Our patients deserve better. When are you driving through Cunnamulla and you have an accident, you deserve the best rural doctors at your bedside. When you are in Walgett, you deserve as good an access to your local GP as you enjoy in the city. We need to realise that promise of quality healthcare in a time of uncertainty is fundamental to Australia, and its more important than ever that we get this right.
4.1
As discussed in this report, there is a maldistribution of primary health professionals throughout Australia. This maldistribution has devastating impacts on people living in outer-metropolitan, regional, and rural areas, who are experiencing higher rates of hospitalisation and a higher burden of disease than those living in metropolitan areas.
4.2
This chapter discusses the impacts of the maldistribution of primary health workforces on individuals and communities. It covers the following issues:
the impacts of the maldistribution and barriers to accessing primary health care;
the impacts of COVID-19 on primary health care; and
the role of networks of primary health professionals.
The impacts of the maldistribution of primary health care
4.3
The maldistribution of primary health services leads to a range of difficulties in accessing health care. The committee recognises that the experience of primary health care varies from outer–metropolitan to remote areas, however, the committee received evidence that can be grouped into general themes regarding the impacts of the maldistribution. This section examines the following:
access and availability of primary health care appointments;
impacts of limited access to general practitioners (GP) on continuity of care;
the costs of primary health care; and
issues regarding distance and transportation.
Access and availability
4.4
A primary issue raised with the committee was the lack of access to and availability of GP appointments. Many inquiry participants described:
the lengthy waiting periods to see a doctor (including to see any doctor and not their regular GP);
situations where doctors are no longer taking on new patients;
irregular surgery opening hours;
delays experienced in waiting rooms; and
last‑minute cancellations.
4.5
The committee heard that individuals were experiencing excessive waiting times to see a GP. Many inquiry participants told the committee that they waited 1–2 weeks or 7–8 weeks or even up to 12 weeks for a GP appointment.
4.6
Individuals expressed a sense of frustration that they could not access a GP when they are sick. This concern was highlighted by Dr Ravi Ravoori, Practice Principal, MyHealth Medical Centre, who said '[i]n the community we need GPs to be available for the day we want them to be—not a week later or 10 days later'.
4.7
The delay in accessing a GP appointment has several consequences for health outcomes. Many inquiry participants told the committee that people become sicker and sicker while they wait to see a GP. The delay in timely appointments can also lead to the exacerbation of acute conditions, delayed diagnosis of illness (which in turn can impact the success of treatment and survival rates) and avoidable presentations at hospital emergency departments.
4.8
One individual discussed how the lengthy waiting times for a GP impacts their health:
Having to wait this long for appointments and discussions of appropriate tests and treatment options has exacerbated these conditions and delayed diagnosis and the implementation of treatment and management plans, causing me increased periods of pain and an inability to work as a result. I have sacrificed my choice of preferred GP to more urgent issues, however the wait for any GP has still often been a minimum of a week, and this results in an inconsistent approach to managing emerging issues with consideration to my chronic health conditions.
4.9
Similarly, Dr John Denness told the committee that:
… we tend to find that people leave things, so they come in quite sick. Someone who had a mild urinary tract infection, for example, called up to tell us, 'It's an emergency right now.' We said, 'We'll try and fit you in in three days time,' so they came in in three days and they had fevers; it had gone, basically, to a kidney infection, and they were quite unwell. If they'd been seen at the start, then it would have been a lot [inaudible], but the person was quite polite, realising that there was a doctor shortage, which took our wait to three days. We see things like that quite frequently, and the community is quite concerned about it. Trying to find doctor's appointments, care and those sorts of things is quite difficult for them. It's quite common for them not to even bother calling up the practice in town; they'll just drive straight to Cairns for help.
