House debates

Thursday, 14 May 2020


Health Insurance Amendment (General Practitioners and Quality Assurance) Bill 2020; Second Reading

12:28 pm

Photo of Chris BowenChris Bowen (McMahon, Australian Labor Party, Shadow Minister for Health) Share this | | Hansard source

The Labor Party will be supporting the Health Insurance Amendment (General Practitioners and Quality Assurance) Bill 2020. It changes the registration of general practitioners—and the whole House will join me in thanking Australia's doctors and medical profession, and general practitioners in particular, for the role they are playing as we deal with the COVID-19 crisis. This bill amends the Health Insurance Act 1973 to simplify the administration of higher Medicare payments for some GPs. This is very sensible streamlining. GPs are eligible for higher Medicare rebates if they are fellows of Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine and meet ongoing, continuing professional development requirements.

The current system is quite shambolic, to be honest. It requires two different systems: the current system for determining eligibility for those higher rebates as administered by Services Australia, and it duplicates the separate requirements of the National Registration and Accreditation Scheme. So this bill removes the requirement for eligible GPs to register with Services Australia and, instead, ties eligibility for higher Medicare rebates to the existing scheme. This is how the eligibility for other specialist rebates is already determined and it will reduce red tape for general practice, colleges and Services Australia. It reduces red tape all around. It is a sensible change. Hence, Labor will support this bill.

I will, however, be moving a second reading amendment which notes the things that the Labor Party does not support and some things that the Labor Party is concerned about. I talk, in particular, of the impact of the government's changes in relation to general practice in regional Australia and outer metropolitan Australia. These are changes which the government has undertaken and, despite the Minister for Regional Health's assertion, which did not require legislation and did not have the support of the Labor Party. He misled the House at one point to assert this. These are changes which have been done administratively.

The Stronger Rural Health Strategy is one with fine ambitions, and we support those ambitions. It has been very important to me in my time as shadow health minister to highlight and focus on rural health disparities and the shortage of medical health professionals and allied health care professionals in rural Australia. It is one thing to support the intent of the strategy, but the way the government is going about it has had intended or unintended consequences in other areas.

The first is to change Medicare bulk-billing incentives. GPs are paid additional incentives when they bulk-bill children and concessional cardholders. These are higher in rural areas than cities to encourage GPs to practice in the bush. But, under government changes to how rural areas are defined, many areas have lost access to these higher incentives and have been moved to lower metropolitan incentives. The government initially claimed that there were just 14 areas that had been affected, but we know through Senate estimates that 433 areas have seen cuts. I have been in electorates and communities which have received these cuts and the local member has been unaware because the government had not been transparent about it. These general practitioners have seen a reduction of 34 per cent in their incentive payments from $9.65 to $6.40.

GPs in places like Queanbeyan have seen those incentives slashed. Queanbeyan is not a major metropolitan centre; it is a regional centre and an important centre. It is not the middle of Sydney or Melbourne, and we need incentives for GPs to work in Queanbeyan. But this government has reduced the incentives there, and I think the government might be hearing a bit more about that in the coming weeks and months. It might find that it will be held to account for its decision to do that.

The second change is to the longstanding District of Workforce Shortage system. Doctors who've trained overseas or in a bonded position in Australia can only claim Medicare benefits for a time in defined rural areas. The government's changed the system for defining those areas to a new Distribution Priority Area system. The old system wasn't perfect, and I was open to a conversation about sensible changes. I looked at the government's changes and looked at them in good faith. I welcome the fact that the new system does take into account an area's socioeconomic status. That is a good thing. It shouldn't just be based on non-economic criteria. Areas that are doing it tough do deserve special consideration. That is one element I looked at favourably. But, again, the change is having consequences which I can only assume are unintended. I can't actually bring myself to believe that the government intended the consequences that some of these changes are having.

