Milton Dick (Speaker) Share this | Link to this | Hansard source

I have received a letter from the honourable member for Calare proposing that a definite matter of public importance be submitted to the House for discussion, namely:

The urgent need for the government to immediately address the shortage of doctors in rural and regional Australia which is now a crisis and deliver better health services for all Australian regardless of their postcode.

I call upon those honourable members who approve of the proposed discussion to rise in their places.

More than the number of members required by the standing orders having risen in their places

Andrew Gee (Calare, Independent) Share this | Link to this | Hansard source

Australia is often called the land of opportunity, where each and every one of us has the chance to thrive and reach our full potential. Yet there exists a stark divide in health outcomes between people who live in cities and those who call the bush home. In fact, the further away you live from a city the sooner you're likely to die—and that's the cold, hard truth. Statistics from the Australian Institute of Health and Welfare reveal that, devastatingly, people who live in very remote areas die about 15 years earlier than their city cousins. With close to one-third of the Australian population living in the regions, how can this possibly be? The answer is simple: country people have less access to doctors such as GPs, who are often the first point of contact when someone feels sick or has a health problem.

I've had many people across my electorate of Calare and beyond contact me about the shortage of doctors in rural and regional Australia. Dr John England OAM is a consultant physician and cardiologist. With heart specialists leaving Dubbo and Bathurst and no word of replacements, he services large parts of the Central West. He recently held a free vaccination clinic in Gulgong, a town of 2,000 people which once had four doctors and now has none, with no sign of any doctors moving there. He sees patients with serious heart conditions from Rylstone and Kandos who face a year-long wait to see a cardiologist in Orange. He writes, 'They would be dead waiting,' if he didn't see them.

Chris Prest from Canowindra wrote to me regarding the imminent closure of the Canowindra medical practice in June this year. The only other doctors in Canowindra have closed their books, due to being full. Chris writes: 'The loss of a doctor is a very significant event in a small town, with a massive impact. If the doctor is not replaced, I can see the ED at Canowindra hospital being overwhelmed by people seeking medical treatment usually provided by their local doctor.'

Jennifer Hughan from Orange contacted my office about the extensive waiting times for children in the area requiring an ear, nose and throat specialist. Her four-year-old daughter faced a seven-month wait to see an ENT specialist and now faces at least a one-year wait for surgery in Orange. One thousand children are currently waiting for ENT surgery in town.

The devastating regional doctor shortage has been made much worse by the government's changes to the distribution priority area system in 2022. Originally, overseas trained doctors who moved to Australia were required to practise in the bush for several years. Now, they are allowed to practise in city areas, like Hornsby, Warringah, Fairfield and Penrith. According to the Department of Health and Aged Care, in the six months following the changes to the DPA, the number of GPs that moved away from country practice jumped by more than 55 per cent on previous years. The mayor of Blayney Shire Council, Scott Ferguson, has reiterated that, 'This is simply devastating for health services in country areas like Blayney.'

In addition to ruining the DPA system, the government scrapped the planned Western Sydney University regional training hub at Bathurst. If we are to solve this crisis, there needs to be agreement across Capital Hill that country people deserve the same access to medical services as people in the cities. Evidence has shown that, if you train doctors in the bush, they will be very likely to stay and practise in the bush. That's why I strongly advocated to get the CSU medical school in Orange up and running. Places at the medical school are in high demand, with around 1,000 people applying for just over 30 places on offer each year. That's why it was shocking that, at a time when the shortage of doctors in country areas has never been more acute, the government did not award the CSU medical school with any additional Commonwealth supported places last year. This is disgraceful. The government needs to get serious about alleviating the rural doctor shortage.

Chris Prest from Canowindra, who I quoted earlier, also said in her letter to me, 'Too frequently policies can get in the way of solving the problem, which is very annoying.' I couldn't agree more. But, as Chris and everyone in the country knows, it's more than annoying. To regional, remote and rural people, it's fatal.

Together in this House and the other place we have the power to cure this crisis. Country people demand and deserve nothing less than equality in access to doctors and medical services. Lives are at stake, and immediate action from the government is required. Get on with it on the double.

Emma McBride (Dobell, Australian Labor Party, Assistant Minister for Mental Health and Suicide Prevention) Share this | Link to this | Hansard source

I thank the member for Calare for moving this MPI today and for his genuine and deep interest in this issue. I spent time in both Orange and Bathurst last July, meeting with some of the dedicated local health professionals in his electorate, people delivering vital healthcare services such as through the new endometriosis and pelvic pain clinic in Orange and Marathon Health in Bathurst. I also visited the Bathurst rural clinical school, which is training health professionals of the future for that region and regions like it. We know how important regional training is because, as the member for Calare has said, local medical graduates are far more likely to stay and work in communities that they grew up in.

