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Speech at the Breathing NEWLIFE into general practice conference 2011, hosted by General Practice Registrars Australia, Canberra

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THE HON NICOLA ROXON MP Minister for Health and Ageing


Breathing NEWLIFE into General Practice Conference 2011 hosted by General Practice Registrars Australia Parliament House Canberra 24 March 2011



I would like to acknowledge the traditional custodians of the land, and pay my respects to their elders, both past and present.

Can I also acknowledge that this is National Close The Gap day - an important day where we remember that Indigenous people should expect the same health status and health outcomes as all Australians

and when we are reminded to redouble our efforts to bring this about.

I would also like to acknowledge: Dr Wicky Wong, Chair of GPRA Mr Amit Vorha, CEO of GPRA Dr Andrew Pesce, President AMA Prof Claire Jackson, President RACGP Prof Simon Willcock, Chair GPET Dr Emil Djakic, Chair AGPN Dr Jeffrey Ayton, President ACRRM Registrars, students and invited guests.

Good morning, and thank you for the opportunity to address you today.

For me, the GP Registrar’s Conference is an important day on the calendar.

To demonstrate how important that I consider it, I was reflecting that this is my fifth address to your conference.

My, perhaps you could call it, somewhat obsessive attendance is not driven by a burning desire for a morning tea, or the chance to see inside the hallowed halls of Parliament House, but rather because when I look at all of the investments that we make annually, from the commonwealth, in our $68.2 billion health service, some of the most important are in this room.

Life-saving drugs, new infrastructure and world-class technology are all of vital importance to the health service, but it is the workforce, the dedicated doctors, nurses and allied health workers on which the

system is built.

That’s why it’s always a pleasure to talk to talented men and women who are choosing careers as general practitioners.

And this is a very exciting time to be entering general practice. Your dreams and plans to enter the medical profession coincide with the Government’s priority to primary care.

The recent Health Agreement negotiated with the States and Territories clearly sets out that the key role that primary care plays in the system and explicitly acknowledges that improvements in primary health care are crucial to the health of our population.

It is through you and your colleagues that these benefits will be delivered to Australians over the coming years and decades.

In fact your presence here today is a very clear and tangible example of practical health reform and an increased investment in primary care .

So then, why is primary health care so central?

Firstly, because primary health carers are best placed to appropriately manage the challenges of the future: in particular, an increasing burden of a population that is ageing and a dramatic increase in chronic diseases.

Secondly, because effective GP and primary health care works - it makes sense. It is good for patients in improving their care and health outcomes and is also the key for the long term sustainability of the health system.

Many Australians are surprised to learn that we here in Australia have a high rate of hospitalisation compared to the OECD average and countries such as the United States, Canada and New Zealand. So we need to ask if there are better - and more cost effective - ways to prevent and manage disease.

To us, the GP surgery, and not the hospital emergency department, is the best option. Research report after research report tells us not only is this cost effective, but better for your health too.

For example, this means that early detection and treatment of your high blood pressure and mature onset diabetes means you never have to see the emergency department with chest pain.

Or a lifestyle change in eating and exercise managed by your GP means that you live an extra five years to spend with your grandchildren.

These are practical ways which make a difference to people’s wellbeing.

So what are the key things that we need an improved primary health care system to deliver?

 It needs a skilled workforce, working together collaboratively in multi-disciplinary teams - so patients get the range of services from the range of health professionals they need, and professionals’ valuable skills are used as effectively as possible

 It needs to provide well coordinated and integrated care, especially for patients with chronic disease - so patients aren’t being shunted around. To do this it needs modern infrastructure so that practices can provide first class settings for an increased range of services.

 It needs to provide accessible care - people being able to get the care they need when and where they need it. This requires better coordination between providers after hours and a more holistic approach to planning with acute services.

 It needs to focus on prevention and early intervention - actively preventing disease and its progression, rather than responding reactively to it.

 And it needs to unleash the potential of modern technology to change the patient experience by increasing the opportunity for them to be involved in their own care.

