Anne Webster (Mallee, National Party, Shadow Minister for Regional Development, Local Government and Territories) Share this | Hansard source

The Prime Minister has been at pains to tell us repeatedly that the only card that we need take to a medical appointment is the Medicare card. He's told us that the Labor government's changes to incentivise bulk-billing would make primary health care free to all those who need it. But across Mallee my constituents are lucky if they can get an appointment with a GP at all, let alone not pay a gap fee. The average GP gap fee, or out-of-pocket cost, is now over $50. The national out-of-pocket GP costs have more than doubled, from $780 million in 2021-22 to $1.66 billion in 2023-24. Out-of-pocket costs have risen steadily across all socioeconomic areas according to the Australian Institute of Health and Welfare. Bulk-billing, under the coalition, was at 88.9 per cent in 2021. Despite Labor rhetoric, it has fallen. In 2024-25, the latest figures, it was 77.6 per cent. That's an 11 per cent drop in bulk-billing. The fact is remote, outer regional and inner regional areas have lower bulk-billing rates than major cities. So your Medicare card is not all that you need, Prime Minister. That is another fabrication from this arrogant and secretive Labor government. This is a government that is all about the headline or the catchy three-second hook on social media to halt the doomscroll but not so much about doing the hard yards and policy grunt work to make lasting change.

The Nationals' perspective on health care, the Mallee experience—when I asked my electorate of Mallee late last year about their biggest concerns, I received more than 5,300 responses, with Mallee residents telling me their No. 1 priority was better hospitals and access to health care. When asked about primary health care, the top concern of my constituents was wait times to see a doctor, followed by out-of-pocket costs and then wait times to see allied health professionals. Health care access and affordability is front of mind for my constituents and regional Australians more broadly. But this Labor government is forever letting them down and putting their needs out of sight and out of mind. The Nationals want to rectify the poorer health status of regional Australians, a status driven in large part by poorer access to health services. Rural and remote Australians have higher morbidity and mortality rates than those in major cities. This is a known fact. In very remote areas potentially avoidable deaths are 2.8 times higher than in major cities. Rural Australians receive less service delivery per capita despite higher need and worse outcomes. How is this okay? This Labor government promised to govern for all Australians, but clearly they are not for rural Australians.

The National Rural Health Alliance published a study in August last year which showed that less money is being spent per person in rural and remote regions than in the city. In 2021, the spend was $848 less per person than for city people. But it gets worse. The latest available data suggests that this underspend has blown out to over $1,000 per person in regional and remote areas. Poorer health access is driven in large part by the lack of health workforce in the regions. Here are the facts. In 2023, small rural towns had the lowest number of GPs and specialists per capita. But it's not just GPs and specialists. Small rural towns also have less than half the allied health workforce per capita that major cities have. The Nationals are committed to supporting regional communities and driving policies and programs that will improve the health status of regional Australians.

In the Health Legislation Amendment (Prescribing of Pharmaceutical Benefits) Bill 2025, the Labor government says it is trying to address healthcare accessibility issues due to workforce challenges by expanding the scope of practice of registered nurses. Nurses are the largest component of the health workforce in Australia. There were 329,000 registered nurses in 2024 compared to 122,000 doctors, making up just over 44 per cent of the total health workforce. There are more nurses in small rural towns, remote areas and very remote areas than any other kind of practitioner. It is great to focus on and support nurses. I have a daughter who is a nurse. We know they do wonderful work and they are the bedrock of our health system.

The problem with this bill is that having a new category of nurse, nurse prescribers, provide pharmaceutical benefit schedules is not evidence based. It's not evidence based policy making nor is it addressing the core issues driving poor access to health care and core health outcomes, particularly in regional Australia. This is lazy policy making, driven by this government's blind allegiance to Labor state governments with abysmal fiscal restraint and failing health systems who, no doubt, want to employ authorised nurse prescribers in urgent care clinics in cities and larger regional centres. Labor are seeking quick wins with little effort to address policy complexity.

What will this bill seek to do? It seeks to grant eligibility for Pharmaceutical Benefits Scheme rebates on medications prescribed by a new category of prescribers—authorised nurse prescribers. The government's proposed authorised nurse prescribers will be registered nurses with additional training who work in a collaborative arrangement with an autonomous prescriber, a professional who can already prescribe independently. Now, that means GPs and nurse practitioners.

