Some communities are “GP deserts”, where there are too few GPs to ensure everyone can get the care they need when they need it. These communities are typically sicker and poorer than the rest of Australia, but receive less care and face higher fees.
On this podcast, host Kat Clay interviews health experts Peter Breadon and Wendy Hu on the problem of GP deserts and how governments can fix them.
Transcript
Kat Clay: Would you pay one million dollars to get a GP to your town? It might sound like a hypothetical question, but some rural communities are so desperate for care, they’re offering large incentives for doctors to move to the area.
Alarming new research from Grattan shows the scale of GP deserts in Australia, where residents receive 40 percent fewer GP services than the national average. I’m Kat Clay and with me are health experts Peter Breadon and Wendy Hu to talk about how bad the GP deserts are and how we can fix them. So, Wendy, what is a GP desert?
Wendy Hu: We’ve defined GP deserts as communities in the bottom 5 percent for GP care after adjusting for age. On average, Australians receive 6. 4 GP services per person, but people in GP deserts get less than 4. This is 40 percent less GP care than the national average, meaning 40 percent less check-ups, screenings and medication management essential to our health.
We’ve used GP services as our measure but acknowledge that GP care is also provided by nurses and Aboriginal health workers. However, even when you add care provided by these other practitioners, GP deserts do not catch up to the national average. And this is not a new problem. GP deserts are persistent.
These are areas which have had low levels of care for at least a decade.
Kat Clay: So, when you say 6. 4 GP services, we’re not talking about six and a half GPs themselves. We’re talking about a much broader range of services here.
Wendy Hu: That’s right.
Kat Clay: So, am I right in thinking that some people in these areas aren’t even getting care?
Wendy Hu: Yeah. Some people even miss out on care altogether. If we look at 65 plus, a cohort that is in particular need of care, 8 percent did not see a GP in 2023 compared to less than 1 percent in the rest of Australia.
Kat Clay: So, Wendy, that’s a large proportion of people who didn’t get the GP care that they might need. Whereabouts are these GP deserts.
Wendy Hu: Around half a million people live in GP deserts, mainly in rural Queensland, Western Australia and the Northern Territory, in areas like the Bowen Basin, Katherine and Alice Springs, but some are even in the city including areas like Molonglo and North Canberra.
Kat Clay: And what do we know about people living in these areas?
Wendy Hu: Yeah, so many of these people are in our most vulnerable communities. These are areas that are typically sicker. People in GP deserts are almost twice as likely to go to hospital for a condition that might have been avoided with better primary care or to die from an avoidable cause. They are also poorer.
Most GP deserts are in the bottom 40 percent of disadvantage. So really, they should be getting more care, not less. And worse still, they face higher costs. Patients in GP deserts get bulk billed less than the national average.
Kat Clay: So, it’s clear that there’s an urgent need for care, but what have governments been doing so far to tackle the problem?
Peter Breadon: Well Kat governments have been doing a range of things so for example there was recently a multibillion-dollar investment to encourage bulk billing through increasing the bulk billing incentive for GPs, which they get every time they don’t charge a fee to a concession card holder or a child patient.
And that incentive increases for rural parts of Australia. That intervention has seen the national rate of bulk billing stabilised and it’s seen increases in bulk billing in rural and regional areas. There’s been an expansion of GP training, including rural generalists who have a broader scope of practice than the traditional GP, and it encourages people to move to rural areas.
There’s been more medical schools and training opened up in rural areas. So, all these things are positive, but they haven’t really addressed the needs of these GP deserts. We’ve seen the levels of care in those areas, as Wendy mentioned earlier, just languishing at a really low level. And we don’t see these broader policies that focus on rural care in general really shifting the needle in those GP deserts.
Kat Clay: Yeah, and some communities have started to come up with their own solutions, right?
Peter Breadon: That’s right, Kat. It’s a really tough situation for these people living in GP deserts and often the care is limited and really precarious and they’ve had to step in to, to prop it up and expand the care available. To give one example, there’s a community on the east coast of Tasmania where a few years ago there was a GP retirement that left the town with only one GP and people had to travel often for hours to try and get into a GP elsewhere. So, the local councils got together, and they put a levy onto council rates so that residents had to pay more to fund the expansion of GP care. And that meant that they could attract GPs, and other clinicians expand a local clinic, provide significantly more care, and I understand they’re now hoping to get a psychiatrist to visit regularly from Hobart building on that multidisciplinary team that they’re building up in that clinic.
So that’s just one example, but we’ve seen a lot of local communities struggling to come up with their own solutions that will work for them.
Kat Clay: I have never heard of a local council having to resort to taxing their community to fund extra GP services. Shouldn’t this be the federal government’s responsibility? And I mean, what can governments do here that’s more sustainable and systemic?
Peter Breadon: You’ve hit the nail on the head, Kat. It, it really is currently local communities struggling to find a solution. And there might be pilot funding or grants or different initiatives, but it isn’t systemic. It isn’t reliable. And it’s often up to towns that, that that might not be able to afford to, to scramble together the funding that’s needed.
Another example you mentioned, you know, right at the top was a West Australian town where they put together a package that added up to about a million dollars to attract a GP by paying for housing, the GP’s salary, bringing in other clinicians and administrative staff to, to work in the clinic. So, this is happening, but many communities can’t afford to do that.
