GENERAL PRACTICE REGISTRARS AUSTRALIA CONFERENCE
BRISBANE HILTON HOTEL
1 APRIL 2016
Dr Jom Cheong, President, GPRA
Professor Michael Kidd, Patron of GPRA, and President of the World Organization of Family Doctors
Dr Frank Jones, President of the Royal Australian College of General Practitioners
Future General Practitioners of Australia
Ladies and gentlemen.
Talking to the up and coming generation of GPs is a priority and a pleasure for me, so thank you for welcoming me here today.
I want to tell you in person about the reforms that are being made in primary care and the broad health system, and to bring more doctors to rural areas.
I want to let you know that I and this government very strongly value our doctors and health professionals.
I know that it is a very long and often difficult path from the dream of helping people to finally getting out there with your specialist qualifications.
The Government has programs and policies in place to support doctors at every stage of your careers – from university through training, as you establish yourself in practice and as you continue to expand skills and knowledge.
Like any government programs, they should be regularly reviewed and adjusted according to circumstances. That’s only fair and sensible.
The changes we are making are designed to ensure your careers are more rewarding by giving you the structures to do your very best work for your patients.
As you know, the Government has put a great deal of effort into a number of parallel and complementary health reform processes.
When they all come to fruition, they will bring the biggest change to the health system in decades.
They will require new ways of thinking and new ways of doing things.
I am sure that you will embrace these changes; and in fact we are well on the way to consensus.
I have been very thorough and open in consulting with the medical profession and other stakeholders on reform.
The Foundation of my reform agenda is improvement to primary health care.
We urgently need reform because the fee for service model was appropriate 40 or 50 years ago when Medicare was being thought out.
It’s not appropriate today in the 21st century when our health issues are so different.
Yesterday I announced truly ground-breaking reform in the way people with chronic disease will interact with their GP and indeed the whole primary healthcare system.
In Australia, one in two Australians has a chronic disease;
and approximately 20 per cent of the population have two or more chronic conditions.
Despite this and the additional care people with chronic conditions need, our primary care system has remained geared toward episodic care and fee for service.
Fee for service has been, and will remain, a cornerstone of our Medicare system.
However, we are substantially reforming our approach to treating people with chronic and complex conditions.
These reforms are designed to ensure that those people who suffer with chronic conditions receive a level of integrated care that will wrap around the patient.
It will ensure that they receive access not just to their general practitioner, but also the allied and other healthcare they need to more effectively manage their condition and to keep them out of hospital.
At the centre of the new approach will be the Healthcare Home.
Patients who have been assessed as needing this level of care will be invited to enrol with a general practice which will then take responsibility for coordinating their care.
This approach will be quarantined to the top 20 per cent of patients who have been risk assessed as most in need.
The Healthcare Home will develop a tailored care plan to be implemented by a team of healthcare providers. Healthcare Homes will support enrolled patients and their carers to be active partners in their care.
To support this, the approach to paying doctors will change.
Rather than the episodic fee for service approach, Healthcare Homes will receive quarterly payments for managing and enrolled patients care.
The provision of bundled payments of this nature will be aimed at encouraging the delivery of comprehensive, proactive, coordinated and continuous care to patients with chronic and complex conditions.
It will also encourage flexible and innovative approaches to the delivery of care to enrolled patients.
Over the next twelve months, my department will be working with the primary care profession – doctors, practice nurses, allied health providers and others – to develop this reform.
In the initial phase, this reform will be rolled out in seven PHN regions. This will involve establishing 200 Healthcare Homes and enrolling up to 65,000 patients.
It is my intention that the first patients will be treated in a Healthcare Home by 1 July 2017.
The Turnbull Government will commit $21.2 million of additional expenditure to this initial phase of my reforms.
This will be on top of existing chronic disease funding in Medicare which will be redirected proportionately to the delivery of these integrated care packages.
This is a bold step in the government’s vision for a Healthier Medicare.
In addition to the changes I have just outlined flowing from the Primary Health Care Advisory Group report, we are reviewing the Medicare Benefits Schedule.
The review will ensure that the MBS is based on contemporary clinical practice.
During the public consultations on the MBS review, more than 93 per cent of health professionals surveyed agreed that parts of the MBS were out-of-date.
The MBS is not the only part of medical practice or indeed general practice that needs to be dragged into the 21st century.
Another example is use of information technology,
The Government is taking steps to finally make the breakthrough on the digital patient records.