4.10
The committee also heard of the impacts when there is no available GP or the GP surgery closes. One case study explained:
After the recent shut down of Brighton Medical Centre, our family has been left in panic. I have spent days ringing as many GPs as I could as new patients with no luck at all and to only be told we are not taking new patients or we can place you on a waiting list. My husband is now left without a GP to monitor his heart and blood pressure condition, my 17‑year-old daughter has now been left without mental health support for her medication. My 11-year old son had his appointment for a mental health plan cancelled due to the closure and now unable to get him assistance. I was halfway through testing to find out what was wrong with my own health with the possibility of Chron's disease and now unable to continue or find out without a new GP. The stress has been tremendous and the likelihood of getting a GP anytime soon seems impossible.
4.11
GPs and other practice staff told the committee that they are struggling to meet the demand from communities for regular and urgent appointments, and that they regularly have to turn away patients.
4.12
For example, the Australia Health Alliance submitted that that their clinics are turning away up to 100 patients per day. Dr Bradley Cranney, who owns and manages four general practices, also described that it is common that across these practices over 200 people who need appointments on a daily basis are turned away.
4.13
Similarly, Ms Tegan Whatley, Practice Manager, Langwarrin Medical Clinic, told the committee:
We've had days where we have shut the doors and just said, 'We don't have anybody today.' What that then means, obviously, for the ongoing care for the patients is: (1) we can't offer any appointments; and (2) we can't offer consistent care to those with chronic conditions or complex health issues. I was explaining before that we have a three-day wait for a male GP for our existing patients—not new families or anyone who had moved down this way during the pandemic—and a seven-day wait for a female GP. So the need is there, but we can't provide the service.
Pressure on the hospital-system
4.14
The committee heard that when people are unable to access timely GP appointments, they will present to hospital emergency departments. According to the Productivity Commission, in 2020–21 there were approximately 3.2 million potentially avoidable GP-type presentations to public hospital emergency departments. This is a 12 per cent increase from 2019–20.
4.15
Dr Gordon Reid, Emergency Career Medical Officer, Wyong District Hospital Emergency Department, told the committee that the Wyong District Hospital has experienced a 37.1 per cent increase in the number of emergency department presentations, including presentations which are more suitably managed by GP. Dr Reid further explained that many of the patients he sees in emergency who should be seen by a GP are those who cannot afford it or are unable to make a timely appointment and as a result their illness 'has spiralled out of control and become quite an acute illness'.
4.16
Dr David Molhoek, Acting Director of Medical Services, Central Highlands, Central Queensland Hospital and Health Service, told the committee of the situation in Queensland:
For the calendar year of 2021, the No. 2 diagnosis code for all the [emergency departments] within the 4-to-5 triage category was Z00, which is general examination and investigation of persons without a complaint or reported diagnosis. I'll elaborate briefly on what that means. This was 4,961 presentations for the calendar year, but the diagnosis code when people put the diagnosis through on the ED system includes diagnoses like scheduled follow-up examination, administration of medication, surgical dressings, blood collection—those diagnosis codes that would very much fall within the remit of primary care. This was our top diagnosis code for a lot of our rural hospitals— Baralaba, Biloela, Emerald, Blackwater, Mount Morgan, Woorabinda and Springsure. In Biloela, for example, last year, when they had approximately 7,000 presentations per year, up to 30 per cent of these presentations were within that diagnosis code: scheduled follow-up exam, 458; administration of medication, 260, or four per cent; dressings, 200, or three per cent; blood collection, 195; UTI, 105; and ankle sprain, 98.
4.17
The increasing rate of presentations at emergency departments also comes at a cost to the broader health system. The Australasian College of Paramedicine estimates that the increased presentation of low and mid-acuity patients in hospitals costs approximately $2.1 billion per year.
4.18
The committee heard that it is cheaper and more cost-effective to service these patients by a GP than to treat them at a hospital. For example, if an individual presents to the emergency department, it can cost upwards of $500. If the individual is admitted to hospital this rises to over $1000. In contrast, a standard consultation with a GP, the Medicare rebate is $39.10.
