1.1
The distribution of the primary health workforce is a significant issue in Australia's health system, and it is well known that those living in outer‑metropolitan, regional, and rural areas have less access to timely and affordable primary health care and experience worse health outcomes than those in metropolitan areas.
1.2
Australians are increasingly accessing primary health care at a rate that is outstripping supply, particularly in relation to appointments with general practitioners (GP). A functioning and well-distributed primary health system can prevent more serious illnesses, reduce presentations at hospital emergency departments, and improve health outcomes for individuals and communities; however, this is failing to occur.
1.3
Successive governments have implemented a range of policies aimed to improve the distribution of the primary health workforce with limited success, leaving communities across Australia without appropriate access to primary health care.
1.4
This inquiry is examining these issues, namely; the current distribution of primary health services, the policies designed to improve access to primary health professionals, and the impacts these have on Australians living in outer‑metropolitan, regional, and rural areas.
Primary health services in Australia
1.5
Primary health refers to health services that are delivered without a referral from another health professional. Primary health professionals include GPs, nurses, midwives, allied health professionals, pharmacists, dentists, and Aboriginal health workers and practitioners.
1.6
Australians living in outer-metropolitan, regional, and rural areas often experience the primary health care sector in a different manner than their metropolitan counterparts. These Australians face difficulty in the accessibility of primary health care professionals, a lack of specialised health services, affordability challenges, and transportation issues.
1.7
People living in outer-metropolitan, regional, rural, and remote areas also experience worse health outcomes than their metropolitan counterparts, have a higher burden of disease, are more likely to experience chronic health conditions, and have a lower median age of death than those in inner‑metropolitan areas.
1.8
These issues are exacerbated for Aboriginal and Torres Strait Islander populations. Indigenous Australians have lower life expectancies and higher rates of chronic disease than non-Indigenous Australians. Approximately 19 per cent of Indigenous Australians live in remote areas where access to primary health care is severely limited.
1.9
The impacts of the maldistribution of the primary health care workforce on the community and individuals are at the heart of this inquiry and are discussed in‑depth in Chapter 4.
Responsibility for primary health services
1.10
The provision of primary health services in Australia is governed by a complex system of policies and funding arrangements between Commonwealth, state, and territory governments. The National Health Reform Agreement (NHRA) 2020-2025 outlines the responsibilities for the Commonwealth, state, and territory jurisdictions.
1.11
Under the NHRA, the Commonwealth Government is responsible for the following:
maintaining the legislative basis and governance arrangements for independent national bodies, including the Australian Commission on Safety and Quality in Health Care, the Australian Institute of Health and Welfare, the Independent Hospital Pricing Authority, and the Administrator of the National Health Funding Pool;
system management, support, policy, and funding for GPs and primary health care services, including for Aboriginal and Torres Strait Islander Community Controlled Health Services;
maintaining Primary Health Networks (PHNs);
working with each state and PHNs on system wide policy and state-wide planning for GP and primary health care;
regulating private health insurance;
planning, funding, policy, management and delivery of the national aged care system;
reforms in primary care that are designed to improve patient outcomes and reduce avoidable hospital admissions; and
functions transferred from Health Workforce Australia and the National Health Performance Authority.
1.12
The Commonwealth is also responsible for funding the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme and certain aged care services.
1.13
Numerous Commonwealth departments and agencies have responsibilities within the primary health care sector. The Department of Health holds responsibility for policy development and implementation; the Department of Education, Skills and Employment is responsible for agreements between the Commonwealth and universities, and related functions in setting the number of Commonwealth Supported Places for medical degrees; and Services Australia is responsible for issuing Medicare provider numbers and paying Medicare rebates. Other agencies such as the Department of Veterans' Affairs and the National Disability Insurance Agency also have primary health care functions.
1.14
The state governments are responsible for:
system management of public hospitals, including, for example, planning funding and delivering capital, managing Local Hospital Network performance and public hospital industrial relations;
management of public health activities; and
management of the relationship with Local Hospital Networks.