This is an important MPI, and it's an issue that I've been acutely aware of since well before my time in this place. I worked in regional pharmacy. I worked in a regional hospital. I worked at Wyong hospital, on the Central Coast of New South Wales, in my electorate. Over the nearly 10 years I worked there, I saw firsthand the challenges of attracting and retaining the health workforce required to give Australians living in rural and remote communities the health care that they expect and that they deserve.

In Australia today, the life expectancy for women living in the most remote parts of Australia is 19 years below that of their city counterparts. That's before we look at the quality of life. This is unacceptable. A big part of this is to do with access to timely, affordable care closer to home. Every member of our government supports strong and prosperous rural and regional communities. Every member of our government wants to see the seven million Australians living outside our major cities have access to quality, affordable care. We know that access to quality care underpins healthy and strong communities.

But the policy response to this challenge is what matters, and it's not the six-year long freeze to the bulk-billing incentive that we got from the Leader of the Opposition when he was health minister and it's not back-of-the-envelope migration policy which would threaten one of the most important sources of rural and regional doctors that we have—international medical graduates. This challenge demands rational, well-thought-out policy which strengthens the health system as a whole and responds to the unique health needs of rural and regional communities. This is the approach of our government, through significant investment and comprehensive programs that we are rolling out.

A strong Medicare supports people across rural, regional and remote Australia to get the care they need closer to home, while taking the pressure off stretched emergency departments and easing cost-of-living pressures. The government's commitment to improving access to health care across Australia is reflected in the 2024-25 budget, which provided $2.8 billion to continue to strengthen Medicare. This was in addition to the historic $6.1 billion investment in Medicare in the 2023-24 budget.

The beating heart of Medicare, as the Minister for Health and Aged Care, Mark Butler, has said, is bulk-billing. As members well know, bulk-billing was in absolute freefall when we came to government. A $3.5 billion investment to triple the bulk-billing incentive has stopped the slide in the few short months since it came into effect. Since 1 November last year, the GP bulk-billing rate has risen by 3.9 per cent in regional, rural and remote areas. What this increase in the bulk-billing rate means in regional Australia is an estimated 550,000 additional trips to the GP bulk-billed since 1 November last year.

But this increase hasn't just helped patients; it has strengthened general practice and given more doctors the confidence to work in regional communities and to bulk-bill patients who need it most. In my electorate of Dobell on the Central Coast of New South Wales, we have seen bulk-billing jump by 5.8 per cent since November, a major rise in such a short time. In the member for Calare's electorate, the bulk-billing rate has risen from 79.6 per cent to 81.4 per cent in the same time. That's four out of five trips to the GP being bulk-billed on the back of higher incentive payments to GPs under Medicare—a significant boost in access to affordable and quality care close to home.

Another flagship initiative of the Albanese Labor government to strengthen Medicare is the Medicare urgent care clinics, with an additional 29 funded in the 2024-25 budget. This will bring the total number of Medicare urgent care clinics across the country to 87, offering walk-in care seven days a week, over extended hours, completely bulk-billed. Medicare urgent care clinics are making a difference for patients and for stretched hospital emergency departments.

I was at the Cessnock Medicare Urgent Care Clinic with the member for Hunter, Dan Repacholi, and I met a nurse there. She was the triage nurse for the Medicare urgent care clinic that day. She was working there because she had come to the urgent care clinic with her daughter as a patient. She was so impressed by the Medicare urgent care clinic model that she asked to speak to the practice manager. The practice manager said to me, 'We are so fortunate to have an experienced, capable nurse, and she came because she was a parent of a patient and saw this model and saw the difference that it's making in that community.' That's what we're seeing right across the country, particularly in regional and remote communities. They're making a big difference.

Ten of the 58 Medicare urgent care clinics already operating around the country are in regional, rural and remote areas, and I visited many of them. They are boosting access to primary care, making it affordable for people and giving them a trusted alternative to the emergency department. About a third of presentations to Medicare urgent care clinics and children under 15, which shows that parents and caregivers trust Medicare urgent care clinics as a safe alternative to the emergency department for their young people. So far, these 10 Medicare urgent care clinics in the more regional and remote parts of Australia have seen over 40,000 presentations. Those are 40,000 visits fully bulked-billed and walk-ins without an appointment, making such a big difference to individuals and families and reducing the demands on our stretched emergency departments.

Last week, I was in Rockhampton to announce a boost in funding for their Medicare urgent care clinic because, in the budget, we're enhancing funding to Medicare urgent care clinics outside of our major cities, acknowledging the cost of resources and attracting workforce in those communities. That clinic has already seen more than 5,000 patients since opening in December. This also is really important to note: this practice was a GP practice at risk of closure. It was the only GP practice in that community that was bulk-billing. Since the introduction of the Medicare urgent care clinic model, they've recruited, I believe, six additional GPs. This has gone from a practice that was at risk of closure to a practice that is now providing Medicare urgent care and also expanding bulk-billing to that local community.

