DOORSTOP: 8/3/22

March 08, 2022


PAT CONROY, SHADOW MINISTER ASSISTING FOR DEFENCE: Good morning, everyone. I'm Pat Conroy, the Federal member for Shortland, and we're in beautiful if slightly wet downtown Windale. I want to thank everyone for joining us. I want to thank my Parliamentary colleagues, Mark Butler the Shadow Minister for Health, Meryl Swanson the Member for Patterson and Shadow Assistant Minister for Defence, Sharon Claydon the Member for Newcastle, and Dan Repacholi Labor's candidate in the seat of Hunter.

As importantly, we're joined by Dr Melissa Collagan from Windale Medical Practice, and Dr Fiona van Leewan and Dr Lee Fong from Hunter GP Association, and we're here to make a fabulous announcement to solve what is a chronic GP crisis in the Hunter.

I and all my other Labor colleagues are being contacted daily by families who are having extreme trouble in finding a GP. And if they are lucky enough to get an appointment with a GP, they have to wait a considerable amount of time to see that GP. And that's unacceptable in a rich, developed nation like Australia. And we're also being contacted by General Practitioners, doctors, every day, who are faced with a very hard choice of which patients do they see, who can wait for an appointment, they are effectively making very, very important decisions. So thank you for joining us today.

I'm going to invite Melissa up as a Practitioner on the front line to talk about our experience, and then we'll go on from there.

DR MELISSA COLLAGAN, GENERAL PRACTITIONER: Hi, my name is Melissa Collagan. I'm one of the GPs here at Windale. I work here in Windale which is a very disadvantaged community, financially as well as a lot of chronic medical illness. And it is becoming increasingly harder for people to access primary health care, to come and see the GP, because of the workforce shortage and also inadequate funding in terms of Medicare rebates. So hopefully what's announced today will help with that.

CONROY: Thanks, Melissa. And if I wasn't clear at the start, the problem is that this Government has changed the way they've classified our region. We are now classified as a major metropolitan area, which means that taxpayer funded doctors, so called bonded doctors and overseas trained doctors, are no longer allowed to practice here which is leading to this massive issue we are now facing. I invite Fiona and Lee to come and give a broader Hunter GP perspective.

DR FIONA VAN LEEWAN, HUNTER GP ASSOCIATION: The Hunter GP Association represents 400 local GPs, and we see this panning out all across our region. Our patients are struggling to get in, we need enough GPs, feet on the ground, easily accessible, and also it needs to be affordable.

Health is one of the most important things in everybody's lives. We need health to rise above all other issues in a way so that people can get on with our lives, work hard, have good successful family relationships, etc. Any government that we have, we require our leaders to provide us with means and ways of having enough doctors on the ground, and making health care affordable. So this announcement is a great leap forward, really recognising that previously when these workforce shortage categories were altered before, it took away vital services to our region. This thing will enable them to come back again. So we're opening the doors, we're trying to improve our local health care.

DR LEE FONG, HUNTER GP ASSOCIATION: I’d just like to echo some of the comments that have already been made by Pat, which is this fundamental issue where the Hunter is being compared to the northern suburbs of Sydney. The Hunter, it should be obvious, we're not Mosman, we're not Manly, whilst we both have low bulk billing rates on pretty much every other metric, including socioeconomic disadvantage, as well as GP workforce shortage, we’re at completely opposite ends of the spectrum.

So we welcome any political party that proposes and pledges to make some steps to resolve that situation. In this particular case we have to say thank you very much to Pat, to Meryl, to Sharon, and to Dan, for their advocacy of this area. And to Mark Butler for taking the time to come to our region to make what I hope will be a very important step to correcting that workforce issue.

There are other issues that need to be addressed as well. So one burgeoning issue related to this reclassification is the bulk building rebate in an area where we have very low – we’ve had that change happen, it’s taken millions of dollars out of our region. So again, we welcome any potential for that to change. Thank you.

CONROY: Thanks Lee and Fiona for that great contribution. Now I’ll invite Mark Butler, the Shadow Minister at the helm, to come up and make some remarks.

