Krystyna de Lange
Good morning and welcome to the Royal Australian College of General Practitioners’ launch of the third annual report, General Practice: Health of the Nation.
My name is Dr Krystyna de Lange. I'm a GP based in Brisbane. I work at an Aboriginal medical service, quite literally seeing anything and everything that walks through the door
On the other end of the spectrum, I work as a GP with special interest in a sub-specialised field of gynaecology, helping to reduce public waitlist times at a major tertiary hospital.
Furthermore, I sit as the Registrar Representative on the RACGP Board.
A GP registrar is a doctor who is undergoing further training to become a specialist GP. I completed that training just last year after a total of 15 years of combined university studies, pre-vocational and vocational training
I chose general practice as a specialty because I yearned to develop long-term relationships with my patients. To be their doctor, but also to be their advocate and to truly make a difference to their healthcare experience and, ultimately, their journey through life.
I am proud to call myself a general practitioner in this country and I am honoured to be your MC for today.
To begin the official proceedings this morning I would like to start by acknowledging the Traditional Owners of the lands upon which we meet, the Ngunnawal peoples, and pay my respect to their elders past, present and future.
I would like to extend my sincere appreciation to all of you for being here today and welcome you all to this morning's event. In particular, I would like to welcome our speakers for this morning: the Honourable Greg Hunt, Federal Health Minister, who will be joining us soon; Senator Richard Di Natale, leader of the Greens; the Honourable Chris Bowen, Shadow Health Minister; and Dr Harry Nespolon, President of the RACGP.
The Royal Australian College of General Practitioners is the largest medical college in Australia, with over 40,000 members and representing nine out of every 10 GPs in this country. We are an evidence-based college, providing the general practice profession and health policy-makers with support, education, policy and advocacy.
Our vision for a healthy Australia is founded on the knowledge and passion of our members.
Whether we're located in the hustle and bustle of a major city or in the farthest reaches of the remotest parts of Australia, as GPs, we quite literally have our fingers on the pulse of our communities. We are the first to see health trends emerge.
The RACGP’s Health of the Nation report is the only annual comprehensive report into the state of general practice in this country. The report tracks trends and changes in the general practice sector from both the patient and GP perspective.
Health of the Nation provides an insight into what is happening within general practices across Australia every day.
So to help launch with this report this morning, our first speaker will be President of the RACGP, Dr Harry Nespolon. Having practised as a specialist GP for over 20 years, Dr Nespolon understands firsthand the importance of general practice, the breadth of the role of GPs, and the impact they have within their communities.
Please join me in welcoming Dr Harry Nespolon.
Dr Harry Nespolon
Thank you, good morning.
It's actually quite a beautiful Canberra morning, and I understand that there may be some members here today that attended the Winter Ball last night and may require a little bit of general practice assistance. I'll also try and speak a little bit quieter today so that I'm not disturbing any headaches.
I too would like to extend my warm welcome to Senator Di Natale, the leader of the Greens and also to the opposition health spokesman Chris Bowen. And I'm looking forward to seeing our health minister when he arrives.
And … I am genuinely grateful that you do take the time to come and hear what we've got to say about general practice, we would argue the most important part of the healthcare system.
I'd also like to acknowledge the traditional owners of the land on which we meet, Ngunnawal people. I pay my respects to their elders past, present and future.
The General Practice: Health of the Nation report surveys GPs across all areas of practice across the whole of Australia. This is our third report. This should be considered as an annual health check on the state of general practice in Australia, and so what is the diagnosis?
If Australian general practice was one of my patients, I would have many positive things to say at the end of the consultation; however, before guiding them back to the waiting room I would also have some firm suggestions about how to improve the overall health of our general practice.
One of my suggestions, not surprisingly, would be to have an increased investment in general practice.
The average patient out-of-pocket costs are increasing at double the rate of CPI year in, year out. This continues to add up over time and this year for the first time the average out-of-pocket cost for GP consultations is more than the Medicare rebate for a standard consultation.
We're already seeing the effect of this trend, as 600,000 Australians delay seeing their GPs due to cost. No one wins when this happens.
If a patient delays a GP visit or doesn't go at all, they may end up requiring more complex and expensive medical interventions, adding further pressure to our healthcare system.
