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

I move:

That this House:

(1) notes that:

(a) rural and remote Australians bear a heavier burden of disease than Australians who live in major metropolitan areas;

(b) the rural, remote and regional health workforce persistently suffers more significant staffing shortages than its metropolitan counterparts;

(c) the former Government established the Office of the National Rural Health Commissioner in 2017;

(d) the inaugural commissioner, Professor Paul Worley, said in 2018 that he had heard the urgency of calls for a National Rural Generalist Pathway for the medical practitioner workforce, and recommended later that year the national recognition, as a protected title, of a Rural Generalist as a Specialised Field within the Speciality of General Practice, which is now federally funded and accredited by the Australian College of Rural and Remote Medicine;

(e) the National Rural Health Commissioner has established the National Rural and Remote Nursing Generalist Framework 2023-27, after consultation commenced by the former Government in early 2022; and

(f) Queensland Health began developing a rural generalist pathway for allied health professions in 2013 which Services for Australian Rural and Remote Allied Health successfully developed further in some jurisdictions but a pathway is not yet available in Victoria for instance; and

(2) calls upon the Minister for Health and Aged Care to advance rural generalist pathways in medicine, nursing and allied health, to address dire workforce shortages in rural, remote and regional Australia.

I move this motion supporting regional health care because there is incredible heartache—or, in departmental speak, unmet need—both within my electorate of Mallee and across rural, regional and remote Australia. A person's postcode should not determine their health status, but it does. As shadow assistant minister for regional health, I have travelled the country to consult with professional organisations, health professionals and community members at the coalface. They have stressed the dire nature of workforce shortages in their local areas. There are currently six general practitioner positions advertised in Mildura, my home city, alone, with several other towns across Mallee also looking for a local doctor. In fact, I am very proud of the fact that my husband has retired after 47 years in general practice just this week, and I will shout out to him what an extraordinary man he is and how proud I am of him. We know that small rural towns—like Dimboola, in my electorate, for example—have on average almost 60 per cent fewer health professionals than major cities.

When one of my constituents needs care for a chronic condition or an ongoing illness, they face waiting lists, travelling considerable distances and additional out-of-pocket costs. Inaccessible health care results in delays to primary care. People present into hospital acutely unwell when it could have been prevented. Ultimately, regional Australians are living with worse health and dying younger than their city counterparts. We can't continue to expect people in rural, regional and remote Australia to put up with second-rate access to health care. It affects their quality of life, their livelihood and their longevity.

During my travels, I have also seen examples of rural communities who are making things work. I visited a single-employer model pilot site at the Riverland regional hospital in Berri last year. They told me they have no doctor shortage in their region thanks to this model. The single-employer model's success in rural and regional Australia builds upon the Nationals' efforts for many years to develop the National Rural Generalist Pathway through the National Rural Health Commissioner. In fact, the first commissioner, Professor Paul Worley, was in that meeting in Berri last year about the single-employer model initiative because he has been working there, ensuring its success, since his term as commissioner ended.

In October, I was delighted to speak at the conference of Services for Australian Rural and Remote Allied Health, SARRAH, in Mildura. The Allied Health Rural Generalist Pathway, developing the skills required to increase rural and remote allied health workforce, has existed in several states and territories since 2014 and in the non-government and private sector since 2019. Disappointingly, it does not exist as yet in the Victorian public sector. Rural generalist pathways warrant further development across the professions.

The current Albanese Labor government has not had the needs of rural, regional and remote Australians front of mind when it comes to health. Implementing policies such as changes to the distribution priority areas, which have resulted in a net flow of international medical graduate doctors away from the regions to periurban settings, has exacerbated workforce shortages. Their signature policy of tripling the bulk-billing incentive payment might have looked good on the surface, but it has not brought more doctors to the regions, nor does it adequately cover the burgeoning costs of running a general practice.

The Nationals are working on significant regional health policies to improve the supply of doctors and other health professionals in rural, remote and regional Australia. As shadow assistant minister, I have been developing bold policies to immediately address our dire health workforce shortages and facilitate structural reform to grow our own supply of doctors and other health professionals in the regions into the future. I must name the member for Parkes, Mark Coulton, who gave his valedictory speech today, for the work that he did previously to ensure better health care into the future for regional Australia.

