Croakey is closed for summer holidays and will resume publishing in the week of 13 January 2025. In the meantime, we are re-publishing some of our top articles from 2024.
This article was first published on Tuesday, September 3, 2024
High hopes surround the development of Single Employer Models to support GP and rural generalist registrars in under-served areas, from lutruwita/Tasmania to rural Queensland.
The model gives GP and rural generalist registrars the option of being employed as salaried employees rather than the current fee-for service contract arrangement with a general practice, reports columnist Charles Maskell-Knight.
His column this week also covers Women’s Health Week, vaping reforms, aged care workforce trends, the need to improve wound management in aged care, and a regressive policy proposal for the introduction of a fringe benefits tax exemption for private health insurance.
The quotable?
Remember the Labor Party’s commitment to establish an Australian Centre for Disease Control?
While an ‘interim’ CDC has been established by rebranding a few areas of the Department of Health, there has been no sign of the legislation needed to establish an independent body, and it is now highly unlikely to be passed before the next election.”
Charles Maskell-Knight writes:
Readers will recall that before the Government reached a compromise with the Greens to get its anti-vaping package through parliament, it was proposing that vapes would be available only on prescription.
The deal with the Greens meant that from 1 October vapes would only be available from a pharmacy after discussion with a pharmacist.
The Tasmanian Government has now decided to go its own way, and introduce legislation that will:
- ban the sale of vape products for children and young people under 18 years, with or without a prescription; and
- ensure e-cigarettes can only be supplied by pharmacies to people 18 years or over with a prescription.
Tasmanian Health Minister Guy Barnett said “the Tasmanian Government has stepped up where the Federal Government has failed to protect the community from the harms of vaping, especially our children and young people”.
The Pharmacy Guild supported the announcement, with Tasmanian president Helen O’Byrne saying “on behalf of Tasmania’s community pharmacists, we thank Minister Barnett and his Government for their leadership on this critical public health issue”.
“It’s a decision that sees Tasmania set the standard on the responsible regulation of vapes.”
It seems the Guild is happy for members to profit by selling vapes somebody else has prescribed, but not happy to take responsibility for dispensing vapes themselves as S3.
Ministers and government
Health Minister Mark Butler announced that the Government was funding a trial of a Single Employer Model to support GP and rural generalist registrars training in Charleville, Queensland.
The trial will be delivered by a group led by the Queensland Aboriginal and Islander Health Council (QAIHC), and will include “high level cultural mentoring and support, to allow [registrars] to build strong connections with the community and expertise in delivering comprehensive primary healthcare for First Nations people”.
QAIHC chair Matthew Cooke said: “The Single Employer Model trial offers registrars the stability and continuity they need to thrive, and it’s a model that reflects the values of our communities – where relationships, respect, and trust are paramount. By embedding registrars within ACCHOs, we’re nurturing a future workforce that will carry forward the legacy of culturally safe, community-driven healthcare.”
The Rural Doctors Association of Australia welcomed the announcement, saying that the model, which gives GP and rural generalist registrars the option of being employed as salaried employees rather than the current fee-for service contract arrangement with a general practice, “is desperately needed to help address the rural doctor shortfall”.
Trials are now already under way or planned in every state except WA.
On 31 August, the Australian College of Rural and Remote Medicine (ACRRM) said it was “thrilled with Tasmanian Premier Jeremy Rockliff’s announcement that the state will embrace a Rural Generalist employment model to combat the shortage of doctors in its rural, remote and First Nations communities”.
Minister Butler also announced that the Government had “worked with local producers and suppliers to secure supply of over 22 million additional IV fluid bags for the affected product lines over the next 6 months, both locally produced and imported. This supply volume exceeds the forecast demand over this period”.
In a subsequent media conference Butler said he was advised that “the additional 22 million bags will ensure that Australia broadly has more bags than we need over the course of the next six months”. He also said he was unaware of any surgery cancellations as a result of the IV fluid shortage.
At another point in the media conference, Butler confirmed that the Government had “only just” received the report from the Health Technology Assessment review, but said he didn’t have a timeframe for a Government response.
Given the Government’s leisurely response to many other reviews and reports, nobody should hold their breath waiting for this one.