For example, Yass struggled to attract and retain doctors even when it was under the District of Workforce Shortage, and it will be tougher now that it's not in the DPA. I suspect the government will be hearing more about the impact on Yass as well in coming weeks because they have neglected the people of Yass and the medical care of the people of Yass. It's just one of 250 regional and outer metropolitan areas around the country that have been negatively affected. This impacts regional areas and outer metropolitan areas. This is a matter that I know my friend and colleague the member for Macarthur is deeply concerned about as a medical practitioner and as representative of outer metropolitan Sydney, as I am. I have experienced difficulty in attracting general practitioners to my electorate, which is not remote. It is not really regional. It is in the western suburbs of Sydney. Even those areas have trouble attracting doctors, as does the area represented by the member for Macarthur and as do areas represented by other members in this place. We know that outer metropolitan areas need more doctors, not fewer doctors. We suffer health disparities as well, we suffer high rates of diabetes, we suffer high rates of obesity and we suffer strong levels of co-morbidity. If the government think that reducing doctors in outer metropolitan Australia is a good idea, we will beg to differ.

The third change is the abolition of the Rural Other Medical Practitioners, or ROMPs, program. This is having a severe impact as well. Just before we stopped travelling and started to stay closer to home in recent times, the last interstate trip I undertook was to Maryborough in Queensland. It's a fine place. It's the birthplace of the author of Mary Poppins, who's justly and quite properly celebrated in Maryborough. I visited a general practice and I visited a former general practice where the sign on the door doesn't have the opening hours of the general practice; it says 'for lease'. 'The practice closed due to changes made by the federal government' is what the sign says on the door at Maryborough. That is the impact of this government's changes. Again, Maryborough is not a thriving metropolis. It is a great place, a lovely town and an important home for many people. It was home to an important children's author. But it is not the centre of Sydney or Melbourne. Yet the government's changes—and this isn't a tweak; this isn't an adjustment; this isn't a policy criteria change—have abolished the ROMPs program completely. Under the ROMPs program, less-qualified GPs were paid higher rebates if they practised in rural or regional Australia. It was a popular program because it had the objective of providing incentives to attract doctors to places like Maryborough, and the government have simply abolished the program in an attempt, they say, to improve rural and regional GP quality.

We all want to see highly qualified doctors in rural and regional Australia, but I would also just like to see some doctors in rural and regional Australia. If the impact of their change is not to attract more highly qualified doctors into places like Maryborough but to see doctor's surgeries close then I say to the government: 'Have a rethink, because the evidence is in. We know how your scheme is working, and it's not working well.' The impact on places like Maryborough has been duplicated across the country. We've seen that time and time again, and I'm not talking from a briefing note and I'm not talking from some sort of study; I'm talking from having been to Maryborough and sat down with the doctors in Maryborough and surrounding areas. I've been to the clinics which have closed. I've looked at the waiting rooms in Maryborough and seen them overflowing. I asked one of the doctors, 'If I were a Maryborough resident and I rang up and asked for an appointment to see a doctor today, how long would it be before I could see that doctor?' You would hope that the doctor would have said to me, 'Well, you could be seen later in the day, or maybe tomorrow.' The answer was two weeks! A two-week waiting period to see a doctor!

Dr Freelander interjecting

As the member for Macarthur points out—I think I heard him correctly—they aren't ringing for fun! They're not ringing because they want to have a chat! They're ringing because they are sick. And in two weeks time either they'll have got better, just through the effluxion of time, or they will have got a lot worse—and often the latter. That's why you need to see a doctor and, usually, you need to see a doctor more quickly than in two weeks time. Occasionally that might be okay—you might just have their annual check-up or there might be something which is not an urgent matter—but on most occasions people want to see their doctor that day, or certainly in a matter of days. Not two weeks away. The problem is not that the doctors aren't willing to work; I saw that firsthand—their waiting rooms were full. The problem is they simply don't have enough time to see everyone because there are so few doctors compared to the population.

These are the real-life impacts of the changes the government is making in Queanbeyan, in Yass, in Maryborough and in Campbelltown—all across Australia. In Werribee, we're seeing the impact of the various changes the government is making. As I said, I will not have the government tell us that they care more about rural health than we do. I spend a lot of time in rural Australia as shadow minister for health. I've travelled through rural New South Wales with Senator O'Neill. I've been to rural and regional Queensland, I've been through remote Western Australia and I've been through the remote Northern Territory. I care about getting more doctors and allied healthcare professionals into remote Australia. But I do not want to see places which aren't in metropolitan Sydney or Melbourne—or, indeed, Brisbane—negatively impacted.

