Kate Ellis (Adelaide, Australian Labor Party) Share this | Link to this | Hansard source

I have previously spoken in this House on numerous occasions to urge the Minister for Health and Ageing to grant an exemption under section 19AB of the Health Insurance Act in order for a particular overseas trained doctor to take up a position at a surgery in my electorate and thus help to ease the huge and overwhelming workload. That case is currently under appeal, and it is not my intention to go through it again today. I would like to speak more broadly and outline to the House some of my deep concerns over the current guidelines which govern exemptions under section 19AB of the Health Insurance Act and, further, to outline my absolute horror at evidence that decisions made under this provision are apparently being determined based on factors outside any of the published guidelines.

From the outset, let us be very clear: it is people who get sick, it is people who need access to GPs and it is people whom our system must be centred around, not postcodes. Yet, strangely, this is not the way that the system is set up. The current guidelines are flawed and are failing us. In assessing areas of workforce shortage, the reality of what is happening within our surgeries and how overworked they really are is not considered to be as important as where these surgeries are located.

Part 4 of the guidelines provides that an exemption may be granted if work is undertaken in districts of workforce shortage. The definition of a district of workforce shortage is given in section 4.1.3 and is restricted to geographical features, including surrounding postcodes, the areas that make up a shire or local district, a division of general practice or a local area as defined statistically by the Australian Bureau of Statistics. This definition does not provide for consideration of the realities of the actual patient catchment area of a surgery. In surgeries such as those operating in my electorate, patients are not necessarily from the immediate local area or the local postcode. In fact, there is a lot of evidence of patients travelling from outside the area to seek treatment. Our system must recognise this fact.

There are enough flaws in these guidelines for me to talk on for hours, though I recognise, Mr Deputy Speaker, that you may not be that generous with my time, so I want to turn instead to the issue of what is not in these guidelines. In a letter of advice sent from the Department of Health and Ageing in January this year it was stated:

The delegate generally does not grant exemptions for inner metropolitan areas irrespective of whether they are statistically a ‘district of workforce shortage’ except in exceptional circumstances. Since the inception of the Act in 1997 there has been a general policy that overseas trained doctors would not be granted an exemption under section 19AB of the Act in inner metropolitan areas.

This is deeply concerning. This governmental ‘general policy’ is not documented in any of the guidelines, which is a requirement of the legislation. The legislation states:

The Minister must, in writing, determine guidelines that apply to the exercise of powers under subsections (3) and (4).

Further, this undocumented policy has injected an extreme bias against inner metropolitan surgeries into the system. The so-called policy indicates that socioeconomic factors, which the guidelines require to be considered, are not at all taken into account by the government. I believe that all members of this House should be deeply troubled if the Department of Health and Ageing is conceding here that it bases decisions on factors which are not outlined in the guidelines.

I must add, as a representative of an inner metropolitan electorate, that I am further horrified if my constituents are being particularly discriminated against not on the basis of their health needs, their workforce shortage and their need to access GPs, as every other Australian needs, but on their location. I believe that this matter is serious enough that the minister for health must today come into this House and confirm or deny the existence of a government policy whereby overseas trained doctors will not be granted exemptions in metropolitan areas. If he confirms this policy then I will argue against the merits of it with him and I will ask him where it is stated in the guidelines. At least then metropolitan surgeries will know where they stand. At least surgeries, such as those in my electorate, will know that it does not matter if they meet every publicly outlined guideline because they do not have a chance. Maybe that will stop surgeries wasting their already so precious time. If this advice from the department is incorrect then the minister must immediately set the record straight and ensure that the government and the department are making decisions based only on the printed guidelines, as required by the legislation.