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

I move:

That this House:

(1) acknowledges the:

(a) disgraceful rural doctor shortage crisis unfolding across rural Australia; and

(b) devastating impacts this crisis is having on the health of country Australians; and

(2) resolves to:

(a) take urgent action to end the crisis and get more doctors practising in rural, regional and remote communities; and

(b) deliver equality in access to doctors and medical services to country residents and country communities.

Sadly, this is not the first time I have risen in this House to put a national spotlight on the rural doctor shortage crisis that is having such a shocking impact on the health of residents in the Central West region of New South Wales and country communities around Australia. Put simply, our communities are at breaking point. The situation can only be described as catastrophic, and I will continue to speak on this crisis until immediate and real action takes place to fix it. Country people have shorter life expectancies than city people. It's both tragic and utterly unacceptable, but it's true, and there is no end in sight as this health crisis worsens every day.

On 29 May last year, I raised this crisis as a matter of public importance, calling on the urgent need for the government to immediately address the shortage of doctors in rural and regional Australia and deliver better health services for all Australians regardless of their postcode. In October last year, I started the End the Rural Doctor Shortage Crisis petition, calling on the Australian government to immediately fix the rural doctor shortage crisis and deliver more doctors to the bush without delay. The petition quickly gained over 13,000 signatures. On 10 October last year, I rose in question time to inform the Minister for Health and Aged Care about smaller towns in our electorate, such as Gulgong, that are being left without doctors and those that are closing their books to new patients. Book closures are happening in smaller communities, such as Molong and Canowindra, but also larger ones, such as Mudgee, Orange and Bathurst. The waiting time to see a GP in Wellington is now about two months. The pressure on our doctors, emergency departments and communities is immense.

In November last year, I again raised this issue in question time, where I highlighted the unfolding crisis and asked the minister when this appalling situation would be fixed and if he would come to the region to meet with local doctors and concerned residents to see the shocking effects this crisis is having. On 25 November last year, I introduced my Doctors for the Bush Bill 2024 in the parliament. This bill was simple and straightforward and would have once again ensured that country areas had priority for overseas trained doctors, who would have to work there for up to 10 years. It would have alleviated the rural doctor shortage crisis, ensuring equitable health care for rural, regional and remote Australians. Unbelievably, the National Party, the Liberal Party and the Labor Party all failed to support the bill. This was extremely disappointing, particularly with respect to the National Party. They say they want action to get more doctors to the bush but don't vote that way in parliament. My bill would have given country areas the same priority for overseas trained doctors that they had before the 2022 election. In other words, it was the previous Liberal and National parties' policy, and they still refused to vote for it in this House. It's yet more proof of a party losing its way.

This unfolding rural health crisis secured further national attention when, on 17 December last year, ACurrent Affair aired a story on the crisis. We heard from local Mudgee GP Dr Edward Lee, who said:

It is at a crisis level. It's a disaster for the patients of Mudgee and the surrounding regions.

One Mudgee resident suffering from end-of-life emphysema and asthma said, 'It's like living in a third-world country.' When asked how this made her feel, she responded:

Well, my end might be coming a bit quicker.

While I've had constructive conversations with the Minister for Health and Aged Care and also the assistant minister, I again bring this issue to the House because urgent action is needed now. This rural doctor shortage crisis is a disgrace. Country people are being treated as second-class citizens. Immediate action is needed, and I call on this House to take it as a matter of urgency. I'm very pleased that the member for Mayo is joining me to second this motion because she knows how devastating this crisis is for country patients and country communities. Action is needed on both sides of the aisle, and I call on all members of this House to support this motion. I commend it to the House.

Terry Young (Longman, Liberal National Party) Share this | Link to this | Hansard source

Is there a second for the motion?

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

I second the motion and reserve my right to speak.

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

I thank the member for Calare for putting forward this motion. Politicians like a quick fix. There is no quick fix to this problem, which has evolved over the last 40 or 50 years. And there are many causes. I approached the Minister for Health and Aged Care when I was first elected in 2016 to describe to him the difficulty that disadvantaged areas, outer metropolitan areas and rural and regional areas were having in attracting general practitioners. The member for Calare was a member of the government at that stage. That government did nothing.

