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Monday, 23 May 2011
Page: 4284

Dr SOUTHCOTT (Boothby) (21:40): My grievance tonight is about another area of government waste. It is not the pink batts and it is not school halls; it is the GP superclinic program. It all sounded so good back in 2007 when Kevin Rudd said he was going to establish these things called GP superclinics. What he did back in 2007-08 was to announce $280 million in spending for 36 GP superclinics. More than three years later, there are only 10 that are in operation around Australia, but the government has gone further and announced another 28 GP superclinics at a further taxpayer cost of $370.2 million. So, since the government took office, they have committed more than $650 million to this program.

The concept of a GP superclinic is to combine general practitioners and allied health under one roof. This is not a new idea. As I travel around Australia, I have seen family practices and medical centres that are co-located with physios or that have diabetes educators or speech therapists in their room. In fact, as a medical student more than 20 years ago, I worked in a medical centre which brought together general practitioners and also had pharmacy, allied health and physio all under the one roof. It was not called a superclinic; it was a medical centre—and it was not funded by taxpayers either. Going around Australia, in towns and in suburbs you will find many medical centres and family practices that have combined general practitioners with other allied health—with diagnostic imaging, diagnostic services and pathology. These clinics are not called GP superclinics, yet they do the same thing, and they have been funded by individuals, by the private sector and by the practitioners themselves. They have been built from the ground up, and they are connected with their communities. These extended practices have been part of our community for a long time.

As we know, the GP superclinic program has consistently underdelivered. Less than a year ago, there were only two GP superclinics in operation; now we have 10. So, after more than 3½ years, only 10 of the total of 64 superclinics are in operation. Only three of the original 36 clinics were fully operational in the government's first term in office. At the government's current rate, it will take another 23 years to have all 64 GP superclinics fully operational.

In estimates, the Department of Health and Ageing has consistently held to the position that the locations of the GP superclinics were a decision of government. We all know what this means. What it means is that Health Minister Nicola Roxon is sitting there with the ALP national secretary with a map, working out which Labor member has a seat that needs to be shored up. Who do they need to shore up electorally by announcing a GP superclinic in their electorate? The decisions were not made on the basis of district of workforce shortage, for which there is an extensive database in the Department of Health and Ageing. They were not made on health need; they were made on political need for these seats. What we know is that the Department of Health and Ageing had no input at all into the process of selecting the locations of the GP superclinics in either the 2007-08 announcement or the 2010-11 announcement. To put that in some perspective, the 2010 announcement was made in the May budget. The government did not consult with the department about the locations but determined the locations during the caretaker period, which was during the election campaign. The locations were selected to ensure the political health of the Labor Party rather than the health needs of the local communities. They were designed to shore up vulnerable Labor members in marginal seats.

On the needs for superclinics, there was no market failure requiring government intervention or the use of taxpayers' hard earned money to remedy. The government funded superclinics were created in direct competition to those that have been set up and funded voluntarily by the private sector. Some pre-existing GPs have claimed that the superclinics are cannibalising their existing practices for patients. This is confirmed by the admission that the Department of Health and Ageing did not undertake an analysis of existing primary health care providers before the locations of GP superclinics were decided by the minister.

You need only look at the fact that some GP superclinics are failing to attract GPs. The Modbury superclinic, one I know well, was opened without a GP. It is a fantastic building with everything there, but the problem was that there were no doctors and no nurses. There was no GP for almost four months. They have actually had to get locums in to staff the superclinic. The director of GP superclinics within the Department of Health and Ageing, Anne Thorpe, has said that some other clinics are finding it challenging to provide the services they were set up to deliver. So we know that some of the GP superclinics are struggling. But only 10 of them are operational, so how much hope can we place on the viability of this $650 million program? More importantly, the GP superclinics are contracted to remain in operation for a minimum of 20 years, so it remains to be seen who will finance the clinic if it experiences operating losses throughout this time frame. Will the government be bailing them out?

There is also a lack of accountability on the GP superclinics. The data being presented by the government on the current use of GP superclinics is based only on self-reported figures from each of the clinics. The Department of Health and Ageing is undertaking no accurate analysis of the services being provided. A figure of $650 million apparently buys no accountability and no compulsory reporting. The GP superclinics have all the credibility and accountability of a Soviet tractor factory plan.

The Department of Health and Ageing has also admitted that the amount of funding determined for each clinic was also a decision of the government—again, Karl Bitar and Nicola Roxon sitting in a room and working it out based on who needs what. There is no record or public justification as to why the money was spent where it was—why one clinic received $3 million but another received $15 million. Nicola Roxon decided these things unilaterally based on nothing more than her generosity and the government's political needs on any given day.

Under a coalition government it would have been very different. The coalition has always strongly supported general practice as the cornerstone of primary health care, and this will always be the case. However, we do not believe that GP superclinics were the answer. We believe we should be supporting the general practices that are currently in existence, encouraging them to expand and to bring in more people and to build on what is already there. We should be providing grants to existing general practices to allow them to further develop their own infrastructure, for training and teaching rooms, for accommodating existing doctors, for expansion of integrated allied health services, for multidisciplinary care and for the extension of after-hours opening times. We should be encouraging the existing practices around the country to expand voluntarily, not placing government funded clinics just around the corner in direct competition to them. To encourage existing practices to expand is a considered approach, and it is one that has been arrived at after consultation. It is an approach that is backed up by the AMA. Their president, Dr Andrew Pesce, has stated that the priority should be to build on the GP services that are established and working, not to compete with them and run them out of business and not to reinvent the wheel.

The $650 million program from the GP superclinics could have been better spent on directly funding existing and established practices. According to figures provided by the department there are more than 7,000 general practices around the country. The $650 million, if it were divided evenly amongst those clinics, would have provided a $91,000 infrastructure grant to each and every general practice in the country. Alternatively, that same money could have provided $182,000 to half the clinics or $365,000 to one-quarter of the general practices. This approach would have provided much better value for the taxpayer and much better value for money and would have seen more results than the paltry 10 clinics around Australia that we have now. Instead, the government has provided grants of up to $15 million each to a select 64 clinics in a select 64 locations, through a process with no accountability, to compete against the age-old family practices which got where they are because of a lot of hard work.

The DEPUTY SPEAKER: I was loathe to interrupt the honourable member; however, under standing order 64 he ought not refer to the health minister by her name.