DPA system under microscope … again

4 minute read

The entire Modified Monash Model system of categorising rurality will be re-examined in a new review from the Department of Health and Aged Care.

Barely 18 months after giving the distribution priority area (DPA) system a massive shake-up, Health Minister Mark Butler has announced yet another review. 

This time, the focus is on how to alleviate the maldistribution of doctors and other health workers around the country. 

The Working Better for Medicare Review will look at how current policies and programs can be strengthened to make it easier to see a doctor, nurse or other health worker in the “outer suburbs of major cities and in regional, rural and remote Australia”. 

The Review will look at Medicare’s role in locating the workforce, as well as the three main policy levers used to distribute the workforce: 

  • Monash Modified Model (MM); 
  • District of Workforce Shortage, and 
  • DPA. 

The announcement of the review coincided with media attention on a GP clinic in the Victorian town of Pearcedale, which has been denied DPA status on multiple occasions despite sharing a postcode with a larger town that does have DPA status.  

Being classified as DPA allows practices to recruit overseas trained doctors who can bill Medicare via a 19AB exemption, as well as rurally bonded medical students fulfilling their return-of-service obligation. 

Without DPA classification, Pearcedale’s only medical centre is struggling. 

“No one wants to be a GP these days – we don’t get paid enough and we don’t have support from our government,” Pearcedale GP and clinic owner Dr Farza Rastegar told The Medical Republic.  

“We can’t get doctors [out here], so eventually we will have no GP.  

“Now you have to wait three, four weeks before you see a GP – it will be six months if they don’t fix this problem.  

“It seems like no one cares.” 

“The aim is to have an appropriately located workforce, particularly in areas that find it difficult to attract and keep doctors, so that all Australians can access the care they need, when they need it, regardless of where they choose to live,” said the department announcement. 

The DPA system was last overhauled just last year, as one of Mr Butler’s first actions as Health Minister.  

In a move criticised by doctors in very rural and remote areas of Australia, the criteria to qualify for DPA status was expanded to automatically include every MM2 area, as well as some MM1 areas.  

Previously, only MM3 to 7 areas were automatically classified as DPA.  

The policy change was felt almost immediately, with roughly 72 GPs moving from an MM3-7 area to an MM2 area in 2022, an increase from around 40 in previous years.  

DoHAC said the review would “identify ways to improve health access for Australians, by building a more stable, motivated, and properly located workforce”. 

The new review will be led by nurse, advocate and remote health expert Professor Sabina Knight, and former senior health bureaucrat and academic Mick Reid. Findings are expected to be provided to the government by the middle of next year. 

When asked directly about whether Pearcedale and other towns caught in the not-rural-not-metro cracks would be able to secure DPA status, Mr Butler said he recognised the current systems were failing.  

“The existing systems for [these] assessments haven’t really kept pace with things that have happened over the last few years – the covid workforce crunch,” he said.  

“The way in which workers, including health workers, are working right now means that we need a review of those systems.  

“I recognise that wherever you draw the boundary, it means that that some practices the wrong side of the boundary feel that they’re not able to access the system that that that is important for their ability to provide care.” 

The Working Better for Medicare Review follows Professor Mark Cormack’s “Unleashing the Potential of Our Health Workforce”, a review of workforce scope. 

“The levers we have to spread doctors and health workers around the country are from a very different time, before the covid pandemic and the global health workforce crunch,” said Mr Butler. 

“The Albanese Government will use all possible levers to encourage doctors and other health workers to be where patients need them to be – outside of cities and in areas of need. 

“I am delighted that Mick and Sabina, two expert, independent reviewers, have accepted my invitation to guide the review and look forward to the outcomes of this important work.” 

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