1.15
There are also several aspects of the health care system that Commonwealth and state governments are jointly responsible for, including:
funding public hospital services;
determining funding policy and exploring innovative models of care in the national funding model;
establishing and maintaining nationally consistent standards for healthcare and reporting on the performance of health services;
collecting and providing patient-level data;
working together on policy decisions or areas of the system that impact on each other's responsibilities;
closing the gap in Aboriginal and Torres Strait Islander disadvantage and life expectancy;
identifying rural and remote areas where there is limited access to health and related services; and
maintaining and improving population health.
1.16
The Commonwealth Government does not directly employ primary health care practitioners. The Commonwealth Government, however, provides most of the income to GPs through the Medicare payments system.
1.17
In addition, most primary health care professionals are employed in a private capacity and work for privately run businesses. According to the Department of Health, 82 per cent of GPs, 34 per cent of primary care nurses, and approximately 73 per cent of allied health professionals work in group or solo practice.
The cost of primary health services
1.18
In 2019-20 total health spending equated to $202.5 billion. As shown in Figure 1.1 below, approximately 43 per cent of this funding was provided by the Federal Government, 28 per cent by state and territory governments and 30 per cent from non-government sources (such as health insurance providers and individuals).
1.19
Primary health care accounted for approximately 33 per cent or $66.9 billion of total health spending in 2019-20. Of the $66.9 billion, $13.3 billion was spent on unreferred medical services (predominantly on general practice), $12.9 billion on subsidised pharmaceuticals and $11.9 billion on other medications.
1.20
Nationally, the rate of primary health care services claimed per person has increased. For example, the number of GP attendances has risen from 113 million (or 5.3 per person) in 2008-09 to 158 million (or 6.3 per person) in 2018‑19.
Geographic classification systems
1.21
There are various classification systems used to define the geography of regions throughout Australia and the level of access different regions have to primary health care services.
1.22
Following reviews in 2012-13, the Department of Health transitioned from using the Australian Statistical Geography Standard – Remoteness Areas (ASGS–RA) system to the Modified Monash Model (MMM). The MMM was designed to better inform and determine a specific regions' eligibility for incentives by overlaying geographical data with statistical data. The MMM also incorporates differences between isolated small towns, in comparison with small towns that have greater access to larger towns.
Modified Monash Model
1.23
The MMM classifies all locations in Australia along a spectrum of metropolitan to very remote communities according to geographical remoteness (as defined by the ASGS–RA) and town size. Table 1.1 below provides a description of each MMM category.
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MM1
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Metropolitan areas, accounts for 70% of Australia's population
All areas categorised ASGS-RA1
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Melbourne, Sydney, Brisbane
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MM2
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Regional centres, areas that are in or within a 20km drive of a town with over 50 000 residents
Inner (ASGS-RA 2) and Outer Regional (ASGS-RA 3)
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Ballarat, Mackay, Toowoomba, Kiama, Albury, Bunbury
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MM3
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Large rural towns that are in or within a 15km drive of a town between 15 000 to 50 000 residents
ASGS-RA 2 and ASGS-RA 3 areas that are not MM 2
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Dubbo, Lismore, Yeppoon, Busselton
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MM4
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Medium rural towns are in or within a 10km drive of a town with between 5000 to 15 000 residents
ASGS-RA 2 and ASGS-RA 3 areas that are not MM 2 or MM 3
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Port Augusta, Charters Towers, Moree
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MM5
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Small rural towns
All remaining ASGS-RA 2 and ASGS-RA 3 areas
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Mount Buller, Moruya, Renmark, Condamine
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MM6
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Remote communities, remote islands less than 5km offshore
ASGS-RA4
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Cape Tribulation, Lightening Ridge, Alice Springs, Mallacoota, Port Headland, Bruny Island
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MM7
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Very remote communities and remote islands more than 5km offshore
ASGS-RA5
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Longreach, Coober Pedy, Thursday Island
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Source: DoH, Submission 38, pp. 12–13.
Distribution Priority Areas
1.24
On 1 July 2019, the Commonwealth Government introduced the Distribution Priority Area (DPA) classification system for GPs. The DPA system is designed to distribute GPs subject to location restrictions to work in areas where there are GP service shortfalls. The Department of Health notes that the DPA system helps to compare relative shortages of GPs between communities, as most communities appear to self-identify that they experience a shortage.
1.25
If an area is deemed a DPA, employers have access to a broader employment pool as certain doctors (including certain overseas trained doctors and bonded medical students) are restricted to practice in DPA locations.
