ADDRESS TO THE RURAL MEDICINE AUSTRALIA CONFERENCE

Thanks very much. Can I start by acknowledging country.

I thank their Elders past and present for custodianship of land and extend that acknowledgement and respect to any Aboriginal and Torres Strait Islander people who are with us today.

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A lot has happened in the last 12 months in health policy. When I spoke to you last the Coalition was pursuing it's GP tax which, in our view, makes it harder and more expensive for patients to see their Doctor.

They cut in their first budget $155 million from healthcare in this country and they also had a raft of policies including proposals to increase the price of medicines. The majority of these proposals have not won favour with either the Parliament of Australia or the people of Australia.

They remain policy but they do not as yet remain law of the land.

It is our job as a patriotic and loyal Opposition to engage in the political debate to ensure, as far as we're concerned, these propositions do not find their way in to the law of this country for reasons that I will spell out.

I remarked earlier that there had been a fair bit going on in Canberra over the last couple of months and one of your colleagues quipped, “yes, you've been keeping us very entertained”.

I'm not sure entertaining you is the aim! I think the word “governance” or “governing” is supposed to be the word that comes to mind, but there has been some changes, obviously in the leadership of the country.

The new Prime Minister, Malcolm Turnbull, has presented himself as very different from his predecessor, but interestingly and of concern - there has not been one statement nor any significant change when it comes to health policy from the new Prime Minister.

This, in our view, is a significant absence from something which needs to be at the centre of national political debate.

So right now, health policy in the country remains in a hole. We are swamped by reviews. There is a lot of activity going on but that should never be confused for action or outcomes.

I want to talk a little bit about access to healthcare. There is a stubborn correlation between low-incomes and poor health in rural, regional and remote regions and this means that for this group of Australians there is a massive disconnect between on the one hand, the need for health services and the other hand, the ability to pay for them.

For as long as the increasing cost burden for the provision of healthcare in this country is being pushed on to private individuals, we are going to see a widening gap, not only economic inequality but health inequality for those who can least afford it.

There is also a key concern from health professionals practicing in rural, regional and remote areas of the country because in a system where the majority of primary care is based on a fee-for-service model, all of those changes have a direct impact not only on the patients in these areas, but on the economic viability of the practices that you work in.

For many rural medical practices that work in these struggling communities, you operate on tight margins and struggle to meet demand.

As a result of both of these shortcomings, people in rural areas are more likely to be admitted to hospital for problems that could have been prevented or better managed by their local GP, at least at first instance.

In our view, it shifts a cost from the most efficient and effective part of the health system to the least efficient and effective part of the health system.

The problem is set to grow with the projected increase in chronic diseases, particularly chronic diseases associated with obesity and with ageing.

I know that these have been matters which you've been discussing immediately prior to this session. There are significant concerns for rural services following cuts to funding across a range of health programs that benefit people living outside our major cities.

These include cuts to the health portfolio Flexible Funds which include the rural health out-reach fund.

At a rural Doctors association conference in Queensland a few months ago we saw guarantees, from the ministers representative, that cuts to these Flexible Funds would not fall upon patients or practices in the programs they fund in the rural, regional and remote communities.

That guarantee was not forthcoming. There are also cuts to the Dental Relocation and Infrastructure Support Scheme and cuts of $72 million dollars to health workforce scholarships.

In our view these are going to have significant and long-reaching ramifications.

We know that the consequences of failing to deal with health policy, particularly with health workforce policies now, will have long-running impacts.

This is not a matter of theory. We need only look to changes that were made to the pipeline in respect of GP training classes and GP provider places in the 1990's.

When you get the policy decisions wrong, they have an echo decades down the track. In fact some of the problems that we are facing or have been facing over the last decade are a result of those changes that were put in place in the 1990's.

Labor is committed to improving the pipeline which delivers GP's, Doctors and indeed, other health professionals to regional, rural and remote communities.

We are critical of the over-reliance on overseas-trained doctors.

We don't believe that is alone is the answer. I do acknowledge that most overseas-trained doctors are excellent health professionals and they are welcomed by the communities in which they work, but short term tenure and lack of knowledge about local circumstances severely limits their capacity to provide more than episodic care.

It is no answer to the burgeoning need for chronic disease management.

This is where a sophisticated understanding of the services and the needs and the realities in local communities is what is needed to put in place, realistic chronic disease management health plans.

So we can't simply rely on luring doctors from overseas. We need to make sure that we have the right policies in place so that rural areas aren't short of the sort of medical professionals that they need.

If putting more students through medical schools was the answer then we would well and truly have it beaten.

In 2000 there were 1660 medical graduates in Australia. In 2011, the number had hit over 3000.

We have more than doubled it in that period and it has risen further since. In fact the number of university medical schools in this country has gone from ten to 18 over the past decade.

Friends, if training more medical students was the answer then we would have the problem whipped.

We were very critical early this year when the then Abbott Government announced the opening of a new medical school in Curtin, in Western Australia.

This is not to deny the intrinsic merits that were put forward by the university that proposed the school or even the community that put it forward with the best bonafides

But we have to ask ourselves, is this where we are most in need investing funds?

When you have students graduating from medical schools today who are unable to find appropriate training places, you've got to ask yourself are there better places where the Commonwealth can be investing to secure the pipeline of medical graduates to the right places in the communities?

The answer from Labor is quite simply, there are better places we could be investing. So if a choice has to be made, we think the wrong choice has been made.

I want say a little bit about incentives for rural practice. When I first took on the job, I was keen to get out to as many rural practices as I possibly could and the man in the very colourful shirt, Dr. Ian Cameron, down the front was very helpful in lining me up with a range of practices throughout New South Wales.

We also visited a range of practices throughout Victoria, so that I could get handle on the real issues that were driving the location of Doctors and keeping doctors in rural, regional and remote communities.