Access to culturally appropriate care
4.19
An important part of the primary health workforce are Aboriginal and Torres Strait Islander health professionals. These professionals have unique skills that ensure Indigenous Australians receive culturally safe and responsive health care; however, Aboriginal and Torres Strait Islander health professionals are underrepresented in the primary health workforce.
4.20
Aboriginal and Torres Strait Islander people continue to have worse health outcomes and are more likely to have higher levels of chronic disease and other pre-existing health conditions when compared to non-indigenous populations.
4.21
The committee heard preliminary evidence that there are challenges in the funding of Aboriginal Community Controlled Health Organisations, a lack of Aboriginal and Torres Strait Islander health workers, and a lack of consultation that occurs regarding Indigenous health.
Continuity of care
4.22
The maldistribution of GPs can lead to a disruption in a patient’s continuity of care. Impediments to continuity of care can occur when there is no regular doctor available, there are extensive waiting times to see a preferred GP, when the regular GP moves away or retires, or in circumstances when there is a reliance on the use of locums. The committee also heard that continuity of care in relation to access to a GP reduces hospital admissions and increases life expectancy.
4.23
Submitters and witnesses expressed several concerns with a lack of continuity of care, including the sense of frustration at explaining issues multiple times to different practitioners, inconsistent treatment approaches, worsening of health conditions and the difficulty in building trust with new medical professionals.
4.24
The issue of continuity of care was particularly raised in relation to ongoing and chronic health conditions. For example, Ms Kirsty Briggs, Provisional Psychologist, Central Queensland Rural Division of General Practice Association said:
The high turnover in staff means that a lot of my clients aren't actually able to see the same GP again, which means having to discuss their situation with someone new, having to expose themselves again to someone new…The downside to that is that clients are walking away feeling that they haven't been heard. They're feeling that they've been dismissed, and they sometimes feel quite lost and abandoned. And the downside to that is that either they cut ties with services completely, and they go out into the community and their condition worsens, or they are forced to present to the emergency department, because that is the only avenue they have for services.
4.25
Another individual explained:
I am now on my 6th GP in 5 years. They keep leaving [the] area. Most good GP's have closed their books and will not accept new patients and [I] wait weeks for an appointment sometimes. I have breast cancer and now on my 3rd Medical Oncol [specialist] since early 2019. They are either retiring or not seeing public patients at the Cancer centre anymore. I just want the same GP/Specialist to see me [through] this medical journey.
Use of locums
4.26
Locums are relief primary health professionals and are often used to fill critical workforce shortages in outer-metropolitan, regional, rural and remote areas. Locums provide welcome relief to doctors and provide valuable services in areas where a doctor taking leave can mean that the community is without access to health services. Locums can sometimes also be the only doctor servicing a community.
4.27
While acknowledging that locums fill a critical workforce shortage, the committee heard that the high rates of locum turnover leads to an inconsistent and fragmented approach to care and creates difficulties for individuals to build trust with the doctor.
4.28
For example, Dr Michael Clements, Rural Chair, RACGP, stated that the locum system can be abused:
… but you're getting mercenaries that come and go from that town with no continuity. They don't have any ownership to the community or to the practice. They stop making discharge summaries. They kick them out of the [emergency department] as soon as they can because it's no longer their problem.
4.29
A similar situation was described by Mr Travis Barber, Mayor, District Council of Streaky Bay, who said:
I have a personal experience that I want to talk about, as Deb spoke about two of hers. Mine's personal; it was my daughter. We took her up to the hospital. She'd been feeling unwell for a few days. We had a locum who said there were kids with gastro and sent her home. She got very unwell over the next 24 hours. We took her up to see another locum—because there had been a changeover and there had been no reporting or any history of what had happened the night before—who also sent her home with gastro. At nine o'clock that night, she became unconscious. We raced her to the hospital and were on SAVES, which possibly saved her life, and found out she had actually got diabetes and we had no idea. The vomiting and the water drinking were all gastro signs, but she had diabetes. She spent 10 days in the ICU.