Bridget Archer (Bass, Liberal Party) Share this | Link to this | Hansard source

Is there a seconder for the motion?

Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

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

The federal Labor government is committed to strengthening healthcare services and our regional healthcare workforces right across this great country that is Australia. As a practising emergency department doctor at Wyong Hospital, I understand firsthand the importance of a robust regional health workforce, particularly in primary care. Our primary care clinicians—some of whom are present here in this chamber—know that, if you can treat an illness at the primary care level in those clinics, then you stop those diseases from exacerbating and don't end up seeing me in the middle of the night.

Following the election in 2022, one of the first actions made by the federal Labor government was to bolster doctors on the Central Coast by changing the region to a distribution priority area. The distribution priority area classification identifies locations in Australia with a shortage of general practitioner services. Changing the region to a DPA has meant that general practices across the region of the Central Coast—that's Robertson, Dobell and a little bit of Shortland, as I like to remind the minister—have access to a greater pool of available doctors. I note that recent data from department of health highlights that, since we came into government, last year Australia added one new doctor every hour on average, with more doctors joining in the last two years than at any time in the past decade. According to the department, an additional 17,846 new medical practitioners registered to practise in the last two financial years.

The 2022-23 cohort of 8,356 new doctors was the largest influx of new doctors in more than a decade, and that record was beaten in 2023-24, when 9,490 doctors registered to practise. This means that more doctors are registering to practise in Australia, more junior doctors are training to become GPs and more medical graduates are aspiring to become GPs since the federal Labor government's record investments in strengthening Medicare. In 2024, close to one in five medical graduates aspired to have a career in general practice or rural general practice, with 17.5 per cent of graduates nominating general practice or rural generalist as their preferred speciality in the annual Medical Deans' survey. In addition, the number of junior doctors choosing to go into general practice grows each year. In 2024, more than 1,600 doctors accepted a place on a government funded training program to become a GP or a rural GP—a 13 per cent increase from the year before. In 2025, more than 1,750 offers are expected to be made to junior doctors to begin government funded GP training, leading to an intake that could be up to 10 per cent larger than 2024.

The federal Labor government's work to improve healthcare services and regional healthcare workforces does not stop here however. On the Central Coast, in the electorate of Robertson, 38 general practices received grant funding between $25,000 and $35,000, through the General Practice Grants Program as part of strengthening Medicare. The federal Labor government has provided funding to general practices across Australia to make improvements to their practices, to expand patient access and to support safe, accessible and quality primary care. For example, in my electorate, the Terrigal and Avoca medical centres combined received $60,000. The funding has enabled both practices to become reaccredited as well as a new consulting room to be built in the Terrigal practice. Additionally, the funding has enhanced practices for infection control and enabled the upgrade of essential equipment. The federal Labor government is working hard every day to strengthen health care on the Central Coast, especially in primary care.

Another one to mention is the Saratoga medical centre. They received a grant of $25,000 from the Strengthening Medicare General Practice Grants Program to update their IT systems. This funding helped to improve patient access and has insured upgrades to critical IT systems that are essential for general practices to function successfully. Whether it's training more GPs, a tripling of the bulk-billing incentive or investing in our general practices, only a federal Labor government be trusted to protect and strengthen healthcare services and our regional healthcare workforces across Australia.

David Gillespie (Lyne, National Party) Share this | Link to this | Hansard source

This motion is a really important issue, or it speaks to a really important issue, and that is the health workforce. My many years of experience in the medical profession—in fact, 33 of them—were preceded by me working in the hospital system as a hospital cleaner, a central sterilising agent, a wardsman and a med student. I saw all sorts of hospitals in my training. I have seen multiple people, 18 beds in a row, down one side and 18 down the other side, with just curtains between and none of this private room rubbish—that was the Royal Prince Alfred Hospital that was built in the 1870s or 1880s and named after Prince Alfred who got shot by somebody when he came out here on a visit the 1860s—through to the Chris O'Brien centre, at the other end of the extreme, or St Vincents in Melbourne or Sydney.

The thing that makes the quality good is like with the F1. It's not the car; it's the driver. The health workforce is what makes Australia's health system great. Many places have Nobel prize winners, and Australia has plenty of them in our health workforce, but there's a uniform, high standard across Australia. Whereas with some countries it's all over the shop because they don't have a good health training system. A lot of them just get book knowledge. Anyone can be a doctor. You just go to uni and buy the books, and you get a medical degree. Germans and Italians used to come out here to get training as med students because they heard that we actually got to see patients.

