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Standing Committee on Petitions - 25/11/2009 - Petitions presented up to 19 October 2009

CHAIR —Welcome. Regarding the petition on the change of rural status of Gawler, South Australia, I have noted that in the minister’s response he had discussions with local doctors regarding transitional arrangements pursuant to the introduction of the new system, including grants to assist with the transition. Could you tell us a bit more about those discussions and what the outcome has been?

Mrs Bennett —There were a variety of meetings preceding the meeting with Minister Snowdon and the local doctors, including broader meetings with the whole of the doctor community and others. As a result of that first meeting, the Gawler community presented their transition plan. It had a number of areas where they wanted to see some action. Some of them were things where, frankly, they had a misinterpretation of the impact of the changes and there were areas where they thought they would be unnecessarily disadvantaged that were not in fact right. A good example of that was their belief that they would not be eligible for any after-hours grants. This is not the case.

CHAIR —Are they fully aware of that now?

Mrs Bennett —They are. We have written to them a number of times and following their meeting with Minister Snowdon he also wrote to clarify that they were eligible to apply for those grants. They originally declined to apply but have now, on 30 October, put in an application for funding under the after-hours program. That application is currently being assessed, but they certainly do meet the eligibility criteria broadly. So I think that has been now clarified.

They thought they were not eligible for the after-hours grant, but also there is a link between the after-hours program that the Commonwealth funds and their capacity to deliver services to accident and emergency under another arrangement funded by the South Australian government. So they felt that if they could not get the after-hours grants that their accident and emergency arrangements and support would also fall down. So in clarifying the first we have been able, hopefully, to clarify the second misunderstanding.

There were other areas where they felt that they would no longer be eligible for district of workforce status because of the change to ASGC-RA. That too is not right and I think they now understand that is not the case. District of workforce status is a metric that is separately developed and they will be eligible whenever they meet the criteria for district of workforce shortage.

CHAIR —When do you think they will meet the criteria?

Mrs Bennett —It just depends.

CHAIR —You have just stated ‘whenever’.

Mrs Bennett —Yes. It is a measure based on national average supply of GPs and it is computed quarterly. Depending on how you compare with the national average at the time, you either are or are not eligible. So their capacity to be eligible for that is not changed by the ASGC-RA. It is probably worth saying that Gawler always was, until October 2007, classified under the previous system as a capital city. It was until October 2007 RRAMA 1. It is 40 k’s from Adelaide. It was a decision of previous Health Minister Abbott in October 2007 to reclassify Gawler to be RRAMA 4, which is a rural district. So there was a one-off reclassification. The introduction of ASGC-RA is obviously a move to a national system. The purpose of the change is to update from the very outdated 1991 based RRAMA population figures, to which many programs were previously linked. You would appreciate there have been a lot of population movements since 1991, so it is fair to say ASGC-RA was felt to be overdue. It goes back to the evidence and to the formal classification system, in line with the evidence. It is a system maintained by the ABS, so it is independent but based on, obviously, the most recent and up-to-date census figures. In applying that new system nationally to the latest data, Gawler found itself back where it started, which is back to being considered a metropolitan area.

CHAIR —Will the application of ASGC-RA result in any loss of medical services in the area?

Mrs Bennett —We do not think it will. We have looked closely at the various programs that are linked to ASGC-RA, and we have come up an with absolute maximum potential of three doctors on a rural training program. However, we actually do not think that there will be any loss—

CHAIR —So you feel there will not be any loss of training.

Mrs Bennett —No. While Gawler will not be eligible for that rural pathway, they will be eligible to get registrars under the general training pathway. One of the other measures that the government has introduced at this time substantially increases the number of doctors under training. The number of doctors on the general pathway will substantially increase around the same time, so we think that their capacity to attract doctors under the general pathway will more than compensate for their theoretical, potential loss of three people on the training pathway. That does not mean that we actually think they will lose any medical practitioners. The one program where we think there is a notional loss is that rural training pathway, but we think it will be completely compensated for.

Mr BROADBENT —I feel for these people. They are fighting the fight that everybody is fighting right across Australia. They are no different to anybody else. It is much easier for a doctor to work in the surrounds of Adelaide with all the facilities there, rather than going to Gawler. This is being run out right across the country though.

Mrs Bennett —It is.

Mr BROADBENT —This is happening in Gippsland. I think it is called getGP.

Mrs Bennett —I do not know, but there are obviously shortages across pockets around—

Mr BROADBENT —I am not talking about shortages. You have made this change right across Australia. The department has been waiting for a change of government for a long time, in my opinion, to make this change. It is a difficult change. There have been changes in Victoria, which I have been very close to. I take it that exactly the same application of policy has gone right across the nation, including Gawler. Therefore, have you monitored whether you have had the same effect in Gawler as you have had in Gippsland or in other parts of South Australia, Queensland or New South Wales? Have you changed all the regions?

