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Senate Select Committee on Health
05/02/2015

JOHNSON, Ms Jennifer, Chief Executive Officer, Rural Doctors Association of Australia

[10:01]

CHAIR: Welcome. I invite you to make an opening statement and then we will follow with questions.

Ms Johnson : Firstly, I would like to table an apology from our president, Professor Dennis Pashen. He is unable to be present today. He is doing some locum work in Tasmania but he is going to be in Canberra next week and quite regularly thereafter. Senator O'Neill, he has an appointment to see you next week. We are also quite happy to organise appointments with other members of the committee at mutually convenient times. I point out that I am not a clinician, but if I cannot answer questions I am certainly happy to take those questions on notice.

I will confine my opening remarks to some commentary on the recent announcements regarding proposals for the MBS system and the various other changes that have happened over the last few months. The Rural Doctors Association of Australia is strongly committed to the provision of quality health care and the improvement of health outcomes in rural and remote communities. We welcome the intent in the recent announcement of the Minister for health to consult widely with stakeholders.

We believe there is a general willingness in the rural doctor community, in particular, to engage in discussions about future sustainable funding models which will promote accessible and high quality health care and sustainable rural practice. However, the consultation is really important because it is necessary not only to obtain a variety of perspectives, because none of us is experts in everything, but also to minimise the potential for perverse outcomes. I think that is really important.

We believe that a number of factors must be taken into consideration during these discussions, and I will summarise them briefly. Firstly, rural health outcomes are poorer—and I do not need to elaborate on this. We put some more statistics in our submission, but I am sure you are all well aware of that. Secondly, quality primary care provides a very strong return on investment for the healthcare dollar—and, once again, I will not elaborate on that in my opening statement. I am sure that there have been lots of stakeholders who have made that point.

New funding models must incentivise and reward quality of care. In addition to sustaining the longer term sustainability of Medicare, funding models should focus on quality rather than throughput and reward doctors who provide the services that are needed in their communities. This is especially important in rural communities, where we need to get the focus away from just having any doctor in the community for the sake of a number to having appropriately skilled and supported doctors who can provide the services that are needed in those communities. They must also build community and workforce capacity in terms of both numbers and skill sets. Once again, this is really important in rural communities, where medical services are very important in the social and economic fabric of those communities.

Detrimental impacts on rural practices will also flow onto other healthcare services in rural communities. I think this is an issue that is largely ignored. Rural doctors traditionally provide a range of primary and secondary care services and some tertiary care services. For example, a rural doctor who is working in his or her general practice will also most likely be providing visiting medical officer services to the local hospital. They will probably be providing mental health services and counselling, they will be teaching medical students and they will be providing after-hours and emergency services. They may be providing more advanced procedural services.

For this reason, there must be a holistic approach to developing and analysing the impact of the proposed policies. For example, if a rural practice is forced to close or it loses a doctor because of economic circumstances, then that will flow onto the local hospital, which will have less doctors to fill its after-hours rosters and to provide emergency and secondary care. This in turn will compromise the ability of communities to access after-hours services. It will lead to a downgrading of services in the hospital and then we get into that awful downward spiral. The unfortunate end point may be a total downgrading of services to those rural communities. Practices may be forced to cut back on staff and that not only impacts on service delivery but also has broader economic and social implications for the wider rural community, as I previously mentioned.

Economic fragility and uncertainty in rural practices limits the availability of training posts for GP registrars and students. This is another really important aspect. This is counterproductive, because fewer opportunities to experience rural general practice will reduce our potential pool of future rural doctors. The evidence is strong that students from a rural background and students and junior doctors who have positive and longitudinal training in rural areas are far more likely to go back and practice there.

General practices are also small businesses. Rural practices, in particular, tend to be more economically fragile. Because of their circumstances, they are less able to change their business models and particularly to change those business models quickly. Rural doctors often take significant business risks and they make considerable personal investment in these practices. It is quite often difficult to recoup that investment. It is not unheard of for doctors to not be able to sell their practices and to just walk away from them if they have to leave.

The proposed freeze, for example, on the indexation of MBS rebates will make it even more difficult for rural practices. Many will need to pass on additional costs to patients. We then look at the combined impact of a co-payment and a freeze on MBS indexation, given that—say, in three years' time—it is going to result in a much, much larger out-of-pocket cost to patients than simply the co-payment alone. We cannot really consider any policy in isolation, particularly when it comes to rural areas, because it is a complicated network of service delivery and funding models. The current atmosphere of business uncertainty is making practice owners more reluctant to make significant practice infrastructure investments, particularly in rural areas. It is also making practices far more cautious about employing staff and particularly about employing GP registrars. This is something we are really concerned about.

