As a new report sounds the alarm about an escalating shortfall of general practitioners, the column this week puts a big focus on workforce concerns, including plans to introduce regular health checks for doctors aged over 70.
The Zap also considers the future of Rex Airlines, and shares an update on climate and health policy as well as an acknowledgement of aged care workers as “the unsung heroes of our communities”.
The Australian College of Rural and Remote Medicine has published a tribute to Dr Jack Best AO, acknowledging his wide-ranging contributions to health policy, especially rural health. Best was also a prolific writer, publishing the final entry on his blog on the morning of his death, 26 July. His funeral was held today and a memorial will be held on 19 August.
The quotable?
Forty-six percent of Aboriginal and Torres Strait Islander GPs already work in regional and rural areas, compared with 28 percent of all GPs who graduated from Australia.”
Charles Maskell-Knight writes:
The Department of Health and Aged Care released the General Practitioner (GP) Supply and Demand study, a “health workforce model that projects the supply and demand of Australia’s primary healthcare GPs over a 25-year period [and includes a] model… designed to simulate complex policy scenarios and analyse the geo-spatial GP workforce implications”.
(As is only too common for documents with important policy implications, the study report was posted on the Department’s website, with no announcement on the news page of the website.)
The study reports that “the GP model results show an undersupply of GPs over the next 25 years, which indicates that we will not have the number of GPs required to keep up with the demand for GP services in the community”.
“The results also show us where there is currently unmet demand in some areas,” it says.
The Australian Medical Association (AMA) responded, warning that “urgent action is needed to address a predicted shortfall of general practitioners and ensure Australians have access to the general practice care they deserve”.
Departing AMA President Professor Steve Robson said policy changes were required to rebuild the GP workforce, starting with training more GPs and supporting them to work in areas of need.
He said “there needs to be greater opportunities for doctors to experience general practice early in their career and policy that ensures the number of GP training places each year is based on community need”. Robson also emphasised the need to ensure parity in working conditions between GP trainees and hospital-based specialties.
The Royal Australian College of General Practitioners (RACGP) also reacted to the report, with President Dr Nicole Higgins describing it as “deeply concerning but not surprising”.
She reiterated the call for “barriers to GP training to be removed – primarily the loss of work entitlements and pay cut they’re forced to take when they choose to leave hospital and enter private practice”.
“This can be fixed immediately by funding an incentive payment and basic work entitlements, including parental and study leave,” Higgins said.
The Australian Indigenous Doctors’ Association (AIDA) also responded to the report, pointing out the role First Nations doctors could play in addressing the shortage.
AIDA CEO Donna Burns said that 48 percent of Aboriginal and/or Torres Strait Islander doctors in training have chosen the route to become GPs or rural generalists with RACGP or the Australian College of Rural and Remote Medicine (ACRRM).
Data shows that “46 percent of Aboriginal and Torres Strait Islander GPs already work in regional and rural areas, compared with 28 percent of all GPs who graduated from Australia”, Burns said.
AIDA called on the Government to “prioritise funding and resources to support Indigenous medical students and doctors in training, and to implement strategies that promote diversity and inclusion in the medical workforce”.
ACCRM President Dr Dan Halliday said the report “underscores the pressing requirement to reset national policies to incentivise a medical workforce that can provide continuous and integrated healthcare in rural, remote and First Nations communities”.
The Australian Healthcare and Hospitals Association (AHHA) also commented on the report, with CEO Kylie Woolcock saying that “we rely on a health system that assumes you can see your GP when you need to, and certainly when you are sick…”.
“GP shortages can mean getting the care you need, where you need it and when you need it, can be almost impossible,” Woolcock said.
Ministers and government
Staying with the workforce theme, Health Minister Mark Butler announced the establishment of “a new body to shape the direction of Australia’s healthcare workforce”.
Reading the fine print, it appears that the Medical Workforce Advisory Collaboration is going to be focused on the medical workforce rather than the health workforce more broadly, and that its role is purely advisory.
Not only that, but its advice will flow to Ministers through the Health Workforce Taskforce, which is a subcommittee of the Health Chief Executives Forum.
The new group may influence, but it certainly won’t “shape”.
