Rowan Ramsey (Grey, Liberal Party) Share this | Hansard source

Last Friday was an anniversary for me and a number of other people in this place, including the member for Parkes, who is sitting in front of me. We've been here for 15 years. For the entire period that I've been here, I have been on about the disparity in health services between regional and rural areas and the city. Despite enormous effort—I note the member for Kooyong's comments, and I'm not suggesting here that there is large-scale Medicare fraud—there are some very low value medical services being offered in places. We know Medicare item numbers are accessed in the city at double the rate they are in the country. I'm not saying for one instance that we need twice as many doctors in the country as we have now, but I guarantee you that we need more. I would also say that, on the other hand, there are definitely more services. Medicare is being debited more often in the city than it should. That's not to say the service is a fraud. But is it really necessary? That's a question that I think we have to deal with.

In the 2018-19 budget, the coalition put the 10-year, $550 million Stronger Rural Health Strategy in place. I understand it delivered 700 extra GPs and 700 extra nurses in the first two years. Out where I live, you'd have to ask where they are—but I'm told those are the numbers—and it's getting worse. We've had a plethora of programs designed to address this issue of GP under-servicing in the country. We have the Rural Health Multidisciplinary Training program, and the 2019-20 budget delivered $62 million to establish and deliver the National Rural Generalist Pathway as well. We have the Australian General Practice Training Program and the Rural Junior Doctor Training Innovation Fund. We've injected $65 million into the rural bulk-billing incentives, which started in January this year. The Workforce Incentive Program, of around $390 million per annum, provides incentives to deliver primary healthcare services in rural, regional and remote Australia. We have the Rural Health Outreach Fund and the Rural Locum Assistance Program.

All of these programs are in the tens of millions of dollars, and I'm here to tell you that the services in the country are still going backwards. It's not through a lack of trying, a lack of effort or a lack of money, but, somewhere along the line, the programs aren't hitting the spot and aren't attracting enough doctors to the country. Not only are they not attracting enough doctors into the country but also they're not attracting enough doctors into GP services—into a GP specialist service, if you like.

I come from the north-eastern Eyre Peninsula. There are five major towns across the northern Eyre Peninsula—Streaky Bay, Wudinna, Kimba, Cleve and Cowell—with an estimated total population of about 7,500. Currently, we have three full-time-equivalent resident doctors, so that is a ratio of about 2,500 to one. I heard some news on the weekend—some bad news, I'd have to say—and I rung up the community where the doctors live. Two of them have announced that they are leaving. That will leave us with one doctor for 7,500 people. I would say that is worse than a crisis; that is an absolute train wreck.

SA Health is trying to fill the gaps with locums. They are way too expensive. Locums can be paid up to $3,000 a day, way beyond what a local resident practitioner would get. We need to get more local practitioners on the ground to address this bleed-off of health funds. There's another problem with locums. God bless them. When I need one, I go to them and I am very grateful that they are there. But it would be fair to say that, if I had a long, ongoing illness, it would be impossible to build up a familial link to that doctor. Every time you go to a new doctor, you have to explain your situation again. Is there any real incentive for a locum to get to the bottom of what is a long-term, difficult issue? It is so much easier to flick it down the road, quite frankly.

I'll come back to the Medicare items and the fact that they are accessed at double the rate in the city to what they are in the country and how we need to do something about it. In 2019, I convinced Greg Hunt that it would be a very good idea to come to South Australia. We did a series of workshops around the Grey electorate. When we came to Eyre Peninsula, in Kimba, my hometown, he met with the Northern Eyre Peninsula Health Alliance. That was September 2019. Disturbed by the severity of the problem, he left $300,000 on the table for NEPHA to come up with a solution built from the ground up. That report was delivered to Greg Hunt in the early weeks of this year. He was very impressed. He said it was the best report he had ever seen developed by a local community to try and address their own problems. But it required a state contribution and, in the way of elections and our democracy, we hit the South Australian state election first and then we had the federal election and we didn't manage to land a deal between the two governments before we went into caretaker mode.

I gave that report to Minister Butler soon after he was appointed health minister, and NEPHA also sent him a copy and requested a meeting. I have written to Minister Butler. I've spoken to Minister Butler. Six months into the job and he has still not found time to meet with this organisation that was provided with $300,000 of public funds to come up with a solution to a problem where we are now facing down the barrel of 7,500 patients to one doctor. I'd say that's an emergency, and the health minister, who's from South Australia, needs to get himself acquainted with this good mob of people from South Australia to discuss the issues on Eyre Peninsula, which I think are at the pointy end of the stick of doctor shortages around Australia.

We had a restricted pipeline through the early 2000s and it led to the situation where we were importing a lot of doctors into Australia. It was one of those things where the choke was kept on too long after the overservicing of the 1990s. But, in any case, numbers have ramped up again. They're turning out about 4,000 a year. There are 30,000 GPs or thereabouts practising in Australia. With 4,000 a year, even if only half of them wanted to be GPs, that should be enough to backfill the problem, to fill up the shortage. But we are finding that less than 15 per cent of medical graduates actually want to become GPs. Why is that? We could talk about status. We can certainly talk about money. If only 15 per cent of medical graduates want to become GPs, it stands reason to me—and I did maths at my rural school—that means 85 per cent of them want to be specialists. How is it that there can be enough money in the Medicare system to support 85 per cent of those graduates to go on and become specialists, unless something is going wrong in the payment system? That's why I support this legislation. Maybe it doesn't go far enough. I'm not saying that there is widescale rorting going on, but there is certainly the misapplication of public funds, because we are funding services and overservicing where we don't need them. We don't need 85 per cent of our medical graduates becoming specialists. It would be a far better ratio if, in fact, we had 85 per cent wanting to be GPs. Even 50 to 50 would be a huge improvement on where we are. That over specialisation, that referral system that sits within our medical system at the moment, is a complete drain on taxpayers' funds and it is a waste of money. There is a whole lot of low-value medicine going on here, and, if we're going to actually do something about this shortage, which is delivering one doctor for every 7½ thousand people, we're going to have to get to the nub of those problems.

Just to reiterate, we couldn't be in this position unless there was financial incentive for it to occur. As we know, most of the money that is earned in the health sector comes from the Medicare system. It draws and holds GPs to the city for lifestyle reasons. It's enticing medical graduates into the specialist stream for reasons of finance—and perhaps prestige and working hours. Either way, we need a workforce that is fit for duty. We need to fashion this workforce completely differently, and I don't think we can do it unless we attack those fundamental levers which are providing the financial incentives in the system. In this case, this bill is about making sure there is less illegality in the system. I hope it also goes the distance to inquire where and how taxpayers' dollars are being spent and if they can be spent more appropriately to bring about a fairer result.

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