But, Houston, we have a problem! Australia doesn't have enough of a health workforce in rural Australia—from pharmacists, physios and OTs through to doctors, nurses and whatever. Because of its roots, the National Party feels this acutely. It's more than what would be felt in Sydney. There's an overall shortage of GPs, as the member mentioned. In the Deans survey, only about 15 to 17 per cent of medical students now want to do general practice. When I graduated—about the same time as your husband, Member for Mallee, or a bit after—the figure was over 50 per cent. We've got specialists for the left toe, the right ankle and everything. There are square inches of the human anatomy that are looked after by only one specialist.

In a big city, you need about 10 doctors to look after a general medical patient; whereas, in the country, a generalist does it all. That's the beauty, because everything is connected—everything in the human body. We have been at the forefront of developing the rural health workforce. Unfortunately, due to the snakes and ladders of political life in this building, I wasn't there to announce the Stronger Rural Health Strategy. That fell to my successor, and I got put into children and families. But I do remember negotiating with University of Sydney, University of Melbourne, La Trobe uni, Monash University and getting medical schools created on the Sunshine Coast, because a wicked sandstone university was convinced to give up a lot of its extra places. So the people in the seats of Fairfax and Fisher have the Sunshine Coast medical school. The Queensland university at the tip of the point up there in Cairns and James Cook uni were beneficiary of the extra spots. We had Charles Sturt uni created. The National Party created that med school, because we got them a bunch of Commonwealth supported medical places, and we partnered them at the start with Western Sydney uni. Then I came back again with a second life in the health portfolio and got them a rural medical school, even though their school was rurally based.

Unfortunately, the member that was the beneficiary of that chose to sit on another part of the building, but there we go. We were just so pleased that we got it for people in country Australia, because they have been short-changed. Convincing Melbourne uni to give La Trobe students a pathway into a Melbourne uni degree was another stroke of genius, and I worked on that. I've been at the forefront of getting all these expansions. With the HECS debt relief for nurse practitioners who go remote, they get two years off for one—the same with doctors. The Stronger Rural Health Strategy is a really good example of that, but we need more pharmacists. We need more physios. We need everything, because it's the professionals that are important, not necessarily the buildings.

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

While living in a regional area of New South Wales, I'm all too aware of how difficult it can be to see a doctor. This government knows that too many Australians are struggling to get in to see a GP. That's why we're strengthening Medicare, and it's why we're doing everything we can to attract, train and retain more doctors, especially in regional areas like Gilmore. We made an election commitment to make it easier for Australians to see a doctor, and that's exactly what we're doing.

The University of Wollongong's Shoalhaven Graduate School of Medicine, located in my electorate of Gilmore, has produced many doctors that continue to live and work in our region. Doctors that study at UOW's Shoalhaven campus are staying on and working as general practitioners in our community and medical specialists at Shoalhaven and Milton Ulladulla hospitals. Former Milton pharmacist Amanda Venables was one of the first graduates from the Shoalhaven school of medicine, and she now works both in a private family medical practice and as an anaesthetist at Shoalhaven and Milton hospitals. As a small-business owner and mum, Dr Venables had long thought about studying medicine, but it wasn't until the training opportunity became available closer to home that her dream career became a reality.

Providing local students with a chance to study and then go on to practice in regional areas benefits the whole community. It provides a much-needed injection of new GPs and also provides patients with a continuity of care that is so important, especially for families and our older residents. This government funds more than $1.9 billion a year for programs that develop the workforce and support more equitable distribution of health professionals to areas of need, especially regional and rural locations. The Gilmore electorate is seeing the benefits of this initiative. In 2024, more than 1,600 doctors accepted a place on a government funded training program to become a GP or rural GP, a 13 per cent increase on the year before. The 2022-23 cohort of 8,356 new doctors was the largest influx of new doctors in more than a decade. Incredibly, that record was broken in 2023-24, when 9,490 new doctors registered to practice.