These clinics are a major vote of confidence in regional primary care. They are encouraging doctors into the regions. I was at a regional Medicare urgent care clinic, and the doctor working there was from Maroubra, in the eastern suburbs of Sydney. I was at one in Queensland, and the doctor working there was a GP from the Gold coast. We are now getting GPs into the regions as part of strengthening Medicare through these urgent care clinics. They are giving more Australians access to high-quality, free health care in places where it otherwise hasn't been available.

There are many more initiatives in the budget which go directly to supporting and growing the health workforce in regional and rural Australia. There is $90 million to fund the implementation of the independent review of Australia's regulatory settings relating to overseas practitioners, also known as the Kruk review; $17.4 million to support health services at risk of closing; primary health networks and rural workforce agencies working with rural communities to support people to get the care they need closer to home affordably; and $74.8 million to support the Royal Flying Doctor Service, which will continue to allow the RFDS to provide its primary care and dental services to more Australians across rural and remote communities; an expansion of the range of free mental health services so Australians get the right level of care for their level of distress, including for those living in a regional, rural and remote Australia. Perhaps most importantly, there are incentives to fund more training and development of regional doctors in regional locations. There is $24.6 billion to Charles Darwin University to establish a medical school in the Northern Territory from 2026. There is $4.7 million for the existing Northern Territory medical training program. There is $4 million for the Australian Indigenous Doctors Association. The single employer model trials will be extended until 31 December 2028 to help attract and retain GPs in the workforce where we need them.

Lastly, in the education portfolio, there are prac payments for nursing, midwifery and social work students. I was at Gosford Hospital with the Prime Minister, and we saw nursing students talking about the life-changing difference it will make. (Time expired)

Andrew Wilkie (Clark, Independent) Share this | Link to 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.

Gordon Reid (Robertson, Australian Labor Party) Share this | Link to this | Hansard source

I just want to make the parliament acutely aware that these health issues—some of the health issues that we face today—do not happen overnight and they don't happen within a week. They happen over decades of neglect and they happen over decades of decay. I want to use my home electorate, the electorate of Robertson, as an example of this. I know that many in my community know this for a fact. The former Liberal member for Robertson, the current state Liberal member for Terrigal and the now Leader of the Opposition, who was the health minister, systematically, over a number of years, ripped the belly out of Medicare. And what happened? We had patients that couldn't afford to see a GP and couldn't get into primary healthcare services and, as a result, they ended up needing tertiary level care. They ended up needing an emergency department and needed higher levels of care.

That is why the Albanese Labor government is getting on with the job of improving health care for all Australians and making sure that we are restoring what is the beating heart of Medicare, and that is bulk-billing. I pay credit to the health executive here in the federal Labor government, Minister Mark Butler, Minister Wells and the two assistant ministers here in the chamber right now, Assistant Ministers Kearney and McBride, one a pharmacist and one a nurse, who know the importance of health care in this country. A healthy society means a healthy economy, which means a healthy industry.

Some of the things that we are focusing on include tripling the bulk-billing incentive. On the Central Coast, that has meant over 10,000 additional bulk-billed visits to the GP. That means people are seeing their doctor for their primary care issues where they need to see them. Then there is the affordable medicines act, where medications have become cheaper for Australians. In my electorate of Robertson, that is over $2 million saved. We are talking about common medications that save lives. I have seen this policy actually working on the ground in the emergency department. I have seen patients who now have the ability to afford blood thinners that prevent them from having a stroke. They can afford that because of a Labor government policy. That is what we do.

We are also talking about the stronger Medicare grants, upgrading the infrastructure in our general practices which for so long have felt the neglect of a Liberal-National coalition. We are talking upgrading basic infrastructure—things like phones and computers; things that they use for everyday clinical operations. That is something that has gone ahead. There is the PBS copayment freeze, where pensioners and general patients will be able to save more and afford more medications that will stop chronic conditions from exacerbating and becoming acute medical conditions.

Then there is one of the hallmarks of our Strengthening Medicare policy, and that is our Urgent Care Network. We are creating a new model of care and a new medical speciality within Australia. That is what urgent care is. This is an exciting time for the medical space. If you are too sick for the GP but you are not sick enough to go to the emergency department, you go to one of these Urgent Care clinics. In my one alone we are talking nearly 5,000 presentations since it started. Those people would have otherwise gone to the emergency department for their urgent issues. These are not clinics where you just see a doctor or a nurse. In my clinic, there are also imaging services for x-ray and ultrasound. There are also pathology services, which can make sure that that patient can receive extended care at point-of-patient contact.

