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Wednesday, 22 August 2012
Page: 6137


Senator NASH (New South WalesDeputy Leader of The Nationals in the Senate) (17:12): Some time ago Dr Paul Mara from Rural Doctors Association had a conversation with me about the inequities that he saw with the incentives to try to get doctors out to regional areas. That was, I guess, the seed for this inquiry; it grew from there. It certainly created the drive for it.

I thank my Senate colleagues for agreeing to hold this inquiry. I think that it has been one of the most important pieces of work we have seen for regional health for quite some time and I really do thank them for their agreement to initiate this inquiry in the first place. I thank also my colleagues the shadow minister, Peter Dutton, and the shadow parliamentary secretary for regional health, Andrew Laming.

There is no doubt, as everybody knows, that there is an enormous inequity when it comes to health between regional communities and the cities. We have just reflected in this committee the solutions that people have brought to us. We have just reflected in this committee the thoughts that are out there, the extremely good commonsense thinking that is going to create a better future for health in regional communities.

But it is going to take commitment to change. There are so many good solutions out there that hit a wall and go nowhere because we have not seen enough commitment to change, and that, I think, is one of the key things that we need to take out of this entire inquiry. We have made, I think, 18 excellent recommendations, but we need from both sides of parliament a real commitment to change.

Initially, the driver was the issue around the workforce incentive programs.

It was and is—this issue still exists—completely stupid to have the same incentive for a doctor to move from the city to a small town like Gundagai, which is under huge pressure when it comes to GPs, as the incentive for a doctor to move to a place like Wagga, which has around 60,000 people and has a specialist support network. To have the same incentive applying to doctors moving from Sydney to Gundagai or to Wagga is just completely stupid. It is bleedingly obvious—pardon the pun—that that needs to be changed, and that very much came through during the inquiry.

Also, for rural generalists, we need to have GPs who can do the general procedural things as well. All the evidence showed that that has really slipped away. We have got to get a focus back on those medicos who obviously provide a great GP service but who also have the training so that they have the procedural skills to be generalists. It is vitally important that we do that.

We also noted very clearly that there is an inadequate supply of rural placements for medical interns. This needs to be addressed. There is no point getting all these students through the system if, once they get to that point, they cannot get an intern place. The quota that is currently required is 25 per cent of students from a rural background. The definition needs to be changed. Currently you have to have spent five years of your life in a rural area somewhere. We figure that is not good enough. We want it to be students who spend either four of the last six years of secondary school in a rural area or four of the last six years with their home address in a rural area, or city students who show rural-mindedness, that being an orientation to work in a rural area, which they would support by a willingness to be bonded.

We also need to look at the 25 per cent rural medical student intake and make sure that we have clarification of where that is not being met. It is vitally important that universities are not allowed to slip that under the radar. It is a requirement, it should be shown to be requirement, and we need to have clarity around those figures. We also need to support rural GPs who provide training. That is vitally important. It should be support both financially and by providing locums to help them. We need incentives to ensure that medical students are encouraged to study at regional universities.

We have done a lot of work around allied health, and it is big-picture stuff. We need to look at the interprofessionalism, if you like, of how health in the regions works. We were looking for things outside the square and we were particularly impressed with the Charles Sturt University proposal for a full-scale medical school. Obviously, students from a rural background studying in a rural area are far more likely to stay in a rural area to practise their profession.

I thank my colleagues. I commend the report. I certainly hope that the government pays attention to it. This is not a report to be thrown under the carpet. There are some very good recommendations in this and we absolutely hope that they are acted upon.