Our position as the Nationals on this bill is cautious. We are cautious about the legislation due to the lack of real world testing of this model in Australia and, therefore, the lack of robust evidence. Applications for registered nurses to become endorsed for prescribing were only declared open last month via the Nursing and Midwifery Board of Australia under national law. The first prescribers are anticipated under this new arrangement from mid-2026—so we're talking July onwards—but require additional changes to state and territory laws.

I want to point out, though, that the usual process is that states or territories run a trial or a pilot first on a new prescribing model without PBS eligibility, to ensure the model is tested and safe. A state or territory trial has not happened. Therefore, the clinical governance, safety and responsibility framework of this new system is untested. It needs to be tested before it is supported by Commonwealth taxpayer funds.

I also want to highlight that the time difference between endorsement for prescribing and PBS rebate access has generally been lengthy for other prescriber groups, so who knows when nurse prescribers will be able to prescribe with PBS rebates. A pilot program should occur within a state or territory without PBS rebates before national rollout of PBS rebates. That is a responsible approach that this government just has not looked at.

Secondly, there is currently no funding mechanism to adequately remunerate these authorised nurse prescribers in primary care settings, which is where they are actually needed. Medicare does not currently fund this approach, and the Workforce Incentive Program, commonly known as WIP, and the Practice Incentive program, PIP, are not adequate or appropriate to fund this model of care. If registered nurses who have engaged in additional study to gain endorsement for prescribing cannot be appropriately remunerated, they will not work in primary health settings. If the services of authorised nurse prescribers are not affordable—in other words, if people have to pay out of pocket—patients simply won't seek them out. Funding mechanisms for this proposed model need to be determined and tested before PBS eligibility is rolled out. This bill is putting the horse before the cart. Who would have thought?

Thirdly, the Nationals are sceptical because this bill does not address key drivers of poor access to health care and health status in the regions, including the lack of a primary healthcare workforce with the ability to prescribe autonomously—that is, GPs and nurse practitioners who will oversee the work of authorised nurse prescribers. If you don't have enough GPs and you don't have enough nurse practitioners out in the regions, how is this program actually going to benefit the regions? I would argue it won't.

The funding models do not adequately meet the financial pressures of primary health care in the regions or facilitate the provision of multidisciplinary care. We're talking about block funding. ACCHOs and NACCHOs have block funding. The only way that this government can ensure that this rollout will work is under a state funded basis, under public health. I don't think Australians want to have their choice removed. And so the funding mechanism itself must be sorted out, along with the governance of this program.

Fourthly, this legislation risks adding to the workload of the limited primary healthcare workforce in regional Australia, adding strain rather than bringing in and training up a workforce who can autonomously assess, diagnose and treat with medications on its own. This negative unintended consequence has not been considered.

The Albanese Labor government has made repeated decisions that disadvantage regional Australians when it comes to health care, especially primary health care, including changing the Distribution Priority Area rules that govern where overseas doctors have to work when they come to Australia, making it possible for them to choose to work in metropolitan areas and large regional centres at the expense of rural and remote areas. This was the very first decision that the Minister for Health made, funnelling excessive amounts of money into inefficient and costly urgent care centres in metropolitan areas and large regional centres but unwilling to address the specific needs of rural towns and remote areas, who are rarely served by these clinics. It is a metro-centric approach—make no mistake.

The Labor government has also failed to tackle the desperate need for complex funding change in primary health care in regional Australia that would incentivise the provision of multidisciplinary health care in small rural towns and remote areas and appropriately address the higher cost of providing care in these regions. They are failing to address a need and evidence base for end-to-end training of medical and other health professionals in the regions to grow our own workforce.

In conclusion, the Nationals are all for positive changes in our health system that will improve access to high-quality care when and where people need it. I acknowledge the essential role nurses play in our health system, especially in our regions, and the very, very important work that they do. But I will always advocate for evidence based policy that is set up to succeed and to address the core issues that my constituents are concerned about. This bill is lazy. It is politically driven policy that does not address the root causes of the problems in our health system. It has not been tested and is being set up to fail.

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