When preparing for this, I did look back at what I had written in 2022 on the same topic and I’m sad to report, dear reader, that our current minister hasn’t implemented many of my innovative suggestions from last time, apart from some minor parts of my suggestions about workforce planning.

So, I am not completely optimistic that my words of advice will be any more avidly awaited or received on this occasion. Nonetheless, hope springs eternal…

Let me address three issues this time. They may seem oddly familiar, but perhaps the policy window will open up this time and my suggestions might be received with more enthusiasm.

First, I shall make better use of the health workforce to deliver improved equitable access to primary healthcare. Nurses, nurse practitioners and midwives make up 54% of the Australian health workforce. They are the most geographically and evenly dispersed health workforce in the country. But more than 30% of nurses, nurse practitioners, and midwives in PHC rarely work to their full scope , which is a ridiculous waste of resources. There has been some enabling of healthcare professionals working to full scope in some limited areas, such as pharmacists, midwives, nurse practitioners and advanced practice nurses providing a few more accessible PHC services in the community. But there is so much more that I could do to improve equitable access to PHC. Nurse-led PHC has been quietly operating successfully in Australia for decades and has increased recently with the rise in the number of nurse-led walk-in clinics in some jurisdictions. They are popular with patients because they are easy to access and are free. They are supported by governments because they take pressure off general practice and emergency departments.

An interim evaluation report of Medicare Urgent Care Clinics undertaken by the Department of Health and Aged Care demonstrates that they are providing care for illnesses and injuries that are urgent, but not life-threatening, and reducing expensive visits to hospital emergency departments. In fact, it estimates UCCs are saving $368 per presentation in reduced ED visits. Key findings from the report include:

• the 75 clinics have prevented 334,000 emergency department presentations a year;
• the average wait times were 14.5 minutes long (compared to between 24-31 minutes for comparable ED wait times); and
• the vast majority of patients are presenting to the clinics with conditions that can be appropriately managed there. 

Further, as I stated in an earlier open letter to the current minister, supporting and employing a local nurse to become the local nurse practitioner or a credentialled mental health nurse, or a local midwife to become endorsed, would provide greater sustainability and stability in continuity of care than an expensive fly-in medical service. Clearly this does not preclude the presence of a local GP who might work with a number of NPs/CMHNs/endorsed midwives across a series of small towns. This would provide a strong service for the community, improve access and be cost-efficient and effective. It would better utilise the skills and capabilities of each profession, supporting these autonomous and independent nurses and midwives in working to full scope, but also allowing the GP to focus where their skills are needed and aligned with their own scope of practice (SoP) . I can envisage this occurring without limiting the SoP of other HCPs in the locality.

My second task as minister would be to improve equitable access to dental care. Why teeth got left out of the healthcare of an individual when Medicare was introduced can only be attributed to an unyielding and iron grip on private dentistry by the dental lobby groups of the day. But, as with access to PHC, access to basic dental care could be federally funded to be provided in greater volume by other registered dental HCPs such as dental therapists, dental hygienists, oral health therapists and dental prosthetists.

However, as my third reform, in order for any of these PHC and dental reforms to be implemented, I and my advisers would need to hear more from the majority of the health workforce, as the majority of DoHA committees at present are monopolised by medical practitioners. I shall be implementing proportional representation of relevant HCPs on relevant committees, so that not only the voices of the medical profession will (quite properly) be heard, but also the voices of the myriad other HCPs working for me in the health system who, I am sure, have great ideas on how I can improve equitable access to health.

One thing I wish I’d thought of last time, but which I am delighted to see has occurred, is the work that has been undertaken on women’s health by the assistant minister for health and aged care and assistant minister for Indigenous health. If I were the next minister for health, I would continue to support it. As the assistant minister for health stated in a speech on 26 March:

Just recently the Albanese Government announced a historic women’s health package: an investment of more than half-a-billion dollars to improve healthcare access and outcomes for women across the nation. From funding for endometriosis and pelvic pain treatment to more affordable reproductive and menopause medications, this package will change the lives of countless women. We believe no-one should miss out on healthcare because of the size of their wallet or because of their sex. This is a core value and focus not just for me, but now for the whole Labor Party. Once again I say that, if you have more women in the room, your priorities change.

And if there was a better distribution of health practitioners in the room, the priorities might change too.