Rural Medicines Australia conference
Read the transcript of Minister Coulton's speech at the Rural Medicines Australia conference on the Gold Coast, 25 October 2019.
The Hon Mark Coulton MP
Assistant Trade and Investment Minister, Minister for Regional Services, Decentralisation and Local Government
It is certainly great to be here. I'd like to thank the Australian College of Rural and Remote Medicine and the Rural Doctors Association for having me here today. Since becoming the minister responsible for rural health, it's been incredibly valuable to work with ACRRM and RDA. I'd like to acknowledge their support, but also, I'd like to congratulate John Hall on his elevation to the role of chair, and I wish him well when he takes over later today.
I should give a shout out to my local GP. I think I could see Di and Clem's probably on the golf course. He should be here, Di. But I live in a little town called Warialda, and we're very well served for the last 30 years, they are having their 30th anniversary of being in that town soon.
When they've been there 25 years, 500 people out of a town of 1000 turned up to celebrate. So- and their influence goes beyond that. A little bit of irony, as I was pulling up outside the casino, on the back of a bus out on a busy street is an advertisement for a medical centre here on the Gold Coast specialising in women's health, and the photo of the doctor on the back was Dr Fleming, who was one young person from my town of Warialda to study medicine in and largely due to the influence of Clem and Di. I always say that when I go and see my local GP, Dr Clem Gordon. I reckon we break even; half the time talking about my ailments and the other half the time talking about the problems with the political system. So, at the end of the consultation I don't know whether Medicare should pay or the taxpayer.
But my electorate's called Parkes. It's half of New South Wales, the town of Parkes isn’t included, but basically goes from Queensland to the Riverina and here to the Hunter Valley and up north to Warialda where I live, right up to Broken Hill. One of the few electorates in Australia that actually has two time zones.
And so, as you could appreciate, the health challenges are many and varied in my part of the world. Regional, rural and remote Australians deserve the same access to high quality health services like those that live in our capital cities. I know everyone here today is committed to this outcome and our focus- sorry- I missed a page- and the other things are very bad form.
I'd like to acknowledge Chris Bowen, who is the Opposition Health spokesman. And Chris, thank you for being here today. I acknowledge your presence. I acknowledge your commitment to rural health and your party's commitment to rural health.
One of those things in Canberra that generally is treated in a pretty fairly bipartisan fashion. So, I should- gone off the script and I missed half of it, so Chris, I'm sorry. But good to see you here.
Look, I know everyone here today is totally committed to the outcome of high quality health services. It is my focus on working with you to improve quality and distribution of health services in the bush and ensure that regional Australian gets the attention and the resources that you deserve. Not only is access to services important, but in many rural communities, health providers are the local major employers as well. In order to support regional growth and better distribution of our country's growing population, we must have adequate infrastructure and local services delivered in our local towns and communities.
I'm also the Minister for Decentralisation and you can't get someone to go and live in a rural area - the first thing I want to know is: what are the medical services are, and what are the education opportunities for my children? First two questions. And so, we will not get anyone to relocate until we deal with these issues, particularly in medical services. Since coming to government in 2013, the Coalition Government has had rural health at the forefront of the priorities in the health portfolio. We have a comprehensive plan to provide health equity to all Australians and to deliver it in a sustainable way. And so, multi-pronged and strategic processes supporting every stage of the training continuum, and better distribute the medical workforce to provide better access to rural communities.
Our $550 million Stronger Rural Health Strategy delivered in last year's budget is now rolling out. And today, I'd like to give you a quick rundown on how that's progressing and other important priorities in primary and rural health. Attracting health professionals in the rural and regional areas remains a challenge. As we know, GPs are at the forefront of our primary care system.
The Australian Institute of Health and Welfare this week released its rural and remote health report that reinforces what we know to be true: Australians living in rural and remote areas have poorer health outcomes and a higher burden of chronic diseases. And in fact, that report wouldn't have been a surprise to everyone sitting in this room. It also confirms the challenges we have in recruiting and retaining doctors and health professionals to rural and remote communities. Addressing these issues is not simple and it requires a mix of short, medium and long term strategies. There continues to be a range of existing policies and programs in place which benefit rural GPs. These include outreach services, support for rural training, and benefits under the Practice Incentive Program. Initiatives under the Stronger Rural Health Strategy build on these and focus on delivering immediate benefits to the community. This comprehensive strategy directly supports the continuum for doctors to learn, train and ultimately practice in rural Australia.
First, there has been updates in our distribution mechanisms, which have an immediate impact on where medical practitioners entering the country can work and access Medicare. The visas for GP programs direct GPs to communities most in need of primary care. This ensures in-flow of overseas doctors away from well-serviced metropolitan areas to where they are most needed - areas that have lower access to services such as the rural, remote and regional areas.