Mrs Bennett —That is a complex question. Essentially, the changes will be rolled out across Australia. We are saying that most of it does not kick in until July next year. There has been no loss of anyone anywhere because the changes are complex in terms of getting Medicare systems changed.

CHAIR —So we should have an indication in July 2010?

Mrs Bennett —No, that is when it begins to rollout. We then have to ensure that no individual doctor anywhere in the country will lose money. There are grandparenting arrangements to be put in place for three years. The impact overall on Australia will be that 500 additional communities become eligible for incentives. The overall impact is substantial in terms of the positive side. ASGC-RA has five categories and most programs in category 2 to 5 will be eligible and that increases the number of areas that are eligible for most things in the change. We estimate that over 2,400 individual doctors will become eligible for the first time for a range of incentives and 500 communities. There are, as far as we can see, only three communities in Australia that potentially will be losers. But as I said, any losers are grandparented anyway—that is, Gawler and Sunshine Coast; sorry, two communities, not three.

Mr BROADBENT —How far is Gawler from Adelaide?

Mrs Bennett —40 kilometres.

Mr BROADBENT —It is outer metropolitan?

Mrs Bennett —As its classification now is part of the urban area, it is eligible for outer metropolitan incentive programs. As you would imagine, the Sunshine Coast has had substantial population change since 1991.

Mr BROADBENT —They would get the positives from the workforce participation exercise because they are outer Adelaide?

Mrs Bennett —They get anything that an outer metropolitan area is eligible for.

Mr CHESTER —You referred to 2,400 doctors and 500 communities. Where are they located? Are they outer metropolitan or inner regional?

Mrs Bennett —They are essentially inner regional. What used to be the case is most programs under RRMA were eligible in RRMA 3 to 7. There is not a precise match between the RA and the RRMA boundaries, but essentially the RA 2, which is just outside metropolitan—the regional towns—become eligible for many things for the first time.

Mr CHESTER —The grandparenting arrangements have calmed a few people down, but concerns have been expressed in regional communities that in future it will be more difficult for them to attract skilled health professionals if they are competing with, say, an outer suburban area that may be 100 kilometres down the road. They are concerned about being able to get people to move that far.

Mrs Bennett —Yes, people are concerned but, essentially, in the new program the incentives will be structured around ensuring that the more remote areas get the bigger incentives. There is clear government policy to acknowledge that the biggest gaps and the most disadvantage, despite people having their own personal concerns, are in the most remote areas. Incentives are structured to really address the most severe shortages that exist.

Mr CHESTER —And the remoteness criteria relates to physical distance from the metropolitan area?

Mrs Bennett —It is slightly more complicated—and this is where it gets a bit hard for me.

Mr Dennis —I think that is a good summation. The further from the metropolitan centre you are, the more remote you are deemed to be, and the greater the road distance to goods and services really defines individual remoteness. As Mrs Bennett said, the greater that distance the greater will be the reward in the incentive programs.

Mr BROADBENT —Have we made the whole of Tasmania remote yet, David?

Mr Dennis —The remoteness that is naturally in Tasmania has been recognised, including that Hobart has been made a regional centre and eligible for the first time.

Mr BROADBENT —Because they are not attracting the professionals?

Mr Dennis —That is correct.

Mrs Bennett —Whereas in the previous system they were just classified as a capital city and not eligible. Similarly Darwin, which used to have a lot of problems, was ineligible for a lot of this support because it was a capital city.

Mr BROADBENT —So the government has been generous in this change of policy?

Mrs Bennett —That would be my assessment.

Mr CHESTER —I have one question. You referred earlier to the Gawler situation and the previous minister exercising some level of discretion. Under the new arrangements, is there any opportunity for ministerial discretion or is it strictly lines on a map decide whether you are in or out?

Mrs Bennett —The government has been absolutely clear that it has no intention of exercising the one-offs. Frankly, Gawler was not the only one. Over the years there were all sorts of one-off arrangements that had been made. So we not only had the base of RRMA being outdated but also all sorts of weird and wonderful personal arrangements. Certainly the minister has, I think, been very clear to date that they do not wish to move beyond having in place a system which is based on evidence. RA, unlike RRMA, is updated by the ABS every census, so it should remain current—and they intend to stick with that.

CHAIR —Thank you very much for your attendance today. The committee appreciates your assistance. If we have any further questions from the committee, the secretariat will contact you. I thank everyone for their participation. The commitment of government departments to the work of the committee and thus to the work of the House is much appreciated. I would also like to place on the record my thanks to our wonderful team, our secretariat, and to Hansard.

Resolved (on motion by Mr Chester):

That this committee authorises publication, including publication on the parliamentary database, of the transcript of the evidence given before it at public hearing this day.

Committee adjourned at 11.52 am