And it can turn into a bidding war if communities are left to their own devices to try and fill these enduring and serious gaps in care. So, we think the government should set a standard for care, a minimum level that all communities are guaranteed to get. We’re calling it a National GP Guarantee. And when care falls below that level, we’ve indicated this level of the bottom 5 percent as one example, when care falls below that level and stays there, then the government should inject money to come up with a local solution.
That money should come from both the federal government and the state government working together. That way they can, instead of competing over resources or creating duplicate clinics or infrastructure, we can make sure we get the best bang for buck. That should be tailored to the local needs of the community.
It might be different in different places. In some places, like in that east coast of Tasmania example, they might set up a new clinic and bring in the clinicians, pay them a salary. In other cases, it might be supporting people to come in, fly in, fly out, drive in, drive out, telehealth solutions, different workforce models.
There’s not going to be a one size fits all, but the thing that we do need is that secure, guaranteed funding to go where it’s needed most to come up with solutions that will work.
Kat Clay: Peter, wouldn’t it be easier to constrain GPs not to work in metropolitan areas like the NHS in the UK?
Peter Breadon: Well, Kat, that idea has been proposed, but it would be quite tricky to do. There are questions about the legality of that kind of requirement due to a clause in the Constitution that essentially limits the degree to which you can tell doctors where they can work.
And, you know, while that could be challenged and clarified, it might be a barrier to this approach. Certainly, it would be very unpopular, I think, with, with doctors and many of the groups that represent them. And it might be technically hard to implement as well to really understand, which communities are definitely over serviced potentially, and where you could safely take care away.
And even whether some of those GPs are working partly through telehealth supporting rural areas or doing part of their work in underserved parts of cities as well as parts of cities with lots of care. So, because of the legal questions about it, because of some of the challenges in, in measurement and implementation and some of the, the real backlash that would flow from it we don’t think that’s the top priority.
You know, we really think you’ve got to focus on, we know where these communities are. based on the data that are consistently getting too little care. And we need a new approach to unlock flexible and secure money to get the care into those regions. So, that’s what we focused on with this proposal about GP deserts.
Kat Clay: I feel like I learned something on the podcast today, which is, you know, that the doctor’s right to work where they work is enshrined in the constitution. So that’s a fact for today.
Peter Breadon: Well, you know, some people debate, you know, how hard and fast that is, and it may not have been challenged in all the ways that that might need to be, to really understand the scope of it. But yes, it does raise a few red flags about the kind of proposal you mentioned.
Kat Clay: So, Peter, we do know that fixing healthcare is going to be expensive. How much would these initiatives to fix GP deserts cost?
Peter Breadon: Well, the cost of delivering the care itself, if it was delivered at the normal cost for the rest of the country, might be approximately 30 million a year. Now in practice, it’ll cost a lot more to deliver care in these rural and regional areas, but even if it costs double or triple that amount, it’s still going to be a small fraction of the money we spend in the rest of the country and even the big investment that was made to increase bulk billing incentives recently.
So, we think that the funding that goes to these areas should be calculated to take into account the different costs of delivering these kinds of different models. Really based on a salary for a multidisciplinary team to deliver the care that people need with appropriate adjustments for the extra costs that that occur in some of these rural and remote communities.
But certainly, we think it’s affordable and it really is time for action because as Wendy mentioned these same GP deserts have been stuck with this level of care for at least a decade. With the election coming up, there’s a chance to really say, let’s flip this and say it’s time for the government to step up and give communities a guarantee.
You will get at least a minimum level of care. And we’re going to unlock the funding for you to do that.
Kat Clay: Yes, and health looks like it is poised to be one of those hot topics for the upcoming federal election. So, we will be digging more into this as the weeks and months go by towards the election. Now, Peter, one final question for you. We have focused on GP deserts, but it feels that this is symbolic of systemic issues facing Australia.
I mean that everyone is finding it hard to get a doctor’s appointment at the moment.
Peter Breadon: Look, the, the system is definitely under strain, and we’ve also recommended changes for other parts of Australia. So, the common thread here is the way we fund care isn’t working. That’s both in GP deserts and also in big cities. For GP Deserts, we need that community focused funding that allows, you know, salaried teams or different interventions to expand or support Aboriginal health organizations or deliver care out of rural hospitals to deliver the kind of flexible solutions I mentioned before.
There’s also a problem with how we fund GPs in the city, and that is that the funding really rewards speed instead of addressing patients’ needs. It’s not really fair, it doesn’t adjust for levels of disadvantage very well. Or for the complexity clinically and socially that different patients have.
And it doesn’t support that bigger team to help a GP provide all the care that patients need as that care gets more complex with rising rates of complex chronic disease. So there’s a much bigger agenda here also for the rest of the country, but we’d love to see in this election campaign governments commit to the really fundamental reforms to GP funding that have been recommended not just by us, but by two major independent reviews of the, the primary care workforce and of Medicare that have come to the government in the last couple of years. Early steps have been made on that journey, but we’d love to hear governments, and prospective governments talk about how they’re going to take the next step to transform GP funding. And that will definitely help improve access support GPs to provide the great quality care that they’re all striving to provide to their patients.
Kat Clay: Thank you very much, Peter and Wendy. This podcast has been based on some research that we’ve recently done into GP deserts. If you’d like to read about that, I am going to pop a link to that article in the show notes below. Likewise, you can read about any of our health research on our website at grattan.edu.au. We do rely on donations from our listeners, and we really appreciate if you want to support a not-for-profit work at the same website as well. Take care and thanks so much for listening.