These changes impact, for example, on the electorate of Paterson. As the member for Paterson has pointed out to me, Kurri Kurri is treated the same as Mosman under the government's changes. Again, Kurri Kurri is a perfectly nice place, but it's not Mosman. It's not Mosman, which is one of the most affluent areas of Sydney, but there are the same incentives to work as a doctor in Kurri Kurri as we have in Mosman. This is an indication of just how cack-handed the government's approach has been when it comes to rural and regional health in Australia.

I will move the second reading amendment, which will give other honourable members the opportunity to point out the impacts of these changes on their electorates—how their electorates have been adversely impacted by the government's changes. The government says, 'Nothing to see here.' Honourable members might recall that I asked the Minister for Regional Health about some of these matters a little while ago. His answers, I dare say, were found by this side of the House to be highly unsatisfactory. He claimed that the Labor Party had supported legislation to do these things. There is no legislation; it's all done by ministerial regulation. So the minister wasn't even aware of how he'd implemented the changes, let alone the impact those changes have had on rural and regional Australia and outer metropolitan Australia.

If the government wants to have a debate about who is better for Australia's regions then we're happy to have that debate, because, when it comes to health, it's not that side of the House. When it comes to health it's not the Liberal and National Party members who are standing up for their communities, it's the Labor Party members. It's not the regional Liberals; I haven't seen them protesting about the impact of these changes on their communities. No; they cop it. They cop it—they go along with these changes. Well, Labor members are a lot more vocal about the impact of the changes.

I move:

That all words after "That" be omitted with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House expresses its concern at the Government’s cuts and changes to Medicare, particularly those changes that have made access to medical practitioners more difficult in the regions, including:

(1) cuts to rural bulk billing incentives;

(2) changes to the District of Workforce Shortage and Distribution Priority Area health workforce classifications; and

(3) abolition of the Rural Other Medical Practitioners program".

We will support the legislation and we will ask the House and the government to take into account the matters that are raised in the second reading amendment.

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

Is the amendment seconded?

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

I second the amendment.

Photo of Rob MitchellRob Mitchell (McEwen, Australian Labor Party) Share this | | Hansard source

The original question was that this bill be now read a second time, to which the honourable member for McMahon has moved an amendment that all words after 'That' be omitted with a view to substituting other words. If it suits the House, I will state the question in the form that the words proposed be omitted and stand as part of the question.

12:42 pm

Photo of Mike FreelanderMike Freelander (Macarthur, Australian Labor Party) Share this | | Hansard source

I rise today to speak on the Health Insurance Amendment (General Practitioners and Quality Assurance) Bill 2020. In doing so, I wish to very strongly echo and support the comments of my colleague, the member for McMahon and shadow minister for health.

I represent an electorate in the outer south-western suburbs of Sydney, an electorate that for many decades has suffered from difficulties in attracting a general practitioner workforce and which for many years has called out for better health resources. The problems that many outer metropolitan, rural and regional electorates face is a very ad hoc approach to general practitioner recruitment and to primary care. From the conservative parties we have seen nothing but this ad hoc approach. That is really echoed in a number of different areas, including the absolutely chaotic rollout of the My Health Record; the extremely-difficult-to-understand and difficult-to-interpret general practitioner reward system for rural and regional areas; and the poor health care that many people in disadvantaged areas are facing, and the lack of response from this government and previous conservative governments to this. One has to ask why this health legislation has been so long in coming.

Labor, of course, will be supporting this legislation and the amendment moved by the member for McMahon because it does aim to simplify the administration of payments through Medicare to some general practitioners. But it has taken years for the government to recognise this and to do something about it. While the legislation itself is largely non-controversial, it is very important, particularly in the midst of a global health pandemic. It's now more important than ever that people engage with the healthcare system and are able to visit their general practitioner should the need arise.

As a paediatrician, a parent and a politician I'm often astounded about the lack of continuity of care that people experience when engaging with the healthcare system. A person's GP is a person's primary giver of health care. People should be able to have a longstanding relationship with a general practitioner and the general practitioner should be able to have an in-depth understanding of their patient's needs and individual circumstances.

The evolution of a digital health record is one step towards ensuring that patients are able to have some semblance of continuous care. It enables their medical records and essential health history to be shared with healthcare providers in a timely, accurate and efficient manner. It's a shame that the rollout of the government's system was so tumultuous, but I believe we must persist. Data, after all, is the future of health care. I acknowledge the difficulties faced by many families in accessing continuous care when they move home, have career changes or live in outer metropolitan, rural and regional areas where there's no continuity of care through a GP staying in the same practice for a continuous period of time.