This is what you can expect from a federal Labor government when it comes to Medicare and when it comes to primary care and general practice. We actually put the effort in to ensure that people can see their GP and can get the care that they need when they need it—unlike what we saw in the previous decade, with the Liberal-National coalition ripping the guts out of Medicare and making sure that people couldn't get in to see their doctor and couldn't afford their medications and then ended up in the hospital for serious medical conditions. Again, I commend the health executive and the Prime Minister for the work they have been doing in restoring bulk-billing and Medicare in this country.

Helen Haines (Indi, Independent) Share this | Link to this | Hansard source

I thank the member for Calare for raising this matter of public importance today. It is of critical importance, and I honestly believe there is not a person in the House who doesn't agree with him. For most of my professional career, before I came to this place, I worked in rural health care, and I want to acknowledge the healthcare professionals that sit on the benches of this House, right across the House—doctors, nurses, me as a midwife, pharmacists, paediatric neurologists and so it goes on. We are all incredibly familiar with the complex challenges that face our medical workforce and, in particular, our rural medical workforce. This problem of a shortage of rural doctors is not a new problem; it's one I've known about since I was a kid. It is right across the country, and it absolutely is affecting the communities I represent in Indi.

When we talk about a shortfall of doctors in regional Australia, we're talking about GPs in private and community clinics. We're talking about doctors in the wards of our hospitals. We're talking about surgeons and specialists. It's right across the board. We see it evidenced in the bills that rural hospitals are paying for locums to cover unfilled shifts. It would make your eyes water when you see those bills. We see it in the burn-out and, frankly, we see it in the despair of our rural doctors. It is heartbreaking. Post-COVID, rural and regional Australia has seen a net migration of around 11 per cent of people out of the cities and into the country and, quite frankly, they are shocked when they can't even get on a waitlist for a local GP. They can't believe that the books are closed. There is simply no more capacity. My office regularly hears from constituents who are deeply concerned by the long surgical waitlist—it makes the front page of the Border Mail on almost a weekly basis. It's not because these hospitals aren't trying their darndest. The health executives, the administrators and the staff specialists are doing their darndest, but they are under-resourced.

I say to this government: as you are negotiating new health agreements with the states around increased funding for hospitals, call them to account on this. Hold them to account on putting that funding towards rural health, rural hospitals and places on the border like Albury-Wodonga Health, who I represent and who are absolutely struggling under the burden of the demand that's upon them.

The postcode that one lives in should not determine the health care that one receives. It's so nice to say that but, frankly, it absolutely does in Australia. The rates of chronic disease are higher in rural areas and the outcomes are worse than in metropolitan areas, and it is all about access. We have many unrealised opportunities to create a prosperous and thriving life in rural and regional Australia, but to achieve this we absolutely have to have top-quality health care and we have to be able to get an appointment with a GP or a specialist when we need it. We absolutely need to look at other models of care. Yes, we've heard about urgent care centres—great, if you've got one—but the Rural Doctors Association of Australia, the Rural Health Alliance and others put forward multiple solutions about how we can remedy this problem. A couple of things are: providing maternity care, and study leave for GPs in private practice. We need to think innovatively about how we support the medical professionals that we have to stay in regional Australia.

I hear many reasons junior and mid-career doctors choose to undertake their training and specialist care in major cities. Often, the specialist training on offer is more limited and the specialist colleges are reluctant to accredit rural training. There are fewer senior doctors on shift, and there's an expectation that junior doctors must work more independently in rural and regional hospitals than they otherwise would in the city, and it is impacting their mental health. We also need to support the family, the wives, the husbands and the partners of our rural doctors so that they, too, can find the jobs and the support that they need in rural and regional Australia. We need to invest in the public transport, better telecommunications and a fair share of housing investment if we want to train and retain our rural doctors.

Critically, we must nurture the talent that we have. The evidence that we have is that rural students who go into healthcare professions stay and are retained in rural Australia in medicine, nursing and allied health. Fund things like the collaborative centre for research and training at Albury-Wodonga Health, which will bring in defence, Charles Sturt University, La Trobe University, the University of New South Wales and our TAFEs. It will train and retain not just doctors but also our allied health and nursing professionals. I acknowledge the member for Cooper and the work she has done on the health team. We need a strong health team to support our rural doctors.

Lisa Chesters (Bendigo, Australian Labor Party) Share this | Link to this | Hansard source

I acknowledge the spirit in which the mover has brought forward this MPI, because I know that, since he got to this place, this has been an issue he has been passionate about. I know that, because in my own electorate of Bendigo, where we have the La Trobe Rural Health School, our university worked with his university to really champion the need for more medical places in our regional areas. That's because, as previous speakers have mentioned, when we train regional students in regional universities they stay and work in the regions. It's a fundamental fact and what all the data now shows.