MARK BUTLER, SHADOW MINISTER HEALTH AND AGEING: Thanks very much. Thanks Melissa, for hosting us today, and to Fiona and Lee as well for the work that you've been doing advocating for better health services in the region.

I'm delighted to be here with the Labor team from the Hunter Valley region as well. They are relentless, I can tell you, in the Labor caucus, and Dan as the wonderful candidate for the Hunter region, in advocating for better health services for the region and the community that they represent. They've been relentless in advocating for better GP recruitment policies in this region, which I'll talk about, but they were also relentless in convincing Federal Labor to commit to reversing the cuts that the Liberal Party made to the wonderful GP after hours service that the community here has had the benefit of for many, many years.

Genuinely, it is the best after hours service in the country and it makes no sense whatsoever for the Liberal Party to cut its funds, which we've already seen has led to the closure of the clinic at the Calvary Mater and cutbacks to other GP after hours clinics around the region. So their relentless advocacy for this, along with GPs across the region and patients, has led to Labor committing to reverse those cuts. And today, I'm announcing that Labor will also reverse the cut to the priority access for GP recruitment this region enjoyed for many, many years. A cut that Scott Morrison made three years ago.

We have carefully considered this question. I and my Labor team, the Labor team in the Hunter, have been meeting with GPs like Melissa and Fiona and Lee over the last 12 months, talking to them about what that cut by Scott Morrison meant for their practices.

We've had a Senate inquiry which we initiated conduct hearings across the country and take submissions, including from this region, about those impacts. The Hunter Primary Health Network said that those cuts impacted 149 GP practices. 149 GP practices in this region were no longer able to supplement their GP workforce with overseas trained doctors or bonded medical doctors from elsewhere in Australia. And that has led to obvious results. It has never been harder to get into see a GP in this region, it has never been more expensive to see a GP in this region. That was the inevitable consequence of the cut that Scott Morrison made, pretending that GP recruitment in the Hunter Valley, as Lee said, is the same as GP recruitment in Mosman, or Rose Bay - it's obviously not. So Labor will reverse that cut, we will restore the priority status for this region, which will start to fix the GP crisis that the people of the Hunter have been living through over recent years.

Only Labor is committed to strengthening Medicare - we are the party of Medicare. With a Labor team like the one I’m with today in the Hunter, the Hunter will get better Medicare services from a Labor Government.

JOURNALIST: Mr Butler how much is this going to cost?

BUTLER: We've had this costed by the Parliamentary Budget Office and they've said that what we're doing is not changing the number of doctors across Australia, what we're doing is making it easier for the Hunter Valley to recruit GPs from other parts, particularly the big cities. So we're confident this is something that's well within the budget of the Commonwealth, but I make this point - these cuts by Scott Morrison, the cuts to Medicare through six years of freezing GP pay, the cuts to the priority status of a region like the Hunter Valley, the 900 cuts and changes to Medicare made last July that drove up out of pocket costs for life changing surgeries, they're essentially a false economy. Because what we're seeing through the cuts to after hours clinics, the cuts to GP recruitment, is people just end up at the emergency department, so our hospitals are overwhelmed. People are receiving much more costly care than they would if they were able to access a GP where they need it and when they need it.

JOURNALIST: Can you give us a cost figure?

BUTLER: Yes, I just did. The PBO has said that this will not have a net additional cost to the budget. What it does is simply allow the Hunter Valley region, the Central Coast, and other regions like it across Australia, to recruit the doctors they were always able to recruit.

JOURNALIST: In regards to the funded medical programme, one can only assume that the reasoning this region has been classified as Metro would be due to population numbers. How unfair is that?

BUTLER: It's completely unfair and we've seen through the evidence to the Senate inquiry over recent months the impact that it's having, not just on the Hunter Valley region, but regions like it across Australia. Here in the Hunter Valley 149 practices had that recruitment path cut off so it's never been harder to see a GP. We're hearing about practices that have consulting rooms that are empty, that are simply not able to be staffed by a GP. Their books are closed, people are unable to get in to see a GP. This should have been obvious to Scott Morrison when he made this change back in 2019.

The idea that GP recruitment in this region is the same as GP recruitment in the inner suburbs of Sydney like Mosman and Rose Bay is ridiculous and Scott Morrison should have known that three years ago, he should certainly know it now, and he should join with Labor in reversing that cut.