We have watched the situation get much, much worse since then. Unfortunately, rural GP training positions were not being filled. More and more GPs were leaving the bush and rural areas. They were also leaving outer metropolitan areas, for a whole a variety of reasons. Health care has become very complex. You need to be highly trained over a whole range of disciplines to become a general practitioner these days. The member for Mackellar here well knows that. People need to train for long periods of time. They need a lot of supports in place to practise 21st-century medicine. In rural areas, that's often very difficult to find. Skilled nurses, skilled allied health professionals, IT specialists, communication specialists and pharmacists are very difficult to obtain in rural and regional areas, but also in outer metropolitan areas. I approached the Minister for Health and Aged Care in the Liberal-National government multiple times about this. Members of the department of health were often present in our discussions. Very little has changed. The Labor government has put in place a significant number of changes. It has increased the number of rural clinical schools. I paid my respects to the member for Parkes, Mark Coulton, who did his very best when he was the Minister for Regional Health in the previous government to try and improve that.

More recently, in northern Australia, we added more medical schools to try and encourage more local training of medical practitioners. In 2024, for the first time, the number of rural training positions for GPs were fully filled. That's after almost a decade of those training positions not being filled. So there's a combination of problems, including complex medicine and the importance of having supports for medical practitioners in rural and regional areas and outer metropolitan areas. There may be difficulties in moving a family to a rural or remote area, such as the lack of supports available through the health system, which has led to difficulty in attracting people to these areas. Unfortunately, as I've said, the difficulties continue. It is important that every level of politics—from local government to state government to federal government—is involved in improving access to health care in the bush. It's going to involve novel, innovative solutions as we move forward.

Twenty-first-century medicine is very complex. For a general practitioner in a rural area, it includes training in emergency medicine, child health, geriatrics, cardiology, and expertise in genomics and genetics, and access to more complex pharmaceuticals. These are highly complex positions, and we need innovative solutions. It's not just about training more GPs and getting more GPs to move to the bush; it's about improving social conditions and giving general practitioners access to sabbaticals. It's about retraining GPs in teaching hospitals on a temporary basis. It involves getting them access to schooling for their children and work for their spouse. It involves a whole lot of modalities, and there is no quick fix. No matter what anyone wants, there is no quick fix. General practice is a highly complex field these days, and people require a lot of training and a lot of support, more so in rural areas where there may not be other general practitioners to help them. We need to encourage more people to move to areas of disadvantage, and this may involve significant expenditure.

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

I rise to support the member for Calare's motion. I also acknowledge many of the comments made by the member for Macarthur. No, there are no easy fixes, but there are fixes. There are ways that we can address this. In my electorate, access to health services is one of the top three most pressing issues. We know that there is a $6.55 billion shortfall in regional and rural health spend. That means that around $848 per person is the difference between what is spent on a person living in metropolitan Australia and what is spent on a person living in rural Australia, and we most certainly feel it in the regions.

While many say, 'Yes, these are problems we've had for several years,' the changes to distribution priority areas, or DPAs, have made it infinitely worse. In South Australia, an overseas doctor can go and work in Mitcham, a very nice, well-heeled area, instead of going out to the bush, and that is what they are doing. They are living in North Adelaide and working in Elizabeth. They are living in Unley and working in Morphett Vale. They're living in Mitcham and working in Mitcham. They are not going to the bush. That is something that changed with the change of government, and that has had a profound impact on my electorate. I'm in a region. I can only imagine what it's like out in Grey or Lingiari, way out west.

In my electorate, what that's meant is that we've had closures in Meadows and Yankalilla. These are clinics that have closed. We have had historic shortages across Kangaroo Island. It has taken weeks—sometimes a month—to get in to see a doctor. On the Fleurieu and the south coast, where the median age is north of 60, the doctors have closed their books. They're saying, 'Well, we're not putting anyone on, because we can't get any doctors into the region.' I've written to the health minister about this.

So what are the solutions? What do the general practitioners tell us are the solutions? Just over a week ago, we had a general practitioners register forum in my electorate. I co-hosted this. It was the SA Future GP Forum, held in McLaren Vale. They talked about a number of issues, and they also, importantly, came up with solutions. We know that some time ago—maybe 10 or 15 years ago—around 50 per cent of medical students were looking to go into general practice. Now that's down to 10 per cent. There are a few reasons for this. One of the reasons is the cost difference. If you are a registrar and you want to go down the GP pathway, you have a shortfall of about $30,000 every year in costs. If you stay in the hospital and work as a registrar in a hospital setting, you get access to study leave and paternity leave, as well as that difference in income. That is a real barrier to people who want to be GPs going and doing the study to become GPs. So we need to address that. That funding was cut in 2014, and it hasn't been brought back since then. That, I think, has had a huge impact.