Assistant Minister Ged Kearney announced the establishment of a Climate and Health Expert Advisory Group to “provide advice on reducing the impacts of climate change on the nation’s health”. The group, chaired by Kearney and including over a dozen other members, will meet at least three times a year (see more in this previous Croakey article).
At its first meeting the group discussed progress on the National Health and Climate Strategy released last year. It was told that “over one-fifth of the key actions have been substantively implemented”, including “joining the World Health Organization’s Alliance for Transformative Action on Climate and Health; investing $5 million in climate and health research through the National Health and Medical Research Council; and preparing new reports on opportunities to reduce health system greenhouse gas emissions from waste, food, and anaesthetic gases”.
With progress like that, we’ll have the problem licked in no time!
Kearney also launched Loneliness Awareness Week, and marked World Breastfeeding Week with a visit to the Royal Hobart Hospital, which is a Baby Friendly Health Initiative accredited maternity facility.
The Department also released (again, with no notice on its news page) a Review of General Practice Incentives consultation briefing paper, presenting the views of the expert panel appointed last September to oversee the review.
It also announced webinars on 12 and 29 August where departmental staff would present the findings and answer questions, and foreshadowed consultation on the emerging recommendations throughout August and early September.
The expert panel’s draft recommendations are generally predictable – for example, payments should be simplified, support community and patient needs, and encourage high quality, accessible, multidisciplinary care.
However, its third recommendation will give the Government pause for thought: “an independent primary care pricing authority to determine Commonwealth payments to general practices and primary care”.
Its recommendation that the Workforce Incentive Payments (WIP) Doctor Stream and Rural Advanced Skills Stream payments should be paid to practices rather than doctors was criticised by the Rural Doctors Association of Australia (RDAA), which claimed that it “could lead to an exodus of doctors from the bush”.
RDAA President Dr RT Lewandowski said that “paying the incentives to practices, rather than direct to doctors, would enable practices to decide how much of the incentive the doctor would receive – all of it, part of it, or none at all – even though the payment is meant to be an extra incentive to doctors for working rurally”.
ACCRM also criticised the proposal, with President Dr Dan Halliday saying that “without a guarantee that these rural incentive payments will be passed on to rural doctors, it becomes even harder to promote rural jobs and there is a real risk of losing RGs [rural generalists] and specialist rural GPs”.
I am a little bemused by all this. If there really is a shortage of doctors prepared to work in rural areas, presumably doctors responding to advertisements for these positions are in a strong bargaining position to demand that that the full amount of the incentive payments is passed on to them?
The Australian Institute of Health and Welfare (AIHW) released the Aboriginal and Torres Strait Islander Health Performance Framework: summary report presenting the latest information on health outcomes, health system performance and the broader determinants of health for First Nations people.
The overall pattern shown in the report is familiar. Over the last decade there have been improvements in many areas, including reductions in smoking, and improvements in the rates of attendance at antenatal care, immunisation, health assessments, and chronic disease management.
There has also been improvement in some social determinants of health such as Year 12 attainment, employment and home ownership, and youth detention.
However, other measures have seen little or no progress in some measures, while others have worsened.
According to the AIHW “key measures such as infant and child mortality, perinatal mortality, diabetes mortality, avoidable mortality and potentially preventable hospitalisations have shown little or no progress; while measures of suicide, death from cancer, female hospitalisation for assault, children in out-of-home care, and adult imprisonments have all worsened”.
The Medical Board of Australia announced it was consulting on a proposal to introduce health checks for late career doctors (by which it means doctors aged over 70).
The Board said “there is strong evidence that there is a decline in performance and patient outcomes with increasing practitioner age, even when the practitioner is highly experienced”.
Its preferred option is for older doctors to undergo triennial general health checks with a GP “to support early detection of concerns with the opportunity for management before the public is at risk”. After age 80, these checks would be annual.
The Consumers Health Forum reacted to the proposal, with CEO Dr Elizabeth Deveny saying that she could see both sides of the argument.
“On the one hand you have the Medical Board saying that practitioners over 70 are 81 percent more likely to face a complaint against them then their colleagues under 70 and then on the other hand you have the doctor’s groups, who are rightly saying that any rule imposed by the board must be based in evidence, fair and non-discriminatory. I think this is a case where two things can be right at the same time.”
