MID TERM REVIEW OF PROVIDER NUMBER LEGISLATION
COMMONWEALTH GOVERNMENT,
DECEMBER 1999

Executive Summary

This review has been undertaken as a requirement of section 19AD of the Health Insurance Act 1973, which provides that:

'The Minister must, on or before 31st December 1999, cause a report setting out details of the operation of sections 3GA, 3GC and 19AA to be laid before each house of Parliament.'

To ensure that this review was at 'arms length', the Commonwealth Department of Health and Aged Care appointed an independent consultant to undertake this review. In summary, the review found as follows:

1. Section 19AA

There is overwhelming agreement with the objective that General Practice be recognised as a vocational speciality (ie graduates without further training should not be practising unsupervised). Claims made at the time the bill was passed that there was a lack of training positions that would result in young doctors being unemployed or 'stranded' in hospitals have not materialised. This legislation is underpinning other quality and workforce packages that have been put in place.

2. Section 3GA

This section is being used effectively to approve training courses and to address workforce shortages. However the following issues need to be resolved:

- the quality and training objectives of the legislation are being weakened by the necessary emphasis on addressing workforce shortages;

- the objectives for and implementation of community terms in early postgraduate years; and

- there is a continuing low rate of Australian trained doctors taking positions in rural and remote communities.

3. Section 3GC

The work and effectiveness of the Medical Training Review Panel (MTRP) in producing much needed information on training issues, and in bringing together stakeholders to resolve training issues, was well recognised and positively regarded by the industry. Given that much of its initial work is done, the Panel should continue to address the growing challenges in the medical workforce environment.

This review is of the opinion that there is a real danger the pressure of workforce issues will progressively result in more and more approvals under section 3GA.

This will undermine the primary intent of section 19AA which is to ensure that all Australians have access to only high quality general practice services.

It is for this reason that of the 10 recommendations made in this report, the review considers the second recommendation to be the most important. This recommendation asks the Minister to consider adopting one of three options designed to put even greater emphasis on training, and encouraging more doctors to practice in the area of greatest need, which is rural Australia. This will build even further on the extensive work already being done in this area.

Further, the adoption of the tenth recommendation would remove the sunset clause now, ending the uncertainty facing junior doctors and medical students as they make their career choices.

This report and the recommendations are tendered to the Minister and the Parliament for their consideration.

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Recommendations

Recommendation No 1

Approval to work in the emergency departments of private hospitals is a quality, workforce and patient service issue affecting private hospitals in both urban and rural areas which needs to be addressed. The Commonwealth should undertake discussions with the relevant parties to resolve this problem.

Recommendation No 2

This review recommends that the Minister consider the following options:

(a) retaining the RACGP Training Program but imposing a quota within it for rural training;

OR

(b) as above but with the addition that those enrolled in the urban-based general practice training program would pay for their training on a user-pays basis unless they trained in demonstrated areas of need;

OR

(c) establishing a separate college of an appropriate size. This new college would deliver rural general practice training, with its graduates being awarded a fellowship which would result in access to a provider number which attracts Medicare benefits.

Recommendation No 3

The operations and intent of the Queensland Country Relieving Program are clearly inconsistent with the intent of this legislation. This review recommends that discussions between the Commonwealth and Queensland Health, aimed at obviating the need for this Program, take place as a matter of urgency.

Recommendation No 4

As it is inappropriate for doctors without the relevant training to provide home visits, serious consideration should be given to repealing the regulations that established the Approved Medical Deputising Services Program.

Recommendation No 5

This review recommends that the role of the Rural Workforce Agencies as a body matching doctors and placements be considered in the context of the national evaluation of the Agencies.

Recommendation No 6

Given the apparent inconsistencies between the name of this program and its objectives, this review recommends that the name 'Rural Locum Relief Program' be changed to more accurately reflect its role.

Recommendation No 7

While inconsistencies have been alleviated somewhat by the new term of 'district of workforce shortage', this review recommends that consistent terminology and definitions of 'area of need' be used in order to avoid such confusion. It recommends bilateral discussions between the Commonwealth and state/territory health authorities.

Recommendation No 8

As there are still very mixed views about the worth and cost/benefit of the MTRP recommendation that all PGY 2s undertake a community term, this review recommends that the original proposal for a compulsory community term be referred back to the MTRP for further analysis and consideration.

Recommendation No 9

It is recommended that a body such as Australian Medical Workforce Advisory Committee (AMWAC) undertake a longitudinal study, aimed toward filling in the gap in medical workforce knowledge of what Australian medical graduates do and why.

Recommendation No 10

This review finds no reason why the sunset clause should remain the in the legislation. In fact the review finds that it would be counterproductive to morale amongst junior doctors to maintain the illusion that the legislation will ever be repealed. It would also provide certainty for medical students.