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Govt reforms to deliver boost to country practice

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The AMA has hailed the Federal Government’s overhaul of outdated rural workforce classification systems as a major breakthrough for country health.

Assistant Health Minster Fiona Nash has announced that the Government will switch from current flawed criteria to a more accurate classification system to ensure doctors have the support and incentives to go where they are most needed.

Senator Nash said she had been working closely with the AMA, other medical organisations and rural and regional communities on scrapping the Australian Standard Geographical Classification – Remoteness Area (ASGC-RA) and the District of Workforce Shortage (DWS) systems and replacing them with arrangements that worked better and eliminated serious anomalies.

“We need to make it easier to get doctors to where they are needed most, with the right doctor, with the right skills, in the right place,” the Minister said.

The AMA and other organisations have been highly critical of the ASGC-RA virtually since its introduction because the way it was structured led to many perverse outcomes, including creating incentives for doctors to move from small rural towns to large coastal cities.

There have been numerous perverse outcomes under the ASGC-RA system, such as doctors working in Cairns, a coastal city of 150,000 people, receiving the same incentives as those working in central west NSW towns such as Hay and Deniliquin.

“The AMA has been advocating for these changes for years,” A/Prof Owler said. “We congratulate Senator Nash for engaging with the medical profession, hearing and understanding the concerns of country doctors and their patients, and delivering a positive outcome.”

Senator Nash said that, instead of the ASGC-RA, the Government would now use the Modified Monash Model (MMM) to decide on the allocation of resources.

The MMM is based on the current Australian Bureau of Statistics remoteness classification structure, and classifies regional areas according to local town size.

The Minister said that, as a result, under the MMM system Charters Towers would be in a different category to Townsville, Port Fairy will have a different classification to Ballarat, Gundagai will be different to Hobart and Sale will differ from Mildura.

AMA President Associate Professor Brian Owler said changes to the DWS system were equally welcome.

Under the system, doctors recruited to serve communities classified as being a DWS are able to bill Medicare for their services – including those who are otherwise subject to Medicare billing restrictions, such as overseas trained doctors, foreign graduates of Australian medical schools and Australian-trained bonded doctors.

Senator Nash said under the old arrangement, DWS classifications were based on outdated population figures and lagged behind the needs of towns that experienced recent growth.

She said the new DWS system would use the latest population and medical services data to more accurately determine areas of doctor shortage.

“The new system will create more stability for towns that fluctuate in their DWS status,” the Minister said, adding that DWS determinations for GP services would be updated annually rather than quarterly, so that access to Medicare billing would be more assured.

A/Professor Owler said this was an important improvement that would “deliver more certainty for communities with poor access to medical services”.

Complementing this change, Senator Nash announced that the Bonded Medical Places (BMP) program would be changed to allow any bonded student to complete their return of service obligation in rural towns of less than 15,000 people, regardless of whether or not they had a DWS designation.

A/Professor Owler said it was a common sense change.

“Some BMP graduates who want to stay in rural towns are currently prevented from doing so if the town is not classified as DWS,” he said. “The Government changes provide more flexibility for BMP graduates who want to live and work in rural Australia.”

Senaotr Nash said she would appoint an expert panel to advise on the transition to the new arrangements, a commitment A/Professor Owler said was “really important”.

“Senator Nash has recognised the AMA’s call for consultation on the implementation of these measures through the formation of the Expert Panel, and the reconvening of the technical working group,” he said. “It is really important that we get these reforms right, and iron out any problems before the changes come into operation.”

Groups including United Gneral Practice Australia, the Rural Doctors Association of Australia and Rural Health Australia also commended Senator Nash on the changes.

Adrian Rollins