However, it's not as simple as creating more medical places. We need to do more. We need to interrogate the data and look at who is applying for medical places and their pathways to those medical places. One of our greatest challenges when it comes to recruiting people to medicine is the very high ATAR that's required. Our ATAR system is skewed towards elite inner-city schools. They do the best when it comes to ATARS. They're the schools whose students go into medicine—and not just medicine but other health professions. We need to have a broader conversation about who we are recruiting into our medical schools and where they're doing their medical placements.

La Trobe's Bendigo campus, in fact, has the largest rural health school in Australia. That may surprise people, because we don't actually have a medical school. What we do have is midwifery, nursing, dentistry, pharmacy and physio. We have all the allied services that go with it, and we continue to grow. When we are looking at solving the crisis in rural health care we need to look at the teams of medical professionals who work in GP practices. The changes this government has put forward in terms of nurse practitioners, allowing and encouraging nurses to work to their full scope, are a measure that will help us solve some of the challenges we have in rural health care. The tripling of the bulk-billing incentive is critical to attracting and encouraging doctors to practise as GPs and remain GPs. In my own electorate we've seen bulk-billing rates increase by 8.6 per cent. Through that one government measure alone we are seeing more GPs bulk-billing.

When it comes to our GPs, we need to have greater interrogation of the barriers to people going into general practice. A generation ago, about 50 per cent of medical graduates were going into general practice; today it's about 20 per cent and dropping. We need to interrogate that. When you ask these students why, they say: 'Well, I'm looking at the experience. I'm looking at how I can have that salary, how I can work in a team environment, when I have a university debt.' We need to look at better models of employment. Graduating as a doctor and then becoming a small-business owner running your own practice isn't attractive for every young person who goes into the medical profession. That is one area where we need to encourage and incentivise.

In my own part of the world, what was known as a GP superclinic is today Bendigo Primary Care Centre. They are at a scale whereby they can start to employ young doctors and bring them in on a salary package. This is becoming very popular where we've got these bigger clinics in regional cities. They are currently running a priority care clinic, funded by the state government, which is taking pressure off the hospital system. Those GPs are able to practise a broader scope of medicine, something like what they might experience in a hospital setting.

This is where our hospitals are critical. I also say the states need to be part of this conversation. It is great that our state governments are building hospitals, but they are also sucking up a lot of our medical graduates. We need to get the states more involved in this conversation if we're to meet the demand not just for GPs but for doctors in our hospitals.

This is a complex issue, and I welcome the bipartisan way in which the discussion is happening—at least between the Independents, the crossbench and the government.

Bob Katter (Kennedy, Katter's Australian Party) Share this | Link to this | Hansard source

I spent my years in the state parliament carrying six doctors' names with me in my briefcase wherever I went. That's because we were constantly without doctors and I was constantly chasing doctors all over the world, mostly in England, to try and get them to come to our outback outposts—our mid-west towns, as we call them, and our towns in North Queensland.

To show you how greatly valued these people are, if you drive into Charleville, there is a big statue to Dr Ariotti—a very outstanding Christian man, I might add. I think that had a lot to do with the self-sacrificing nature. If you drive into Cloncurry, Father Dr David Harvey-Sutton, who was a priest in the Anglican Church—again, the highway into Cloncurry is named after him. This is how important these people have been to our communities.

But I have had to face up to this problem. We called a meeting to get a medical school built. We called that meeting for eight years continuously. We got it eventually, thanks to an outstanding person of the Jewish faith who established the medical school. I'm very proud to say that my daughter, Mary-Jane Katter Streeton, got the credit, but I think that doctor, Professor Wronski—and she would agree—deserved most of that credit. We got the first medical school built in 44 years in Australia. Now there are something like 19 medical schools that have walked through the door that we have opened, and the situation is worse now than it was before those medical schools came in. I've heard two speakers tonight say that 70 per cent went into general practice, presumably a lot of them in regional areas, and now that figure is down to 10 or 20 per cent. Two speakers have referred to that. Therein lies the problem.

I don't think there's any way out of this problem except to go back to what the much-maligned Bjelke-Petersen government had in place. I just look back and think, 'Were we really that good?' Yes, we were! If you became a medical graduate, you had to spend two years doing a practice wherever the government sent you. That was part of the deal. You could not practice as a doctor in Queensland without doing those two years. I think there's only one way to deal with this problem, and that is to go back to 1½ years compulsory at the direction of the government. You'll be sent wherever they send you. And, really, if you're sent to an outpost like Richmond or Julia Creek on your own Shanks's pony, you've got to make the decisions yourself. I think that's important in the development of a GP.