From January 2020, our incentive programs for GPs will be improved when the General Practice Rural Incentives Program and the Practice Nurse Incentive Program are merged into the new Workforce Incentives Program. It will use the 2019 Modified Monash geographic classification system to ensure incentives are going to areas that are genuinely rural. Similarly, from January 2020, rural bulk billing incentives will use the 2019 Modified Monash Model, ensuring that the higher incentives are paid, to where it's correctly classified as rural. Areas losing access to these items has some of the highest concentrations of doctors in Australia, including Canberra, Newcastle and Geelong. Better-targeted incentives will help increase workforce distribution, giving patients in rural and remote areas improved access to medical nursing and allied health services.
If we want country communities to enjoy health services comparable to those in major centres, we need to build, train, and establish the health workforce in our regions. The evidence says when students complete the majority of their training in a regional setting, they are more likely to live locally and practice rurally over the long term. That's why we've chosen to expand rural and medical training by establishing the Murray-Darling Medical Schools Network to provide more training that is rurally focused across New South Wales and Victoria. I'm personally very excited about the facility that will be built in Dubbo by the University of Sydney in my electorate.
This flips the current city centre medical training models with the majority of training to be undertaken in the regions, rather than a shorter period of rural experience. We're already seeing the dividends from this investment in rural training and the network. The university has an extremely strong interest for their joint program they have with the University of Melbourne. This tells us there's a strong interest in a rural training model.
Before [indistinct] skills in the network, we'll be taking enrolments for commencements in 2021 - that timeframe is coming to us very quickly. While we are doing everything we can to help communities now, we do know that the change in this space takes time, and significant strategic reform. Another priority focus and part of our long term strategic vision is that, of course, the National Rural Generalist Pathway. Those of you that are here today from rural Queensland - and I congratulate you on the work that I know you have experienced, the work you've done and the success of this program in your communities. Rural generalist has played a key role in aiding rural and remote Australians to access health services, while providing general practice emergency care and other special services in hospitals and in the wider community.
In this year's federal budget, the Coalition Government committed more than $62 million to start implementing the first aspects of this pathway - and just as an aside, one of the first jobs I had as a minister, I'm going through signing briefs late at night in my office, was the $62 million brief that went back- ticking off this program, I had an immense pride to be taking part such an important project that has been talked about for such a long time. This will ensure rural generalists are trained, recognised, and resourced to meet with adverse health needs in rural and remote communities. Our investment will help deliver by investing in coordination units to join up various stages of rural generalist training, commencing in 2020.
Providing funding to support generalist- support specialist recognition of rural generalism, and further expansion of the Rural Junior Doctor Training Innovation Fund with new places to support rural primary care rotations. But coordination units are a key mechanism in the Australian Government's commitment and the state and territory governments will deliver this function for their jurisdiction.
The units will engage closely with key stakeholders to ensure a comprehensive training pathway is developed with a strong link between hospital and primary care training. In terms of specialist recognition, the RACGP and ACRRM are currently preparing an application to the Medical Board of Australia, and I thank them for the work that they are doing. This is about getting clarity on how rural generalism differs from general practice, and explaining the critical role our rural generalists play in rural communities. The pathway is very exciting. We are on track for the first elements to commence in 2020, and as announced in last year's budget, an additional 100 rural generalist training positions will also commence in 2021. Expanding the training will ensure there is a pipeline of rural generalists coming through to support a viable and sustainable workforce. Work is underway to progress a single employer model, which is a key concern for registrars on this pathway.
Following a productive workshop held by the Department of Health last month, I'm looking forward to considering the options that came from that workshop to the best short and long term solutions. This is a critical aspect of the success of the pathway, and I want to assure you that Minister Hunt and I are supporting on delivering a model that is flexible, meets local needs of the community, and can be rolled out nationally. It is a high priority for this government. Many of you in this room have played key roles in the development of the pathway, and I commend the commitment of ACRRM and the Rural Doctors Association working with government communities in the sector to deliver this and have a very productive discussion with ACRRM and the Rural Doctors Association while we're here today.
Turning the pathway into reality has been made possible in large part thanks to the work of Australia's first National Rural Health Commissioner, Professor Paul Worley, who I know joined here yesterday. Since commencing in the role, Professor Worley's focus has been to develop the pathway in consultation with the sector, and he continues to support the two colleges to progress the implementation of the pathway. Many of you will note Professor Worley was appointed for a two-year term as Australia's first National Rural Health Commissioner from 11 November 2017. I can announce here today that with his appointment (*) was due in at the end of this next month, I'm very pleased to announced that Professor Worley has been reappointed right up until the end of June next year. The establishment of the commission's role in the office is a key part of the Coalition Government's agenda, and we support the continued function. The plan will work to be done to improve rural health outcomes. The commission will play an important role in advocating for local communities and providing advice to government in the future.
