Real change for primary care is likely to be dependent on the next National Health Reform Agreement

The Australian primary care system is currently in the storm of several government reviews which could reform the way primary care is delivered in the future.

In the Primary Care Division of the Department of Health and Aged Care, reviews are examining general practice incentives and after-hours primary care policies and programs. In Health Workforce Division, two significant reviews underway are the Scope of Practice Review examining the barriers and incentives health practitioners face working to their full scope of practice in primary care. There is also the Working Better for Medicare Review which has examined workforce distribution levers and how this impacts the distribution of health professionals to rural locations examining such factors as Monash Modified Model; Districts of Workforce Shortage; Distribution Priority Areas and use of Sections 19AA and 19AB of the Health Insurance Act 1973, which outline the geographic locations where doctors are allowed to use Medicare based on their level of training in Australia or overseas. This is in addition to various reviews and introduction of legislation for the aged care and disability sectors which also impact rural service delivery.

All the reviews are in their concluding phases with a suite of recommendations being put on the table for government to consider. We all know something needs to be done, in particular, for rural, remote and regional Australia. No doubt there will be some significant changes, because of these reviews and there does seem to be an optimistic feeling in the air that the primary care sector is ready to act. However, even in the optimist camp, there is a sense that change will need to be ‘changed managed’ and if it needs to be ‘change managed’ the change will need to be scheduled over a period of time. In fact, the GP Incentives Consultation paper which is in line with the Government's Primary Health Care 10 Year Plan 2022–2032¹ anticipates changes over the best part of the next decade (up to 2032). Given the extent of the recommendations proposed, it is no doubt realistic, that significant change is not going to be in the short term.

There is one other major policy and funding piece that has the potential to lead on reforming how health, and importantly primary care, can be supported in rural communities.

The National Health Reform Agreement (NHRA) is an agreement between the Australian Government and all state and territory governments and through this agreement, the Australian Government contributes funds to the states and territories for public hospital services. This includes services delivered through emergency departments, hospitals and community health settings.

To date there has only been limited scope in these agreements for innovation particularly in the area of primary health care. The current NRHA covers the period 2020–2025. A mid-term review of this current set of agreements was undertaken and the report of this review was published in October 2023.²

The current National Health Reform Agreement does not offer enough funding and policy flexibility to enable joint planning and commissioning to support local service needs, particularly in rural and remote communities. This is why the Alliance has welcomed the focus made in the mid-term review report about prioritising rural and remote health through specific recommendations.⁴

The Alliance believes these recommendations need to be implemented urgently, as they will be real drivers of funding and policy reform which in turn will lead to delivery of new models of care that meet community need. If the recommendations are not implemented, the opportunity will be lost for a shared commitment between all levels of government to make real change—because the real driver of change is funding, and the National Health Reform Agreement is the vehicle that drives health in Australia.

This is in line with the advocacy the Alliance has been calling for which is a 10-year National Rural Health Strategy as a compact with state and territory governments and with funding allocation embedded in a rural and remote policy and funding schedule to the National Health Reform Agreement.

A National Rural Health Strategy must support fairness, dignity, equality and respect for rural Australia, as a basic human right. Through a commitment to a minimum reasonable level of access to care, be it population and socio-economic need defined, the support for continuity of care across the life span, reinforcing Closing the Gap commitments for First Nations' people, supporting the continued investment in rural health workforce and recommitment to the National Health and Climate Strategy.

This would be welcome and rightful reform for rural communities.

Margaret Deerain: Supervision; resources; writing – original draft.