Assistant Minister Ged Kearney told the ABC that the census should collect LGBTQIA+ data to inform policymaking and support inclusion.
She said “the census not only informs policy and service delivery but paints a picture of modern Australia in all its beauty and diversity. For too long LGBTQIA+ people have felt excluded from this picture … I’m working to ensure these views are represented within the Albanese Labor Government”.
The Government subsequently announced that data would be collected in the Census, subject to successful testing of a question.
The Department of Health and Aged Care announced the launch of a “super-kids” advertising campaign to remind First Nations parents and carers about the importance of childhood vaccination.
Remember the Labor Party’s commitment to establish an Australian Centre for Disease Control?
While an “interim” CDC has been established by rebranding a few areas of the Department of Health, there has been no sign of the legislation needed to establish an independent body, and it is now highly unlikely to be passed before the next election.
Croakey’s managing editor Alison Barrett has written about the interim CDC here, and the Department has provided some responses to questions about it here.
While we wait for a permanent body, the Department has now opened a consultation process “asking the Australian public to share their concerns and expectations” about how the CDC will use and manage data.
The Australian Institute of Health and Welfare (AIHW) released a report on the aged care workforce. After dropping sharply during COVID-19, the total number of people working in residential aged care reached an all-time high of just over 300,000 in 2024. The proportion of full-time employees increased from 50.5 percent in 2022 to 51.2 percent in 2024.
The AIHW also released its monthly report on MBS-funded services, showing the average proportion of GP fees met by Medicare has inched up from an all-time low of 83 percent in January to 85 percent in July.
The Australian Commission for Safety and Quality in Health Care (ACSQHC) released a revised Australian Framework for National Clinical Quality Registries “to support and encourage the use of data to inform clinical practice and policy”.
The ACSQHC maintains a register of registers (although it notes that not all clinical registers are necessarily clinical quality registers) with dozens of entries, and a document setting out “the principles under which all clinical quality registries should be operating [with] clear and practical guidance on how those principles can be implemented” must be very helpful.
Ahpra’s Accreditation Committee opened consultation on its draft guidance on developing professional capabilities. Chair of the Accreditation Committee, Professor Andrew Wilson AO, said that the draft “raises important issues associated with the governance and ownership of professional capabilities documents and the potential for core capabilities to be shared across professions. It also provides practical information to assist organisations to develop their professional capabilities”.
The Aged Care Quality and Safety Commission foreshadowed Wound Awareness Week with a statement reminding aged care providers of their “responsibility to ensure good clinical governance that supports effective wound management”. Apparently inadequate wound management is one of the most common clinical complaints received by the Commission.
First Nations health
The National Indigenous Times reported that Aboriginal Medical Services Alliance Northern Territory (AMSANT) had congratulated the new Northern Territory Government on its election win, and “look[ed] forward to working with the new Government to improve the health of Aboriginal Territorians”.
AMSANT CEO Dr John Paterson said that the organisation “recognised the substantive structural change that is required to address the ongoing burden of poverty, discrimination and ill-health that our people continue to bear”.
The Pharmaceutical Society of Australia also congratulated the new Government, welcoming its plans “to expand pharmacy services in the community through the Pharmacy Scope of Practice program, which will offer additional health services for up to 21 conditions”, and to “implement pharmacist prescribing for uncomplicated Urinary Tract Infections (UTIs) in women”.
(See Croakey’s coverage of the NT election here).
Consumer and public health groups
COTA commented on the aged care star rating system, saying that “it’s concerning that a system meant to reliably inform older people and the community is seen as sometimes delivering conflicting or confusing information based on whether non-compliance notices are formally issued or not”.
“This must be addressed through ongoing improvement to the way star ratings are calculated, to restore community confidence in the star-rating system,” COTA said.
As I and others have observed, the system is not providing useful information when services can receive three, four or even five stars while failing to meet the quality standards.
Women’s Health Week runs from 2-6 September. The Jean Hailes Foundation, which auspices the event, provided an introduction to the week, with the theme #YourVoiceYourChoice.
CEO Dr Sarah White said the Government’s #EndGenderBias survey had found that many women feel their voices are not heard when they seek healthcare. In addition, difficulties with access – including physical and financial barriers, as well as simply finding the right service – mean healthcare choices are also limited.
