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

I move:

That so much of the standing and sessional orders be suspended as would prevent the private Members' business order of the day relating to the Doctors for the Bush Bill 2024 being called on immediately and being given priority over all other business for final determination of this House.

This bill needs to be debated urgently. There is a crisis unfolding in rural and regional Australia. It's a health crisis. It's a disaster unfolding before our eyes, and its consequences are absolutely devastating. This is an urgent matter. My Doctors for the Bush Bill actually does something about this.

All over central-western NSW and around country Australia, doctors are leaving the bush and they are not being replaced. Around the Calare electorate, the rural doctor shortage crisis is being felt in communities big and small. Gulgong had four doctors but now doesn't have any doctors at all, and this is putting pressure on larger towns like Mudgee. It has two medical practices and they are both no longer accepting any new patients. Practices in communities like Canowindra and Molong have also lost doctors and they are also closing their books to new patients or adopting a locals-only policy for appointments. In Wellington, it now takes two months to see a GP. The impact this crisis is having on the health of country people is very concerning and very shocking. It was only recently that I spoke to one local doctor, who said that they recently met one patient who had advanced cancer and had not been able to get in to see a doctor and had therefore missed out on vital treatment.

The rural doctor shortage crisis has been made much worse because country areas no longer have priority for overseas trained doctors. Before July 2022, if an overseas trained doctor or international medical graduate, as they are known, wanted to practise in Australia and bill Medicare they had to work in a country area for 10 years, unless that was reduced because they worked in more remote areas. These country areas were and still are known as distribution priority areas. For many rural areas, this policy was a lifeline, providing badly needed access to GPs and basic medical services. But all that changed in 2022 when the Labor government upended the Distribution Priority Area system and, for the first time, allowed outer metropolitan areas to become distribution priority areas.

For the Australian public tuning in now, all parts of Australia are classified according to what is called the Modified Monash Model. There are seven categories, ranging from MM 1, which is a major city, to MM 7, which is very remote. Previously areas MM 3 to MM 7 were distribution priority areas. To give people context, large regional centres like Bathurst and Orange are classified as MM 3; Lithgow and Mudgee are MM 4; Molong, Gulgong and Canowindra are MM 5. The government has now declared MM 2 areas as distribution priority areas, therefore destroying the priority for overseas trained doctors that country areas once had. This means that areas such as Fairfield, Hornsby and Warringah and the outer suburbs of Sydney and Melbourne now have the same priority as country areas for overseas trained doctors.

When you look at the map, it's quite clear that the whole state of New South Wales is basically one big Distribution Priority Area except for the inner suburbs of Sydney. People in the country cannot understand how this could possibly be, but the Doctors for the Bush Bill, which I introduced today, remedies this blatant unfairness by restoring the priority that country areas should have by legislating that Modified Monash Model areas MM 1 and MM 2 can't be classified as distribution priority areas. It will mean that country areas and country Australia once again has priority for international medical graduates. This restores the Distribution Priority Area system to that which existed before the last election. I would therefore expect that every single coalition MP would be lining up to support this bill. It will be very telling if they don't, and I would be very surprised and disappointed if their support isn't forthcoming.

In terms of the urgency of this matter, you only need to speak to the residents of the Calare electorate to hear what they have to say about the urgency of this issue. Carlo Nazeti writes:

A lack of consistent GP services has left many residents in distress. For example, some have shared their experiences on social media of running out of critical medications, such as thyroid medication, because local doctors are either unavailable or not accepting new patients. This level of neglect is putting lives at risk, and it is unacceptable in a country like Australia.

Mr Nazeti also writes:

It is critical that the government steps in to address this crisis before more lives are put at risk.

I have received correspondence from Ian Marsh, who is the president of the Gulgong RSL sub-branch. He is worried this shortage will mean, and he puts it bluntly, that people will die:

… from not being diagnosed or treated for conditions if they cannot get a GP appointment or a misdiagnosed through telemedicine or a subject to haphazard management of chronic conditions through lack of continuity of care.

He says:

I am sure you would not accept this in your home city or town and nor would you like to see your loved ones being treated in this system.

Helen Chisholm has written to me. She has said that she spoke to a local doctor in the Mudgee area and:

… he advised me that the GP shortage is now putting extra strain on the Mudgee Hospital as many people can no longer see their GP in a timely manner, if at all.

And it does not stop there. Sue Stanmore has written to me. She said:

I'm writing to you in regard of the sub standard health system we have here in the Mudgee District.