This flows onto my last point, which is that general practice and particularly rural general practice must be an attractive career option. We are very concerned that the current atmosphere of uncertainty is deterring medical students and junior doctors from a career in general practice. Certainly, we are more concerned that the funding models will really deter them from rural general practice. The proposed deregulation of higher education may also have significant negative impacts not only on the capacity of rural and remote students to undertake medical degrees but also on workforce distribution. It is quite likely that students are going to choose to work in more lucrative aspects of the medical profession rather than in general practice and certainly in rural general practice. I am saying that purely from a business perspective, because we working very hard to make sure that rural general practice is seen as a strong and interesting career option for medical students. There has been a lot of good work done in that area. It would be a pity to be taking backward steps when we are just seeing positive progress.

There is also a strong need to provide prevocational exposure to rural general practice for interns and junior doctors, because they spend those years mostly in hospital based environments in larger metropolitan and regional areas. The previous Prevocational General Practice Placements Program provided them with that important exposure. We do desperately need a replacement for that program.

Just to summarise quickly: we believe that the circumstances and needs of rural communities and rural medical practices must be given particular consideration in the development of new policies and funding models. These circumstances include generally poorer health outcomes, maldistribution of medical workforce—and we are talking both geographically and in terms of skill sets—and the ongoing difficulties in accessing healthcare services in many rural communities.

It is important that the rural incentive programs, which are very welcome, are continued and we have supported the adoption of the modified Monash model as a new rural classification system that will be used to determine levels of incentives. We believe that is a positive step forward. Thank you.

CHAIR: Thank you very much, Ms Johnson. Can I just ask for a bit of an outline of the degree and nature of consultations you have had with the incoming new minister.

Ms Johnson : We have met with the new minister on one occasion to date and we have certainly flagged our willingness to engage in further positive and productive discussions. As I mentioned before, I think that there is a general willingness for the general practice community to engage in discussions about what funded models should look like into the future. We meet regularly also with the Assistant Minister for Health, Senator Fiona Nash. We are obviously willing and ready to engage significantly into the future, if that opportunity arises.

CHAIR: You have already been having regular meetings with the assistant minister, Senator Fiona Nash—

Ms Johnson : Absolutely.

CHAIR: Throughout the period since the Abbott government has come into being?

Ms Johnson : Yes. We have had regular meetings.

CHAIR: Would you call them consultations?

Ms Johnson : Yes, I would.

CHAIR: So there has been a degree of consultation that has been going on?

Ms Johnson : In terms of opportunities to put forward our policy, I have to say that the announcements regarding the MBS rebates, those sorts of issues, were a complete surprise to us as I think they were to most people. The government's intention to make those announcements was not flagged with us beforehand, so we had no idea.

CHAIR: So you must be a little concerned about the word consultation, given the fact that you are the first person actually to say to us that you have had consultations on a regular basis with a member who lives in a rural area—now we have a minister who is from a rural remote area. In light of the fact that you have been having consultations, yet they went ahead with the extraordinary changes to policy—which we have heard this morning are based on ideology, anecdote and personal assertion rather than fact—how can you have any confidence at all that consultations moving forward will be any different?

Ms Johnson : We are just waiting to see to tell you the truth. In the consultations we had with Senator Nash, because obviously we had no idea that the Medicare announcements, for example, were even on the agenda, we have very productive consultations around the rural classification system, the need to design incentives to make sure that they were going to the areas where they were most needed with those issues. So we are hopeful and, as I said, we have made it perfectly clear that we are willing to engage in consultation.

CHAIR: So we have heard this morning about the primary healthcare access and the determination of the government to continue to advance a policy of a price signal and a claim about sustainability that is a lie. They are still going to push ahead with a price signal. Do you have any sense that in the forward consultations there will be any change to that policy about sending a price signal and getting between people and their GP?

Ms Johnson : I think that the minister has made clear that she is committed towards a price signal, and that is as much as we know.

CHAIR: Given that the government is committed to a price signal—and you have spoken about the already significant challenges for access to healthcare in the regions and remote areas of Australia—how can a price signal be at all palatable to GPs who practise in the bush?