The other issue is that we haven't lifted Commonwealth supported places to study medicine in pretty much a decade. Again, the number was frozen in 2014 and governments of both persuasions have not lifted it. We need to seriously lift the number of medical places, because our population has grown substantially but we've only seen very marginal increases. I think that in the last couple of years there have been maybe 100 extra places across the nation to study medicine, while we have an ageing population. These are two very simple policy matters that are contained and can be addressed. Those things could change One sits in education and one sits with the health minister.

So I support the member for Calare's motion in saying that this is a critical issue. If, as people do in some parts of my electorate, you live an hour or an hour and a quarter from the city and you can't get in to see a GP, or you move to the area and the GP says, 'We're not even going to add you to our books,' that is a very serious issue. The brunt of the impact of this is in regional Australia. It's not in Mitcham, Morphett Vale or Elizabeth. This is in the regions, and the regions must have this addressed.

Susan Templeman (Macquarie, Australian Labor Party) Share this | Link to this | Hansard source

I'm very happy to speak on this private member's motion, and I want to highlight the challenges of peri-urban areas like mine, which sit in a bit of a no man's land between urban and regional. In fact, the region I represent is a mix of urban, regional, rural and remote in its character and geography, with small towns, hamlets, villages and large properties that mean it is not a one-size-fits-all place. No single model of primary care is going to suit my constituents, and that means we really need to break down the issues area by area. Remember that this is something that the Minister for Health and Aged Care has described as a crisis. We have a crisis because of the failure to invest in this very key part of primary care for so many years.

The first region I want to focus on is the Blue Mountains, which sits anywhere from 60 kilometres to 120 kilometres from the Sydney CBD. I recently held a roundtable with consumers in Katoomba, towards the top of the mountains, about their experiences, and then I held a separate roundtable with GPs and practice managers. Both of these groups provided enormous insights into their experiences and their challenges. I'm really grateful to all those who participated, and I also want to thank the Nepean Blue Mountains Primary Health Network representatives who were there, given their role as an agent for distributing Commonwealth funding to primary health care at a local level. There are a range of issues, and they include the constraints of the Modified Monash Model that the previous government brought in. It applies only to the very top of the mountain. That's the bit that gets incentives. Yet a few kilometres down the road, the town of Katoomba does not attract those incentives. That is our key population base, but the model really constrains the services. There are a whole range of challenges that we face locally and nationally that I'm going to continue to work on.

What has emerged is the issue of access for those with a chronic illness or chronic condition who are experiencing problems in getting ongoing continuity of care. The steps we're taking are to look at the health system as a whole, to look at the role that nurse practitioners can have and to look at the role that pharmacies can have, so that people are working to what we call the top of their scope, the top of their ability, and getting extra training where it's needed. That might mean giving these people Medicare item numbers to deliver certain things. It's making sure that, whether it's contraceptives, treatments for UTIs or immunisation, pharmacists are able to service that part of the healthcare system. These are all things that take the pressure off GPs so that they can see the people that only they can see.

I'm very pleased to see that, in 2025, a record 1,750 offers are likely to be made to junior doctors to begin government funded GP training and that a huge chunk of those have already been taken up. We've certainly seen bulk-billing rates turn around with, in the 2023 budget, the biggest investment in bulk billing in that 40-year history of Medicare, and in the last two years we've delivered the two largest increases to Medicare rebates in 30 years. In our two-and-a-bit years, we've increased rebates by more than those opposite did in nine long years.

One of the things that are helping in the lower part of the mountains is the opening of the urgent care clinic in Penrith, and, while it's not ideal for lower-mountains people to travel down off the mountain, it is understood that that does provide more options for them compared to those higher up the mountains. I know parents of young children have been particularly grateful for that Medicare urgent clinic down in Penrith, which I opened the year before last.

I want to talk about why one is needed so badly in the Hawkesbury. The Hawkesbury desperately needs a Medicare urgent care clinic because people don't have the same access to the existing ones. This would be a walk-in mini-emergency clinic for urgent but not life-threatening conditions, with radiology there open seven days a week, 365 days a year, usually from eight in the morning till eight at night, so that everybody knows where to go when something urgent but not life-threatening happens. I know my community wants this, because 1,600 people have already signed my petition in support of this. I will keep advocating this as something that can be a real life-saver for parents who don't want to be in the emergency department and want to get good, urgently needed care for their kids.

Terry Young (Longman, Liberal National Party) Share this | Link to this | Hansard source

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