It shouldn't surprise many in this room that the average cost to the Government for a standard GP visit is only $38.20, which pales in comparison to the average cost of a visit to the local emergency department of $515.
All the research tells us that well supported and properly funded primary healthcare will result in a more efficient and effective healthcare system that delivers the care that patients need and deserve.
Being a GP is an incredibly rewarding profession and the data has consistently indicated that patients also have a very positive experience when they visit their GPs.
I genuinely feel humbled each day when patients see me, putting their trust in me to take care of them their parents and their children. It's one of the most rewarding parts of being a GP and, as Krystyna pointed out, it's about those very long-term relationships, which is the lifeblood of general practice.
However, I'm not blind to the realities regarding the future of my profession, and the sustainability of the general practice workforce in particular.
The report highlights that for every new GP there are almost 10 new non-GP specialists, and the gap is growing. It used to be 50/50 and now we're seeing a massive change in where our young doctors are going and it doesn't necessarily bode well for our healthcare system.
This is occurring at the same time as the number of unfilled general practice training places continues to rise.
When we also consider that GPs generally earn less than their peers, on average around half what our non-GP specialists earn, it's clear why many medical graduates are not joining general practice.
Compounding this is that almost half of the surveyed GP said that their workload can be excessive, a 6% increase from last year.
So what must be done to ensure the health of our nation and the sustainability of the profession of general practice?
I've briefly discussed the importance of government funding keeping pace with the cost of providing quality care, but we do need to look at it at the way that we deliver GP–patient services. We remain hopeful regarding the recently announced voluntary enrolment model for patients aged over 70 years with chronic and complex conditions.
I do see Wendy there. I'm hoping that she can come up with a name for this program, because saying ‘the voluntary enrolled model of patients aged over 70 with chronic and complex conditions’ doesn't really go down in a radio bite. I would like to take the opportunity to suggest ‘Medicare plus’ or ‘Medicare 70-plus’. Just give me something short; even an acronym would be good.
This has the potential to provide a funding model that will allow for defined groups of patients to get the services they need the way many general practices and patients would like to see them delivered.
Integrated care is fundamental to the RACGP’s updated Vision for general practice and sustainable health system, which we will soon release and look forward to working with government on ways that we can deliver our patient-centered model for care.
I now want to talk about the health of our doctors.
Four in 10 GPs report that they delay seeking care in the past two years. Time constraints are definitely a factor, with some doctors feeling uncomfortable seeking care from other GPs. All states and territories, except for Western Australia, require doctors to report their colleagues if they believe patient safety is at risk and, separately, if a colleague has sought help their help as a doctor–patient.
Unfortunately, almost one in 10 surveyed GPs said that they delayed seeking care for their own health because they were worried about being reported to the regulatory body. This is a conservative estimate and, sadly, these are the doctors most likely to need the most care and support.
Statistics show that doctors are more likely to complete suicide than the general population and this is a tragedy.
We appreciate Minister Hunt and the Prime Minister's commitment to the zero-suicide framework. We now need to see some action, particularly as it pertains to doctors.
Why are other frontline professionals, like our police officers, supported to seek care, but those caring for the entire country are not?
This is why we must rescind the mandatory reporting legislation as it applies to doctors. This will allow doctors to freely discuss their health, including mental health concerns, just like any other Australian.
Australian GPs are first-class doctors, but shouldn't be treated as second-class patients.
This report highlights the importance of maintaining our primary healthcare sector as one of the best and most efficient in the world.
We accept that changing the system isn't easy, but necessary.
I am genuinely proud of the work that every one of our general practitioners do each day throughout the whole of our country, caring for all Australians.
Krystyna de Lange
As the Shadow Health Minister, Chris Bowen has been a keen advocate for all Australians being able to access affordable and high-quality healthcare, particularly to address health challenges in low-socioeconomic areas.
Please join me in welcoming the Shadow Health Minister, the Honorable Chris Bowen, to the stage.
Well thanks, Krystyna, and good morning, everyone. Welcome to Canberra.
I too want to acknowledged that long before this was our nation's capital, it was Ngunnawal land and continues to be, and pay my respects to elders past, present and emerging.