4.30
Concerns were also raised about the costs of locum services. The daily rate for a locum doctor can be upwards of $2000. This does not include the cost of travel and accommodation which is often borne by the general practice. Witnesses commented that this discrepancy in the pay between what an average GP can earn in a day compared with a locum acts as a disincentive to people taking on positions and staying long-term in an area.
4.31
For example, Dr Gerard Quigley, Principal, Lower Eyre Family Practice, stated:
So if you were to do locum at Port Lincoln Hospital ED, you would get paid $2,500 for a 12-hour shift. I don't know what business could possibly afford that. The other problem that then causes for us is the people who have the skills we want, the rural generalist who has ED skills and inpatient care skills, is going to look at it and say, 'Why would I go and work somewhere like Streaky Bay or Cummins or wherever and get paid much less than that when I can—as you say—work three months of the year and make that money?' A market has been created that I can't compete with.
4.32
This view was echoed by other inquiry participants. For example, Mr Matthew Cooke, Chief Executive Officer, Nhulundu Health Service, told the committee that in the last five years, the organisation had spent $3.5 million on part time locums and that in total, they are spending 75 per cent of their funding from the Commonwealth paying for locums.
4.33
To improve continuity of care in communities reliant on locum services, one solution proposed to the committee was to implement a system where the same locum regularly visits the community.
4.34
A submission from the Western Australian General Practice Education and Training described that in the Pilbara region a pool of specialists has been recruited and rotate through the region alongside a resident specialist. This has ensured that 'the specialists rotating through the region are familiar with the services and networks and how the region operates' and has been 'highly successful and ensures a level of stability, while not being reliant on a single resident specialist for all services'.
4.35
The Department of Health submitted that there is a planned evaluation of the Rural Locum Assistance program in 2021–2022. This program supports locums in MM2–7 locations.
4.36
The Department of Health further submitted that, while data is limited, the consultations on the National Medical Workforce Strategy 2021–2031 (NMWS), indicated that there is growing concerns about the over-reliance on locums and the risk this poses to continuity and quality of care, cultural appropriateness of care, and longer‑term workforce sustainability.
4.37
The NMWS has listed as an action item to 'determine and monitor optimum use of locums'. This is expected to occur over a 2–5 year timeframe and to use data to 'determine a nationally agreed but locally responsive approach to the optimum use of locum workforce, taking account of patient, community and service needs'. During consultation on the strategy the following ideas were offered as potential solutions to the use of locums:
standardise and cap locum pay levels and terms to rebalance usage of locums versus permanent positions;
address recruitment and staffing models such as approval requirements for permanent staff recruitment, to allow hospital administrators more flexibility in recruiting doctors without the need to rely on locums;
create incentives that encourage limiting locum use by health services; and
implement new locum management models.
Costs of accessing a general practitioner
4.38
For some, the cost for an appointment with a non-bulk-billing GP can be prohibitive.
4.39
The average out-of-pocket costs for GP non-referred attendances where a co‑payment is charged has increased in the past ten years. In the 2011–12 financial year, the national average for out-of-pocket costs was $27.65 and in the 2020–21 financial year this increased to $41.12. The highest out-of-pocket costs were experienced in MM6 and MM7 locations at $43.48 and $43.44 respectively.
4.40
Bulk-billing rates and out-of-pocket costs also differ across the country by region. According to the Department of Health, in 2020–21, the bulk-billing national average was 88.75 per cent and the highest bulk-billing rate was in MM7 locations at 91.14 per cent. Table 4.1 below shows the bulk-billing rates for non-referred GP attendances by Modified Monash Model (MM) classification.