1.26
Regions (categorised as GP catchments) are designated as a DPA based on the availability of GP services to the population, its level of remoteness and other demographic factors. It is benchmarked against the average level of primary care services to patients living in MM2 areas. If an area has less GP services than the benchmark it is classified as a DPA.
1.27
MM1, inner-metropolitan areas are automatically classified as non-DPA. MM3–7 areas are automatically deemed a DPA, as is all of the Northern Territory. DPA classifications are changed annually on 1 July based on any variations in the characteristics used to determine DPA status.
1.28
In September 2021, at the request of the Government, the Department of Health introduced an exceptional circumstances review process that enables practices to apply to have their catchment’s DPA status changed. To seek a review, a practice must make an application to their Rural Workforce Agency which will assess the region's needs. Applications are sent to the Distribution Working Group which considers applications on the following criteria: changes to health services, workforce or health systems, patient demographics changes and absence of services, and will determine whether an area should have their DPA status changed.
Composition and distribution of the primary health workforce
1.29
Currently there is no single source of workforce data across Commonwealth, state, and territory jurisdictions, and different data sets and methodologies are used to understand workforce supply and undertake planning. The Department of Health analyses primary health workforce data according to the MMM.
1.30
The primary health care workforce grew from 134 794 full-time equivalent (FTE) in 2014 to 159 801 FTE in 2019. Despite this growth, the composition and distribution of the primary health workforce varies across the country. For example, the distribution of pharmacists is relatively consistent across MM categories. The number of FTE pharmacists per 100 000 population is between 62 to 74 for MM1 to MM4, with locations in MM5 and MM7 reporting slight increases on 2014 FTE numbers.
1.31
For primary care nurses, the number of nurses generally increases with increasing levels of remoteness. For other primary health professionals such as allied health professionals and GPs, the numbers decrease with increasing levels of remoteness.
1.32
In addition, different cohorts of the primary health workforce are facing varied challenges, including in relation to over and undersupply and maldistribution. For example, Aboriginal and Torres Islander health workers are consistently underrepresented in the primary health workforce, and there is an oversupply of paramedics but an undersupply of domestic medical graduates training as GPs.
General practitioners
1.33
GPs are the most frequently accessed primary health care professional. According to the Patient Experience Survey, 82.4 per cent of individuals aged 15 years and over saw a GP in the 2020-21 year.
1.34
General practice is a recognised medical speciality in Australia. Following graduation from university level education and the required intern and residency periods, medical graduates can choose to specialise in a particular field of medicine, including general practice.
1.35
To become a GP, medical graduates are required to undertake further training through either the Australian College of Rural and Remote Medicine (ACRRM), a four year training program, or the Royal Australian College of General Practitioners (RACGP), a three year training program. Once completed, practitioners are known as 'Vocationally Recognised' GPs and receive a Fellowship with their training college. Vocational recognition enables registration with the Medical Board, use of the title 'specialist GP', and access to higher Medicare rebates.
1.36
The numbers of GPs in Australia have grown from 2015-16 to 2020-21, however, maldistribution remains a pertinent problem. The number of GPs in the Northern Territory has been declining since 2017 and in the 2019-20 period, New South Wales, Western Australia, South Australia and the Australian Capital Territory all experienced a decrease in the number of GPs.
1.37
Table 1.2 below shows the number of FTE GPs by the MMM.
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MM1
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22,799.0
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21,859.5
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21,587.5
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20,889.2
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19,996.7
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19,268.8
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3.4%
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MM2
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2,651.4
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2,512.7
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2,491.3
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2,436.0
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2,344.5
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2,260.9
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3.2%
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MM3
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2,130.7
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2,025.5
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2,023.8
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1,983.3
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1,947.4
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1,915.7
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2.2%
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MM4
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1,320.6
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1,277.0
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1,280.1
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1,239.7
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1,213.4
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1,184.7
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2.2%
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MM5
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1,468.7
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1,403.6
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1,395.5
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1,352.5
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1,314.2
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1,312.7
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2.3%
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MM6
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224.7
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228.4
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233.0
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236.8
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232.3
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228.7
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-0.4%
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MM7
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141.0
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148.1
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149.6
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145.3
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135.9
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132.6
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1.2%
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National
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30,736.1
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29,454.8
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29,160.7
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28,282.8
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27,184.3
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26,304.2
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3.2%
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* Growth refers to a compound annual growth rate. Source: Department of Health, answer to inquiry question on notice: IQ21-000324, received 9 February 2022.