And of course at events like this we should, in acknowledging them and all Indigenous Australians, recognise that we are not on track to meet our life expectancy Closing The Gap target by 2031.
Indigenous Australians still die far too young and we all have a long way to go in making Australia a truly equal country in which our First Nations are equal with non-indigenous Australians in every regard.
I want to acknowledge my parliamentary colleagues here, Greg, Richard and all my parliamentary colleagues. I do particularly acknowledge those parliamentary colleagues who are also doctors – Richard and Katie, and my friend and mentor, Dr Mark Freelander as well.
Thanks for the invitation to share with Greg and Richard in launching your report on the state of health of the nation.
It's a good report. I think it's fair to say a clear-eyed report. It's a an objective analysis of the strengths and weaknesses in our health system, which I regard as an imperfect act of genius.
The Medicare system, our creation of universal healthcare is, I think, one of the great achievements of Australia over the last 40 years. I often look at the health debates in other countries, including the United States, and just wonder how they could get it so wrong so consistently, when we've struck a good balance.
But it is very imperfect with a long way to go, and your report highlights, I think, many of the issues that we need to tackle. Certainly, from my point of view, preventive health, primary healthcare are areas a great focus and should be areas of great focus for governments and alternative governments.
I will, just in a few moments that I want to burden you with my words, focus on three issues that you've identified in the report.
Access. I mentioned before and we use the term pretty freely – universal healthcare – but it's not really. It's not really.
When you have more than 600,000 Australians delaying or avoiding access to healthcare, getting the medical advice they need, we do not have a universal healthcare system in Australia.
The reason they're avoiding or delaying the necessary healthcare is they can't afford it; the out-of-pocket costs are too high. Until we find a remedy for that, we don't truly have a universal healthcare system in Australia.
And your report mentions the great challenges and that this is not getting better, it may indeed beginning worse, particularly in relation to access to good primary healthcare in our rural and remote areas of Australia.
You note, as others have, that the pool of GPs is not getting bigger, it's getting smaller. GPs are getting older, the pool of GPs is getting older. Fewer doctors are choosing general practice and that means the pool of doctors available to go into rural and remote areas is getting smaller, just as we face the challenges of the great disparities of health outcomes between rural and metropolitan Australia.
Now, you know and I know that this is a complex problem that just getting more GPs, just getting indeed more specialists into rural and remote areas won't fix the health disparity. There are great social determinants of health issues at play, but it is an important part of the picture and this does need to be in focus in improving our primary healthcare across the country.
Which leads us to the second point of reform, and the report points out and it's a quote that I highlighted because I agree with it entirely. The Australian healthcare system was designed at a time when healthcare focused on acute care of single conditions.
Again, that is no longer fit for purpose. It's understandable when Medicare was desired that that was the focus, but that is no longer fit for purpose when you consider the degree of comorbidity, of chronic disease, of complex needs that you and your colleagues across the country are treating.
In the Medicare system, the rebate system still focuses on single conditions, on short consultations when better care would be provided so much more comprehensively. And we all need to consider how governments can better support GPs in that complicated care that's being provided.
I spent some time recently in Mount Druitt with Dr Kean-Seng Lim, for example. He's doing what many GPs across the country are doing; he spent some time showing me his computer program which enables him to keep in contact via text message with his patients who are trying to deal with comorbidities and chronic disease, and with all the other healthcare professionals, allied care professionals who are treating them as well.
One case where there was a text message chain between Dr Kean, a dietitian, a podiatrist, treating somebody with obesity and diabetes and trying to get their health back on track, and the patient was sending in pictures of their meals and getting the allied health professionals to comment on whether that meal was healthy enough for them, etc. A very complicated treatment mechanism which simply isn't recognised by our Medicare system and the rebate system as it stands.
And if we are going to improve primary health we need to better compensate to better recognise the nature of complicated care and comorbidities, and the first-class treatment which is leading doctors to avoid hospitalisation, leaving GPs to avoid hospitalisation, reducing the amount of hospital admissions and taking pressure off the tertiary healthcare system.
So that's appropriately highlighted in your report.
