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Thursday, 25 August 1994
Page: 390


Senator CROWLEY (Minister for Family Services) (3.49 p.m.) —I think this debate today is interesting. That might be the best way I can describe it. Senator Sandy Macdonald has worded his call for a matter of public importance in a curious way, but I presume he is concerned about the declining number rather than just noting it. I take that from the tenor of what he has been saying.

  I think it is always timely to talk and think about what is happening in various regions of Australia, particularly rural Australia. The point Senator Macdonald raised about general practitioners in rural Australia is well worth our thinking about, particularly in the light of what the government has done, is doing and will continue to do to restructure general practice and assist doctors to either return to general practice in rural Australia or consider moving out there and taking it up.

  I do not think it is possible to talk about health care in rural and regional Australia without talking about allied health professionals. The government wants to contribute to this debate this afternoon by my making some more generalised comments and commenting on particular details of the funding. Then Senator West will take up the issue of allied health professionals and, very high on the list, the great contribution to good health care in rural Australia of the nurse, and Senator Murphy will follow by picking up Senator Macdonald's points about other matters, including indemnity.

  All of those are very important issues—there is no doubt about it—but it is also important to recognise that the government has known this, accepted it and addressed it. In fact, Senator Macdonald can raise many of the issues and points that he did precisely because this government has actually already put funding into them.

  It is true, first of all, that the number of medical practitioners in rural areas is in fact not declining but has stabilised. There was a slight increase in the number of doctors in rural and regional Australia in the early 1980s. In fact, that figure has not changed terribly much since 1984, but it is certainly not declining. We have an insufficiency of general practitioners—I think everyone would agree that it would be better if there were more doctors—but, as Senator Macdonald has already said, we cannot force doctors to go into rural or regional Australia. This government has recognised the problem and is providing a number of different kinds of incentives.

  I cannot, in the time available to me, cover all the points Senator Macdonald has raised, but I think it is important to recognise that we need data and facts about the numbers of doctors and the services that are being performed in these areas. We have to recognise that there are relocation grants, one-off incentive grants of $20,000 to GPs to assist with the relocation. Also, there are training grants, individually based grants of up to $50,000 for relocating GPs—particularly to rural areas but also to very remote areas.

  I think it is important to know that under this scheme two doctors have gone recently to Utopia and Kintore. Indeed, for the record, I believe these are the places visited by the Leader of the Opposition, Mr Downer, in recent times. Perhaps he forgot to come back and give that piece of information to Senator Macdonald. But it is important to know that those relocations are happening. In fact, the relocation grants, the training grants, are making a great contribution to those changes. Those people are moving out there.

  It is interesting to note whether it is just money. I am not sure, but I think Senator Macdonald alluded to the training of doctors and whether or not they have the confidence and the skills to practise some of the procedures and other things that are required of a general practitioner—all the way from setting bones and attending car accidents to delivering babies and so on. A lot of doctors and medical students have reported that they are not sure they would like to be left to do those things in an area where they did not have somebody down the phone that they could ring up or refer to, either for themselves for professional assistance or for the patient. This puts a tremendous pressure on doctors and students and I think it is actually one of the things that are now being addressed, perhaps not sufficiently, in undergraduate courses.

  So we do want to pick up a number of things to encourage doctors to return to or go to rural and regional Australia. One is seeing whether we can select medical students from those areas or encourage people from those areas to consider taking up medicine. Another is changing some of the undergraduate teaching and focus so that all of the students coming out of our medical schools have that kind of new confidence and a wider range of skills.

  As for medical indemnity, the points Senator Sandy Macdonald raises are important, and the answer incorporated today addresses most of those issues. I find it very interesting that, at the same time as the number of doctors providing obstetric care is significantly declining, we have a very significant resistance to alternative carers, particularly midwives, who have been able to provide very adequate delivery care. That has not been taken up in very significant numbers, at least in a number of places. Indeed, it is being fought rigorously by the college of obstetricians and gynaecologists.

  So we have a solution that may well pick up one of the problems of care in terms of having assistance for parents, particularly women, at the time of delivery, but that is being resisted. The doctors seem to be saying, `We do not want to do it, there is a danger that we could be sued, there are very large costs entailed and we are not sure about the competence,' while down the road there are nurses and midwives who are saying, `We are very comfortable doing it,' yet they are being opposed and resisted.

  I believe we should be looking at not just GPs out there but also the package of health services that might allow the best use of what used to be called manpower and what we might now want to call allied professional power—nurses, doctors and other services, whether they are educational or social work, or state facilities or Commonwealth facilities.

  One of the interesting things about this has been the federal government's response through incentives: the relocation and training grants, the remote area grants, the continual medical education and particularly—this is the other point Senator Macdonald mentioned—the importance of a good locum service. We cannot have doctors who do not have that confidence. It might be an even greater requirement for those doctors who are just going to drop into a practice without necessarily knowing that local community and so on. The locum service for rural Australia is a very big challenge, I think. The government is picking up and addressing that, along with undergraduate support.

  I believe there is a need for recognition, as Senator Macdonald said in relation to programs in New South Wales, by doctors themselves that they have to change their thinking, approach and attitude. There is evidence that those things are changing a whole lot. I know that in my own state there are very significant incentives for doctors to relocate all the way to Port Pirie. Some people would say that Port Pirie does not even deserve the title of rural and regional. It might be regional, but it is not too rural or isolated. So far there is nobody prepared to make that move while, on the face of it, the financial incentives are very significant indeed.

  It is still interesting to see why those changes are not happening. It may well be that we have to look at an almost 10-year time frame, a generation of medical students and university teaching, before we see a significant change in those processes.

  It is an interesting debate that Senator Macdonald brings here and I think that he has trawled across a lot of the issues with a fair amount of reasonableness. The point I would like to close with, though, is that the government very much recognises all of these issues. It has clearly seen the value of incentives.

  It is also very clear that we cannot do this without the cooperation of the medical profession. I have been around over the last 11 years, since the medical profession was definitely against us, digging little trenches around the place and not wanting to talk to government at all. It is since we have got rural doctors, the AMA and government working at trying to get the best outcome that we have seen those changes, the best cooperation.

  I think the rural general practice changes fit very well with the restructuring of general practice across urban as well as rural Australia. I think these are the things we need to encourage. We are talking about a different kind of doctor, a more confident and more skilled doctor, and one I hope who has no trouble at all working with his or her professional colleagues out there—in particular, the great nursing profession, which has been out there when the doctors have been inclined to leave. While Senator Macdonald does well to draw attention to a challenging problem, I am delighted to have the opportunity to tell him that the government has known about it, has been talking about it and is addressing it.