Table 4.1: GP non-referred attendances bulk billing rates (percentage)
|
|
|
|
|
|
|
|
|
|
|
2018-19
|
87.22
|
82.70
|
83.11
|
83.52
|
84.67
|
83.66
|
89.90
|
86.24
|
|
2019-20
|
88.46
|
84.03
|
84.60
|
85.17
|
86.20
|
84.47
|
90.17
|
87.54
|
|
2020-21
|
89.56
|
85.39
|
86.09
|
87.00
|
87.95
|
85.38
|
91.14
|
88.75
|
Source: DoH, Submission 38, p. 67.
4.41
In contrast, the committee heard that the number of bulk-billing GPs is declining and that it is exceedingly difficult for individuals to find a GP that will bulk-bill. The committee also received evidence that individuals are delaying health care due to costs and that this leads to worse health outcomes.
4.42
The Consumers Health Forum of Australia submitted that gap payments deter people from receiving care and that this has implications for the individual:
The gap keeps people away. For country people, it means they have to go to the city to get treatment and they have to leave their families and businesses and supports … that means they leave things for too long and end up with major health problems and that is also a huge cost to the system.
4.43
One submission provided accounts of individuals who delayed their health care due to cost:
As a pensioner it is deflating and an insult that I have to regulate my Dr's visits due to them not Bulk Billing as they once used to. I had to change Dr's due to that reason only to find 12 months later my new Dr is no longer Bulk Billing. I feel like now I have to write a list of things that I need to ask the Dr about as I cannot afford to go when I need to see him.
4.44
Many GPs and practice managers discussed the difficulty in balancing affordable health care for their patients while meeting practice costs. Many GPs told the committee that they cannot viably operate a practice on the current Medicare rebates and must charge a co-payment to meet the costs of practice.
4.45
For example, one GP submitted that:
…much to the disappointment of our GPs, who used to pride themselves in offering services at no cost to patients given the area's low socio‑economic demographic; we are gradually introducing co-payments to patients who can barely afford to pay.
4.46
Similarly, Ms Lucina Wilk, Director, Total Care Medical Centre told the committee:
I work in a low socioeconomic area. I have been encouraged—RACGP, AMA—to bring in private fees. They can't afford it. They just can't. Last week I had two patients that came out. They didn't have money for scripts. I went into my wallet and gave them the money to go and buy the scripts and buy their injections. This is the type of area that I'm working in. I have just recently put out that any new patients coming in that don't have a pension card or a health card have to pay a private consultation fee. As soon as they hear that, they're out the door.
4.47
The Department of Health submitted that in the 2017–18 Budget, the Government announced a $1 billion commitment to re-introduce the indexation of Medicare Benefits Schedule (MBS) rebates and noted that for standard GP consultations indexation has occurred annually since 1 July 2018. However, as discussed in Chapter 2, the re-introduction of indexation and current Medicare rebates are insufficient to meet patient needs and the rising cost of running a practice.
Distance and transportation
4.48
Travelling for health care is a particular concern in smaller outer-regional, rural, and remote areas. The vast distances required to travel to receive primary health care causes disruptions to the individual and their family, and creates difficulty for the management of conditions as there is little or no local services available for follow-up appointments.
4.49
Access to appropriate transportation was also raised as an issue in the availability of primary health care. Witnesses told the committee that a lack of available public transport and high costs involved with travelling large distances can be prohibitive to individuals receiving health care.
4.50
The Department of Health notes there are several programs that encourage health professionals to travel to regional, rural, and remote communities to provide health care.
4.51
One program is the Rural Health Outreach Fund (RHOF). The RHOF aims to improve access to GPs, allied and other health providers, and other medical specialists in regional, rural, and remote areas of Australia by subsiding the cost of travel, facility hire and equipment leasing. It has four priority areas, including maternity and paediatric health, eye health, mental health, and support for chronic disease management. In the 2019–20 year, 206 797 patients used RHOF services.