I'm fortunate to have close relationships with a number of my present and former medical colleagues. I'm well aware of the issues they face on a daily basis. This legislation aims to make it a little easier to maintain their evidence of continuing professional education—a little less paperwork for them. The bill takes some steps towards addressing some of the administrative issues that they face as a medical professional being recognised as a specialist general practitioner for Medicare purposes. It will make it a little easier in aligning Medicare eligibility for the GP with the National Registration and Accreditation Scheme registration requirements.

Each and every year specialist GPs must make a declaration to the Australian Health Practitioner Regulation Agency that they have met their CPD requirements. With a busy GP and a busy practice this takes significant time. This bill seeks to remove the present requirements of specialist GPs to further register with Services Australia and will instead tie their eligibility for higher Medicare rebates to the existing NRAS system.

Our public healthcare system is a very good one, but it is far from perfect. One area where the government has been particularly poor is in the coordination and delivery of primary care general practitioner services to disadvantaged areas. It's okay if you live in Mosman, Toorak or some of the more affluent areas in other states, but if you live in outer metropolitan, rural and regional Australia, it's often very difficult for people to access appropriate continuous general practitioner care. There has been little formal planning by the government to make sure that the same levels of health care apply to all Australians, not just those from wealthier areas. This is a great shame. A gap is emerging between the working poor and the elite. This is well demonstrated by the current coronavirus pandemic if one looks at where the outbreaks are and where people have had difficulty accessing care. It's true in rural, regional and outer metropolitan areas.

We must take steps to strengthen the public health system and our beloved Medicare system. Ensuring that medical professionals have less bureaucratic hurdles to constantly navigate is one such way that we can work towards retaining trained professionals in this area, but it is important that there is a logical and appropriate plan for delivering primary health care to all Australians. This is something that this government does lack. It needs to lift its game.

I commend the legislation to the House. I thank the member for McMahon for his terrific contributions in this area and also for his second reading amendment. I will have more to say at a later date about primary care in Australia.

12:49 pm

Photo of Peta MurphyPeta Murphy (Dunkley, Australian Labor Party) Share this | | Hansard source

I rise to speak on the Health Insurance Amendment (General Practitioners and Quality Assurance) Bill 2020 today because there is nothing more important than equal access to health care. That is a theme of this bill. More importantly, it's not a theme for Labor; it's a heartfelt belief and commitment. I join what my colleagues have said with respect to the specific provisions of this bill, but I want to take this opportunity to raise the issues that have been presented to me by doctors, GPs and surgeries in my electorate of Dunkley. Notwithstanding the view of the government that my electorate of Dunkley is adequately served by GPs, that's not how my community feels and it's certainly not how a number of the GP practices feel. They have contacted me because they cannot recruit enough doctors to meet the need. They cannot adequately service some of the most vulnerable people in my community in Frankston and Carrum Downs because they cannot adequately recruit the GPs that they need. They have made representations to me that it isn't working for them, because of the way the system has been designed and is being operated by this government.

I have written to the Minister for Health in regard to Total Care Medical in Frankston, one of the legendary doctors in Frankston who has given his life to being a GP and serving people, and two GP practices in Carrum Downs, which is one of the more disadvantaged pockets of my electorate. A lot of the time they serve people who are vulnerable, particularly now in the middle of this global health crisis and pandemic. The Ballarto and St Mary medical centres in Carrum Downs contacted me and asked for help. I wrote to the minister on their behalf. I told the minister that they are having difficulty recruiting Australian trained doctors, particularly to the St Mary clinic. They've tried many times as a participant in the AGPT Program but are on a waiting list and have been unsuccessful.

Ms Hatzopoulos, who is the practice manager for these two clinics that serve a quite vulnerable community, informed me that, because the region is not classified as a distribution priority area, the clinics have restricted ability to sponsor doctors through visa programs. She's advertised a position online with Seek. All six applications that came in required visa sponsorship, all of them, so they couldn't fill any positions from this ad. They attempted to participate as an after-hours medical deputising service, but due to program restrictions it wasn't feasible to proceed with the service. I am advised by those clinic that changes to the Medicare Benefits Schedule will mean that the clinic will be financially disadvantaged because of a classification change. Their capacity to bulk-bill has been changed. It will further impact on the clinic's ability to entice doctors and also to retain doctors.