1.38
A report by Deloitte Access Economics and Cornerstone Health predicted that by 2030 there will be a 37.5 per cent increase in the demand for GP services. It also found that there will be a shortfall of 9298 GPs or 24.7 per cent of the GP workforce. The report found that the deficiency will be most extreme in 'urban' areas with a shortfall of 7535 GPs or 31.7 per cent of the GP workforce.
Demographics of primary health care
1.39
The provision of primary health care varies across Australia. Along the spectrum of the MMM system, communities experience significantly different contexts which affect the provision of primary health care. This includes population characteristics (such as socio-economic status), patient demographics, available infrastructure, available support services, and workforce mix. The following section provides an overview of generalised characteristics regarding the accessibility of primary health care according to the MMM.
Outer-metropolitan areas (MM1)
1.40
Under the MMM, all metropolitan areas are classified as MM1, however, there is variation between inner and outer-metropolitan classifications. Outer‑metropolitan areas are characterised by high levels of diversity, including a high proportion of recent migrants and refugees, and Aboriginal and Torres Strait Islander peoples. Outer-metropolitan areas are also experiencing high rates of population growth leading to an increased demand for primary health services.
1.41
Outer-metropolitan areas have lower numbers of GPs which leads to lengthy waiting periods for appointments and poor health outcomes. The population is reliant on bulk-billing and the cost of seeing a GP can be a barrier to people seeking care.
Regional and rural areas (MM2–MM5)
1.42
There are important distinctions between regional and rural areas in the provision of primary health care, however, these areas share some common characteristics. Regional and rural areas experience significant workforce shortages, and it is difficult for primary health practitioners to viably provide services to small rural (and remote) towns.
1.43
It is common for health services in large regional centres to act as a hub for those in outer-regional and rural areas, which means those living in rural areas often must travel extensive distances to receive health care in these locations.
1.44
Regional and rural areas are expected to experience a dual challenge of a declining population and increasingly ageing population. The population in these areas tends to experience higher levels of socio-economic disadvantage, lower rates of literacy, physical activity, and nutrition.
Remote areas (MM6–MM7)
1.45
The population of remote areas is very small and dispersed between large distances. Primary health services are often provided by remote area nurses, Aboriginal Health Practitioners or visiting locums as it is less likely to have a resident GP. In remote (and rural) areas it is common for a single health professional to cover several towns and for doctors to travel to more remote areas, which places pressure both on the local community and the workload of doctors.
1.46
Those living in remote areas experience significantly worse health outcomes, with higher rates of chronic disease and preventable illness, high rates of teenage pregnancy, high rates of developmental vulnerability in children, and higher rates of avoidable hospitalisations and mortality rates than experienced in metropolitan areas.
Policy levers
1.47
The Department of Health recognises that the maldistribution of the primary health workforce, particularly in rural and remote locations, leads to poorer health outcomes for individuals living in these areas. It submitted that a key objective for the Government is to 'have a well distributed primary care workforce able to provide services tailored to community needs, as close to home as possible' and that there is a 'particular focus on improving the distribution of the primary care workforce outside of metropolitan locations'.
1.48
The Commonwealth Government has several policy levers at its disposal to influence the supply and distribution of primary health care professionals. Commonly employed mechanisms relate to education and training policy, immigration policy, Medicare payments, financial incentives and other programs to encourage practitioners to relocate to outer‑
metropolitan, regional, and rural areas. The following section provides an overview of some of the policies implemented to improve the distribution of the primary health workforce.
Bonded medical programs
1.49
Bonded medical programs provide medical students with a Commonwealth Supported Place at an Australian university in return for a commitment to work in eligible regional, rural, and remote areas (known as the 'Return of Service Obligation'). The current program is a statutory scheme under the Health Insurance Act 1973 and commenced on 1 January 2020.
1.50
Bonded medical students on the statutory scheme must complete a three-year Return of Service Obligation within 18 years following graduation from university. This means they must work in an eligible regional, rural or remote area for three years within 18 years of completing their university study. The Return of Service Obligation can be undertaken non-continuously, full-time or part-time, or as fly-in/fly-out.