I'd also like to talk briefly about two areas of healthcare which are rapidly expanding in rural and remote practice. The first of these is the use of Telehealth, which also relates to regional communities, which I'm responsible for in Regional Services portfolio, but also have rural telecommunications are responsibilities as well, so the two mesh very nicely.
Since Medicare first recognised Telehealth in 2011, services have been steadily expanding. Currently the MBS covers video consultations by specialists, consultant physicians and psychiatrists and general practitioners patients outside metropolitan areas, and quite frankly we've got a little bit more work to do in that space with the MBS because we're having great success with consultations to remote patients via the satellite that is very quickly, easy to use up your data allocation.
Rural education has been removed from the data allocation, monthly data allocation from the NBN Sky Muster satellite. And there's certainly an argument- we're certainly looking at rural health being removed as well, as that rolls out. We're actually seeing psychology consults delivered from the Flying Doctor base in my electorate in Broken Hill to someone who is on a remote station quite a few hundred kilometres away. I think the potential that we spend that, certainly not replacing face to face, but the potential to expand that is very, very high.
As healthcare providers and patients become more savvy with IT and as connectivity continues to improve with the backing investment of the regions, we can do more with Telehealth than it is said. Their access to Telehealth is already available to the logical people in rural and remote Australia, where barriers to distance affect access to mental health services. Next week on 1 November, 12 new Telehealth items for GP's and non-specialist medical practices will be added to the MBS, benefiting patients in the Modified Monash areas six and seven. The new NBS items are expected to result in around 200,000 additional services for people in isolated areas over the year.
Every year there are four million Australians who suffer from challenges of mental health. Leaders from all leagues and persuasions have played an important role in raising awareness is making that a priority. It's a story that everyone is touched by at some stage and in some way. Our rural and remote communities are resilient, but they aren't unbreakable. Improving mental health is a key pillar to our national long term health plan. In the past two years, the Government has put a high priority on better rural mental health services, especially for farmers and communities dealing with anxiety, stress and uncertainty due to drought. That aside, I think we need to be very, very careful that we just don't tie mental health to drought.
Sadly, I know people who have taken their own lives, farmers that have taken their own lives with grass in the paddock and money in the bank. And just to tie mental health in rural areas, in the drought, I'm concerned that our teenagers, our people who work in the towns - no one is immune from mental health aspects. And while obviously it's important we look after farmers, we want to make sure that that's not the only message that we put out around mental health.
Most of this is going to the nine primary health networks, the community led action providing immediate support and longer term recovery. This includes a three year trusted advocates network drop to provide mental health first aid or accidental counsellor training to local people, so they can support people around them who experience mental health concerns. This sort of information and support will build community resilience, increase awareness for mental health, and complement more formal services. Young people are a priority for mental health and suicide prevention. This year's budget allocates another $503 million for youth and Indigenous mental health and suicide prevention nationally. Headspace services will receive $152 million to reduce waiting times and 20 of the 30 planned new Headspace services will be in rural and regional Australia and the changes of the guidelines to allow more Headspaces into smaller communities has been a big plus over the last couple of years. Those who can't get to a Headspace, there's going to be a funded e-Headspace to provide anonymous phone and internet based support for people aged 12 to 25 years.
While I'm talking about mental health, we can't forget the mental health of you, our health workforce. You're all committed to improving health patients but it is critical that you look after yourselves too. There's still plenty of work to do to ensure equal access for all.
As I outline, I'm strongly committed to delivering the general, rural generalist pathway. This will be valuable to help address current workforce challenges in rural and remote areas and support the development of a modern, innovative and integrated models of care. I believe there is merit in a rural model where the treatment of doctors and health professionals providing services and access to the support, a range of smaller towns on a rotational basis. And we've had very active discussions over the last couple of months from various parts of Australia looking at it. This is something that both Minister Hunt and I are keen to consider in our rural context, and particularly as our population ages.
Our commitment to rural health service delivery is important to support the growth in regional areas. Across government, we're prioritising policy settings that encourage investment, jobs and growth, and ultimately sustain places where families can and want to live. Regional services and important access to quality healthcare is a critical part of the mix of services; infrastructure and investment and the connectivity of government is delivering to encourage the growth of the vibrant regional economies. The range of short, medium and long term measures we have underway will help overcome the doctor shortages that we have recognised in regional Australia for decades.
No one can solve these challenges alone. We are committed to working closely with the sector and the states and territories to reform- on reform to ensure that what we are doing is working, because we are all striving for a sustainable health service in regional communities. Refining our approach to rural health service delivery will help alleviate hospital admissions, reduce the reliance on locum services and cut the need for patient travel. I cannot emphasise enough the important role everyone here plays in their local communities, which is so important and critical to our collective success. I applaud the work you are doing and I look forward to collaborating with you to ensure rural health services are more accessible and sustainable in our communities in the long term. I thank you for your attention today. Thanks very much and enjoy the conference.