What these clinics—Ballarto, St Mary's and Total Care Medical Group—have asked me to advocate for is a reclassifying of the Frankston and Carrum Downs region as a distribution priority area. The minister has responded to my correspondence and has set out the reasons why the department and the minister are unable to do so, but in doing so also made the observation that they're content that Carrum Downs is adequately serviced by GPs. My community is not content that they're being adequately serviced and the GP centres aren't content that they can recruit the doctors they need to adequately service them. I am raising these matters in the parliament today as another opportunity for the government to look at these vulnerable areas, particularly in this time of a global health crisis, and see what you can do to assist my community.

I also want to take this opportunity, while we're talking about health and access to health, particularly in a time of a global pandemic, to raise an issue that I think everyone knows by now is dear to my heart. I have said it before: Ladies, check your breasts; Men, listen to what your body is telling you and go and see a doctor when you need to. That is even more important now. I have been speaking to the Breast Cancer Network Australia, amongst other services and support providers, who are very concerned that at the moment too many people are putting off going to see their general practitioner for other illnesses and ailments and for other check-ups because of their concerns about COVID-19. Don't do it. Go and get the check-ups that you need. The Breast Cancer Network Australia is there to support any woman who has a diagnosis or believes that they need to get checked. They are there to help you to go through the system, to get the help that you need and, if the worse thing happens and you get a diagnosis of cancer, to then help you go through your treatment. It's a pretty simple message that we want to put forward to people today: do not stop looking after the other aspects of your health just because we are fighting coronavirus. Go and get yourself checked by your GP if you believe there are any other issues that need to be addressed.

Of course, the only way we can ensure that all Australians can heed that advice—no matter what their income is, no matter where they live, no matter whether they were born here or came here, if they're an Indigenous person in a remote community, if they're a wealthy person in Toorak—is that we have a universal health system that benefits those who need it, a universal health system that works. It's more important now more than ever. It's more important that those of us in this place continue—as my colleagues on this side of the chamber will never stop doing—making sure that our precious Medicare system is properly resourced and properly run. Thank you.

12:56 pm

Photo of Sharon ClaydonSharon Claydon (Newcastle, Australian Labor Party) Share this | | Hansard source

It gives me great pleasure to stand in support of the amendment moved by our shadow minister for health, the member for McMahon. In this environment where we're all faced with the challenges of the COVID-19 pandemic there can be nothing more important than primary health care in this nation. If this is not a time when all our minds are extremely exercised by health care then I don't know what is. I cannot imagine the idea that this government and this parliament would have a debate on any piece of legislation in the field of health without drawing attention to the radical importance of a universal health care system in this nation. I cannot even begin to imagine the state that we would be in right now had we not had the benefit of a universal safety net in Australia.

Actually, we do know what it looks like when you don't have universal health care, as we need only look to the United States of America and the diabolical destruction that has occurred in that nation. The gross inequities of access to a quality health care system results in unfathomable death and misery. That is something our nation has avoided. All of us in this House have been so thankful that there has been a prioritisation of science and medical health expertise at this time of a pandemic and that these experts have applied all of their skills and knowledge to ensure that our nation has been, in the scheme of things, spared so much pain and so much trauma. This parliament needs to spend every moment we can debating health issues, ensuring that we are doing all we can in this place to better support, to better finance, to better ensure the strength of our universal healthcare system in Australia.

It's astonishing now to think that the Prime Minister started this year of 2020 with a fresh round of cuts to Medicare bulk-billing. If we just think about what we were doing at the start of this year, before we actually knew what we were facing with the pandemic, it is gobsmacking now to think that the Prime Minister would have thought that that was a good plan for this nation. Newcastle is one of the 14 areas that he and his government targeted to cut the bulk-billing incentive payments. The government encourages GPs in Australia to bulk-bill vulnerable patients by paying them each time that they bulk-bill. It's called a bulk-billing incentive payment. In Newcastle, like my neighbouring areas of Maitland and Kurri Kurri, Scott Morrison slashed this payment. The loss of that incentive payment is estimated to cost the Newcastle and Hunter region some $7 million. I've met with many of my local GPs and representatives of the Hunter primary care sector. We've talked about the detrimental impact that these cuts to the bulk-billing payment incentive scheme have had for our region. As I said, they've taken $7 million out of our primary healthcare system overnight. This has meant that doctors have started making very, very difficult decisions about whether they are bulk-billing children, whether they're going to bulk-bill more than one sibling in the household, and whether they're going to be able to bulk-bill concessional patients and pensioners coming in. Well, you know what? They've already had to start making decisions about not bulk-billing those vulnerable people in our community. It's already happened. And, indeed, I have lost GPs. I have had GPs' surgery doors close. If anybody in this House thinks that now is a good time—if, indeed, there is ever a good time—for our GPs to be hit to the point that they are closing the doors of surgeries in the middle of a pandemic, I would be astonished. Nobody in my community thinks that this is okay, I can assure you of that.