1.51
Participants in the program can also receive a 6‑month Return of Service Obligation 'discount' if they work full-time for the first 24 months in a MM4–7 location.
International medical graduates and overseas trained doctors
1.52
Australia is reliant on international medical graduates and overseas trained doctors to provide primary health care. This cohort of doctors are often used as a mechanism to fill workforce shortages in outer-metropolitan, regional, rural and remote locations. Under section 19AB of the Health Insurance Act 1973, certain international medical graduates and overseas trained doctors are subject to restrictions on their location of practice in their first ten years in Australia (known as the ten-year moratorium).
1.53
Those subject to the ten-year moratorium can only provide services eligible for Medicare rebates in a DPA area for GPs or a District of Workforce Shortage (DWS) for other specialities. However, there are no restrictions on practise in salaried positions such as public hospitals, as these services do not attract Medicare rebates.
1.54
Between 2014 and 2020, international medical graduates practicing as a FTE GP grew at a faster rate than for Australian and New Zealand graduates, at a rate of 4.3 per cent and 1.6 per cent respectively. The GP FTE for international medical graduates has increased from 48.2 per cent of total GP FTE in 2014 to 52 per cent in 2020.
1.55
Table 1.3 below shows the proportion of GP FTE services delivered by overseas trained doctors according to the MMM.
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MM1
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51.6%
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51.5%
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51.2%
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50.3%
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49.6%
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48.6%
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3.0%
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MM2
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56.1%
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54.6%
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54.5%
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54.3%
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54.1%
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53.7%
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2.3%
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MM3
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53.7%
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53.5%
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53.7%
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53.2%
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54.0%
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54.9%
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-1.2%
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MM4
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52.0%
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51.3%
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50.1%
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50.1%
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50.7%
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52.8%
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-0.8%
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MM5
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55.0%
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54.0%
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54.4%
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54.4%
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55.1%
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55.9%
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-1.0%
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MM6
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46.5%
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47.5%
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49.4%
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51.8%
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52.1%
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53.4%
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-6.9%
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MM7
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33.4%
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36.9%
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37.5%
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38.2%
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38.8%
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38.6%
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-5.2%
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Total
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52.2%
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51.9%
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51.7%
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51.0%
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50.5%
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50.1%
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2.1%
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Source: DoH, answer to inquiry question on notice: IQ21-00324, received 9 February 2022.
1.56
As shown in Table 1.3, nationally, approximately 50 percent of GPs are trained overseas.
Stronger Rural Health Strategy
1.57
The Stronger Rural Health Strategy (SRHS) is the key government policy aimed at 'building a sustainable, high quality health workforce that is distributed across the country according to community need'. Announced in the 2018–19 Budget, the SRHS committed $550 million across the forward estimates. The SRHS is made up of a suite of programs aimed at addressing health workforce quality, distribution, and planning. It also aims to support nurses and allied health professionals in the delivery of more multidisciplinary, team‑based models of primary health care. Below is an overview of three key programs and incentives under the SRHS.
Rural Generalist Training Scheme
1.58
Following several reviews and recommendations, the Federal Government in conjunction with the National Rural Health Commissioner and the two GP colleges, established the Rural Generalist Training Scheme (RGTS) in 2021. It is a four-year, fully funded GP training program that leads to a Fellowship with ACRRM. Rural generalists are critical to rebuilding the rural health workforce because they can work in both primary care and hospital settings. Up to 100 places are offered annually under this scheme. The Department of Health notes that the development of the RGTS is recognition of the unique skills of doctors who practice medicine in rural areas.
Workforce Incentive Program (WIP)
1.59
The WIP provides financial incentives to doctors and practices delivering services in rural and remote areas (MM3–7). The program has two streams, the Doctor Stream and the Practice Stream. It aims to improve access to quality medical, nursing and allied health services and team-based care in regional, rural and remote areas. More than 8000 doctors and 5600 practices receive incentives under the WIP each year.
Rural Bulk Billing Incentive
1.60
The Rural Bulk Billing Incentive (rBBi) provides extra funding to GPs who accept a patient’s Medicare Benefits Schedule (MBS) rebate as full payment for their services. On 1 January 2020, eligibility for the rBBi was aligned to the MMM.