CHF said that it “wants to see the Medical Board of Australia fully engage with the community on this important issue”, and that this will mean going beyond the traditional model of asking people to review the proposal and send in a written submission.
The Psychology Board of Australia released new professional competencies for psychology to come into effect on 1 December 2025. The competencies were last updated in 2010, and strengthen cultural safety requirements, provide more detail about requirements for working with diverse groups, and include material on self-care, reflexive practice, and digital health practice.
The Inspector-General of Aged Care released the 2024 progress report on the implementation of the recommendations of the Royal Commission into Aged Care Quality and Safety.
The summary of the report observes that “with a particular focus on access and navigability issues – which are widely acknowledged systemic issues in the delivery of aged care – …[there is a] need for more ambitious action and a continued concerted effort from government”.
On the fundamental issue of access rationing, the report says: “The Royal Commission called for a paradigm shift, recommending establishing a new seamless aged care program with access to care as an entitlement based on assessed need.
“The Inspector-General is disappointed that the Government is not implementing this cornerstone reform – the new Aged Care Act and the new Support at Home Program retain a ration-based approach. As a direct consequence, older Australians with assessed needs will continue to miss out or face long delays in accessing care”.
Consumer and public health groups
The National Rural Health Alliance commented on the developing story regarding the future of Rex Airlines, saying that Rex had been “crucial” to allowing rural communities to access healthcare in cities and to supporting fly in, fly out health professionals to deliver care in rural areas.
NRHA CEO Susanne Tegen said that “the Government’s consideration of a partnership with the airline, rather than a direct bailout, represents a strategic approach to preserving regional connectivity and healthcare support, an understanding that when market fails, government often needs to step in”.
Trade unions
Allied Health Professions Australia (AHPA) welcomed the Inspector-General of Aged Care’s report on implementation of the Royal Commission recommendations, saying that the report highlights the decline in allied health service provision in aged care following introduction of the Australian National Aged Care Classification (AN-ACC) model and mandatory care minutes for nursing and personal care.
AHPA agreed with the Inspector-General that a recent joint statement purporting to clarify the different roles and responsibilities of the Commonwealth, states, territories and aged providers in the provision of health services in aged care “falls short of the Royal Commission’s recommendation, and is unlikely to deliver any tangible improvements”.
The Australian Dental Association (ADA) issued a series of statements marking Dental Health Week.
One presented data from the ADA’s annual oral health survey of 25,000 people, which found that almost 40 percent of people delayed dental treatment in the last year because of cost.
ADA President Dr Scott Davis said “there needs to be help from the government for a greater number of Australians so they can get the regular dental treatment they so badly need and often can’t afford. This is particularly the case for seniors in residential aged care, and our most vulnerable populations including Aboriginal and Torres Strait Islander Australians, those on low wages and people with a disability”.
Another statement drew attention to the number of children hospitalised for dental problems (a little over one percent of children aged five to nine), and urged parents to start taking their children to the dentist when teeth emerged, rather than when a problem arose.
Tasmanian members of the RACGP “descended on the Parliament of Tasmania to advocate for government support to ensure the state is training the GPs it needs to keep its communities healthy”.
As well as arguing for government assistance for additional GP training places, the College urged the Government to follow the lead of other states and fund meningococcal and RSV vaccines.
The College also issued statements railing against an expanded role for pharmacists in Queensland and WA.
Industry groups
The Aged and Community Care Providers Association marked Aged Care Employee Day on 7 August. CEO Tom Symondson said that the sector “extends our heartfelt gratitude to all aged care workers for their unwavering dedication, care and commitment”.
“These employees are the unsung heroes of our communities,” he said. “Their compassionate and tireless work ensures the wellbeing of older people, and their commitment is nothing short of extraordinary. We sincerely thank them for their exceptional service”.
The Australian Health Service Alliance (AHSA) published an article by CEO Andrew Sando titled ‘Amid the opposition and finger-pointing, let’s not forget the great work of private health’. (AHSA is one of the largest health purchasing groups in Australia, contracting with hospitals on behalf of most small and medium-sized private health insurers.)
Sando wrote that “the majority in private healthcare know we are in it together, and – whether provider or payer – our job is to act in the interests of consumers. This means striving to provide care at the right time, in the right setting, and in the right manner – all while trying to make private health affordable for all”.