As to the answer of bringing people from overseas, I personally have had the rather unnerving experience of having pains in the chest. Three doctors from overseas looked at me at the hospital. It was a long time ago now. They said that there was nothing wrong with me and sent me home twice. The ambulance man just rushed me straight through to Townsville. He didn't worry about what the doctors said. I was having a massive heart attack, and three foreign doctors didn't pick it up! I was rushed into emergency surgery. So, for some of these doctors that have degrees from overseas, they are not degrees as we understand it here in Australia. Some of them, on the other hand, are very excellent. I pay great tribute to Mo Diqer, who did the operation and restored me to extremely good health. He was an outstanding man in every respect. He died recently in North Queensland.

In summary, the answer to the problems outlined by the speakers—and I think there have been very excellent contributions made by the speakers; I very rarely hear as good a contribution as I've heard tonight—will have to lie in compulsory 1½ years. If you're going to get a job that's going to pay you half a million a year, surely you owe something to the people of Australia. No-one complained about the two years. I never got a single complaint in my years in the state parliament about the two years. In fact, I think most of them really enjoyed it. But we have to make the 1½ years compulsory. We have to do that, or the situation is going to get worse and worse, bad as it is.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

The Medical Journal of Australia, in August 2023, published an editorial that described the shortage of doctors in remote, rural and regional Australian communities as 'a longstanding health policy challenge' many decades in the making, and that is very true. To create a generalist rural GP requires at least four to eight years of postgraduate study. For a rural specialist or subspecialist, it's five to 10 years or longer. So the timeframes for increasing our medical workforce are very long.

We had coalition governments that, for 10 years, did nothing. In 2016, when I was first elected, I went to see Sussan Ley, the member for Farrer, now the deputy opposition leader, to express to her my concerns about the declining and ageing rural GP workforce. Nothing was done. When she was removed as health minister and replaced by Greg Hunt, I went to see Greg Hunt on several occasions to say that the rural GP workforce was worsening. I met with him, I think, on a second occasion about six months later with members of the Department of Health to say that the workforce modelling was very poor, that our rural GPs were declining in number and that this was becoming an increasing crisis—they were the words I used—for primary care in rural and regional places and also in outer metropolitan areas. Very little was done.

I would like to congratulate our health team, led by Mark Butler and also by the member for Dobell and the member for Cooper, for the incredible work they are doing to improve access to primary care through our rural workforce and for the things that they have done to increase the number of medical students wanting to go into general practice. I'm pleased to report that in 2022, the last year we have statistics for, there was actually an increase, although small, in the number of medical students wanting to go into general practice schemes. We know that medical students that are trained in rural areas are more likely than city medical students to stay in the bush. That's very important. It's the reason why the Albanese Labor government is doing all it can to improve access to rural GP training.

On top of increasing investments in bulk-billing, we're investing $1.5 billion in an indexation boost to every single Medicare rebate. That increases the amount that doctors are receiving for every single Medicare service and makes it more likely that people will work, and more viable for people to work, in rural general practices. As we've heard, there is statistical evidence that bulk-billing is increasing in rural and regional areas as well as in metropolitan areas.

Further to this, our government is investing a further $2.2 billion in reforms to help strengthen other Medicare item numbers, including prolonged consultations, now and in the future. This includes payments for GPs to improve and grow their teams and to have case conferencing rebate, and it includes easier access to telehealth for many patients. It's very important, with issues like distance and transport difficulties, that telehealth is providing healthcare access to people who find it difficult to get into GP practices in rural and regional areas. Importantly, the Albanese government is really expanding that. There are practice incentives of up to $21,000 a year, with workforce incentives, to improve workforce participation in health care.

We know that there are problems in the bush not just in our GP workforce but in our nursing workforce and with specialist nurses such as diabetes educators. We've seen huge shortages in rural and regional areas. We're doing what we can to improve access to general practices for these rural health workers as well. There's also $4,000 to $10,000 a year for doctors to provide skilled services and speciality training for eligible doctors to provide emergency care through our emergency care centres.

Our government is doing as much as it possibly can. After 10 years of coalition neglect, it's going to take a long time for us to turn the workforce issues around, but we are determined to do it, and we will do it. As a member for Clark has said, it can be done.

Kylea Tink (North Sydney, Independent) Share this | Link to this | Hansard source

I want to start by acknowledging the record investment this government has made in the healthcare sector over the course of the last two years. It's welcome, and it's a strong indication that this government is both aware of and willing to engage in appropriate discussions that could potentially resuscitate our overstretched and flailing primary healthcare system. But today's MPI's not about that investment; it's about our system's inability to incentivise, retain and attract talented general practitioners, a challenge that faces so many communities across our country.