JOURNALIST: Critics may argue that changing this classification here may then draw people from more rural and remote areas to the Hunter as opposed to there - is there potential for that?

BUTLER: We don't pretend that GP recruitment in the Hunter Valley is the same as the far west of New South Wales or other more rural, more remote parts of Australia, any more than we should pretend that recruiting GPs in the Hunter is the same as Mosman. So there are additional incentives for the more rural, the more remote parts of Australia, and they should remain in place. But there's got to be a middle path for regions like this, and that's what was abolished three years ago. You know, the Hunter Valley is not the same as Dubbo, it's not the same as far west New South Wales, but it's also not the same as Mosman as well. So there do need to be additional incentives for the more rural more remote parts of Australia. Labor doesn't intend to impact those or to adjust those at all. But there needs to be this pathway to supplement the GP workforce in a region like the Hunter Valley that was cut off by Scott Morrison three years ago.

JOURNALIST: Is what you’re proposing today the same as what we've seen recently happening in Maitland, I believe, there was a change there with allowing overseas doctors?

BUTLER: Yes, we've seen a band aid here and a band aid there from the Government in small parts of the Hunter Valley and other parts of the country around Australia which have been very seriously impacted by these changes – it’s simply not good enough, it simply ignores that this is not a particular issue for those small parts of the Hunter Valley region, as welcome as those changes are, this is a region-wide challenge. That's why today we're putting the challenge to Scott Morrison to join us. Reverse this cut that you made and ensure that the whole region is treated as a priority recruitment area.

JOURNALIST: From the local MPs, I guess from a local perspective, there are so many impacts of a shortage of doctors on mental health, on physical health, on all sorts of things.

MERYL SWANSON, MEMBER FOR PATERSON: Good morning everyone, Meryl Swanson, Federal Member for Paterson. You just raised Maitland, well that's in my electorate, and we have been raising hell with the Government about areas just like Maitland and Kurri Kurri, saying how under a Modified Monash Model, can you put it in category 1, which is exactly the same as the CBD in Sydney. So how can Kurri Kurri be exactly the same as the CBD?

We have lobbied long and hard and I am just so relieved to be truthful with you, and pleased that Labor has said enough, this is not fair. It's certainly not fair on not only doctors, but also practices in general, who have seen costs rise, they’ve seen that freeze that preceded that. And we've had that all come together at a time when people's health has never been more critical and concerning to them. A once in a century pandemic, people are clamouring to see doctors. In the new Maitland Hospital we've got up to an eight hour waiting period in the emergency department. That's a brand new hospital. Across the board health has been dreadfully underfunded in our region, which is the fastest growing region outside Western Sydney, in New South Wales. So we know that there needs to be good, sensible investment in health and that's what this announcement today is about. It's about making a difference to the lives of the people of the Hunter who so desperately want to look after themselves. As Fiona pointed out, you know, if you're healthy, you can get on with the rest of your life. If you're not healthy, it impacts everything in your life.

CONROY: If I can give you a specific local example of the of the impact, Scott Morrison's changes in 2019 had, Swansea Medical Practice has moved into new custom built medical facilities. They have a clinic room, so a room a doctor sees patients in, completely empty every day of the week because they can't get overseas trained doctors or bonded doctors under Mr Morrison's change. They are completely full, their books are closed, but they've got a purpose built clinical room empty every day of the week, and they’re not open on Saturday or Sunday because they don't have the doctors. So this change means that local practices like Windale and Swansea and all throughout the Hunter region can hire more doctors, which means it'll be quicker for Hunter people to see a doctor, and hopefully, it will be more affordable as well.

SHARON CLAYDON, MEMBER FOR NEWCASTLE: The people of Newcastle and the Hunter have every reason to feel completely gutted by this Government. We've already seen the closure of the GP access after hours clinic at the Mater Hospital. Christmas Eve, that was the gift of Scott Morrison to our region. On top of that, I've got doctors screaming out to fill vacancies, they've had to close their books, it's not that there's been any decrease in demand, they just need to be able to access doctors. So this is a terrific announcement. The experiences you've heard from both Pat and Meryl are universal, every part of my electorate in Newcastle, particularly those regions that are in the growth corridors in places like Maryland and Fletcher, screaming out for doctors now, doing everything they can to fill those vacancies, but it's just not enough when you've had all of the incentives pulled from underneath you by a government that is more focused on undermining universal health care at every opportunity it gets.