The impacts of COVID-19
4.52
The COVID-19 pandemic has impacted all aspects of health care in Australia. In relation to the provision of GPs and related primary health services, the COVID-19 pandemic has exacerbated issues of accessibility and availability of health professionals and resulted in difficulties for individuals to receive timely health care, preventative health care, and management of chronic conditions.
Preventative health care and management of conditions
4.53
Submitters and witnesses told the committee that the COVID-19 pandemic intensified the issues of access and availability of GP appointments. Many told the committee that waiting times for a GP appointment increased as doctors were engaged in the pandemic response and that this led to a decrease in the level of preventative health care and management of chronic conditions.
4.54
Dr Michael Clements, Rural Chair, RACGP, told the committee:
We got a taste of what it's like when people don't see GPs, with the COVID lockdowns. I had 60-, 70- and 80-year-olds too scared to leave their house for months. They didn't come and see us, because of the COVID fear. We saw what happened. We saw later diagnoses of cancer. We saw people with abdominal pain for four months present with metastatic colorectal cancer. One of my GP friends' partners is a pathologist and said: 'Oh my gosh! I've never seen such advanced cancer. Normally I see cancer much earlier. Now I'm doing pathology samples on things that are a lot further.' We are seeing the health burdens. We are seeing a cancer increase. We're seeing the mental health burden when people don't have access to GPs for that preventive aspect. We are seeing it already, and it's just going to get worse.
4.55
The Latrobe Health Advocate also submitted that during the COVID-19 response people were not having routine screening and pathology tests and this caused health professionals to be concerned about the impacts for preventative health and the management of long-term health conditions.
Telehealth services
4.56
In response to the COVID-19 pandemic the Federal, state and territory governments implemented a range of measures designed to improve accessibility of health care while reducing the risk of transmission. One key policy response was the creation of MBS numbers for COVID-19 telehealth appointments. These were introduced across a range of primary and specialist health professions.
4.57
According to the Department of Health, in 2019 GPs claimed 0.05 million MBS telehealth items. In 2020 this increased to 36.96 million and the number of face‑
to-face consultations decreased from 100.86 million in 2019 to 77.99 million in 2020.
4.58
Many inquiry participants welcomed the telehealth initiative and expressed the view that such technology is beneficial to accessing primary health care; however, concerns were raised about the potential impacts on continuity of care and to ensure that telehealth is not the only way of accessing health services. This was particularly raised in the context of allied health services as MBS telehealth rebates for these services are minimal or non-existent.
Border closures
4.59
International and state border closures due to COVID-19 also impacted on the accessibility of primary health care. This particularly occurred in communities that regularly rely on locums, as the border closures and quarantine requirements created difficulties in recruitment.
4.60
The WA Primary Health Alliance and Rural Health West explained that Western Australia relies heavily on international medical graduates and visiting locums from interstate to fill workforce shortages. They explained that COVID-19 severely impacted on the ability to recruit health professionals:
COVID-19 has resulted in [a] reluctance of medical professionals to travel, and the controlled interstate border conditions have limited WA’s access to interstate doctors. GPs and allied health professionals are now remaining in their home countries and Australian States as they are unwilling to accept the risks of remaining in two weeks’ isolation as they enter and exit WA. Furthermore, the major attraction of providing locum services within WA was for GPs and other medical and health professionals to experience a working holiday. This is now much more difficult given the COVID-19 related complexities and constraints.
4.61
In South Australia, the Northern Eyre Peninsula Health Alliance, described a similar situation during the pandemic in which the region was unable to recruit locums to supplement resident GPs who cover a population of 5151, despite the increase in demand for GP services. They stated that general practices across the country were 'fighting over a limited talent pool' due to COVID-19 border closures.
4.62
The Department of Health submitted that the decrease in the number of GPs working in New South Wales, Western Australia, South Australia, the Australian Capital Territory, and in MM3–7 locations may be due to the COVID-19 travel restrictions. The Department also notes that these restrictions are expected to result in fewer than usual international medical graduates entering the primary health care system for the 2020–21 year.