Ms Johnson : I am not saying that it is, by any means. Once again, this price signal needs to be taken into consideration, in regional areas in particular, with all the other aspects. We have already stated that a co-payment—a price signal, for example—will probably impact more severely on rural doctors and rural communities. We know that rural patients are far more reluctant to seek medical assistance. That is for a number of reasons—one of which is access. Most times, they obviously have to travel much further to see a GP. We know that economic and social circumstances are quite often poor, and particularly economic situations. In rural communities that might not necessarily be reflected in eligibility for, for example, healthcare cards. So quite often in farming communities you will have people who are asset rich, for example, but cash poor.

One of our concerns is that, because rural doctors are integral parts of their communities, there is going to be increased pressure on them to waive putting increased costs on patients, because they know those people personally and they are aware of what their personal circumstances are. They are the people they meet in the street every day. It is going to put a lot of personal and business pressure on rural practices.

As I pointed out, the other issue is that the totality of the cost. There would be the price signal but the fact that the MBS indexation is frozen will mean that maybe in the first year the out-of-pocket costs will not be so great but, by the time the third year comes around and practices are forced to pass on those costs to their patients, the payment may be more significant.

CHAIR: So the gap between patients in the bush seeking care and their doctors is already larger than that for their city cousins and what is proposed by the government in terms of a price signal will further that gap and very certainly impact negatively on their health outcomes?

Ms Johnson : We are certainly concerned about the impact on access, and obviously health outcomes in rural communities are very strongly dependant on access.

Senator McLUCAS: Thank you very much for appearing before the committee today. I think you have covered the consultation issue fairly well. I come from a regional centre but grew up in a town of 1,000 people where there was one doctor. Over time we have seen, particularly in cities and regional centres, that the number of practices have coalesced and you are getting larger practices. That is good, because you can then have the capacity to buy in other types of services into a larger practice. But, if you take a town of 1,000 people, you probably have a one-doctor practice. Can you talk to the committee about the different business model that that small one- or two-doctor practice has compared to a larger practice where you may have five, eight or 10 doctors and allied health providers, practice nurses and probably someone like a practice manager. That does not happen in the little 1,000 person town. I am trying to understand the level of disproportionate effect on those small one- and two-doctor practices compared the larger practice.

Ms Johnson : As I mentioned, certainly the smaller the practice the more economically fragile the practice. The tradition used to be that a doctor would go out to a rural community and his or her partner would become the de facto practice manager, because there was nobody else available. I think that still happens to a certain extent. I think it impacts particularly on overseas trained doctors with very little experience who go to rural communities, and they are sometimes expected to run a general practice as part of their work in those communities.

The business of running a general practice, as I am sure you are aware, is becoming more and more complex. Not only have we the incentive programs, which, in themselves, require quite a lot of extensive knowledge and administration to make the most of, but also there are lots of red-tape requirements—reporting requirements. So what happens is that rural doctors, quite often, particularly in small practices, actually end up doing a lot of that stuff themselves, as well as attending to what is quite often a very busy practice load and after-hours workload.

That is the other issue. Having come from a rural area myself, I can remember that we would sometimes have to sit in the waiting room—and people did it quite happily because they understood what the burden was on the doctor, but it was not uncommon to go or to ring up and be told: 'No, Doctor is out at an emergency; ring back in three hours time and we'll see how they're going.' That doctor would then, let us say—having maybe been up half the night delivering a baby—get to their practice at nine o'clock, see a full workload of patients, go off to see outpatients at the hospital at lunchtime, and then attend to heaven knows what during the day. That is a huge load, both personally and professionally.

I think one of the important things that we have to do is to look at different models and, particularly, to look at ways in which we can make one-doctor towns into two-doctor towns, or improve the support base, because the other thing that has been shown is: that is a significant deterrent to attracting younger doctors to rural and regional areas. You get a critical mass and people are more inclined to go.

Senator McLUCAS: Have you said these sorts of things to Assistant Minister Nash?

Ms Johnson : Yes. We have. These views are always brought out in our submissions.

Senator McLUCAS: So she knows—

Ms Johnson : Yes, I think she does.

Senator McLUCAS: that the proposals that the government has put forward will have a disproportionate effect on rural doctors?

Ms Johnson : We have made that view quite clear. We have made that view clear in the media. We have made it clear in a number of meetings that we have held with elected representatives in parliament.

