DPA set for another makeover but moratorium to stay

The Rural Doctors Association of Australia does have some concerns over how the recommendations sit with the Kruk report.

---

A new independent report recommends that the 10-year moratorium stays put until Australia is closer to self-sufficiency and proposes another Distribution Priority Areas makeover.

In 2022, to address what the ACRRM labelled “relatively minor” workforce shortages in some regional centres and outer urban areas, the federal government expanded DPA eligibility, which allows IMG doctors and rurally bonded medical student employed in DPA areas to bill Medicare.

Automatic DPA status was extended from MM3-7 to MM2 and above.

Last November, a mere 18 months after implementing the change, federal health minister Mark Butler announced a review into the ongoing national maldistribution of doctors.

The review focused on workforce levers including the DPA system, the Modified Monash Model, District of Workforce Shortage (DWS) classification systems and Sections 19AA and 19AB of the Health Insurance Act 1973.

Submissions from the likes of ACRRM and the Rural Doctors Association of Australia called for the DPA system to be returned to its former state.

“Within a short space of time, [the expansion] triggered significant movement of IMG doctors out of MM3-7 to take up positions in MM1-2 and has made it substantially harder to recruit to MM3-7 vacancies,” ACRRM wrote.

Yesterday, the government released the final independent report on the Working Better for Medicare Review, which included 26 recommendations.

The reported heeded concerns that the expanded DPA eligibility did not reflect need and was thereby a weak tool to target workforce maldistribution.

It suggested that the proportion of GP catchment areas with DPA status should sit at around 40-50%, rather than the current 85%.

“The DPA should focus on distributing GPs to areas of comparatively higher need (rather than only identifying areas of GP workforce shortage),” read the report.

It also recommended that MMM classification no longer be used as the “primary criterion” for DPA status.

Instead, assessment should be based on the National Assessment Tool and may include other criterion like average travel distance for patients and wait times.

“DPA status should not automatically apply to any location,” the report said.

“The new DPA threshold that determines whether a GP catchment has DPA status should be based on the NAT Workforce Need Score for GP catchments (calculated at a national level, not for each State/Territory).”

The report recommended the establishment of a Health Workforce Independent Review Panel, with DoHAC as secretariat, to oversee any changes to the DPA, DWS and GP catchments.

“The Health Workforce Independent Review Panel should be used to assess any GP catchment anomalies that are not captured by the new DPA threshold,” the report read.

RDAA CEO Peta Rutherford told The Medical Republic that, when considering GP workforce need, it would be important not only to look at the data, but also to the future.

For rural practices serving expansive communities with a handful of doctors, losing GPs to retirement can have far reaching impacts, she said.

Rural generalists also often split their time between general practice and hospital work, meaning that even with the numbers, the workforce is spread more thinly.

“We need to make sure that we support practices’ succession plans,” said Ms Rutherford.

“What we don’t want to do is punish those practices that do plan ahead, because what we want to build is a model of general practice or a medical workforce in our rural and remote communities that’s sustainable for the future, and the way to do that is to avoid going into a crisis situation.”

Ms Rutherford said that MMM was a great tool to determine rurality and remoteness, but incorporating more data into DPA assessment would allow for a more nuanced assessment of need.

“We need to be careful in just applying a one size fits all solution,” she said.

The RDAA CEO also said transparency over why some practices qualified for DPA and others didn’t would be important to avoid it becoming too “political”.

“It would be great to take the politics out of it, however my expectations are realistic, so I don’t know if you’ll ever completely succeed in that,” she said.

“We hope that putting a new process in place, so having some independence and expertise with the advice that’s given, would help the politicians make informed decisions and decisions that they can justify, because it does come at a cost to Australian taxpayers.”

Ms Rutherford said there was a place for MMM as the basis for other incentives and initiatives, like HELP debt.

The report also supported the retention of section 19AB of the Health Insurance Act 1973 “at least in the medium term”, which allows overseas-trained GPs working in DPAs to bill through Medicare.

These GPs must remain in DPAs for 10 years from their date of registration.

“Without 19AB, there is a strong view that many IMGs would choose to practise in metropolitan areas,” the report said.

“While there was support for the retention of 19AB, the extent of exemptions to the 10-year moratorium is undermining the efforts to address workforce maldistribution.”

The reviewers said the retention was necessary until Australia was “closer to self-sufficiency”.

Ms Rutherford said the report would need to be considered in parallel to the Kruk report, which reviewed Australia’s regulatory setting for health professionals.

“[RDAA] are a little bit concerned with … whether or not [this report] lines up well with the recommendations for overseas trained doctors that came out of the Kruk review,” Ms Rutherford told TMR.

“We need to make sure that we invest and support these doctors for the valuable contribution they make to our medical services.”

The report also touched on GP training pathways, recommending the potential expansion of 3GA programs to specific non-GP specialties with significant community-based practice and more support for trainees and supervisors.

“Financial, professional and peer supports should be made available to all GP registrars- both Australian Medical Graduates (AMGs), and IMGs to match what is currently available under the Australian General Practitioner Training (AGPT) pathway, regardless of training pathway,” read the report.

“Supervision of all GP training should be remunerated in line with the National Consistent Payment Framework and remote or blended (i.e. mix of remote and on-site) supervision models should be used to increase and sustain supervision capacity and capability in rural and remote areas.”