1.61
From 1 January 2022, the rBBi progressively increases as the level of remoteness increases. The Department of Health states the '[rBBi] in MM7 locations is approximately 190 per cent of the standard bulk-billing rate available in metropolitan areas.' It should be noted that the '190 per cent' figure relates to the $6.50 bulk-billing incentive which is received on top of the standard Medicare rebate. Table 1.4 below shows the incentive structure and payment rates.
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MM1
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$6.50
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$6.10
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$6.10
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MM2
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$9.80
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$9.20
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$9.20
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MM3
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$10.40
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$9.75
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$9.75
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MM4
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$10.40
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$9.75
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$9.75
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MM5
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$11.05
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$10.35
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$10.35
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MM6
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$11.70
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$11.00
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$11.00
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MM7
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$12.35
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$12.00
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$12.00
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Source: DoH, Incentives and support for GPs and general practices, 4 February 2022.
Other initiatives
1.62
Further to the initiatives under the SRHS, there are a range of other bodies and policies designed to improve the maldistribution of the primary health workforce, as outlined below.
National Rural Health Commissioner
1.63
In 2017, the Government established the Office of the National Rural Health Commissioner to independently and impartially improve rural health policies, and champion the cause of rural practice. The Office of the National Rural Health Commissioner has the following work priorities:
Aboriginal and Torres Strait Islander engagement;
developing Primary Care Rural Innovative Multidisciplinary Models; and
developing the National Rural Generalist Pathway and recognition of rural generalist medicine as a distinct field of practice.
Primary Health Networks
1.64
On 1 July 2015, the Government established 31 PHNs across Australia. PHNs are independent primary health care organisations that work to reorient and reform the primary health care system. PHNs have the following three main roles:
to commission health services to meet the needs of people in their regions and address identified gaps in primary health care;
to work with GPs and other health professionals to build health workforce capacity; and
to integrate health services at a local level to create a better experience for patients, encourage better use of health resources, and eliminate service duplication.
Rural Workforce Agencies
1.65
Rural Workforce Agencies (RWAs) are funded by the Commonwealth to work in each state and the Northern Territory to deliver a range of activities aimed at improving the access, quality and sustainability of regional, rural and remote health workforces. The work of RWAs targets MM2 to MM7 locations and Aboriginal Community Controlled Health services in MM1 to MM7. RWAs have broad responsibilities in the following areas:
Access (Health Workforce Access Program): improve access and continuity of access to essential primary health care, particularly in priority areas, through a jurisdictional workforce assessment process involving health workforce stakeholders.
Quality of access (Improving Workforce Quality Program): build local health workforce capability with a view to ensuring communities can access the right health professional at the right time, reducing the reliance on non‑vocationally recognised service providers in rural communities.
Future planning (Building a Sustainable Workforce Program): grow the sustainability and supply of the health workforce with a view to strengthening the long-term access to appropriately qualified health professionals.
The National Medical Workforce Strategy 2021-2031
1.66
The National Medical Workforce Strategy 2021–2031 (NMWS) is designed to ensure that the medical workforce continues to meet Australia's ongoing health needs.
1.67
The NMWS notes that Australia has an excellent health system, however, there is an inequality of access to the health services and that the 'optimal' distribution and service mix is not consistently achieved across Australia.
1.68
The NMWS identifies the following concerns for Australia's current and future medical workforce: geographic maldistribution; imbalance between specialist disciplines, subspecialisation and generalism; junior doctors' workload and wellbeing; the need for more Aboriginal and Torres Strait Islander doctors; and the reliance on locums and international medical graduates.
1.69
The NMWS contains five priorities for the medical workforce, including:
collaboration on workforce planning and design;
rebalancing supply and distribution;
reforming the training pathways;
building the generalist capability of the medical workforce; and
building a flexible and responsive medical workforce.
HELP Debt arrangements for certain rural, remote or very remote health practitioners
1.70
In December 2021, the Minister for Regional Health announced that the Commonwealth Government will incentivise medical graduates and nurse practitioner graduates to work in non-metropolitan areas by discounting the amount of Higher Education Loan Program (HELP) debt to be repaid. The Education Legislation Amendment (2022 Measures No. 1) Bill 2022 was introduced on 17 February 2022. If passed, from 1 January 2022 (applied retrospectively), the Government will eliminate 100 per cent of an eligible individual’s outstanding HELP debt, subject to meeting eligibility requirements.
