Building on the previous three Distribution Working Group (DWG) meetings, the June 2018 meeting was chaired by the Chief Medical Officer, Professor Brendan Murphy.
Agenda Items – 8 June 2018 meeting
- topics discussed during the previous DWG meeting in February 2018;
- update on the recently announced Stronger Rural Health Strategy from Budget 2018-19;
- discussion on Department of Health (the Department) programs recommended to transition to the Modified Monash Model (MMM);
- discussion on correspondence received on issues with the District of Workforce Shortage (DWS) and MMM geographical classification systems;
- discussion on exceptional circumstances upon which to provide an additional rural loading for towns/regions experiencing workforce recruitment issues;
- update on how the Budget 2018-19 will impact workforce regulatory arrangements; and
- update on the review and reforms of the DWS system.
Stronger Rural Health StrategyMembers were provided with an overview of the Stronger Rural Health Strategy announced in Budget 2018-19. It is a historic 10 year plan to meet current and future health workforce challenges. It will support the largest overhaul of Australia’s health workforce in decades. It has a comprehensive package of reforms in a $550 million investment over 5 years from 2017-18. It will provide all Australians with the right mix of qualified health professionals in the right place, at the right time to deliver high quality health care.
The Strategy will provide a framework for investment over the coming years to support better targeting and prioritisation of health workforce programs to ensure the Australian community can access high quality health services no matter where they live. Measures implemented initially will focus on regulating supply, targeting distribution, improving quality and building evidence.
Programs recommended to transition to the MMMA list of the programs recommended by the Distribution Working Group to transition to the MMM will be provided to the Minister for Health and Minister for Rural Health and published in a future communique. Members noted that timing of the transition will be critical for some programs and that the Department will need to ensure appropriate consideration is given to each program.
Where some programs do not fit the MMM system, members agreed that the new Health Demand and Supply Utilisation Patterns Planning (HeaDS UPP) Tool may assist with the ability to better target these programs.
Correspondence received on the DWS system and MMMMembers discussed correspondence referred to the Distribution Working Group from towns and communities that reported DWS and MMM issues impeding recruitment and retention of health professionals.
Members were presented with quantitative and qualitative analysis of workforce issues of the towns presented. Members concluded and agreed that the issues raised by correspondents of the towns listed above were not principally related to the DWS or the MMM classification systems.
Correspondence from the towns and communities discussed will be advised of this outcome directly.
Discussion on exceptional circumstances upon which to provide an additional rural loadingMembers discussed principles under which an area could be granted a higher General Practice Rural Incentive Program (GPRIP) payment other than that determined by their MMM classification. Members agreed that any exception would be time limited and agreed that the list of exceptional circumstances would include only geographic anomalies and demographic considerations.
Members agreed that once the group concludes their work program at the end of the year there still is a need for a group, external to the Department, that can consider similar issues and provide feedback to assist with informing policy development.
Budget impact on regulatory arrangementsMembers were provided with a presentation that explained the current regulations on the provision of Medicare provider numbers for non-VR doctors and how these create an environment where Australian trained non-VR doctors have the fewest options for private practice.
As a result of the Budget and related measures:
- All new non-VR doctors will be required to be on a 3GA program for MBS access;
- All new non-VR doctors will have access to MBS items providing 80% of the rebate provided to recognised GPs in MM 2-7, with restrictions to some items in MM 1 and;
- Overseas trained doctors will continue to be subject to work in DWS areas.
District of Workforce Shortage update and reformsMembers discussed the new GP catchment structure, the purpose of the DWS and two potential new methods by which to define an area as a DWS.
GP catchment structures have been designed through an analysis of five years of data which identifies where patients access GP service. This new structure was endorsed by the members subject to further consideration of the methods used by a technical working group.
Members discussed that the purpose of the DWS system is to allow an area recognised as DWS to recruit doctors subject to location restrictions under section 19AB of the Health Insurance Act 1973.
Members agreed to an approach that is based on the GP services an area receives, factoring for the demographics, socio-economic status and other population based measures in the GP catchment.
It was agreed that a working group would be established to further consider the implications of this method and to report back to the group at the next meeting.
Distribution Working Group MembershipThe Distribution Working Group membership includes a number of peak bodies representing the rural health workforce and the National Rural Health Commissioner.
Members in attendance for the 8 June 2018 meeting were:
- Australian Antarctic Division
- Australian College of Rural and Remote Medicine
- Australian Indigenous Doctors’ Association
- Australian Medical Association
- Monash University, School of Rural Health
- National Rural Health Alliance
- National Rural Health Commissioner
- Royal Australian College of General Practitioners
- Royal Flying Doctors Service
- Rural Doctors Association of Australia
- Rural Health Workforce Australia
- Rural Workforce Agency Victoria
- University of Newcastle, Department of Rural Health
- University of Melbourne, Melbourne Institute of Applied Economic and Social Research
- University of Queensland, Rural Clinical School