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Addressing the GP crisis

I rise to move a second reading amendment to the Higher Education Support Amendment (2022 Measures No. 1) Bill 2022, as circulated in my name:

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 calls on the Government to:

(1) recognise that the financial benefit delivered under this bill, will, in many cases, not be sufficient to overcome other perceived barriers for entering the regional, rural and remote workforce;

(2) acknowledge that Australia is facing a nationwide GP crisis with a workforce shortage of 11,000 GP's forecast by 2032;

(3) acknowledge that not enough medical students are choosing general practice and commit to long term planning to increase the number of GP's including improving GP training programs; and

(4) substantially increase the Medicare rebate for GP services, as per recommendation 6 of the Senate Community Affairs References Committee Provision of general practitioner and related primary health services to outer metropolitan, rural, and regional Australians—Interim Report".

Australia is in the midst of a GP crisis, both because the rising cost to see a GP is a barrier to many Australians accessing health care and because of a widespread shortage of GPs across the country. With an ageing GP workforce and not enough new medical students choosing to specialise in general practice, the problem is set to only get worse as GPs retire over the next 10 to 15 years. Only 14 months ago I was working as a GP myself during the COVID pandemic. During this time, we faced not only the COVID-19 pandemic but the increased incidence of eating disorders, mental health issues, addictions and chronic disease management. Our practices also faced the challenges of being used as COVID call centres.

I know first-hand the pressures GPs across the country, including in my electorate, are under. I've spoken to many practices on the brink of financial collapse, a position supported by research conducted by the Royal Australian College of General Practitioners which shows 48 per cent of GP practices are in the same position. Very few GP practices in my electorate offer comprehensive bulk billing to all their patients. Many have had job ads up for months and can't fill GP positions. This Parliament is on notice that we are facing a breakdown of Australia's primary healthcare a system. It is now an emergency and in need of intensive care. Currently, the situation is worse in our rural areas where people are waiting months to see a doctor. The doctor they eventually see is working up to 80 hours a week, day in, day out, to cope with the demand. We desperately need more doctors and nurse practitioners in rural and remote areas.

I welcome this bill which seeks, amongst other measures, to incentivise doctors and nurse practitioners to move to and service rural and remote areas in exchange for eliminating or reducing the higher education loan repayment debt. I also note that this measure was recommended by the Royal Australian College of GPs, the Australian Medical Association and the Australian College of Rural and Remote Medicine. However, there is no definitive evidence that reducing or eliminating the HELP debt will drive an increase in the numbers of GPs working in these areas of need. Firstly, the financial benefit conferred by this bill may be substantially offset by the lower wages received in those areas compared to metropolitan and urban areas. Secondly, there is a concern that the incentive may become an ineffective bonus if it is given to people who intended to move back to rural regions anyway. The government's modelling suggests that this measure will help 850 doctors and nurse practitioners move to regional and rural areas per year. If that number is correct and it does consist of medical practitioners who would not otherwise have moved to rural and remote areas, then it is good policy.

Despite welcoming this measure, I must acknowledge that this is the equivalent to placing a bandaid on a gaping arterial wound. The GP crisis is not a rural and remote one only; it is a crisis that impacts every electorate across Australia. In order to assess the success of this policy, we need to track and review it; however, in this legislation there's no planned review, and this is concerning. Good policy and governance depends upon evidence of effectiveness and success, particularly when the benefits are conferred upon individuals. We have had schemes like this before, but, due to a lack of evaluation and evidence, we are unsure of their benefit. We need to evaluate this initiative to determine its effect.

This measure shouldn't stand alone. We know that changes to general practice need to be comprehensive. The Australian Medical Association has an 18-point plan for supporting equal access to health care for rural communities. It includes measures to drive the rural medical training pipeline, such as by delivering a strong rural training pathway, and measures for retaining existing medical practitioners. The Royal Australian College of General Practitioners has a targeted investment plan to support patient access to general practice care.

In 2021, the Senate Community Affairs References Committee commenced an inquiry into the provision of general practitioner and related primary health services to outer metropolitan, rural and regional Australians. They released an interim report but never a final report, noting that there was merit in having the matter re-referred to the committee under the 47th Parliament. The interim report that was issued under that inquiry was extensive; it made recommendations that mirror the calls from professional bodies such as the AMA and the RACGP.

In early October of this year, the RACGP also convened a GP crisis summit here in Canberra with GP groups from around the country. Again, recommendations from that summit called for greater investment in and planning and reform of general practice. Those recommendations are not piecemeal, stand-alone measures, nor are the ones called for by professional bodies. They call for structural reform and a multifaceted approach to address the GP crisis and reverse the falling trajectory of new GPs entering the workforce. Today, only 13.8 per cent of medical students are choosing general practice as their specialty. We need to get that back to 50 per cent. Today, we face a year-on-year decline of GPs, with a 15 per cent decline in urban areas and a 27 per cent decline in rural areas. This is coupled with almost doubled demand. We are on track for a GP deficit of over 11,000 GPs by 2032. These figures are incredibly concerning, and GPs in my electorate are already feeling the impacts of doctor shortages, as are all GPs around the country.

The outcomes of the recent GP summit are clear. The pool of GPs must be increased. Reinstating GP rotations for junior doctors will help increase the number of junior doctors who choose to specialise in general practice. It is also necessary to reduce the red tape for international medical graduates to be able to participate in general practice. We need to ensure that general practice is a sustainable career path by introducing measures to, for example, increase the Medicare rebate and bulk-billing incentives, and to support GPs to spend more time with patients, which will, of course, also deliver better patient health outcomes. We also need to strengthen the role of GP team members, including nurse practitioners, practice nurses and allied health.

Australians have endured the COVID-19 pandemic and experienced the impact of a healthcare system in crisis. They have seen what happens when we fail to take the risks to the system seriously enough to plan and mitigate. We can't make the same mistakes again.

Last week many MPs were visited by passionate and dedicated GPs who shared their experience of the GP crisis and called for it to be urgently addressed. I thank the Parliamentary Friends of General Practice, of which I am a co-chair, and the Royal Australian College of General Practitioners for organising this initiative. I also appreciate the minister for health's acknowledgement that general practice is indeed in crisis, describing the low number of medical graduates applying to specialise in general practice as the most terrifying statistic in health care.

I now call on the Government to prioritise this reform, plan for it in the May budget and, at minimum, deliver recommendation 6 of the Community Affairs References Committee's general practice interim report to substantially increase the Medicare rebates for all levels of general practice. I commend this bill to the House.