While I welcome this MPI and the fact it calls out the challenges faced by regional and rural communities, the truth is that my seat of North Sydney is not exempt. Recently I found myself speaking to my own GP about her frustrations with what she perceived as a persistent trend at the federal level of undervaluing general practice as an expertise. As she argued, GPs train for as long and as hard as any medical speciality and yet an hour of their time is deemed to be only worth somewhere around $170, while an orthopaedic surgeon can charge upwards of $2,500 for the same period. With Medicare rates falling behind and in many instances now considered almost disrespectful, bulk-billing rates are falling rapidly right across our country, with a recent survey of my electorate showing that, of the 54 GP clinics, only eight bulk-bill. That's 14 per cent.

Meanwhile, just this week, the AMA released figures showing that one in 10 patients in New South Wales leave emergency departments without completing their treatment, due to waiting times. The median waiting time between arriving at and leaving the emergency department at the Royal North Shore Hospital in my electorate has risen to four hours and 40 minutes, an hour longer than the state average of three hours and 38 minutes. The government tells us we should look to urgent care clinics to bridge both the GP and emergency care gap, but there isn't an urgent care clinic in my electorate. So what is my community to do?

Ultimately, I recognise the circumstance we find ourselves in is something that has taken decades to create. While we do feel it in the urban centres, I acknowledge the healthcare services of my youth in regional north-west New South Wales, where I grew up, are now actually unrecognisable. In the eighties, my hometown of Coonabarabran was a healthcare hub. We had several incredible GPs, including Dr Kerr and Dr Varley, who cared deeply for our community. They did it all, from delivering babies to setting broken bones. They stitched wounds and removed suspicious skin spots. They worked from both their rooms and a state-of-the-art regional hospital facility that was a centre of excellence for road trauma. We also had an incredible multi-vehicle ambulance service, which unfortunately my family actually had to rely on on several occasions.

Fast forward to today and, now, despite having an incredible local doctor, Dr Iannuzzi, my parents often talk to me of being unable to secure a walk-in appointment anymore and of women now having to travel to either Dubbo or Tamworth to have their babies. For me, the demise of services became incredibly stark when my children and I came across a road accident on our way home not that long ago to visit my folks. The accident involved two cars. It happened seconds before we rounded the same corner. Having grown up out there, I knew what to do. I pulled off to the side of the road, called 000, set my hazards to flashing and went to help. What followed, though, was a complete shock in terms of how long it took the police to respond, the lack of resources the police had and, indeed, the fact that the ambulance never showed up because that ambulance was actually carrying someone who was drunk and disorderly to Dubbo. There is only one ambulance in town these days. Instead, I was tasked with carrying one of the people involved in the accident into town in the front seat of my car.

Herein lies the rub: in an environment where our cities cannot keep pace with the housing demand and where one option will surely have to be for us to explore the option to encourage people to move to rural and regional Australia, how can we possibly make that argument when we cannot guarantee those people access to services that we should all fundamentally expect? It is time we fix our primary healthcare system, that we begin to decentralise it again and that we empower communities in regional and rural areas to be the healthy, thriving places and spaces they once were. It is a choice that our federal government makes every year when it continues to fund urban centres for healthcare provision rather than looking beyond that to true regional and rural community hubs.

I thank the member for Calare for bringing this really important matter of public importance to the House, and I encourage us to continue this debate until we find a reasonable solution.

Libby Coker (Corangamite, Australian Labor Party) Share this | Link to this | Hansard source

COKER () (): The Albanese government is committed to improving the health outcomes of Australians living in regional, rural and remote areas. We on this side of the House recognise that, by strengthening Medicare, we can support more people across our regions to get the care they need and deserve. Our government's ongoing commitment to improving access to health care across Australia is reflected in our 2024-25 budget, which provides $2.8 billion to further strengthen Medicare. This is in addition to the historic $6.1 billion investment in Medicare in the 2023-24 budget.

These investments address the pressing challenges in our healthcare system. We recognise that, after a decade of coalition neglect of Medicare and our health system, it has become harder and more expensive to see a GP. The former Liberal government froze bulk-billing rates and decimated primary care, including in rural and remote areas. They ripped billions of dollars out of public hospitals, which has had a lasting and devastating impact on Australians living outside major cities.

It's no secret that general practice was in its most parlous condition in the 40-year history of our system when we came to government. Under the Liberals it had never been harder or more expensive to see a doctor, and bulk-billing was in sharp decline. That's why our government acted swiftly with a historic investment in Medicare. The GP bulk-billing rate has risen by 3.9 percentage points in regional, remote and rural areas in the first five months since our government provided $3.5 billion to triple the bulk-billing incentive. The increase in the bulk-billing rate is achieving results with Australians in our regions, who are taking on an extra 550,000 trips to GP bulk-billed services since 1 November last year. For locals in my electorate of Corangamite, this has meant an additional 26,400 bulk-billed visits to the GP since November 2023.