When I became health minister, if there was one area of the health system that cried out for investment after years of neglect it was the area of health workforce.

I am proud that when we came to office, the government recognised and acted on the urgent need to increase the medical and health workforce.

For too long, there had been chronic shortages of GP’s caused by the Coalition’s capping of training numbers in the Australian General Practice Training Program.

Mr Abbott’s cap strangled the supply of GPs to communities across Australia.

He tightened the purse strings at the patient’s expense.

Training doctors is not a sprint but a marathon and the damage that he wrought will take years to undo.

But we are making good progress, putting in the hard yards.

Mr Abbott’s 600 training places will be doubled to 1,200 by 2014

2011’s new GP registrars in training is a whopping 900.

This means that we have this year delivered a 50% increase in training GPs - reaching the half way mark. We are determined and excited about increasing in the coming years to complete this marathon job of training enough GPs for the community.

This increase in places means that today we already have an additional 475 actual GPs in training, people that simply wouldn’t exist if Mr Abbott’s restrictions were still in place. These actual people are providing services to communities from Tiwi in the Northern Territory to Gumeracha in South Australia. Today. Now.

That’s more GPs for every state and territory and by the end of the decade we will have added an extra 5,500 GPs in training or in practice.

This is the highest number of trainees since the program’s inception - an investment in training tomorrow’s GPs of $762 million over the next four years.

These are impressive numbers, but the story is more impressive when you think of what this means on the ground.

For example, more services in the Kimberley where doctors have returned to practice on completion of their training and that has led to a GP obstetrics post in Derby - the first time in 15 years that obstetric services have been offered there.

As part of encouraging more doctors to go into general practice we have also expanded the number of placements for junior doctors to have a stint in general practice during their postgraduate training period - up to 975 places each year by next year.

All these initiatives are part of a comprehensive response to health workforce issues.

A response that has led to the establishment of Health Workforce Australia, a national body tasked with increasing the quantity, quality and availability of clinical training in Australia.

A vital part of expanding and growing training in general practice, is prioritising support for GP infrastructure.

Our investments in GP Super Clinics and smaller primary health care infrastructure grants will help bring together GPs and other health professionals in the one setting, and provide more convenient access for patients and a great setting for training the next generation of doctors nurses and allied health professionals.

To give a real example, I recently opened the Palmerston GP Super Clinic on the outskirts of Darwin.

The clinic is a purpose-built facility currently staffed by a team of four GPs, two practice nurses, four medical students as well as a physiotherapist and dietician with more allied health services to come online, including mental health services.

As well as providing an excellent setting for clinical training, since the first early services commenced in 2008, there have been in excess of 24,000 services provided to local residents - that’s a fantastic outcome for the Palmerston community.

The GP Super Clinic program has progressed well with 30 GP Super Clinics now either open, providing early services or under construction.

In addition to GP Superclinics, we’ve listened to your advocacy and will also provide grants to around 425 existing general practices, primary care and community health services, and Aboriginal Medical Services across the country. The first 240 have been shortlisted through an enormously competitive process.

These existing practices will use the money to expand their premises so that they can offer wider services to the community, extended hours or more facilities for training young doctors like yourselves.

So growing the GP workforce, expanding training opportunities and investing in primary care infrastructure is vital to achieving this.

As is funding more practice nurses so we have the range of key primary health care staff in numbers that are needed.

We are also supporting more team-based multi-disciplinary care through reforms such as enabling eligible nurse practitioners and midwives to provide Medicare and PBS-subsidised services.

Our after-hours investments are to come online from 1st July. All these initiatives are aimed to provide more health care for the people closer to their homes and at all times of the day.

Medicare Locals: Our vision extends to better coordinating and bolstering primary care.

Medicare Locals will play a key part in helping shift the centre of gravity of health services: giving primary care the status that it deserves.

Medicare Locals will have a critical role to play in coordinating and integrating services, addressing gaps in services, bringing health professionals together to work in teams, and over time bringing more focus to prevention and early intervention.

