Everyone reading this knows how hard it is to get a GP appointment in Tasmania. Yet Tasmanians should be getting more GP care than other Australians. One in three Tasmanians report having at least one long-term health condition, compared to one in four in NSW and Victoria. And Tasmania is second only to the Northern Territory in potentially avoidable early deaths.

Despite these dire statistics, a smaller share of Tasmanians visited the GP in 2021-22 than in any other state or territory, except for the Northern Territory. Tasmania had the fewest full-time GPs per person of any state or territory. And the bulk-billing rate in Tasmania for GP visits – at nearly 80 per cent – is much lower than the national average of close to 90 per cent.

The situation is desperate, and there have been attempts to plug the gaps. Several councils have introduced medical levies to subsidise local GP bulk-billing clinics.

A number of incentive programs and scholarships have been introduced in recent years to attract or retain medical and allied health professionals. And a new pilot program will allow doctors training in rural medicine to be employed by the Tasmanian Health Service.

These are all good steps, but a bigger national plan is needed.

Federal Health Minister Mark Butler has declared that primary healthcare is a top priority, and the May budget was a good start.

GPs are getting billions of dollars of funding to encourage them to bulk-bill. The federal government has recognised that GPs are carrying too much of the healthcare load, leading to long wait times and rushed appointments. To help other healthcare workers to better use their skills, the budget funded a review of workforce regulations, and will pay GP clinics in under-served areas to employ allied health workers.

GP clinics will also be able to choose a new way to get Medicare funding, called ‘My Medicare’.

Instead of just getting one-off payments for each visit, with better pay for shorter visits, clinics will also get a flexible patient budget. That will allow them to plan ahead, fund different ways of providing care, and do more to keep people healthy between visits.

All of that will help. But it will only work where clinics already exist. Another solution is needed for areas where there are simply far too few GPs, as in so many parts of Tasmania.

Some areas have too few patients to sustain a full-time clinic. Some communities are so disadvantaged that almost no patients can pay fees. And in some regions, there aren’t other health services such as pharmacies and allied healthcare, meaning GPs burn out after trying to fill the gaps in the broader healthcare system. Some parts of Tasmania are probably confronting all these problems at once.

In places with those kinds of challenges, the federal and state government should work together to establish and fund the clinics that are needed.

By working together, governments can use all the resources available, including those that typically aren’t used for primary healthcare, such as rural hospitals and paramedics.

Clinicians would have one employer, but they could work in both primary care and hospitals.

Some of this happens now, but there is no system to make it happen consistently where it’s needed most. An opportunity to change that is coming up.

In two years, the federal-state agreement on hospital funding and health reform will expire. The current agreement encourages governments to work together to fund and manage healthcare, but there’s almost no money behind the idea.

The next agreement should set a minimum standard for how much general practice care a region gets. If services fall below that level, funding should be triggered for federal and state governments to fill the gap.

And governments need a new playbook when they are setting up these clinics. That should include building telehealth into primary care, and using healthcare workers we rarely see in Australia, such as medical assistants and physician assistants, who can free up GPs to focus on more complex work.

Decade after decade, Australia keeps putting healthcare where it is needed least, while some areas keep missing out.

It is a problem with how we run our system, and tweaks to Medicare payments won’t fix it.

Instead, the next national funding deal needs to set fair expectations about how much care all communities should get, and allocate money to make it happen. Tasmanians deserve no less.

Peter Breadon

Health Program Director
Peter Breadon is the Health Program Director at Grattan Institute. He has worked in a wide range of senior policy and operational roles in government, most recently as Deputy Secretary of Reform and Planning at the Victorian Department of Health.

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