DPA changes ‘take doctors away from rural areas’

A Federal Government move to expand GP priority areas will make it harder to recruit doctors to remote parts of the country, according to RACGP Rural Chair Associate Professor Michael Clements.
 
It follows an announcement confirming a number of new locations with Distribution Priority Area (DPA) status, allowing practices to recruit from a growing stream of overseas doctors moving to Australia.
 
Federal Health and Aged Care Minister Mark Butler said 17 areas will become more remote under new Modified Monash Model (MMM) classifications, also giving clinics access to more Medicare bulk-billing and workforce incentives.
 
A handful of the new DPA changes are due to the MMM re-classifications. A shift from metropolitan status (MM1) to the more remote MM2 category means they automatically become a priority area.
 
This allows them to recruit overseas doctors under Australia’s 10-year moratorium rule.
 
Minister Butler also announced 15 metropolitan areas will gain full DPA status, while two will gain partial DPA status. He said those changes are based on recent Department of Health and Aged Care (DoHAC) data on the level of GP services and community demographics.
 
Under those changes, catchment areas including Noosa and Surfers Paradise in Queensland, Molonglo in the Australian Capital Territory, Mount Barker in South Australia and Gosnells in Western Australia will all have full priority status.
 
Associate Professor Clements said while changes made due to a new MMM classification are data-driven, he did not see a similar justification for changes to the other areas.
 
‘Noosa and Surfers Paradise, that just sticks out like a sore thumb,’ he told newsGP. 
 
‘Nobody would suggest that Surfers Paradise or The Gap or Noosa really is an area of shortage or desperate need.
 
‘The change that they’ve announced … is done to shore up votes.
 
‘It will absolutely take doctors that would otherwise have worked in a more remote or rural area into those locations.’
 
The changes build on a significant expansion in DPA areas introduced in 2022 which gave all MM2 areas priority status, barring only major city areas – with some outer metropolitan exceptions – from recruiting international medical graduates.
 
The move was strongly criticised by the RACGP at the time as likely to prompt an exodus of overseas doctors from rural areas – a warning Associate Professor Clements says has proved correct. 
 
‘That really increased a large number of areas very close to cities that became a supposed priority, and really drained workforce from the rural and remote areas towards the urban areas where we know many of our overseas trained doctors would prefer to work,’ he said.
 
‘That had an immediate effect.’
 
However, he also noted that some general practices will welcome the new change in classifications, which will allow clinics now classified in more remote locations to attract greater bulk-bulling and workforce incentives.
 
In the announcement, the Government said it has taken a ‘no losers’ approach to the new MMM and DPA classifications.
 
‘This will see 34 communities unlock greater support from Medicare, while ensuring no community receives less support,’ the announcement states.  
 
According to Associate Professor Clements, the move has shielded practices from losing revenue, saying that practices can often find themselves adversely affected by the changes.
 
‘They’ve protected us from some of the negative aspects of MMM reclassifications that we sometimes see,’ he said.
 
Earlier this year, a clinic owner in Tasmania who had to close her practice told newsGP how the MMM system had been ‘a big issue’, with the clinic missing out on incentives available just five kilometres away.
 
As well as bulk billing incentives, MMM status affects reimbursements made to practices and GP registrars for training through the Workforce Incentive Program (WIP) and Practice Incentive Program (PIP), which are loaded according to remoteness.
 
MMM classifications are reviewed after every census, with Government saying the latest update was paused ‘while an independent review into the classification system was underway’.
 
Some of the areas previously classified as MM1 already had DPA status.
 
The Working Better for Medicare Review released last October made 26 recommendations, including the establishment of a Health Workforce Independent Review Panel to oversee arrangements for DPA and GP catchment methodologies.
 
It called for a change in the use of MMM classification for priority status, suggesting the DoHAC ‘should move to progressively use the GP catchment area as the prime building block to establish DPA status’.
 
‘MMM should no longer be used as a primary criterion for DPA status (i.e. remove all MMM blanket rules) and DPA status should not automatically apply to any location,’ the report authors wrote.
 
So far, the Government has not responded in detail to those recommendations.
 
The DoHAC and Minister Butler’s office were approached by newsGP for an update on a response to the review, as well as for more detail on how the new DPA status of the listed metropolitan areas was decided, and the benchmark referred to in the announcement.
 

Distribution Priority Area DPA GP workforce