Senator McLUCAS: Have you done any modelling on it? I am not talking about the health outcomes. I am actually thinking about the small business considerations around a one- or two-doctor practice in a regional town. It is a hard thing to do—I understand that—but have you done any work on trying to work out how disproportionate the effect on a small practice would be compared to a larger practice? I am not saying that it would not be impacted as well—

Ms Johnson : We have not done any specific modelling in this instance. A number of years ago the Rural Doctors Association of Australia, in conjunction with some other stakeholders, completed a very large project on viable models in rural general practice. I think that the principles around that are still valid. I think the work definitely needs updating, but it is work that would be quite worthwhile to do, I believe.

Senator McLUCAS: Thank you for your evidence today.

CHAIR: Thank you, Senator McLucas. Dr Di Natale?

Senator DI NATALE: Thank you very much, Ms Johnson. There has been a lot of work done in trying to recruit young doctors into rural environments. It is a tough gig, and workforce challenges are ongoing. Have you got any anecdotal evidence to suggest that some of the changes occurring in general practice are dissuading new graduates from deciding to embark on a career in general practice in a rural or regional environment?

Ms Johnson : I think that, because most of those announcements have been recent, it is a little bit too early to tell. What is concerning for us is that we have had reports from rural doctors who say, 'I do not know if I'm going to be able to take a GP registrar next year,' or, 'I used to take three GP registrars; I'll probably only take two.' There are a number of reasons for that. One is that there is this whole atmosphere of business uncertainty. People are not willing to make new investments because literally they do not know what their source of income is going to be or the quantum of the income from that source. That is largely determined by the government, through the MBS rebates—particularly for practices that rely on bulk-billing.

CHAIR: Was that exacerbated by the determination under Minister Dutton to push ahead with that regulatory change that was held up at the last minute? Is that critically a part of this increasing business uncertainty in the bush?

Ms Johnson : I think there is a number of factors there that all contribute to the uncertainty. The fact that there have been changes announced and then more changes. People at the moment are just waiting and seeing. That is unfortunate—

CHAIR: We are all waiting and seeing.

Ms Johnson : If you are looking on from the sidelines, that, combined with the announced changes to GP-training arrangements and the abolition of the PGPPP, will deter some medical students from choosing General Practice as a career at a time when we really need to be focusing on continuing to grow our own medical workforce and when we are starting to make significant progress through rural-training pipelines towards attracting and retaining young, highly skilled and motivated doctors to the bush.

Senator DI NATALE: To carry on from that, the outcome for patients in a regional or rural or remote community is that they will not be able to see a doctor. If they need to see a doctor, they are going to have to wait longer and/or face higher out-of-pocket costs. If we train fewer doctors, that is the reality for someone living in an environment like that.

Ms Johnson : Absolutely. Even though we are making strides, the maldistribution is alive and well. As I also said, we need to get past this place where any doctor is good enough in a rural community. Rural people are entitled to the same access and standard of health care as their urban counterparts. There is a special and wide range of skills that are needed in rural areas. It is a great investment in the long term, but we need to work on it.

Senator DI NATALE: The government has said that if you do not like their proposals, you should come up with new ones. Have you suggested anything to the new health minister that may provide savings as well as improving the quality of care?

Ms Johnson : We are certainly actively working on some options and we will be putting them forward to everybody. Once again, I have to stress that it is really important that these conversations include a wide range of stakeholders—we all have different perspectives. In order to avoid as much as possible unforeseen and adverse consequences, we need to have a broad range of perspectives and stakeholders really need to be brought on board. I think there is a willingness there for dialogue.

Senator DI NATALE: That is the sense I get, too. Do you have any suggestions? Rather than looking at primary care and the language around price signals—which, we have heard a million times, is not going to do anything to improve the sustainability of health care but just shifts the cost onto patients—what would you do? If there were a few things you could change in health, what would you do?

Ms Johnson : We would certainly be looking at ways in which to reward care quality and continuity of care. Rural practices do a lot of that already, and that is really important. Perhaps item descriptors that focus on quality care rather than throughput—maybe some sort of blended funding models—

Senator DI NATALE: Let's explain that for people who are not clear about blended funding. Are you saying fee for service could be one part of how doctors earn their income but it should not be their only source of income?