Women’s Health Week aims to “encourage women to use their voice, to not be afraid to ask for what they want and need and thus transform the power relationship between a woman and her health professional”.
Trade unions
Allied Health Professions Australia (AHPA) announced that its Aged Care Working Group was working on “a sustainable model of care for allied health in residential aged care”.
AHPA released a facts sheet setting out the problem (terrible and worsening access to allied health services) and the key elements of the solution (“a multidisciplinary model and a nationally consistent assessment of allied health needs”).
The Royal Australian College of GPs (RACGP) welcomed a proposal by the oxymoronic Coalition of Independent candidates in the forthcoming ACT election “to attract GP registrars to train and stay on in the ACT by offering twenty $40,000 grants per year and co-designing a retention and burnout prevention strategy”.
The Society of Hospital Pharmacists of Australia announced it had rebranded itself as Advanced Pharmacy Australia – acronym AdPha. The new identity is “a response to the increasing needs of patients and a pharmacy profession outgrowing traditional workplace boundaries”.
Speech Pathology Australia marked Speech Pathology Week, which this year had the theme “Communicate Your Way”.
Industry groups
In July a contract dispute between private health insurer nib and the St Vincent’s hospital group made headlines, with warnings of patients facing out-of-pocket costs.
That dispute was no sooner resolved, than UnitingCare Queensland announced it was terminating its hospital agreements with over 20 private health insurers represented by the Australian Health Service Alliance (AHSA).
UnitingCare operates the Wesley Hospital, St Andrew’s War Memorial Hospital, Buderim Private Hospital, and St Stephen’s Hospital, Hervey Bay.
AHSA said that UnitingCare was “demanding over a 10 per cent increase each year over the next two years”, and that “such price increases in this inflationary climate disregard the current cost-of-living pressures felt by the majority of Australians”.
The Australian Medical Association (AMA) issued a statement “urging UnitingCare and AHSA to continue negotiating to strike a deal that puts the needs of patients first, while also delivering a reasonable return for all parties and recognising the rising costs of providing quality care”.
The AMA reiterated its call for the establishment of an independent Private Health System Authority to “drive long-term reform and ensure the sector is appropriately regulated and patients get real value for money from their private health insurance”.
The AMA does not appear to envisage that the Authority would have any power to regulate out-of-pocket costs charged by doctors – which is one of the most significant issues many patients face when using their private health insurance.
Department of Health and Aged Care Secretary Blair Comley PSM addressed the general issue of insurer-hospital contracting in a speech to the Catholic Health Australia conference. He said “we have to be clear that these are commercial negotiations between parties, and the Government has to be cautious about getting into the middle of that”.
Comley added that the data the Department had collected during its private hospital review showed that profitability “varied widely depending on factors like geography, hospital size, the power of the insurance provider, the services provided, and a myriad of other factors”.
Private Healthcare Australia (PHA, the private health insurance lobby group) issued a statement marking the release by APRA of private health insurance statistics for the June quarter, including year-on-year comparisons.
After discussing the increase in hospital benefits (now fully recovered from the COVID-19 slump) and the record number of people covered by some sort of insurance, PHA returned to its bete noire – growth in prostheses benefits.
CEO Dr Rachel David said “there’s been an 18.8 percent increase in the volume of medical implants and surgical supplies claimed from health funds since 2019. This is totally out of proportion with a 4.7 percent increase in the number of medical services funded by health funds over the five years to June 2024”. She added that there had been no measurable improvement in patient outcomes as a result of this “runaway growth”.
While the previous Government decided to remove low value, high volume items (so-called General Use Items or GUIs) from the prostheses list, the current Government, after delaying for a year, decided to reverse that decision earlier this year.
The Department has now noted that “some stakeholders raised concerns about the increasing growth in use per episode of care and the resulting expenditure for these products, following the announcement to retain GUIs on the [prostheses list]”, and it is “undertaking further consultation and engagement to identify ways in which these concerns might be addressed – both regulatory and non-regulatory”.
I’m sure the Department will receive a submission from PHA before the deadline of 20 September.
The Members Health Fund Alliance also commented on the APRA private health insurance statistics. CEO Matthew Koce used the occasion to suggest introducing a fringe benefits tax exemption for private health insurance.