They will be the engine room that makes it easier for patients to access the services they need, by better linking GP’s, nursing and other health professionals in response to local needs.

For example, if a Medicare Local identifies that too many patients are being admitted to a local hospital with foot conditions due to diabetes, it will work with primary care providers to ensure that there is a podiatrist available in the community which GP’s will be able to refer to.

Medicare Locals will provide an opportunity for doctors to play a role in fixing systematic or community wide problems not leaving you regularly frustrated that you are patching up problems too late in the cycle.

They will work closely with Local Hospital Networks, providing a bridge between the primary care and acute sectors to ensure that they work together for the benefit of patients.

We want to make it easier for patients to see a doctor after hours so that the sole option available to a mother whose child is running a temperature is not only the hospital emergency department.

The Government is bringing forward its investment in after hours services and as each Medicare Local is established it will be given funding to plan, co-ordinate and support comprehensive face to face after hours GP services.

Practically this means that they will be able to compile local after hours directories, identify gaps in services, arrange on call rosters and fund local GPs to expand their reach or hours.

This will work hand in glove with the national GP after hours advice line that will be operational from July 2011.

The first group of up to 15 Medicare Locals will be up and running from the middle of this year - building on existing, high performing Divisions of General Practice.

A further group of 15 will be operating from next January, with the remainder commencing in mid 2012.

I encourage doctors to be part of this opportunity to improve health outcomes in their communities, not for purely altruistic reasons, it will improve your work too.

Electronic health records will help improve coordination of patients’ information and the ease with which they can navigate the system - especially chronic disease patients who need to see multiple health professionals.

Work in this complex project is progressing well and it is planned that consumers will be able to register for a personally controlled electronic health record from July next year.

Legislation establishing the Healthcare Identifiers Service came into effect in June last year and the Healthcare Identifiers Service managed by Medicare Australia has already completed the task of assigning an identifier to 23 million Australians.

The National E-Health Transition Authority (NEHTA) has begun releasing its sectoral plans for implementation of healthcare identifiers - starting with primary and ambulatory care.

And the first three lead implementation sites - in North Brisbane, the eastern suburbs of Melbourne and the Hunter urban health area - are starting to deploy and test e-health infrastructure and standards in local healthcare, based around GP surgeries.

We have also had a strong response to applications from locations wanting to be included in the second round of lead implementation sites.

Conclusion Medicare Locals, e-health, increasing after-hours services, GP infrastructure are all ways in which I and the government are encouraging and pushing for modernisation in primary health care and in its core, general practice.

I do expect GPs - which means you - to work with other primary health care providers and actively participate in these reforms, to improve health outcomes for people in local communities.

I know that many of you have been instrumental in leading the way, and I ask that you continue to play that role.

Your profession is both challenging and rewarding and the community will rely on you to provide leadership as we collectively look to face the health challenges of an ageing population.

As I have been outlining above, fundamental to these primary care reforms is a well trained workforce working in places where patients need them.

So here you are on the verge of your career as GPs at a time of major changes in health, including primary health care.

As you know, for the great majority of Australians, their GP is their first point of contact with the health system. In any one year, more than 85 per cent of Australians will visit their GP.

You will remain the lynchpin of primary health care as it is becomes stronger and more connected to the other parts of the modernised, 21st century health system.

As I have outlined, the Government’s investments are already starting to make a difference the increase in your numbers being an obvious example.

There is much more work to be done which will require your effort, your expertise, and your leadership.

As GPs and aspiring GPs, you will be the first point of contact for your patients with the wider health system.

Your experience of general practice will be different from your predecessors’, and it will be better.

That’s the strong conclusion of the extensive inquiries and consultations on which our major reforms are based.

They will require support and engagement across all levels of government, the private sector, and communities.

GPs will be pivotal to their success, and I urge all of you to take up the challenge and become a part of these reforms.

Not just because you are the part of the new wave of GPs; but also because you can see the huge benefits that these changes will bring for Australians - for your patients’ health and wellbeing.