth is that the further you live away from the city the younger you will die. The average life expectancy in the country is significantly less than it is in the city. That divide worsens as you move away from the city and go further out into the regions.

One way that we can deal with this great divide and this huge inequality is by getting more GPs to the bush so that they can practice in the bush and bolster health services in country areas. This is really important because, as the Australian Institute of Health and Welfare has noted, potentially avoidable hospitalisations can be 2½ times higher in remote areas than in cities. We have to bridge that great divide in health, so the distribution priority area system identifies areas in regional, rural and remote Australia with unmet need or lacking access to GP services. What it does is basically brings in overseas trained doctors and participants in the Bonded Medical Program. They have to set up in those distribution priority areas. It's all designed to bridge that great divide.

But what the new government has done is basically expanded distribution priority areas to include everything up to the outskirts of the major cities. It's no longer a program designed to get more GPs into country areas; it's expanding it to more metropolitan areas—

Periurban areas, as the member for Barker says. Here are some of the new distribution priority areas around Australia. In Sydney, if you live in Hornsby—that's right—you're now a GP distribution priority area. Hornsby is not Struggle Street. Warringah, Fairfield, Penrith, Rouse Hill, Richmond and Windsor are now distribution priority areas. It's absurd! In Canberra, Belconnen, Gungahlin and Fyshwick are now distribution priority areas for GPs. If you live in the outer suburbs of Melbourne, like in Frankston—yep, that's right—you're now a distribution priority area. In Adelaide, suburbs like Mitcham; and, in Perth, suburbs like Kalamunda are now distribution priority areas.

Tony Pasin (Barker, Liberal Party, Shadow Assistant Minister for Infrastructure and Transport) Share this | Link to this | Hansard source

Very regional!

Andrew Gee (Calare, National Party, Shadow Minister for Regional Education) Share this | Link to this | Hansard source

And very regional, as the member for Barker says. What it's going to do is greatly reduce the number of GPs available to country areas. The Rural Doctors Association is very alarmed by this. Dr Megan Belot says that they:

… were set up primarily to address the shortages of doctors in rural areas by mandating that Overseas Trained Doctors (OTDs) and rurally bonded medical students… spend time working in the bush …

To introduce this change, without the implementation of rural specific policies to address the very real issue of the maldistribution of the medical workforce across Australia, is very concerning for the future of rural general practice.

Dr Belot said:

We are fearful for rural communities right across Australia who are now at extreme risk of losing their doctors as they take up positions closer to the cities, abandoning their rural and remote patients who will be left with no access to care close to home at all.

She sounds a further warning:

This will cost lives of rural and remote patients who already suffer poorer health outcomes than their city counterparts.

The Royal Australian College of General Practitioners is also warning that this policy change is going to adversely affect rural and regional Australia. The president, Dr Karen Price, has stated:

Robbing Peter to pay Paul will not solve the GP shortage in communities across Australia. And that is what the unintended consequence of this policy will be, it will draw GPs from more rural areas to MMM2 areas—

Those are the more urban areas.

The rural chair of the Royal Australian College of General Practitioners, Dr Michael Clements, has also sounded the alarm bells. He says it's not good news for more rural and remote parts of Australia. He talks about a migration of doctors out of more regional, rural and remote areas. This policy is of real concern. (Time expired)

Rebekha Sharkie (Mayo, Centre Alliance) Share this | Link to this | Hansard source

The time allotted for this debate has expired. The debate is adjourned, and the resumption of the debate will be made an order of the day for the next sitting.