While the current premium rebate is regressive, the income testing and phasing down of the rate of the current private health insurance rebate as income increases ameliorates some of its regressive impact.
By contrast, an FBT exemption would confer large benefits on high income earners who do not currently receive any subsidy. It is hard to think of a more regressive subsidy measure.
Politicians and parliamentary committees
Greens health spokesperson Senator Jordan Steel-John issued a statement highlighting the party’s commitment to using the proceeds from a Big Corporations Tax to fund “dental for all” under Medicare.
The Senate committee inquiry into excess mortality reported on 30 August, with a brief list of recommendations including:
- the Australian Bureau of Statistics include geographic indicators in its excess mortality estimates, and produce data for sub-populations such as First Nations people and people with people with disability
- the Government consider a no-fault compensation scheme for Commonwealth-funded vaccines in response to a future pandemic
- the Government establish the Australian Centre for Disease Control as soon as practicable
- the Department of Health and Aged Care review public health information communication strategies during the COVID-19 pandemic to improve future public health communication.
Finally (and quite remarkably) the committee recommended that the Senate take note of the following:
- witness participation in public hearings is critical to the committee inquiry process
- all witnesses who participate in committee public hearings should be treated with respect
- Senators should be reminded of the Resolution on the Broadcasting of Senate and Committee Proceedings.
This last recommendation was made in response to the actions of Senator Ralph Babet, who posted on his social media accounts video excerpts of Government officials giving evidence, edited to give the impression that they were not answering questions. Comments on the posts from Babet’s followers included references to “hunting [witnesses] down” and ensuring they are “shown the gallows”. The posts were removed after committee chair Senator Penny Allman-Payne wrote to Babet.
International
An article in BMJ Open by Drs Rachel Wilkie and Jessica Ho explored life expectancy and geographic variation in mortality across six high-income Anglophone countries.
They found that:
“Australia is the clear best performer in life expectancy at birth… While Australians experience lower mortality across the age range, most of their life expectancy advantage accrues between ages 45 and 84.
Australia performs particularly well in terms of mortality from external causes (including drug- and alcohol-related deaths), screenable/treatable cancers, cardiovascular disease and influenza/pneumonia and other respiratory diseases compared with other countries.
“Considering life expectancy differences across geographic regions within each country, Australia tends to experience the lowest levels of inequality, while Ireland, New Zealand and the USA tend to experience the highest levels.”
(The only caveat I would add is that the regional analysis focused on differences between states, while differences between metropolitan, regional and rural areas are far more significant.)
Finally
This week a video appeared in my Facebook feed from the ABS, showing the ten sectors that have added the most value to Australia’s GDP each year from 1990 to 2023. In that year health was the seventh most important sector, and manufacturing the most important.
By 2019 health was in third place, almost tied with construction, while mining was in first place.
During the pandemic health took second place, where it remains.
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.
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
The Joint Standing Committee on Aboriginal and Torres Strait Islander Affairs
Parliamentary inquiry into the Truth and Justice Commission Bill 2024
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
Independent Health and Aged Care Pricing Authority
Pricing Framework for Australian Residential Aged Care Services
20 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
Draft of the National Roadmap to Improve the Health and Mental Health of Autistic People
27 September
Department of Health and Aged Care
Review of MBS health assessment items
30 September
Department of Health and Aged Care
How the Australian CDC plans to use data
30 September
House of Representatives Standing Committee on Health, Aged Care and Sport
The health impacts of alcohol and other drugs in Australia
30 September
The Medical Board of Australia
Introduction of health checks for late career doctors
4 October
Therapeutic Goods Administration
Draft guidance on the new regulatory requirements and transition arrangements for medical devices containing medicinal substances or materials of animal, microbial, or recombinant origin
9 October
Therapeutic Goods Administration
Future regulation of assistive technologies
13 October
Therapeutic Goods Administration
Proposed changes to the Australian Essential Principles for Safety and Performance of medical devices
16 October
Ahpra Accreditation Committee
Guidance on developing professional capabilities
18 October
Note from editor: Due to editor’s error, the final paragraph in the section on the excess mortality report was omitted from the initial publication.
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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