We're investing in doctors and we're growing other areas of our health system by offering Commonwealth supported university places, which subsidise up to 75 per cent of tuition fees for eligible students studying in a range of courses, including public health, exercise physiology and medical biotechnology. Labor is also offering fee-free TAFE courses providing more training in the areas of Aboriginal and Torres Strait Islander primary health care, allied health, disability support, mental health, aged care and nursing.

Not only are we training more doctors, nurses and health workers; we're providing better access to their services, particularly in regional areas like Gilmore. In my electorate, we've opened the doors to a new Medicare urgent care clinic in Batemans Bay, Kiama headspace, the South-Eastern Endometriosis and Pelvic Pain Clinic and the Shoalhaven walk-in adult mental health hub. These services are free, which is taking some financial pressure off families who we know are doing it tough. Since opening, more than 7,000 patients sought care at the Batemans Bay urgent care clinic, including Louise, who said she had a great first experience at the urgent care clinic with her toddler. She said the clinic was a great service to have in Batemans Bay. Jane turned up to have her eye checked on a Sunday, and, after thinking she would have to wait for hours in emergency, she was seen immediately by a nurse and then a doctor and sent on her way with the appropriate scripts. Best of all, her visit was all bulk-billed, and on a weekend—how good is that?

The people of Batemans Bay are loving their clinic, and the 2024 Albanese budget is investing a further $227 million so thousands more Australians can get the free urgent care they need, with another 29 Medicare urgent care clinics offering walk-in care seven days a week over extended hours, completely bulk-billed. There have been almost 400,000 visits to Medicare UCCs across Australia, and almost one in three visits have been for children under the age of 15. As a mum of four, I know all too well what weekends with kids can be like, with little ones falling off bikes, footy bumps and twisted ankles on the soccer field. These clinics are proving just fabulous for families, in terms of time, convenience and affordability. This government is delivering on its promise to provide more doctors, more health workers, and more accessible, affordable health care for all Australians.

Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

Firstly, I want to commend the member for Mallee, the shadow assistant minister for regional health, on bringing to the parliament this vital motion. It is important, and if there's anybody in this place who would know just how integral it is to the success, prosperity and productivity of rural, regional and remote Australia it is the member for Mallee, whose husband of 47 years, Philip—my favourite Webster—is a long-serving GP at Mildura. He understands fully the pressures that the rural areas of Victoria face. Rural Victoria is just like the rural areas of any other state, and I found it very interesting—intriguing, in fact—to hear the east coast Labor members talking about distribution priority areas, as if they would really know!

When you really go out to regional Australia and to remote Australia, where you can kick the red dust around, there's such a shortage of doctors, and but for the Nationals that shortage would continue. We have, along with our regional Liberal cousins, put forward policies that have helped ease the situation, through the National Rural Generalist Pathway. I commend the member for Parkes, who gave a wonderful valedictory speech, for the work that he did, and I commend the member for Lyne, who spoke earlier in this debate, and the shadow minister now at the bench for the work that they have done, the work that they are doing and the work that we will do in the future.

I look at the Murray-Darling Medical Schools Network situation, particularly in Wagga Wagga. We have a young student there by the name of Madeline Ingram. She was educated at Mater Dei Catholic College. She's just 23 and in her first year at that wonderful facility. It is a bright and shiny new facility. It's yet to be opened—three storeys with a car park underneath. It's replacing Harvey House, which is an old nurses quarters, which has been in use since 1936. But, as the member for Lyne said, the important thing is that it's not about buildings; it's about the people. There's so much work that Dr Gerard Carroll, Dr Nick Stephenson and others have done to make this a reality, to get the professionals in. They've given of their own time, just as Dr Philip Webster has done for many years, to make sure that we get the best outcomes in rural and regional health, and that's what it's all about.

Madeline Ingram spoke to me at the topping-out ceremony on 15 April. That's when the 18-metre height was reached for this building, which will overlook Edward Street in the medical precinct right next to Wagga Wagga Base Hospital. She talked about the 90 students that will learn there, and she talked about the importance of doing the course, which ends up getting you your doctor's degree, from start to finish in a rural setting. All too often in the past we've seen the brightest and best of the students start their course. They go off to Sydney to do a couple of years and never come back. They fall in love with somebody, just like the member for Mallee did all those years ago—not too many, Member for Mallee, but you get my drift. Indeed, we want our student doctors to learn from the best, like Dr Carroll, Dr Stephenson and others. We want our doctors to be able to have beautiful new infrastructure, where they can feel the ambience and they can feel that there is a future in a rural setting.