Well, enough. The people of the Hunter, they’re feeling abandoned. When you look at the track record of this Government you understand why. So it's a terrific announcement, building on already good foundations that Labor has put in terms of strengthening Medicare in this region. And I really thank Mark Butler for listening to all of us and being able to deliver for the people of Newcastle and the Hunter.

JOURNALIST: Just a couple of questions for Melissa if you don’t mind. Can you talk us through a bit about, you know, the issues of the reclassification and how it's really hit you guys here in terms of, how hard has it been to get more GPs on board in the area since it was reclassified?

COLLAGAN: So it has affected GP recruitment – recruitment has been an issue. And when we don't have enough GPs on board, and I’d say the demand hasn't changed in fact it's increased because of the pandemic, then a wait time for an appointment with a General Practitioner is longer, so sometimes up to three weeks, so this obviously affects the local population accessing the health care that they need. So this reclassification will really help us recruit more General Practitioner to the practice and increase accessibility of appointments.

JOURNALIST: How short have you been in terms of staffing, and how long has this been ongoing for?

COLLAGAN: This has been an issue for several months, throughout the last six to 18 months. And as I say, it can be up to three weeks for an appointment. Obviously that's often not good enough when patients need an urgent appointment, and it leads to unnecessary ED presentations.

JOURNALIST: I can imagine this also puts pressure on you guys as well?

COLLAGAN: Yes, it puts a lot of pressure on us, when we are already under a lot of pressure, emotionally, mentally, financially, from the pandemic, and increased care needs for patients.

CLAYDON: Can I just add one more thing really quickly? Dr Sarah Bailey was named Port Stephens Woman of the Year because it is International Women's Day. Yesterday she was telling me about the fact that she has managed her Practice and continued to see patients all throughout the pandemic. And as soon as they stop seeing patients at seven o'clock in the night, they're working through to midnight vaccinating people.

Her Practice alone has vaccinated 49 thousand people, and they've done that on top of working a 70, 80, 100 hour-week as a GP. So I just don't think you can get your head around how hard our medical people have worked in the last few years, but particularly in the last 12 months. So on top of practicing medicine every day they've been vaccinating, they've been conducting respiratory clinics for people who might think they've got COVID but they've got something else. So I think we just actually have to really take a step back and understand the pressure that our phenomenal medical teams, not just doctors and nurses, but their receptionists - can you imagine being on the end of the phone to someone who's just desperate to get an appointment? So I just wanted to say, particularly to the women who've worked so hard on International Women's Day, our medical teams, well done and thank you.

DAN REPACHOLI, LABOR CANDIDATE FOR HUNTER: Good morning, everyone. How are you all? I'm out on the street every day, talking to people. I've talked to well over two thousand people in the last few weeks here, and all we hear is “it’s such a long wait to get in to a doctor, every doctor is the same”. Everybody is just disappointed in the fact that they can't get in to a doctor, and they’re clogging up emergency departments. So this is a fantastic decision by Labor to make this happen, and to really put it forward for all of our community, because this will support everyone and support our local doctors, our local GPs, and most importantly, support the community, which is the main thing at the end of the day, because everyone's fed up with this current government, and we need to do something to make it better. And we're here to do that today.

JOURNALIST: General Practice isn’t seen as lucrative of a career progression as some other medical specialties, does Labor have any strategies or policies in mind to increase the interest in pursuing a career in General Practice?

BUTLER: We’ll obviously have more to say between now and the election about our broader plans to strengthen Medicare, but one of our really deep concerns is the plummeting rates of interest among medical graduates here in Australia to take up a career in General Practice over the last decade or so. The running down of Medicare, the running down of General Practice under this Liberal Government has meant it is a less attractive career in the eyes of many medical graduates than working as a specialist or working in the public hospital system.