She goes on to state the surgeries in the Mudgee area have 'closed their books' and:

… Gulgong has no Dr's at all. With the growing community what are we expected to do, it's a joke in this day & age.

This highlights the urgency of this matter and of addressing the rural doctor shortage crisis. There is a Change.org petition we have started, which already has 13,000 signatures or thereabouts, which basically calls on the government to end the rural doctor storage crisis. So this bill that I have put into the House today is very important, because it actually takes action to do something about it.

As I said to this House earlier today, it's predicted that, in Australia, we will be short 10,600 GPs by 2031. At the same time, demand for GP services is expected to increase by 58 per cent over the next decade.

There is a fundamental unfairness and inequality in access to health services in this country. Out in the Central West of New South Wales, we call the Great Dividing Range the 'sandstone curtain', but it is a great divide in so many other ways as well. We need to actually take action, because the cold hard truth is that the further away you live from the city the shorter your life expectancy will be. That's the truth of the matter. 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. This crisis is adding more strain onto an already overstretched hospital and emergency department system. We need to take action on it straightaway.

I commend this motion to the House, and I commend the Doctors for the Bush Bill 2024, to achieve better health outcomes for country patients. This situation is urgent. It's at crisis point, and it's critical that the House deals with this issue without delay.

Maria Vamvakinou (Calwell, Australian Labor Party) Share this | Link to this | Hansard source

Is there a seconder for the motion?

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

Yes, I second the motion. It's not entirely germane to what we are proposing here, but there were three Katter boys—my father and his two brothers. Their parents had gone out to their region in a stagecoach in the 1870s. Two of the boys died as a result of the tyranny of distance. My uncle was injured in a football match—and this is where the story does not really pertain to doctors in the bush. By the time the Qantas aeroplane—and my grandfather was a major shareholder in those days—came back from Longreach to Cloncurry and then took him from Cloncurry to Brisbane, it was too late. Sadly, he died. If the aeroplane had been at Cloncurry, he'd have been alright. So he died as a result of the tyranny of distance. My father had cancer. He should have gone down for the operation, but the airline strike came. He wouldn't jump the queue and he was in no condition to drive down. By the time he got down there, 3½ months later, it was too late; the cancer had got away. So he also died as a result of the tyranny of distance.

There are people dying every day in Australia because there is no local doctor. The actual statistics that were done some years ago indicated that, where you've got a thousand people in a town without a doctor, there will be a death once a year. So there's an actual figure that we can put upon this.

The honourable member quite rightly pointed out, when he moved to call on this legislation, that—and I could not believe this—when the very special help was given to country areas to help them to attract doctors, that included Cairns! It's one of the most salubrious places in the world to live. And it's isolated? Heavens! If Cairns is isolated, God help the rest of Australia! The honourable member is pointing out that most of Sydney is in the same category as far western New South Wales. How can that be? The government, whatever government it was, with good intentions, moved the legislation, and some serious lobbying by vested interests got them to change the legislation. So the minister quite rightly brings his attention to bear upon this fact.

For six or seven years of my life, I carried the names of six doctors around with me because, every time we lost a doctor in Julia Creek, I would ring up England or, I don't know, America. There was a place in the Middle East where a doctor was available. He's a good bloke. I had six doctors overseas that I could call to come in because I was determined that Julia Creek would not be without a doctor. Julia Creek had over a thousand people in those days and now it's got very much under a thousand people. One of the reasons people leave is that there are no doctors there. Yes, they send a doctor out for four or five days a week from Mount Isa or Townsville or somewhere, but that's not having a doctor there.

In our day, though we didn't have many doctors coming through the Brisbane university, which was the only university in Queensland, those doctors were, for two years, bound to go where the government sent them if they wanted to become qualified to practise in Queensland. We should return to that. I wouldn't say for two years but I'd say for a year and a quarter. The government puts a million dollars into you. If you graduate as a doctor, the government has put a million dollars into making you a doctor, and it will give you the right to earn a squillion dollars a year. If you've got the right to practise as a doctor, you'll be a very rich person. If the government gives you that right and gives you a gift of a million dollars to get that right, then I think you owe something to the people of regional Australia.

I say regional Australia because it's not just the Julia Creeks that we're talking about here. We're talking about the Mareebas. Mareeba's only 30 kilometres from Cairns, yet their situation is grim. (Time expired)

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

The government acknowledges the member for Calare's deep interest in this matter as we do the member for Kennedy's. In the member for Calare's community, he faces a challenge which many of us do: the need to attract and retain more doctors to deliver the quality, affordable health care that communities need and people deserve. I recall an MPI the member moved on this matter in May, and, following his question to the Minister for Health and Aged Care last week, a meeting has been scheduled for the member for Calare and Minister Butler, and I look forward to joining them for that important discussion. The government is keen to continue our constructive engagement with the member for Calare; however we will not be supporting this motion to suspend standing orders.

