Govt big on rural practice, but what about the rest?

By Crispin Hull

In the past week the Federal Government renewed its commitment to extra funding for health care in rural and regional Australia and to extending training into smaller rural communities and rural residential aged-care facilities.

Answering a question in the Senate (2 December 2020) the Minister for Employment, Skills, Small and Family Business, Michaela Cash, stressed the need to move away from a one-size-fits-all approach.

This comes at a time when the Department of Health is working with the Royal College of General Practitioners and the Australian College of Rural and Remote Medicine so that the colleges take over the Australian General Practice Training scheme from the department.

Obviously, the quality of training must be paramount. But as with most changes, the question of funding is a significant priority.

Minister Cash seemed to indicate that government funding for the rural and regional side of GP training will be maintained or increased. However, the overall picture is not so clear.

Minister Cash said, “Regional Australians will benefit from improved access to health services, and that’s because we have made a $1.2 billion investment to boost health care in the bush. . . . .

“Our reforms focus on addressing the distribution challenge and we are now investing in new approaches and localised solutions. As a government, we understand that one size does not fit all. . . . We are very much breaking new ground by investing in unique subregional models of primary care delivery. We are trialling different approaches to address the unique challenges to regional health care.”

She was asked by NSW Senator Perin Davey, “How is the government securing better training for rural GPs, which makes rural health practice more appealing to our regional medical practitioners?”

Minister Cash said, “[The Government is] looking at drilling down into more innovative and collaborative ways of supporting our regional health workforce. Evidence shows that when students undertake their training in the regions they are more likely to stay in the regions. That’s why the funding that we’ve provided in the 2020-21 budget includes an additional $50.3 million to enhance the rural training pipeline through the longstanding Rural Health Multidisciplinary Training Program. We understand that providing the funding to ensure that we can extend training into smaller rural communities and rural residential aged-care facilities will assist those in rural and regional Australia.”

Patients and the public are probably generally unaware that general practice is in fact a speciality and like other specialties requires training as a registrar, beyond basic medical training. By unlike other specialities, training as a general practice registrar of its nature cannot be done in a hospital but must be done in a general practice, essentially by employment in private general-practice businesses.

The renewal of the national terms and conditions for general practice registrars is coming at the same time as the Department of Health is stepping back from GP training in favour of the colleges. That process will be completed in 2022.

Will that mean less government money for GP training? If so, who will bear the burden? The colleges, the individual practices or the registrars.

General Practice registrars have already expressed concern about their pay levels, especially the fact that they are usually paid less than hospital-based registrars. They also argue they are not skilled at negotiating working conditions. Also, it might be more difficult to get better pay and conditions from a small cash-strapped practice than a large teaching hospital.

But the practice businesses themselves are coming under greater pressure on several fronts. The Federal Government has been rattling their cages over rental agreements with pathology practices under their roofs. State Governments have been stalking them over payroll tax. Now it seems they might come under further pressure from the top as the Federal Government withdraws from GP training so the colleges take all the running and from underneath as the registrars seek to negotiate better pay and conditions and/or a bigger slice of income they generate from patients and Medicare. And the Medicare payment itself has been a continually shrinking income source.

On top of this the Covid-19 pandemic presents further uncertainty. It has added to the costs of general-practice businesses, like most businesses. It has also changed the way medicine is practiced. There may be benefits from greater use of telemedicine, but who will gain from that is uncertain.

Again, the Government has been keen to push its rural-and-regional credentials. Minister Cash said this week that 10 million telehealth services had been delivered to more than 3.2 million people in regional Australia. But the overall picture is less clear.

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