I have written to the minister on many, many occasions about this issue, and, indeed, have launched a campaign locally in Newcastle with regards to the devastating impact that the changes to this bulk-billing incentive payment scheme have had. There were almost 1,000 petitioners on my online petition, but, additionally, more than 2,000 people had written in to me with a petition prior to the COVID-19 pandemic starting. Three thousand people is nothing to be sneezed at in this House. That is 3,000 people who had the capacity and time to actually petition and contact their federal member. For every one of those, you know that there's a 10-fold number of people who don't realise they can contact their federal member about these issues. They just turn up to the doctor, only to find out that they cannot be bulk-billed anymore. Imagine what it's like taking your three kids off to the doctor because they've all got sick at the same time, which is not an unusual scenario for families. You used to be able to bulk-bill. Now, you're up for three consultations. Or you make difficult decisions about maybe not taking them to the doctor, or just taking one. And if the doctor actually prescribes something, you've of course got all the additional costs then of follow-up pharmaceuticals. At a time when this pandemic has really made abundantly clear the importance of strong, universal primary healthcare in this nation, it is astonishing that the government should even contemplate proceeding with this cruel scheme to cut bulk-billing incentive payments.

And it is in regions that we feel this pain most acutely—although I don't wish to take anything away from others; I've listened to my colleagues from Western Sydney talk about the impacts it's had in their regions as well. This is a time when our GPs are under even more pressure. Many of them are now reporting to me that they are doing a lot of unpaid work where they are calling people who are trying to get advice and follow-up around COVID-19 at the moment. Many of my GPs are making those kinds of follow-up calls to many, many poor people on their own time and at their own expense. For those GP clinics there have also been significant additional costs in securing enough PPE, personal protection equipment, and the scrubs that are required in their surgeries. And there's been, simultaneously, a reduction in the number of face-to-face visits to GPs. People are actually quite scared of going to their GPs at the moment—hence the increase in telephone advice—for a couple of reasons. Some people in my community say, 'I don't want to pester my GP,' assuming they're going to be superbusy, 'They should be focused on people with COVID-19-related illnesses.' Or they are concerned about going there and thinking that it's a place of infection or possible source of infection. Either way, it is a diabolical situation for our citizens at this very time when we have asked them to heed health advice, and they have made many personal sacrifices to do so.

It is the obligation, then, of this government—indeed, this parliament—to ensure that we utilise the Commonwealth of this nation to support those people making sacrifices to ensure that this pandemic is contained. Therefore, any contemplation of a reduction in bulk-billing payment incentives now really should be unthinkable. I really do say to the government: there's no shame in realising you've made a mistake. There is no shame in that. You can come back to the House on this. I'd love to hear the minister say: 'We got that wrong. We should be, in the midst of a pandemic especially, doing all we can to support our GPs and frontline health workers.' It's no good sending platitudes of thanks and appreciation for everything that our frontline health workers are doing whilst you're simultaneously pulling the rug out from underneath a whole bunch of frontline GPs.

I'd like to just share with the House comments from one of the clinics that contacted me in relation to the impact of that withdrawal of the bulk-billing-payment scheme, on top of all these additional expenses of the unpaid work that they're currently doing—the increased spend on PPEs and scrubs and the reduction of actual visits into the surgery at the moment. This doctor, a doctor of many decades in my community, said, 'We feel that primary care doctors have been abandoned by the government and left to fend for themselves in the front line of this pandemic.' I don't think I could have put it any better myself. That is shameful. That is a shameful indictment of this government: at this time, to leave frontline GPs feeling abandoned.

