A stoush has erupted between the New South Wales and federal governments over the Single Employer Model of GP training, with NSW Minister for Regional Health Bronnie Taylor saying they want it in every health district in the state now.
With one eye firmly on the election less than two months away, the NSW Government say they are moving ahead with its plan to rollout the Single Employer Model, first trialled in the Murrumbidgee area in southern NSW to attract and retain doctors in country areas, despite Federal Labor refusing to come to the party.
The Single Employer Model is commonly known as the Murrumbidgee Rural Generalist Training Pathway or Murrumbidgee model, and was first trialled in the Murrumbidgee Local Health District in 2020. The model allows seamless transition between hospital and General Practice training placements. Trainees are employed on up to a four year contract (depending on level of entry to the pathway) and remuneration and award entitlements align with other medical specialty training giving certainty and the protection of the industrial award.
The Federal Labor Government announced last week it would rollout the program in Tasmania, which NSW leaders have taken as some kind of insult, saying Mark Butler ignored multiple requests from to support a full expansion of the NSW developed initiative throughout NSW.
Deputy Premier and Minister for Regional NSW Paul Toole claimed the innovation was the result of “this Liberal and National Government’s foresight”. The model was designed by Paul Mara, the former president of the Rural Doctors Association of Australia.
“Federal Labor knows we are ready to commence a full rollout of this program, based on a successful trial that we had already run over the past three years in the Murrumbidgee,” Mr Toole said.
“We are ready to work with Federal Labor to help fix doctor shortages in regional primary and acute care now – the time for talking and trials is over.”
The Federal Government this week proposed a minor expansion of the trial in NSW, supporting two additional areas, however, Minister for Regional Health Bronnie Taylor said this falls well short of what regional NSW needs.
“Today we are announcing plans for a full rollout across regional NSW under an enhanced model that delivers more rural generalists in more locations within an accelerated timetable,” Mrs Taylor said.
“Under our proposal, people in regional NSW will not have to wait years to see these rural generalist doctors working in our hospitals and our communities; every region will be ready to take on the next intake of medical graduates.”
“We’re proposing to rollout a significantly scaled up program, rather than just the two trials proposed by the Commonwealth, with up to 100 rural generalists to be recruited each year across all seven regional local health districts.”
The Minister’s office was unable to provide more detail of the ‘plans’ being announced or the ‘accelerated timetable’, beyond what was in their announcement which is a proposal as follows:
1. The Commonwealth would guarantee exemptions statewide to allow up to 100 places per year, which reflects the size and distribution of regional NSW
2. Flexibility in exemptions that allow Medicare to follow the trainee, not attach to the facility or practice, and apply in different acute or primary services
3. The Commonwealth to agree to support a full rollout rather than a small trial, on the basis that NSW has already developed and implemented a three-year trial successfully in the Murrumbidgee
4. Annual review to ensure the model supports training and enhances workforce retention, primary and acute care delivery in regional, rural and remote areas.
“We are not asking for any funding contribution, simply for the Commonwealth to support our proposal so the people of rural and regional NSW can get the health care they need and deserve,” Mr Toole said.
Mr Toole also said there should be nothing to hold the Federal Labor Government back from granting exemptions under section 19(2) of the Health Insurance Act 1973. The proposed reform needs the exemption for the model to work.
Section 19(2) of the Health Insurance Act prevents Medicare rebates being claimed where the service is provided by a government service, such as a state funded hospital or a local council funded community health service. An existing exemption program allows doctors operating in government funded clinics to access Medicare rebates – but only in rural and remote areas classified as MM 5, 6, or 7 under the Modified Monash Model used to class remoteness. A number of New England centres including Bingara, Guyra, and Quirindi, already have this exemption. The NSW Government want the exemption everywhere so that all GPs employed by the state health system can access Medicare rebates for the patients they see.
Last year the NSW Government informed Federal Labor that Hunter New England was ready to commence the single employer model program, as well as Western NSW, Far West NSW, and Northern NSW, and a further expansion of the program in Murrumbidgee. Since then, all remaining regional Local Health Districts have confirmed they are ready to implement the program.
Federal Health Minister Mark Butler rejected the claims of the NSW leaders that Tasmania had been favoured over NSW, and confirmed they had offered to expand the service to two more sites in NSW.
“The first single employer model trial was launched in Murrumbidgee in rural NSW. Because it has showed early positive results the Albanese Government has committed to expand the trial to 10 sites nationally, as part of the $185 million health and aged care workforce package in the October Budget, including two further sites in NSW.”
“We are not preferencing any state or territory.”
“I’ve written to all of my state and territory counterparts seeking their vision for how the model might work in their state, to suit their individual circumstances.”
“The NSW state government, along with most other state governments, has been in discussion with the Commonwealth and those discussions will continue.”
“The Commonwealth will continue to work collaboratively with all states and territories, including the NSW state government, to improve access and quality of health care in the country – including through innovative approaches,” Mr Butler said.