Changes to health workforce distribution system come into effect

Amanda Lyons

1/07/2019 4:09:56 PM

newsGP explains the changes and what they mean for rural and remote GPs, international medical graduates and the communities they serve.

Rural Australian town
Changes to the workforce distribution system for medical practitioners take effect from 1 July, including a new name.

The Department of Health (DoH) has, from 1 July, changed its District of Workforce Shortage assessment areas for GPs and bonded doctors to a new Distribution Priority Areas classification.
Both systems have been designed to identify locations in Australia with a shortage of medical practitioners in order to help facilitate their placement into communities with the greatest need. As a part of these efforts, international medical graduates (IMGs) are able to receive a Medicare provider number if they work in such communities.
But, while the DWS system used a GP-to-population ratio in its classification, the new Distribution Priority Area system instead takes into account the characteristics of patients living in GP catchments, including demographics, such as gender and age, and socioeconomic status.
GP catchments are themselves part of a new custom geography developed by the DoH, using the Australian Bureau of Statistics’ (ABS) Australian Statistical Geography Standard 2016 in combination with five years of Medicare and ABS demographic data, including information such as location and number of general practices, population size, and distribution and patient flows.
Further blanket rules that will be applied under the Distribution Priority Area system include: 

  • inner-metropolitan areas are automatically deemed non-Distribution Priority Area
  • areas of remoteness classified between 5–7 under the Modified Monash Model are automatically deemed Distribution Priority Area
  • the entire Northern Territory is automatically deemed Distribution Priority Area. 
However, medical practitioners themselves have received little notice of these changes and some, including Dr Tim Senior, Medical Advisor for RACGP Aboriginal and Torres Strait Islander Health, are uncertain about their implications.
‘I think there’s a lot of uncertainty among international medical graduates about what it means for them and the 10-year moratorium,’ he told newsGP.
Some GPs are also concerned about the possibility of changes affecting IMG eligibility to work at Aboriginal Community Controlled Health Organisations (ACCHOs). But the DoH has confirmed Aboriginal Medical Services that would have been considered District of Workforce Shortage under the previous system would automatically be considered to be a Distribution Priority Area.

Dr Tim Senior believes medical practitioners remain uncertain about possible implications of the changes.

However, some concerns remain for Dr Senior.
‘There are two ways [the system change] could have an effect,’ he said.
‘One could be in regional areas serving large communities of Aboriginal people, perhaps without an Aboriginal Medical Service, who may now struggle.
‘And the other would be, my understanding is that the [District of Workforce Shortage] classification used to be based around workforce distribution – the number of doctors per head of population with some measure of attempting to recruit locally trained doctors before being eligible for district of workforce shortage.
‘Now it looks like it’s a comparison with Modified Monash 2 average level of service given in those areas, with some modification for population demographics like age and medical need. I don’t know how well that works.
‘In terms of Aboriginal and Torres Strait Islander health, I could imagine it going both ways, where it works okay because the needs part of the equation takes into account the extra need in those communities. Or, it may work in the other direction because the level of service in some Aboriginal and Torres Strait Islander communities may be less because of access issues.
‘So it’s just a bit uncertain. I think it would be nice to know if there’s going to be any unintended consequences.’
Despite such misgivings, the DoH has been keen to emphasise the changes are in line with regular annual modifications, and that their main purpose is to provide a more accurate picture of where patients access health services. It also stated that benchmarks will be used to determine services required in GP catchment areas and will be fixed for three years to allow areas to stabilise their workforce.
In terms of existing workforce, the changes apply only to new contracts and will not impact doctors already working in the area or staff undergoing existing contract negotiations.
Further information is available on the DoH website, including a searchable map of geographical classifications throughout Australia.

Distribution Priority Areas District of Workforce Shortage GP workforce rural health

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Dominic Higgs   2/07/2019 8:00:46 AM

Dear Team
As a registrar on the AGPT program and an IMG based in PERTH, I find these changes very hard to swallow. With 12 months training left I haven’t entered into negotiations and over night have lost in excess of 50% of the previous places I could work south of the Rover in Perth. We had made medium term plans to remain in this area to allow both myself and my wife (physician trainee who requires access to tertiray hospitals) to complete training then move back rurally where we want to be. This plan is now likely dead in the water. I also worry about other IMG in similar situations being able to undertake training in the future. Are those areas changed over night really going to be able to provide the service wanted by the doh without new IMG’s to support retiring and leaving GPs in those areas in the future?

Karina   5/07/2019 2:00:52 PM

I am an Australian trained bonded GP registrar. The changes to the map are drastic for me in Victoria. There are no more outer metro positions. I signed my contract based on DWS calculations. Now with DPA areas that last week were not short of GPs now apparently are DPAs. If I move to these areas, will I get patients given that one week ago the map was telling me that the GP supply was adequate? I’m finding these changes very disappointing and a little distressing actually.