The state party has promised big, but is the 'GP Guarantee’ just robbing Peter to pay Paul?
Despite having already been in government for a decade and running an antivax doctor as a candidate, Tasmania’s Liberal party swears it has a plan to fix general practice in the island state.
Pre-polling for the 23 March election has already opened, even as promises from both major parties continue to flow thick and fast.
Health is shaping up to be a particularly critical battleground. Behind WA and the ACT, Tasmania has the lowest bulk billing rate in the country and is struggling with a dire health workforce shortage.
According to the latest Cleanbill report, four of the nine electorates across the country which have no bulk billing GP clinics at all are in Tasmania.
The Liberals, led by incumbent premier Jeremy Rockliff, have announced a five-point “GP Guarantee”.
In brief, these consist of:
- Creating a state employed team of 10 GPs who will be deployed to struggling practices at short notice
- Extending Hobart’s mobile GP practice trial for another two years
- Boosting funding to non-metro clinics by up to $250,000 per year
- Paying off the HECS debts of 40 GPs who work in rural and regional areas for five years or more
- Establishing a GP-led ADHD specialist service
On top of this, Health Minister Guy Barnett said a re-elected Liberal government would look to lift the ban on GPs prescribing ADHD medicines.
RACGP Tasmania chair Dr Toby Gardner said GPs were “ready to step up” for patients with ADHD and that the proposal to pay off HECS debt was a “strong incentive” for young GPs.
Overall, he said, the Tasmanian Liberals’ commitments to general practice “is something other states and territories should consider as a model”.
The 10 state-employed GPs, to be known as the GP NOW team, will be activated when a clinic shuts down at short notice to ensure locals can still see a doctor.
It’s not clear how long they would be expected to remain in place once deployed, or what would happen if 11 different clinics decided to shut up shop at the same time.
Their services would supposedly be bulk billed, something which Dr Gardner pointed out was a legal impossibility if they were to be salaried medical officers employed by the state.
“[The idea] was sort of sprung on us,” he told The Medical Republic.
Dr Gardner was told that the 10 salaried GPs would be pulled from the pool of 40 GPs whose HECS debts the government had committed to paying.
When they weren’t needed to fill workforce gaps, he was told the salaried GPs would do virtual care.
“I can’t see a GP moving … to cover a whole community for an indefinite period of time until they recruit someone,” Dr Gardner said.
“There are a lot of specifics that I don’t think have been worked through.”
AMA Tasmania president Dr John Saul welcomed the pitch in principal but said the state’s workforce situation was so dire as to make it potentially problematic.
The truth is, he said, that Tasmania doesn’t need 10 new GPs in order to relieve pressure on the health system – it needs about 150 new GPs.
“Already I know of one GP who was looking at going rural, but now she thinks one of these GP NOW positions might be much more enjoyable than setting up her own practice in a rural area,” Dr Saul told TMR.
“Ironically, the biggest risk with these 10 GP Guarantee positions and the two ADHD positions – which are all very welcome – is that it will rob Peter to pay Paul and take away GPs from existing frontline services.”
Dr Saul also questioned the Liberals’ ability to follow through on its plan to ban hospital ramping, saying it seemed “almost impossible” unless the number of staff at each emergency department was increased by 20.
“Unless they seriously address emergency department bed block and logjam, we’re not going to see any progress on that one at all,” he said.
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The Liberals have also committed to keeping the payroll tax status quo for general practice.
Tasmania’s tax laws are harmonised with the eastern states, meaning the Thomas and Naazcontractor provisions technically apply there.
However, the state revenue service has not been actively pursuing medical clinics to date.
The Liberals’ commitment is that they will simply keep doing nothing.
Labor has gone a step further and made a “guarantee” that general practices in the state will not be hit by payroll tax if it wins government.
Except for promising to clear the payroll tax issue, Labor’s focus has been firmly on hospital and emergency services.
Dr Gardner told TMR that Labor was expected to announce more GP-specific policies in the coming days.