4.63
A range of other measures were also introduced, such as developing a short‑term pandemic sub-register to enable qualified and experienced, but not currently practising, doctors, nurses, midwives, pharmacists and Aboriginal and Torres Strait Islander Health Practitioners, to return to the workforce.
4.64
Further, the Department of Health introduced a number of automatic extensions to the Health Insurance Act 1973, such as a 6-month extension for international medical graduates to continue to use their Medicare provider number, enabling them to practice in areas of need.
Scope of practice and a network of primary health professionals
4.65
Throughout the inquiry the committee also heard from other primary health professionals who spoke about the need for GPs to be better supported by strong networks of primary health practitioners.
4.66
These primary health professionals discussed the importance of enabling health care workers, such as nurses, to be working to their full scope of practice to improve health outcomes for individuals and relieve pressure on GP workload. For example, Mr Ken Griffin, Chief Executive Officer, Australian Primary Health Care Nurses Association, told the committee:
Our universities are training truly world-class nurses, but Medicare does not allow them in general practice to use all of their skills, which is madness when you're talking about the largest workforce in that part of the health system. Nurses are qualified, trained and experienced and are able to provide quality team based care; however, currently, 34 per cent of them, according to our annual survey—that is, one-third of primary healthcare nurses— say that they are not being fully utilised to the extent of their skills and experience. You wouldn't design a health system that way. Thirty per cent of nurses who asked to do more complex tasks are told no. The main reasons they're told no is: 'There isn't funding for it' or 'We're not used to doing it that way.' This needs to change. Nurse practitioners, who are our highest trained nurses, can do so much. They can work autonomously, diagnose and prescribe, but the current policies that surround this particular profession actually restrict their capacity as well. Data suggests that 30 to 40 per cent of nurse practitioners in primary health care work part time and only do a fraction of their scope.
4.67
The committee heard similar views from Ms Claire Bekema, Senior Pharmacist, Clinical Governance and Workforce, Pharmacy Guild of Australia, in relation to pharmacists.
4.68
The Australasian College of Paramedicine told the committee that currently there is an oversupply of paramedics in Australia and there is scope to better utilise paramedics in primary care settings. Mr John Brunning, Chief Executive Officer, Australasian College of Paramedicine, discussed the role that a 'community paramedic' could perform to support GPs:
Community paramedics can provide urgent, acute, mid- and low-acuity care to patients in consultation with a GP. The paramedic could be engaged to undertake house calls, manage acute and urgent patients and undertake after-hours care to provide a more complete service, removing those patients from the ED system.
4.69
The Department of Health submitted that the Government funds Services for Australian Rural and Remote Allied Health to administer the Allied Health Rural Generalist Workforce and Education Scheme. This scheme is a pilot scholarship program to support graduate and early career allied health professionals.
4.70
The Department of Health notes that this scheme will directly contribute to expanding the scope of practice of allied health professionals and provide rural and remote communities with increased access to a highly skilled specialist generalist allied health workforce.
Committee view
4.71
Access to health care services and treatment is a right of all Australians, regardless of where they live. It is unacceptable that Australians living in outer‑metropolitan, regional, and rural locations do not receive the same quality of care and experience worse health outcomes than their metropolitan counterparts.
4.72
The committee recognises that the Government has implemented several well‑intentioned policies in an attempt to improve the distribution of primary health care professionals across the country; however, these policies are failing to have a substantial impact and as a result individuals and communities are left with limited or no access to primary health care.
Access to primary health professionals
4.73
The committee was shocked to hear that individuals are waiting weeks or months to make an appointment with their GP. It is clear that these delays result in poorer health outcomes. Individuals are getting sicker as the wait for an appointment, and this can lead to the exacerbation of health conditions and delayed diagnoses.