Ms Johnson : It may well need to be, and it already happens to some extent with rural doctors who also obtain income from providing state based services to rural hospitals. It may also mean looking at the way in which the funding is provided for longitudinal care of chronic disease. That is one issue. We have, together with the AMA, often looked at the rural rescue package, which we are in the process of updating. There are loadings for the isolation in which a service is delivered and also the complexity of that service, so you are rewarding doctors who are providing the services that are needed in the locations where they are needed. There are a number of options around that. Obviously, there are other areas of the healthcare system where there is a potential for quite significant cost savings as well. Particularly in rural areas, it really has to be a holistic approach. Rural health services are just like a big jigsaw puzzle: if you take one bit out and you are left with an incomplete picture and possibly an incomplete range of services.

Senator CAMERON: Ms Johnson, you indicated that your organisation had some discussions with elected representatives in the bush. Do you represent rural and regional?

Ms Johnson : Yes, we represent regional, rural and remote doctors.

Senator CAMERON: How many engagements have you had with elected representatives on a formal basis?

Ms Johnson : We have had regular meetings, as I said, with Senator Nash. We have met with backbenchers, we have met with senators, and we also met with the Minister for Small Business to talk about the issues that were impacting on rural practices as small businesses. We have met with both members of the government and members of the opposition to put forward our views and to obviously advocate strongly for high-quality health care in rural communities.

Senator CAMERON: Given the outcome of the last election, you would have met predominantly with National and Liberal Party members in the rural and regional sector?

Ms Johnson : We make a point of meeting with politicians, elected representatives, of all political persuasions to get our message across.

Senator CAMERON: That is not the point. I am not accusing you of bias or anything. I am just saying that the practical implications of the last election are that, predominately in rural and regional Australia, there are Liberal and National Party members. That is the point I am making. It is not about any bias or anything like that. Do any of them get it?

Ms Johnson : They are aware of the difficulties in accessing health care. I am quite sure that they are aware in their local communities. We have encouraged our members to contact their local MPs with their concerns. I am sure they do. I am quite confident that a number of them have raised those concerns.

Senator CAMERON: In public, have you seen any comments on this from any of those coalition MPs in rural and regional Australia, defending Medicare?

Ms Johnson : I am not aware of a lot of the public announcements, but, as I said, we have made our concerns known privately.

Senator CAMERON: Wouldn't you think that one of the tests of how effective your consultations and lobbying have been is whether a coalition MP comes out and says, 'Rural and regional doctors have got this right. We just can't continue down this track'? Wouldn't that be the test for how effective you have been?

Ms Johnson : We do obviously work very hard to be effective and to advocate for our members and for our communities.

Senator CAMERON: They do not get it, do they?

Ms Johnson : I would not say that.

Senator CAMERON: In your discussions with either the junior minister, Senator Nash, or the rural and regional coalition MPs, have you been able to understand what this is all about? Is it about a budget emergency? Is it about sustainability of the system? Is it about a medical research fund? What is your understanding of why this massive attack on Medicare is being undertaken?

Ms Johnson : The very clear and consistent message that we have been given is concerns about the ongoing sustainability of the healthcare system, and that is why we have been saying that we are certainly prepared to engage in productive discussions to make sure that the healthcare system is sustainable going forward.

Senator CAMERON: So do you disagree with the AMA? Does your organisation have a different view from the AMA, the Newcastle doctors groups, the college, consumer groups and the academics that have given us evidence to say Medicare is perfectly sustainable? Do you have a different view on that?

Ms Johnson : No, we do not have a different view. I think what we are saying is that we would consider any number of proposals, but they must be considered holistically, particularly in light of the way in which services are delivered in regional, rural and remote areas.

Senator CAMERON: Yes, because one of the arguments we have heard is that, if you put the co-payment in place, if you are in a metropolitan area there is another option for a patient. That other option is to present at the emergency area of the hospital. In a rural area—I used to live in Muswellbrook—if I could not afford to go to the local GP, it would be the same GP I would present to in the emergency at Muswellbrook hospital.

Ms Johnson : Yes.

Senator CAMERON: So that is an avenue that is not available to many rural and regional Australians, isn't it?

Ms Johnson : That is another issue that we also made. Another point that we made post budget was the fact that any increase in presentations to outpatients and emergency in rural areas is going to result in one of two things: it is going to result in the local doctor being called away from his or her practice or being called after hours—so it is going to mean an increased workload—or it is going to mean, unfortunately, emergency transfers, which come at an enormous cost.

Senator CAMERON: Has Senator Nash confirmed that this is about budgetary issues in your discussions with her?

Ms Johnson : I do not recall Senator Nash specifically making those comments, but certainly the general impression that I have received in our discussions is that the major concern is the ongoing sustainability of our healthcare system.