I ask the minister to reconsider this short-sighted measure and to come and support the member for McMahon's amendment here. That is what a great health minister would do right now: come in and say, 'I got that wrong. Those cuts to rural and regional bulk-billing incentives were short-sighted.' He could come here and realistically argue that he didn't know what was coming at us with this pandemic. He could say, 'I didn't really understand the full consequences, but now I do, and we're going to reverse those bulk-billing measures.' That's what I want to hear Minister Greg Hunt come in here and say. I want him to make sure that the changes to the district work shortage and distribution priority areas for our health workforce classifications actually work for our rural and regional communities again. Really, the abolition of the Rural and Other Medical Practitioners Program—what's going on?

Anyway, Minister, if you are listening, this is a great opportunity for you to come into the House right now, back in Labor's amendment—

Mr Coulton interjecting

Well, that's right, Minister Coulton. You could jump up and support this amendment for us now.

Mr Coulton interjecting

Indeed. You'd be hard pushed to not be supporting our front-line medical workers in the bush—your community, your constituency, Minister. Your constituents stand to benefit enormously from Labor's amendments here right now. It's just a matter of standing up to that despatch box, making your commitment, joining with us now to express your concern about the government's cuts and changes to Medicare. Everybody in this House should be concerned about those cuts and changes to Medicare, particularly people in the bush, particularly those of us in the regions; and particularly in relation to those changes that are making access to medical practitioners more and more difficult right now, at a time when we need GPs more than ever to be focused entirely on delivering the very best primary health care service we can. I really do feel for your own constituents, Minister. I think that they would welcome increased levels of support into rural and regional areas of Australia.

So I look forward to Minister Hunt joining you, perhaps, in this move to support Labor's amendment on the table. It's done with good heart and good intention, and it's based on some very clear evidence that we've witnessed firsthand in our own communities.

1:11 pm

Photo of Mark CoultonMark Coulton (Parkes, Deputy-Speaker, Minister for Regional Health, Regional Communications and Local Government) Share this | | Hansard source

The bill simplifies Medicare administrative processes for recognition as a specialist general practitioner for Medicare purposes under the Health Insurance Act 1973. It would align Medicare eligibility for GPs with the requirements of the National Registration and Accreditation Scheme, otherwise known as NRAS. The NRAS commenced in 2010 and for the first time provided a nationally consistent process of regulation for 16 health professions, including GPs. The NRAS established the Medical Board of Australia, otherwise known as the MBA, which is responsible for standards for the medical profession, including specialist registration, and setting standards for mandatory continuing professional development. The Australian Health Practitioner Regulation Agency—AHPRA—provides operational support for the MBA and holds the most up-to-date and accurate data source for the registration status of GPs. Services Australia will automatically update GPs' Medicare access based on regular data provided by AHPRA. This will simplify processes for GP Medicare recognition.

This bill will update the definition of a GP in the Health Insurance Act 1973 to align with national registration arrangements. Transitional and grandfathering provisions to be made in the Health Insurance Regulations 2018 will ensure that medical practitioners who are currently eligible for these higher GP rebates will continue to maintain this eligibility.

The Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine are the peak professional bodies for general practice and, together with the MBA, are responsible for ensuring quality in general practice in Australia. Every three years the RACGP and ACRRM advise Services Australia that GPs are compliant with the CPD requirements to maintain patient access to higher Medicare rebates. This amendment will remove this duplicative reporting of CPD to Medicare. Extensive consultation with RACGP, ACCRM, the Australian Medical Association, AHPRA and the MBA has involved careful consideration to ensure that currently eligible medical practitioners who are practising as GPs will continue to be eligible for higher rebates with minimal administrative requirements to be completed.

Schedule 2 of this bill removes references to 'repeal legislation' and replaces it with the reference to the Federal Financial Relations Act 2009. The bill will also ensure that activities declared on or after 1 July 2009 are taken to have been valid declarations. Key stakeholders have been consulted as part of the drafting of the bill and support these streamlined processes. I would like to extend my thanks to the professional groups who engaged with the proposals in this bill, and I thank the members for their contributions to debate the bill.

Photo of Tony SmithTony Smith (Speaker) Share this | | Hansard source

Order! The original question was that this bill be now read a second time. To this the honourable member for McMahon has moved as an amendment that all words after 'That' be omitted with a view to substituting other words, so the immediate question is that the words proposed to be omitted stand part of the question.