Big challenges remain in getting enough doctors to communities which need them in the years ahead, and Minister Butler has repeatedly said that general practice has been his key focus under our strengthening Medicare agenda since we came to government. There are many initiatives working to support that, and I will go through just a few today: historic increases in the Medicare rebate and bulk-billing incentive deliberately designed to deliver the most support to rural and regional doctors; increased GP training through a college led training system and more Commonwealth supported places; $90 million to implement the recommendations of the Kruk review and make it easier to bring internationally trained doctors to Australia in a globally competitive market; and innovative models of care grants to support innovative team based approaches to primary care in rural settings.

We know these measures are beginning to work. The slide in bulk-billing has stopped, and rates are increasing, including in Calare, which is up to 81.8 per cent of consultations fully bulk-billed. GP training programs are fully subscribed for the first time in many years. GP morale is improving and more GPs are feeling valued in their specialisation and are importantly recommending it as a career to young doctors in training. This is from the RACGP's General practice: health of the nation report.

But we know there are also people living in regional and outer metropolitan areas who find it difficult to see a GP when they need one. The complexity of this challenge means we cannot equate morality with need, as has been common practice in the past, so our policy work is set out to fully understand these complexities and respond to them, in particular our distribution levers, GP incentives and scope-of-practice reviews. The government is considering each of the reviews and has committed to working with our key stakeholders in the response. Indeed, I was speaking last week with the Australian College of Rural and Remote Medicine and this morning with the incoming president—the new president—of the Royal Australian College of General Practice about them.

To the member for Kennedy, bulk-billing rates in Kennedy are up 4.1 per cent from November last year when the tripling of the bulk-billing incentive flowed—came into effect—to October this year. I thank you for the opportunity to visit in your community, including with your local GP. We are aware of the challenges facing the GP practice in Charters Towers and have ensured the Rural Workforce Agency and Primary Health Network are providing recruitment and business planning support.

I extend the same offer to the member for Calare and other members with a keen interest in this work. We, as a government, are working determinedly to grow doctor numbers and take affordable health care back to every region in the country and will continue to do so through the many policy initiatives that I have mentioned.

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

I remember when this went through back in 2022. I said at the time that this will have a huge effect on people who live in the regions and that is why we must debate this today. This decision by government has stripped doctors from the regions. It has made clinics close. It has meant that if you move into many parts of my electorate of Mayo, the local doctor surgery says, 'Our books are full and we're not taking you.' This was, I think, an incredibly callous thing to do to rural areas.

I have said it before, but we have seen doctors coming from overseas, some of whom even had contracts at the time, who were going to go work in the regions but saw the change in rules and went, 'Great, I am going to go and work in the outer metropolitan areas or even, in some cases, in the inner metropolitan areas, and I am going to live in the city. I am going to live in the affluent suburbs'—I am talking about around South Australia—'and I will work out to those areas.' They are not going to the regions.

I cannot think in my near nine years in this place of a decision by government that has had a more profound effect, negative profound effect, on people accessing health care in the regions. This was a terrible decision by government , so I absolutely support the member for Calare's work to call this on, to call for a suspension of standing orders, to deal with the distribution priority areas. Because in South Australia, we are looking at areas like Tea Tree Gully and Mitcham. The inner city, leafy suburb of Mitcham is considered a priority area and is taking doctors away from the bush. I have a rural electorate and an area that has remote medical needs—Kangaroo Island. My goodness, what must it be like if you are in Kimba or Port Lincoln or in the member for Kennedy's electorate? This was a terrible decision by government and must be reversed, so I absolutely support the motion of the member for Calare as seconded by the member for Kennedy because people can't get in to see a doctor.

I remember at the time, when this went through, we had some people say, 'Oh, I can't get in to see the doctor until late in the afternoon or even the next day.' Try weeks, try months, or trying ringing the only doctor surgery within your area to be told they won't see you at all. We had an elderly lady who had just moved to the Goolwa area, on the south coast of my electorate, ring my office, pleading with us to try and help her find a doctor.

They can't employ doctors from overseas because they all prefer to liver in the metropolitan areas. They all prefer to live in the cities, and it is this legislation the government put through that has made that possible. It has starved the bush of doctors and it was an unconscionable decision by government to do that.

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

The question is that the motion be agreed to.