Senator CAMERON: Has she presented any evidence at all about the unsustainability of Medicare?

Ms Johnson : I have to say that we have not really discussed the sustainability of Medicare per se specifically with Senator Nash. Our discussions, as I said—before the budget and before this last round of announcements—have been focused on rural, regional and remote incentives. As you are aware, there was a lot of work around that. We have made our concerns known to Senator Nash about what the impacts may be, and I am sure that she has taken that on board.

Senator CAMERON: So you have done that one on one?

Ms Johnson : Yes.

Senator CAMERON: And she has not been able to advise you as to why in the view of many of the submissions we have, even from the AMA, this could destroy Medicare? You have not raised that with her?

Ms Johnson : We have not raised specifically the issue of the ongoing sustainability of Medicare. As I said, we have provided her with our responses to these announcements and to the budget announcements when they were made.

Senator CAMERON: Do you agree with the proposition that the policies that the government is promoting could destroy Medicare?

Ms Johnson : I have to say that I do not think that as an organisation we have discussed that in any specific detail. Given the fact that I am the chief executive officer and obviously very keen to reflect our policies, it is not something that I would be prepared to comment on at this stage.

Senator CAMERON: Given the importance of Medicare to your members, do you think that you may now—after hearing the AMA, reading the submissions from the Newcastle doctors and looking at the college's submissions—want to raise the issue of the future of Medicare with the assistant minister?

Ms Johnson : This is certainly an issue that is, as I said, on our agenda and we are engaging in some more detailed policy work to actually put forward some proposals that we see would promote and ensure the provision of continuity and quality of care in an economically sustainable way.

Senator CAMERON: If Medicare collapses all the incentivisation that you are talking about would be really under a cloud, wouldn't it?

Ms Johnson : Obviously one of our considerations would be maintaining Medicare.

Senator CAMERON: Yes. Do you intend to continue to raise these concerns with rural and regional members of parliament? Would your members have some plan to actually get a change in this destructive policy?

Ms Johnson : We will be continuing to raise these issues. We will be continuing to meet regularly with elected representatives to put forward our policies and certainly to advocate for our members and for our communities.

Senator CAMERON: Given that the minister has not been in a position to tell you whether it is a budget emergency, sustainability or the research fund that is creating this chaotic position, have any of the local members been able to advise you as to what this is all about?

Ms Johnson : Well, once again, as I said the response from members was consistent. My recollection of their response was that there were concerns about the sustainability of the healthcare system and that measures were important.

Senator CAMERON: That was assertions from them, was it—no evidence; just assertions?

Ms Johnson : Yes.

Senator CAMERON: Okay. Thanks.

CHAIR: I want to ask for clarification of a couple of things. Firstly, 'regularly meeting' what does that mean—weekly or monthly?

Ms Johnson : No. We have limited resources, particularly in terms of getting our president and whatever to Canberra. We would aim to have our president down here every couple of months and then we would organise some meetings as people's times permit.

CHAIR: Okay, so every couple of months. I note that Dr Jones in his evidence this morning alerted the committee to the reality that there may be only two more weeks of consultation with the new health minister before more policy seems to be ready to be formulated. You are talking about preparing documentation. Do you have an appointment to see the new minister within the next two weeks?

Ms Johnson : No, I was not aware of those timeframes.

CHAIR: So is that a concern to you, Ms Johnson?

Ms Johnson : We have made it quite clear that we think it is important that extensive consultations take place before any new policies are developed. Obviously we would be concerned if that did not happen.

CHAIR: In the evidence you gave this morning you indicated the interconnectedness and the perverse outcomes that have been delivered by the policy that has been made thus far. What sort of a timeframe would you like? We heard from the RACGP this morning that they thought a six-month moratorium on any further decisions needed to be called as a minimum to allow for a reasonable period of consultation. Do you share that view?

Ms Johnson : I do. I think our members would share that view. These are important decisions. If, as I said before, we are going to consider how all the issues interrelate and get that rural perspective then we would need that length of time.

CHAIR: So predominantly regional, rural and remote communities that are represented in large part by Liberal-National Party members need to let their minister know very promptly that two weeks is a completely inadequate timeframe to give consideration to the impact of policy making on them, their health and their families in the bush.

Ms Johnson : Certainly I think we need much longer than two weeks to consider new policies and certainly what their implications might be.

CHAIR: Thank you very much, Ms Johnson.

Proceedings suspended from 10:44 to 11:01