We’re rebooting the national system, now called My Health Record.
We have also announced major changes to mental health care, to provide people with the right level of care for their problems and match services to regional needs through our Primary Health Networks.
And we are tackling the big ongoing issue of getting the right health professionals, with the right skills, into the areas where they are needed.
This is essential for meeting the future health care needs of the population.
We are investing more than $1 billion a year in programs to build the health workforce and direct it especially to under-serviced rural areas.
Around one fifth of this, or $200 million a year, goes on the AGPT program.
We have significantly increased the number of training positions funded under the AGPT program and targeted more of these places to rural areas.
Between 2008 and 2014, the number of government funded training places doubled from 600 to 1200.
The current Government provided an additional 300 places annually from last year – which means by 2017 there will be an additional 900 GPs to care for Australians.
People in rural communities have poorer health outcomes and the shortage of doctors is a factor in this.
At the start of this year, nine new regional training organisations began delivering the AGPT program in 11 training regions across Australia.
In addition, to support and expand the rural and regional health workforce, I announced last December an Integrated Rural Training Pipeline, with funding of $93.8 million over four years.
It’s called a pipeline because it will allow medical graduates who are interested in rural careers to complete more stages of their training in a rural area.
There are three key components to the pipeline.
$14 million a year will be provided to universities to create up to 30 new regional training hubs across rural Australia, starting next year. .
These training hubs will coordinate rural training opportunities from undergraduate through to vocational training.
Secondly, also from next year, we will provide more than $10 million a year for a Rural Junior Doctor Innovation Fund, to fund general practice rotations for junior doctors undertaking their internship in a rural area.
And finally, we will provide up to 100 new specialist training places in rural areas, in two tranches of 50 places in 2017 and 2018.
I remain committed to 50 per cent of general practice training being undertaken in rural and regional areas.
At present, we have an oversupply of graduates wanting to take AGPT places which provides a further opportunity to target places to rural candidates.
Last year the department received 2,450 eligible applications for 1,500 AGPT training places.
I am hopeful that the RACGP and Australian College and Rural and Remote Medicine will take a greater role in selecting entrants to the AGPT program in the future and have invited them to submit proposals outlining how they would do this.
A proposal under consideration is that the RACGP would select 90 per cent of the registrars and ACRRM would select 10 per cent.
I am sure that all of you agree that governments should target their health spending to activities which will make a difference to Australians patients.
We continue to provide direct support to General Practice Registrars Australia to help GP registrars progressing through their training.
GPRA will also continue to be consulted on GP training issues.
Over the next three years, GPRA and the Indigenous General Practice Registrars Network will receive $1.9 million of core funding to support the important role that GPRA plays with our future GPs.
The health gap between Indigenous and non-Indigenous Australians is a matter of continuing concern to the whole nation.
Supporting more First Australians into medical careers will assist health outcomes, directly and indirectly.
I am very pleased therefore that the number of Aboriginal and Torres Strait Islanders completing their medicine degrees and moving into training for medical practice is growing fast.
Last year, there were 25 Aboriginal and Torres Strait Islander GP registrars.
This year, it is up to 44.
Those are still small numbers but what a terrific increase in percentage terms.
Every registrar from an Indigenous background is making a difference. It can be a tough and challenging route and I have no doubt that in the past it has been quite a lonely one.
As the numbers build, it inspires others to pursue the dream. And to all of you here today, I congratulate you for coming this far and wish you all the best in the remainder of your journey to become practising GPs.
I hope of course that many Indigenous doctors in training will choose practice in rural, regional and remote areas, along with many non-Indigenous doctors.
The Government is being thorough in assessing everything that we do in the health portfolio and how we can do it better to improve the health of Australians.
We are continuing to improve the efficiency of health services and programs, at every level.
We continue to reduce duplication in services and fill in gaps. We are cutting red tape for doctors and other health services.
And we are building a strong workforce which is well matched to the needs of Australian patients.
General practice will be at the centre of the revitalised health system which we are building.
You will be amongst the first wave of GPs to begin your careers with these improvements in place.
I think that is really exciting and I am sure you do too.
I am very pleased to have played a role, as the Minister for Health, in lifting our health system into the 21st Century.
But the role that you will play in caring for the health of your patients will be more important.
I wish every one of you a successful and rewarding start to your careers, and for now, a very productive and informative conference.
Australian Institute of Health and Welfare (AIHW) reported in mid-2015 – quoted in PHCAG Final Report Executive Summary.