Previous inquiries and reports
1.71
There have been several inquiries and reports into the provision of primary health services across Australia in the past two decades, including the following:
Australia's Health Workforce—Productivity Commission (2005);
Audit of Health Workforce in Rural and Regional Australia—Department of Health and Ageing (2008);
Internal review of rural health programs and geographical classification systems—Department of Health and Ageing (2008);
Rural and remote health workforce capacity – the contribution made by programs administered by the Department of Health and Ageing—Australian National Audit Office (2008–2009);
Review of Undergraduate Medical Education in Australia—Department of Education, Science and Training (2008);
The factors affecting the supply of health services and medical professionals in rural areas—Senate Community Affairs References Committee (2012);
Lost in the Labyrinth: Report on the inquiry into registration processes and support for overseas trained doctors—House of Representatives Standing Committee on Health and Ageing (2012);
Review of Australian Government Health Workforce Programs (known as the Mason Review) (2013);
Australia's Future Health Workforce reports (2012–2019).
1.72
There have also been reviews conducted into specific programs, such as reviews of the Rural Health Multidisciplinary Training Program and the Rural Health Workforce Support Activity program, and a five–year review of the MBS.
1.73
In addition, at the time of reporting, several state parliaments were conducting inquiries into the provision of primary health services in regional, rural and remote locations.
Report structure
1.74
This is an interim report that focusses on the provision of GPs and the associated policies relating to the supply and distribution of GPs across Australia.
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Following this introductory chapter, which provides an overview of primary health in Australia, the composition and distribution of this workforce, and key programs designed to improve the distribution of primary health professionals and the health outcomes of those living in non–metropolitan areas, this report consists of three chapters:
Chapter 2: details key issues raised with the current policies and programs designed to correct the maldistribution of the primary health workforce;
Chapter 3: discusses how medical education and training influences the supply of GPs and investigates the barriers experienced by primary health practitioners in working in outer-metropolitan, rural and regional areas around Australia; and
Chapter 4: details the impacts of the maldistribution of the primary health care workforce on communities and individuals in outer-metropolitan, regional, and rural Australians.
Conduct of inquiry
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On 4 August 2021, the Senate referred this inquiry to the Senate Community Affairs References Committee (the committee) with the following terms of reference:
Inquiry into the provision of general practitioner and related primary health services to outer metropolitan, rural, and regional Australians, with particular reference to:
(a)
the current state of outer metropolitan, rural, and regional GPs and related services;
(b)
current state and former Government reforms to outer metropolitan, rural and regional GP services and their impact on GPs, including policies such as:
(i)
the stronger Rural Health Strategy,
(ii)
Distribution Priority Area and the Modified Monash Model (MMM) geographical classification system,
(iii)
GP training reforms, and
(iv)
Medicare rebate freeze;
(c)
the impact of the COVID-19 pandemic on doctor shortages in outer metropolitan, rural, and regional Australia; and
(d)
any other related matters impacting outer metropolitan, rural, and regional access to quality health services.
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As noted in the terms of reference, the committee has focussed on the provision of primary health services in outer-metropolitan, regional, and rural communities. However, the committee acknowledges that the issues for remote communities in Australia are exacerbated.
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The Senate set a reporting date of the last sitting day in March 2022. On 8 February 2022, the Senate granted an extension of time for the committee to report by 30 June 2022.
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The committee received 218 submissions. A list of submitters is available at Appendix 1.
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The committee held the following six public hearings:
Canberra, Australian Capital Territory, 4 November 2021;
Erina, New South Wales, 14 December 2021;
Launceston, Tasmania, 24 January 2022;
Whyalla, South Australia, 1 March 2022;
Frankston, Victoria, 7 March 2022; and
Emerald, Queensland, 17 March 2022.
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A list of witnesses who provided evidence at the public hearings is available at Appendix 2.
Acknowledgements
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The committee thanks the individuals and organisations who made submissions to this inquiry and the witnesses who appeared at public hearings.
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The committee greatly appreciates all of the witnesses who took the time to appear at its public hearings and recognises that it heard from many GPs and other health workers who changed their patient schedules to attend.