We also want them to be let loose, so to speak, on our rural patients, because it shouldn't be that when you are in pain you have to catch a plane. It should be that in our regional hubs, such as Wagga Wagga, Orange, Mildura, Shepparton and Dubbo, we have those rural medical schools through that Murray-Darling network. We have the buildings. We have the people. We have the political will, thanks to the National Party. It has been the National Party that's pushed that. It's been the National Party that's delivered that. I am so very proud that it is making a difference along with all the other options and policies that we will bring forward to the next election.

The member for Mallee is right when she says that the burden of disease experienced in the population increases with geographic remoteness. It's not right and it's not fair. Let's not forget that it was these regional and remote Australians who carried this country during the COVID pandemic. They were the ones who still mined. They were the ones who still farmed. They were the ones who helped our balance of payments. They're the ones we should never ever neglect and make sure they've got the best health outcomes in the future.

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

The regions bear a heavier burden of disease than any other part of Australia. Within my electorate, I have regional areas, rural areas and remote areas. Kangaroo Island is classified as a remote area. I am very conscious of the regional health inequity that exists in my community. So I am delighted to lend my support to the member for Mallee's motion and join her call asking for government and the minister to advance rural general pathways in medicine, nursing and allied health.

As well as significant staffing shortages in the regions and the tyranny of distance to access metropolitan services, those of us living in the regions receive less health spending per person. If you live in the regions, you are less likely to have affordable and timely access to a GP. You are less likely to have access to diagnostic services, such as regional breast care screening. If you need to see a cardiologist, you'll want to hope you live within 50 kilometres of the CBD.

Rural Australia produces at least 80 per cent of Australia's exports, 90 per cent of Australia's food—we feed the nation—and 50 per cent of our tourism revenue despite housing only a third of our population. Rural health care remains critically underfunded, and rural outcomes in our communities from a health perspective are vastly inferior. Rural areas have up to 50 per cent fewer health providers such as general practitioners, physiotherapists, psychologists, dentists—my goodness, how much do we love a dentist in the regions?—pharmacists, optometrists, and podiatrists than the major cities. In fact, remote communities bear 1.4 times the total disease burden compared to those in major cities and we receive less funding on a per capita basis despite that.

Analysis commissioned by the Rural Health Alliance shows that in 2020-21 there was a $6.5 billion gap in expenditure on health care in rural Australia compared to the cities. Expenditure and health services for a person living in rural Australia sits at $848 less per person per year than for their metropolitan counterpart. That's the difference between them, largely due to a lack of affordable health care in regional, rural and remote Australia. This equates to a gap of $6.55 billion between metro and rural areas.

I have previously raised some of these issues, including the closure of many rural general practices in my electorate. We are not the most remote. Kangaroo Island is remote, but many parts of Mayo are accessible within an hour and a half—of course, that's if you've got a car—from the metropolitan areas. But we are feeling it with the closure of GPs. Often it's because the GPs, with the changes the government's made, are able to now be reclassified, particularly if they're from overseas. They can work in places like Morphett Vale and live in Malvern. They can live in North Adelaide and go out to Elizabeth. That's how people from overseas can get around the system now, because they changed it from being MM 5 down to MM 2. What that means is that we've had a shrinkage of the workforce, particularly with our GPs.

As an aside, I'd also like to speak in support of the call by General Practice Registrars Australia for the GP workforce shortage to be addressed more generally. GPRA has asked government to fund an independent GP registrars employment fund, comprising a base rate wage, a supplement for first-year GP registrars, and independent GP training support. These are the kinds of initiatives we need. We need every avenue possible to get the smart country kids who go off and do their medical degrees back into the regions so they can work in the place they know. We desperately need them. If we don't have health services across our regions, people just can't live in the regions. And we need people in the regions, because otherwise the rest of us are going to starve. We in the regions grow the food, we grow the fibre—we support the nation—yet we are the country cousins. We are second-class citizens when it comes to health in this nation, and the government need to address this.

I thank the member for Mallee very much for her motion on this. We need to talk more about rural health in this place.

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

There being no further speakers, the debate is adjourned and the resumption of the debate will be made an order of the day for the next sitting.

Federation Chamber adjourned at 19:16