4.74
The committee acknowledges that there is recognition by the Government of the GP shortages in regional, rural, and remote Australia. However, the committee is concerned that the Government and the Department of Health are unaware of the full scale of the shortages and that they do not recognise the lengthy waiting times many people experience in their assessment of GP workforce data.
4.75
The committee acknowledges that Indigenous Australians experience worse health outcomes compared to non‑Indigenous Australians and that one way to improve health outcomes is to ensure that Indigenous Australians receive culturally appropriate care.
Continuity of care
4.76
The committee acknowledges that continuity of care is a real issue for Australians living in outer-metropolitan, regional and rural areas, and that a lack of continuity of care causes difficulty in building trust with a medical professional. It can also lead to other perverse outcomes such as an exacerbation of chronic and complex conditions, misdiagnosis, and can leave otherwise treatable conditions untreated.
4.77
The committee notes this issue was particularly raised in relation to use of locum doctors, and recognises that locums are sometimes the only option for communities to receive primary health care.
4.78
The committee acknowledges that the Department of Health has a planned review of the Rural Local Assistance Program for 2021–22 and it awaits the results of this review
4.79
The committee further notes that the NMWS has an action to item to 'determine and monitor optimum use of locums' over a two to five year period. The committee is also concerned that this issue requires immediate action and that a further two to five year waiting period for consultation and review is too long when communities are already struggling.
4.80
The committee is, however, supportive of this overarching objective and the proposals suggested during the consultation on the NMWS, including the proposals to:
standardise and cap locum pay levels and to rebalance usage of locums versus permanent positions;
address recruitment and staffing models such as approval requirements for permanent staff recruitment to allow hospital administrators more flexibility in recruiting doctors without the need to rely on locums;
create incentives that encourage limiting locum use by health services; and
implement new locum management models.
4.81
The committee supports the suggestion that many communities would benefit from a locum system in which the same locum GP was able to visit the same community regularly and repeatedly. This would ensure that individuals would benefit from continuity of care and that the locum would become aware of the broader context and health needs of their patients.
Costs of accessing a GP
4.82
Individuals are struggling to find GPs who will consistently bulk-bill them for their appointments, and the committee is deeply troubled that individuals are delaying health care due to cost.
4.83
Medicare was designed to ensure that every Australian can access affordable health care; however, the current rates are forcing GPs to implement gap payments to meet their costs, and this is leading to negative impacts on individual health outcomes.
4.84
The committee was distressed to hear that many people are delaying their health care as they are unable to find a GP that solely bulk-bills.
4.85
The committee reiterates its recommendation to substantially increase the Medicare rebates, as discussed in Chapter 2.
Telehealth
4.86
The committee acknowledges that the introduction of Medicare rebates for telehealth has led to improvements to accessing primary health care, particularly in the context of the COVID-19 pandemic. The committee notes that some telehealth MBS items have been made permanently available while others have been removed.
4.87
The committee also heard several concerns about the use of telehealth and the importance of maintaining face-to-face consultations. The committee further notes that the Medicare rebates for telehealth services predominantly focus on GPs and do not extend to other primary health professionals.
Networks of primary health professionals
4.88
Throughout the inquiry the committee heard that it is important to consider the full range of primary health professionals and their scope of practice when discussing the health outcomes for individuals and the broader environment of the primary health care sector.
4.89
The committee also acknowledges that there is variation in the distribution of other primary health professionals. The levels of access to certain primary health professionals, such as those in the allied health sector, generally decline with increasing levels of remoteness.
4.90
It is clear to the committee from the evidence received thus far that the primary health system works best when there is collaboration amongst multiple primary health professional. There is a clear need to improve the distribution of other health professionals and increase their role in supporting GPs in delivering health care. The committee is interested in receiving further evidence from this sector, particularly in relation to different primary health network models that could provide a solution to the maldistribution of the primary health workforce across Australia.