Canberra Liberals: Primary Care

The Canberra Liberals have announced their primary care plan: more clinics with GPs and nurses walking together, incentives for clinics to stay open longer, waiving payroll tax, and paying the HECS debt of 30 GPs willing to stay in Canberra for five years would deliver more than 200,000 GP visits, shadow health minister Leanne Castley said.

“The health of Canberrans has long been neglected under a Labor–Greens Government, and these initiatives announced today by the Canberra Liberals signal to the entire community we will put their health first,” Ms Castley said.

The Australian Medical Association (AMA) ACT said it welcomed the Canberra Liberals’ plans to support GPs.

“Our Canberra GPs are the beating heart of our health system, delivering primary healthcare to patients across the national capital and into the surrounding region,” AMA ACT president Dr Kerrie Aust said. “For too long, they’ve been an undervalued part of the health system, but today’s announcements by the Canberra Liberals will help to turn that around.

Opposition leader Elizabeth Lee said that as a result of the government’s neglect of primary care, “we now have one of the worst health systems in the country, which includes the longest emergency department wait times in the nation”.

Earlier this year, the Australian Medical Association stated that the ACT’s public hospitals were not meeting national standards for emergency department wait times and planned surgeries, despite the “tireless efforts” of hospital staff and the largest share of public hospital funding from any state or territory government.

“A Canberra Liberals Government will respect GPs and prioritise primary care, which will play a big role in taking pressure off the emergency department that is at breaking point,” Ms Lee said.

The Liberals promise to exempt GPs from Andrew Barr’s payroll tax, which they believe limits Canberrans’ ability to access essential healthcare.

A new interpretation of payroll tax, following the example of NSW and Queensland, considers tenant GPs as employees rather than as contractors. The Royal Australian College of General Practitioners warned last year that only 3 per cent of clinics would be able to absorb the costs, and 78 per cent of doctors could be forced to increase their bills by $15 or even $20 a consultation. A survey last year found that one-quarter would consider closing their practice and half would consider selling. At the time, the ACT had the highest average out-of-pocket costs for seeing a doctor in the country.

Canberra Liberals bills on this issue failed to pass the Legislative Assembly last year. The ACT Government accused doctors’ groups like the RACGP and the Australian Medical Association of seeking to minimise tax for their members. Instead, the government waived payroll tax liabilities until this past June, and agreed to not retrospectively access and collect payroll tax debts that would otherwise have been payable. The government extended time for compliance until 2025; and offered a two-year moratorium until June 2025 for health care businesses that bulk bill 65 per cent of their patients.

“The Liberals’ decision to exempt GPs from payroll tax, should they be elected in a few weeks’ time, is a boost for both patients and GPs,” Dr Aust said. “Access to primary care remains a major challenge in the ACT, and payroll tax relief is a good thing to help ensure that patients get the access they deserve.”

ACT health minister Rachel Stephen-Smith said today that the ACT was the first jurisdiction in the country to attach payroll tax exemption to the rate of bulk-billing; three other jurisdictions have since followed the ACT’s example, she noted. From next year, income from bulk-billed services will not be subject to payroll tax.

The Canberra Liberals promise to deliver “even better” walk-in centres in South Tuggeranong, West Belconnen, North Gungahlin, and the Inner South. Under the Liberals’ model, GPs would work with nurses. The Liberals would incentivise practices to provide after-hours services such as CALMS to reduce the burden on emergency departments.

Ms Castley said this model would deliver more than 200,000 GP appointments each year. More than 40 per cent of monthly Emergency Department presentations were non-urgent or semi-urgent cases that could be handled by a GP, Ms Castley noted, while more patients are arriving at the emergency department with chronic conditions that went undiagnosed for long periods due to poor access to primary care.

“By enhancing primary care, the ACT becomes more attractive to healthcare professionals, easing pressure on emergency services and ultimately providing better care for Canberrans,” Ms Castley said.

Ms Stephen-Smith, however, said that there was not sufficient demand for another four walk-in centres in the ACT. Nor, Ms Stephen-Smith said, was it clear how the centres would work. Neither nurses nor GPs would support the walk-in centres, she said.

“It would really just fragment the model of care that we already have.”

Ms Stephen-Smith claimed that the Liberals “cannot be trusted to maintain our nurse-led walk-in centre model that Canberrans know is highly successful and that they really appreciate”.

The government’s investment in walk-in centres had resulted in the lowest proportion of GP-type preventable presentation to emergency departments in Australia, Ms Stephen-Smith said. More than 80 per cent of patients had their condition fully treated at the walk-in centre.

Earlier this year, however, the Canberra Liberals obtained correspondence between Ms Stephen-Smith and the Director-General of the ACT Health Directorate which they allege shows that the government considered trialling GPs in walk-in centres.

Up to 30 new GPs would have up to $100,000 of their HECs debt paid, provided they committed to practice in the ACT for five years, the Liberals also promised.

The AMA commended the Canberra Liberals for their proposal. “Workforce remains our major challenge, and innovative schemes such as this deserve support,” Dr Aust said.