He gave an example of AHSA identifying a hospital with disproportionately high rates of coronary care unit admissions following a particular procedure, and working with the hospital to address the issues that led to the higher usage.
Sando wrote that this was “just one of many examples of how member-owned health funds and not-for-profit hospitals, and clinicians, work hand-in-hand to improve care delivery”.
Politicians and parliamentary committees
As the IV saline supply shortage worsened, Shadow Health Minister Anne Ruston criticised Minister Mark Butler for being “missing in action”.
She said that “the Government must urgently commit to a nationally-coordinated response to the shortage of IV fluids”.
“The Minister cannot hide behind the TGA on this issue. It is a matter of national importance,” she said.
After hearings in Adelaide and Perth on 5 and 6 August, the Senate inquiry into issues related to menopause will hold what appears to be its final hearing in Canberra on 13 August before reporting in September.
International organisations
The Commonwealth Fund (a United States health policy think tank) released a report on a survey of Federally qualified health centres – community-based outpatient clinics that provide primary medical, dental, behavioural, and other health care services, and are funded through a combination of federal funding, Medicaid reimbursements, and other revenues.
Almost 1,500 centres provide primary healthcare to about 30 million patients at more than 15,000 service sites.
Findings with an Australian resonance include 70 percent of centres reporting workforce shortages; and a substantial increase in telehealth services compared with 2018, but associated issues with patient access to the necessary technology.
Finally
A statement from ACCRM marked the death of Dr Jack Best AO in late July.
The College said that Best was “recognised as an authority in the policy and provision of medical services and medical education in rural, remote and First Nations communities”.
As well as working as director of medical services at a series of Victorian rural health services, Best held positions as deputy secretary-general of the AMA; President of the International Society for Quality in Health Care; and President of the RACP Australasian Faculty of Public Health Medicine.
ACCRM described Best as “a key instigator of the development of the national network of University Departments of Rural Health and Rural Clinical Schools [which] have been significant in supporting medical training outside metropolitan centres, leading to the development of cohorts of medical graduates who establish their careers in rural practice”.
He was also chair of the Australian Institute of Political Science (now the Australian Institute of Policy and Science) for 18 years. In that role he was instrumental in establishing the Tall Poppy Campaign to mark the centenary of the birth of Sir Howard Florey, which eventually grew into “a campaign to recognise and celebrate Australian intellectual and scientific excellence and to encourage younger Australians to follow in the footsteps of our outstanding achievers”.
I met Best in 1999, when he was carrying out a national “stocktake” of rural and remote health for the Department of Health. He was very generous in sharing his knowledge and experience with an obscure mid-career public servant.
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Therapeutic Goods Administration
Proposed exposure model for assessing the safety of sunscreen ingredients in Australia
13 August
Therapeutic Goods Administration
Revised TGA Instructions for Disinfectant Testing
16 August
Therapeutic Goods Administration
Reforming Australia’s Therapeutic Goods Testing Regulations
18 August
Australian Technical Advisory Group on Immunisation
Removal of information about Zostavax in the Australian Immunisation Handbook
27 August
Department of Health and Aged Care
Clinical Categories Review Advisory Committee Report
30 August
Department of Health and Aged Care
Multi-Purpose Service trial sites direct care targets
30 August
Department of Health and Aged Care
How to implement the MSAC advice about the cost of technical support services for cardiac implantable electronic devices
6 September
National Health and Medical Research Council
Australian Drinking Water Guidelines – public consultation on draft guidance for lead replacements in plumbing products
6 September
Food Standards Australia and New Zealand
Amend the definitions in the Australia New Zealand Food Standards Code (the Code) for ‘food produced using gene technology’ and ‘gene technology’
10 September
Department of Health and Aged Care
Improving commercial foods for infants and young children
13 September
Therapeutic Goods Administration
Proposed changes to the Permissible Ingredients Determination
13 September
Department of Health and Aged Care
Prostheses list – General Use Items utilisation, expenditure and integrity
20 September
Australian Commission on Safety and Quality in Health Care
National Safety and Quality Medical Imaging Standards (to replace the Diagnostic Imaging Accreditation Scheme Standards).
27 September
Department of Health and Aged Care
Review of MBS health assessment items
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK.
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