I've got to say that I've never met a Doctor who said that the reason I am here is because of the incentive schemes. They are relevant, but I never met a Doctor who said that the reason I am here, is because of the incentive schemes.

I will say, however, that the changes that were announced by the Minister just over a year ago, to regional classification system, were welcomed by Labor.

This is a bipartisan position and indeed when we are in government the then Health Minister, Tanya Plibersek, commissioned Jenny Mason to do a review of the medical workforce.

One of the recommendations of that review was adopting the Modified Monash Model. We know that it has made a difference.

It came in to place on 1 July, this year. We know that it has made a difference to the allocation of incentives to practices throughout the country.

It is a more rational system, based not so much on the remoteness from a capital city but also looking at other factors, including the size and the attractiveness of a town.

It passes the common sense test that a large town, although it might a remote town from a capital city, is a more attractive location than one that may be less remote but not as large.

We welcome these changes but it's too early for us to pop the champagne corks. As important as these changes to the regional classification scheme have been, we argue what the Government has done is give with one hand and take away with the other.

I'm not talking about the closed pot which was the money within the rural incentive programs.

Instead, what I am talking about is the changes that were put in place by the Government when they could not get the GP tax through both houses of Parliament.

The Medicare rebate freeze is in effect a GP tax through the back door.

It is effectively asking Doctors to do what Parliament has refused to do. We have seen through some very useful research from the Medical Journal of Australia what the impact that the GP rebate freeze is having and will have.

The study indicated that the freeze will cost GP's around about $384 in 2017-18 terms per 100 consultations.

To make up the shortfall Doctors will have to charge approximately $8.43 in a co-payment for non-concessional patients to off-set the loss.

We've had a look at what this would mean for a normal practice and had a look at the sorts of consultations that a normal practice would put in place.

In a busy practice, Doctors may take up to 40 consultations within a day. That would be a busy practice in my view.

That equates to a little over nine and a half thousand consultations a year. Perhaps in a less busy practice, Doctors might take, for example, somewhere a little bit north of five and a half thousand consultations a year.

We had a look at this spread, to see what the impact of it was. Let's take the example of a rural GP that is located in a small town of less than five thousand people.

They gained an extra $11,000 under the new classification system. Let's also say that you are a Doctor in that practice that is on lower end of the scale in terms of the total number of consultations, let's say six thousand consultations a year.

Some of those may be frequent patients with chronic diseases who require close attention. Others might be people who don't see primary care very often.

If you are a Doctor in a practice such as this where a significant number of your patients are bulk-billing you know that you can't ask these people to pay more because they simply can't afford it.

The simple act of asking them to pay more will guarantee that they don't come and see you, meaning they don't get the follow-up care that they need.

Asking these people for a co-payment is simply not on the table. By the end of the year, in a practice such as this, that is the six thousand consultations a year practice, you will be losing around $23,000 over the course of that year.

Now as a government, our principal concern is the impact that this has on the healthcare of your patients. Of course we must be concerned about what it means to you and your practices and your incomes, but our principal concern, is what it means to your patients.

I'm certain every Doctor in this room would withhold from passing those costs onto our patients who simply could not afford it.

We are also not blind to the fact that you will be forced to either close up shop, engage in practices that a government wouldn't say were best practices or you would have to pass those costs onto other patients.

This means the other patients within your practice are bearing the impact.

We have got to ask ourselves whether this is the best way to deliver primary care in this country. Labor, for one, says no.

The Government is patting itself on the back for saying they've introduced an answer to a bug-bear of every Doctor in this room - an irrational system of regional classification, a change that we welcome.

But the overwhelming evil that has been done through the pushing through of a GP tax by stealth through the Medicare rebate freeze more than off-sets that.

We argue that it's going to have deleterious impact on healthcare for your patients, particularly in regional and rural Australia.

As I said, there is a stubborn correlation between low incomes, low ethics status and poor health outcomes in many of the areas that you practice in.

We are saying that this is going to make matters worse. We know that over the course of this conference and indeed, over the course of this morning, we've talked about the importance of managing the costs of chronic disease.

We believe the best place that we can deal with this is in the primary care space.

Primary care is going to be front and centre of our health policy when it is announced later on, a little bit closer to the election, by the shadow Minister for Health, Catherine King and the Leader of the Opposition, Bill Shorten.

We will ensure that as we roll out those policies that we adopt the principal of rural proofing.

We have a lot of faith in the capacity of new initiatives in the area of eHealth, for example, to deliver outcomes for patients, particularly in rural and remote areas.

It is no substitute to a person sitting face-to-face for a lot of healthcare needs, but it is an important. It provides an important capacity to supplement the care that is currently been given.

I have to make the point though, and this goes to a very fundamental Labor principal, that some of the best health care initiatives lie outside the health policy.

The best eHealth strategy in the world won't work unless we are getting safe, affordable, reliable broadband in to the communities that need it most. We have been very critical of the Government’s approach to the NBN in this respect.

Friends, I look forward to further engaging with you in the process of policy development.

Those of you who are keen policy wonks would have known that over the last month there has been a raft of announcements that Labor has put out there in the policy space.

That pace will continue. Whenever the next election is held you can be assured that health will be front and centre of Labor's policy offering as it has always been.

From the party of the Pharmaceutical Benefits Scheme under Chifley, Medibank under Whitlam, Medicare under Blewett and Hawke and the National Disability Insurance Scheme under the Gillard and Rudd governments, you can be assured that health policy would be up front and centre of what we want to talk about in the lead-up to the 2016 elections.

Thanks very much for your stamina, I've got to say. I know it's been a long conference.

I've always enjoyed the engagement that I've had with you and I look forward to seeing you all in a month. Thank you very much.

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