Labor’s $4 million Professional Development and Wellbeing Fund, announced last week, would retain and attract GP registrars to the ACT, as well as supporting other GPs to engage in research, training, and professional development, Ms Stephen-Smith said. Labor would also offer GPs placements through Canberra Health Services.

The Liberals have also committed to fund a research chair for general practice at the ANU Medical School to make Canberra the place of choice for GPs; to deliver medical imaging services at the GP integrated clinics in West Belconnen and South Tuggeranong; to provide legislative reforms and training for GPs to prescribe and diagnose attention deficit hyperactivity disorder (ADHD); and to expand the scope of practice for pharmacists.

Dr Aust said she welcomed the proposed changes to permit GPs to prescribe and diagnose ADHD, “as patients and families continue to struggle to get access to the life-changing services they need”.

“By expanding GP care through these initiatives and commitments, Canberrans will have better access to healthcare services outside of emergency departments,” Ms Lee said.

“The Canberra Liberals have produced a package that’s good for patients and families and good for GPs and young doctors looking to set up in general practice,” Dr Aust said.

“This is a very strong package and we welcome it.

“Finally, it’s a huge boost to the morale of our GPs when both major parties in this election are proposing initiatives to help patients get access to the services they need. Investment in general practice is key to improving our health system, and we welcome many of the initiatives both the Canberra Liberals and ACT Labor have announced thus far.”

The ACT Greens have committed to set up four bulk-billing GP clinics and to ensure all GPs at the clinics are exempt from payroll tax, by providing only bulk-billed appointments.

“The ACT Greens want truly universal healthcare for Canberra, where there are no barriers to get help when and where you need it,” health spokeswoman Emma Davidson MLA said. “Canberra simply needs more GPs who bulk bill. Currently, the cost to see a GP in Canberra means people are putting off check-ups, sometimes until the point of hospitalisation. The ACT Greens plan guarantees bulk billed doctors’ visits across Canberra and continuity of care with the same doctor, giving people the best support for their health needs at no cost.”

Independents for Canberra have also committed to offer incentives to attract more GPs to the ACT. The group’s leader, Thomas Emerson, said this announcement, made four weeks ago, had prompted the Canberra Liberals and ACT Labor’s policies.

“This is the role of independents; to apply positive pressure on the majors and push for the implementation of good ideas, no matter who comes up with them,” Mr Emerson said. “We look forward to seeing more of our commitments making their way into the platforms of the major parties.”

Bill Stefaniak (Belco Party) said it was a good policy, as were some Labor ones, but wondered how either party would finance their health policies.

Labor, Mr Stefaniak said, “have had 23 years to get this right – why now? And how are you going to pay for it? We are already nearly $10 billion in debt, and you and your Green comrades are going ahead full bore with the tram extravaganza! To paraphrase a famous lady PM (good old Margaret Thatcher): ‘The trouble with Labor (and the Greens) is that they eventually run out of other people’s money to spend’.

“I suppose in the Libs’ case, they’re going to can the tram, which will save between $4 and $10 billion. Still, those savings won’t last forever.”

The Belco Party would soon release details of how it aimed to be fiscally responsible, Mr Stefaniak said. He stated that he had developed seven budgets as a minister in the Third and Fourth Assemblies, and his departments never went over budget. “It’s actually not rocket science. Just common sense and practical fiscal discipline.”

ACT Labor: Free preschool

ACT Labor introduced free preschool for three-year-olds earlier this year; now it has promised to double free preschool from 300 to 600 hours per year, or 15 hours per week. Labor claims that this would save the average family more than $2,600 per child.

Labor would also introduce before and after preschool care for four-year-olds.

“It’s a practical and proven plan that not only saves Canberra families on their early learning costs, a quality early childhood education sets children up for life,” a Labor spokesperson said.

The ACT Greens have committed to 18 hours of early childhood education and care a week for all three- and four-year-olds by 2028, education spokeswoman Laura Nuttall MLA said. The target should be 30 hours a week, according to the federal productivity commission, she noted.

Independents for Canberra Anne-Louise Dawes said: “Doubling the number of preschool hours seems to be less about ‘the child’ and more about people paying childcare fees. It would ease the tension between work-from-home and child raising for people endeavouring to do both, but what is the motivation? If we want to put ‘the child’ and all that is offered in the preschool setting back into the equation, we must consider our workforce of early childhood educators.

“Absent investment in early childhood educators, including those for our small number of Koori Pre-Schools, we risk blurring the line between playful introduction to learning and child-minding. We need to look to the future, to what skills and attributes we want our children to have and how to best achieve school readiness: physically, socially, and cognitively.

“No other state has universally increased preschool hours from 15 hours despite general advice that preschools are great places for early learning. If this is a short-term measure to ease the lives of working parents, that is a good thing, but can we also look beyond the Band-Aid?

“This is why we need a Future Generations Act; to require people in power to take a long-term, cross-portfolio view of building a better society for the next generation.”