New recourse for GPs to appeal DPA status

Jolyon Attwooll

2/09/2021 5:07:10 PM

The DoH says the change will better allow rural and regional areas to respond to workforce and population changes affecting general practice.

A rural road.
General practices can now appeal their DPA status, a move welcomed by RACGP Rural Chair Dr Michael Clements.

A new appeal process has been introduced to allow GPs to challenge the Distribution Priority Area (DPA) classification for their area.
Federal Regional Health Minister Dr David Gillespie­­ announced the new ‘exceptional circumstance review’ on Thursday.
The change will help regional and rural areas ‘respond to unforeseen workforce and population changes’ affecting local GP services, according to a release from Minister Gillespie’s office.
The move follows strong RACGP advocacy on the issue, with both RACGP President Dr Karen Price and Chair of RACGP Rural Dr Michael Clements calling for such a mechanism to be introduced for some time.
‘This review is strongly welcomed, and it does reflect what our members have been asking for and the advocacy we have been providing,’ Dr Clements told newsGP.
‘This ability to be able to appeal and show the circumstance of your particular practice, and the growth around you is an excellent change.’
The DPA classification system was put in place from 1 July 2019. The assessment takes place annually and involves a range of factors to categorise healthcare needs in 829 general practice catchments across the country. General practices had previously been unable to request a review.
Dr Clements said the recently-introduced system has consistently been among the main issues raised with him by members and that status changes can be hard to understand and have a profound impact.
‘It has been a mysterious mathematical algorithm that determines who gets what. Our members are in the dark as to what makes these changes occur,’ he said.
‘Some of our practices rely on retaining DPA status to attract the overseas trained doctors and those on moratorium.
‘What has been happening is that status has been ripped out from underneath you without warning and practice viability has been ruined. We have had [general practice] closures.’
According to the Department of Health, the factors considered for DPA status include:

  • patient flows using MBS data
  • population demographics
  • the size of the GP workforce
  • the location and number of practices
  • the catchment’s size and geography.
All the most remote areas, categorised in the Modified Monash Model as MM 5–7, are automatically given DPA status. Inner metropolitan areas are not eligible.
Under the system, general practices in places with DPA status can employ international medical graduates and Australian-trained bonded doctors who are required to work in priority areas to access the Medicare Benefits Schedule.
In June, Dr Price wrote to the DoH’s Rural Access Branch to raise concerns about the system and ask for a review, advocating that practices affected by DPA status changes should have the right to appeal.
Last month both Drs Price and Clements met Minister Gillespie­­, who was appointed as Regional Health Minister in June. The issue of DPA reviews was again raised at that meeting.
‘When we discussed it with Minister Gillespie, he was very engaged and interested and had his own awareness of the issue and he agreed that there needed to be an ability for raising concerns,’ Dr Clements said.
In the statement announcing the change, Minister Gillespie said he had heard ‘loud and clear’ the concerns about the current approach, and reiterated that the Government is ‘acutely aware’ of GP shortages in regional, rural and remote areas.
‘As a regional doctor myself for most of my career, I understand the impact this has on health outcomes and community wellbeing,’ he said.
The statement says any appeal needs the support of the Rural Workforce Agency (RWA). Other factors that would be considered include patient demographics, unexpectedly large changes to the health workforce, and the absence of services, including a demonstrable difficulty in recruiting GPs.
Noting there remains a limited pool of doctors to recruit from, Dr Clements said he will be watching the way the review process functions closely.
‘The proof will be in the pudding,’ he said. ‘Practices need to able to raise their exceptional circumstances at any point in time and have faith those concerns will be addressed appropriately.
‘This is advocacy in action, but we still need to keep the process accountable.’
A further review of the methods used to assess DPA is due later this year.
More information about the appeal process is available on the DoH website.
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Dr McMullan   3/09/2021 2:02:01 PM

Good result.