As a result of this year's budget Australians living in the regions will benefit from a $213 million package that will deliver cheaper medicines, more access to scans and other tests, more Medicare urgent care clinics, more free mental health services and more investments in our health workforce, along with telehealth services in the regions. The measures in our budget include $17.4 million to support health services at risk of closing; $74.8 million to support the rural flying doctor service, which will continue to ensure primary care and dental services are accessible to more Australians across more remote communities; and expansion in free medical health services, ensuring Australians get the right level of care for their level of distress, including for those living in our regions. Importantly our government provided funds of more than $1.8 billion for programs that develop the workforce and support a more balanced distribution of health professionals in areas of need.

The 2023-24 budget took the first steps in supporting our highly trained health workforce. This included a number of new incentives and additional payments to promote and secure more doctors in rural and remote communities. We are already seeing the benefits of this investment, with a significant increase in junior doctors starting as GP trainees in this year alone as well as an oversubscribed rural generalist training scheme to build our rural workforce. The extra GP training places will see more doctors living, working and training outside our major cities while providing care to people in our regions. Our government will continue to build on this progress.

Labor governments have a proud history of investment in the health of all Australians. Our support for GPs in the regions and our ongoing investment in Medicare and bulk-billing build on this legacy and demonstrate the Albanese government's commitment to a stronger healthcare system for all Australians.

Zali Steggall (Warringah, Independent) Share this | Link to this | Hansard source

I thank the member for Calare for raising the issue of the urgent need for the government to immediately address the shortage of doctors in rural and regional Australia that is now a crisis, and the need to deliver better health services for all Australians regardless of their postcode. Too often in this place members seek to sow division between urban and regional communities. But the reality is that all members here and all communities care about all of Australia moving forward, in particular my urban community of Warringah. I decided to get into politics very much because I was very concerned about the future our children face, so I will focus a little more on that aspect when I think of rural and regional health and the crisis it faces, in particular because in Warringah we have the Royal Far West, which I believe is the only national charity focusing on delivering services to regional and rural children, which it has been doing since 1924.

As they state, the need is so great. While all parents want the best for their children, not all parents in Australia have the same access to resources to help their children with their health and development needs. There is a widening gap between the needs of country children and families and the health services available in rural and remote regions of Australia. The evidence is stark and indisputable: where you live matters. The rates and consequences of not addressing developmental vulnerabilities increase the further a child lives from a metropolitan centre, and can have impacts that last a lifetime.

Some of the disadvantage and growing complexity: some 190,000 children across rural and remote Australia need development support. Children living in very remote areas of Australia are twice as likely as city children to start school developmentally vulnerable. Over 50 per cent of country children through our child family services have experienced trauma—that is from Royal Far West and their services. Sadly, Aboriginal and Torres Strait Islander children are twice as likely as non-Indigenous children to be developmentally vulnerable.

Children's mental health: half of all lifetime mental health problems emerge in childhood by the age of 14. One in five children in regional and remote Australia have a mental disorder. They have very limited access, with long waiting lists and long distances to travel to services, which exacerbates the problem. Seventy per cent of parents and carers in the children and family services within the Royal Far West report mental health concerns, and over 55 per cent of country children through the Royal Far West children and family service require psychiatry. Are they getting access to those services in regional Australia in other ways? The problem is that they are not. That is something for the government to address.

Ultimately, only a few weeks ago we saw the government deliver the budget, and while I acknowledge there has been progress and further development and there is a better focus on this issue, budgets are about priorities, and there is still a lot more work that can be done.

We know workforce and access to services is a major problem. We know nurses in very remote areas are a third of that in major cities when it comes to mental health services. There are 37 psychologists per 100,000 people in outer regions compared to 80 per 100,000 in cities. Over 80 per cent of people in remote and outer remote regions live in child-care deserts, compared to 30 per cent in major cities. There is one GP per 1,250 people in remote areas. So it's clear there is a huge difference and a huge distinction.

We need to do so much more. So one of the things that were so frustrating when I saw the budget a few weeks ago was that, despite much, much advocacy to ministers and the government about the important service Royal Far West is doing in delivering many of these services—yes, through telehealth ways, but they are delivering them to rural and regional and remote children—there's no funding, so many services are due to finish.

One of those particular services that Royal Far West has delivered has been in relation to recovering from natural disasters. We know regional children are much more likely to be exposed to significant floods and bushfires. They have huge levels of stress as a result. This is going to have huge long-term impact on their development. That is something we should all be focused on. So for me it's incredibly important that those children are not left alone. We know that they are impacted to a huge extent, but we don't yet have the focus and the delivery of services they need. I urge the government to focus on this area.

Ross Vasta (Bonner, Liberal Party) Share this | Link to this | Hansard source

The discussion has concluded.