The College of GPs tells me that from historical levels of about 50 per cent or so of medical graduates choosing to practice as General Practitioners, that rate has plummeted over recent years to as low as 15 per cent. If we're not able to turn that around, we are going to have an even worse crisis in General Practice.

So we will have more to say over the coming weeks about our broader plans to strengthen Medicare, but there's no doubt that we need to make General Practice for doctors, but also for Practice Nurses and others as well, as we've been talking about today, an attractive career because we know that General Practice and primary care is the backbone of Australia's healthcare system. And failings in primary care just end up in the emergency department of our hospitals, people don't miraculously get better if they can't see a GP when and where they need it. They end up in the emergency department, much sicker, and costing taxpayers much more.

JOURNALIST: Do you mind while you’re there just talking me through how exactly the after hours cuts affected this region, what they did?

BUTLER: I might hand over to one of my colleagues about that. But I will say this, firstly, there were funding cuts which have had an impact already for closure, as Sharon said, of the Mater Clinic and cutbacks in the other clinics in the region. But there's also a recommendation on the Government’s desk to downgrade even further the after hours services here in the Hunter, and put them at a level that you see across the country, the lowest common denominator approach that would see the country's best after hours service, which this community has enjoyed for many years, pulled down to a national average.

So not only will we restore the funding that has already been cut by the Liberal Party, we will promise not to reduce any further the level of service that's enjoyed in this region, but I'll hand over to my colleagues.

REPACHOLI: The cuts and the impact on with the GP after hours service are extreme. Prior to the cuts, GP after hours service had the equivalent of five clinics, they've cut the equivalent of two clinics. So the Mater has gone on Christmas Eve. And they’ve halved the hours at the Toronto Poly Clinic, and the Belmont Hospital Clinic. Those services are now operating for half the hours that they were previously and that impact is being felt right now.

To give you an example when the Belmont Clinic had to close because of a staff shortage some while back, the waiting time at Belmont Emergency Department went from two hours to five and a half hours - from two hours to five and a half hours overnight, immediately. And we're seeing that impact right now with families not able to see a GP after hours when they need it and clogging up the emergency department.

As Mark said the Government's cuts have cut a service from four and a half million to four million. And that's led to two clinics gone. If the Government accepts the recommendations that are sitting on Minister Hunt’s desk right now, another $3 million will go from that service. So it'll go from four and a half million a year to one million a year. That means that service is dead.

That will kill the GP after-hours service in the Hunter. And that means that we will see not only the loss of access for families, we will see $20 million of additional costs hitting the Local Area Health District through the emergency departments according to an independent economic study commissioned by GP after hours service. So this is a matter of life and death for the Hunter. As Mark indicated then, when Anthony Albanese came up in January to announce that we were saving the GP after-hours service, we will do whatever it takes.

So, if the Government accepts that recommendation, we will reverse it. And we'll make sure that the Hunter, the 70,000 families that see the GP after hours service every year before this cut, will get to enjoy that fabulous service that I know every single person behind me have used. My family has used the after hours service many times, like every other Hunter family.

JOURNALIST: How much more pressure has this put on GPs in the area?

VAN LEEWAN: Reducing the after hours service availability does mean that people end up presenting to GPs later, sicker, without brief, cheap, rapid, immediate intervention by the right person at the right time. It just ups the ante. It just puts the GPs, already in this pressure cooker, under more pressure essentially.

It causes more illness. I guess we're talking about how much things cost. But there's also the cost of illness, the burden of illness, and the distress that all of us feel when we’re ill. Many things can been managed so quickly and efficiently by GPs and Practice Nurses and practice teams, and we in the GP Association recognise that what we're looking for in a government - we're looking for our leaders, our governments to plan for a sustainable future where General Practice truly is the backbone of the service we provide, which will be cost efficient, very effective and sustainable. Where we can reverse some of these things that have been heading in the wrong direction for a long time.

So we need governments who are really willing to make these courageous, immediate steps to ensure service, but based on a really good long term plan with some medium term outcomes. And that involves different clinicians across allied health, Practice Nurses, education, support packages for GPs. We want people to be bold and courageous, because if we're not, we won't have a primary health care system within probably five or ten years. The average age of a GP in the Hunter region at the moment is 55. And I think we'd all agree that that's too old.