And the final one I want to thank the college for highlighting, and frankly it's not what I thought about very much and you've lifted it in my to-do list and the things that I focus on, is, as Harry said, GP wellbeing.
Now, of course, we talk about mental health more; you know, the government and the opposition are in the warm glow of bipartisanship when it comes to lifting the profile and importance of mental health and suicide prevention in our healthcare debate.
But there are particular areas which we need to focus on.
We know about indigenous suicide rates, we know about men at certain ages, we know about rural suicide rates, we know about mental health of gay and lesbian Australians, but it's also appropriate to talk about the pressures of certain professions.
Now, GPs are Australians going about their lives, worrying about, you know, who's going to get the kids to school and what's for dinner tonight and just running their lives as well as their practices. But also you are taking a burden. People who come to see you are unburdening themselves to you with their problems.
And if you if you don't mind indulging me for a minute with a comparison between our two professions, I had an electorate day the other day, in my electorate; back-to-back appointments of people who needed to see their MP.
And it only occurred to me when I got home and my family said to me, how was your day? and I said, every single person I saw today cried, every single person. One after another.
If you people come to see their MP they've normally got a problem. It's normally advanced, complicated, difficult.
The first one I saw had an NDIS problem, crying that their son needed a wheelchair. The second person I saw was crying that their brother has been stuck in a refugee camp in Turkey for 10 years and we've been working very hard to try and get them here but we hadn't yet succeeded, and on and on.
And our colleagues in the United Kingdom, we call them electorate days or constituent days, our colleagues in the United Kingdom, members of the House of Commons, call those days surgeries, where they're providing advice to their constituents.
And we do need to consider that if you're providing that sort of surgery, that sort of advice, you're taking a weight on your shoulder.
It's of course wonderful when you can help, huge job satisfaction when you can solve someone's problem, when you can treat someone, when you can get them on the path to health, or in our case on the path to a better outcome, get a wheelchair or get their brother here and see the family reunion.
But it's a burden when you can't, it's a frustration when you can’t and we do need to focus on GP health, mental health in particular.
And I was frankly surprised and concerned by the figures that doctors aren’t self-reporting their own conditions because of concerns for their for the professional outcome and we can't allow that to be the case.
I'm very open to the conversations, as I'm sure my colleagues are, but how we can improve that situation and provide better support for GPs.
But thank you again for the invitation. I value my working relationship with the college.
Harry was one of, if not my first call when I was appointed Shadow Minister for Health. In fact, I rang him before it was announced. I rang him in the morning, it was announced in the afternoon, to open up the line of dialogue as the new Shadow Minister for Health, and I've enjoyed the dialogue so far.
It's fair to say we're still getting to know each other, but we've had a warm and constructive engagement and I look forward to that continuing as we develop our policies and focus on the next elections, the alternative government, and work cooperatively with the college and the government wherever we can to improve the health of the nation.
Thanks for the invitation and thanks for the first-class report that you're launching today.
Krystyna de Lange
Our next speaker this morning is leader of the Greens, Senator Richard Di Natale.
The Australians have demonstrated a strong support and advocacy for general practice, which is unsurprising given Senator Dr Natale’s previous life as a GP himself.
Please join me in welcoming him to the stage.
Richard Di Natale
Thanks very much. Let me also begin by acknowledging the Ngunnawal people as the traditional owners of the land on which we meet, and acknowledge that sovereignty was never ceded.
To Harry, thank you for the invitation to launch this report. To Chris, to Greg and to all other members of parliament, it's again an honour to be able to share the launch of this report.
Look, there are no surprises in this report. You guys are at the coalface and you see these issues each and every day.
We know the burden of mental ill health is something that confronts you in your practices each and every moment. We know the growing burden of chronic disease is something that you're struggling to deal with and, of course, the issues around of the health of the GP workforce.
And what it does highlight is that the part of our health system which is the most cost-effective, I mean, it’s the most important part of our health system, that interface between a member of the community and their GP, that trusted relationship, is the most important, most cost-effective investment that governments can make.
And there are, I think, some warning signs in this report.
While it's pleasing to 86% of services are bulk billed, one of the really worrying signs here is that the number of GPs who will bulk billing for all services is declining and has declined over successive years. That's really cause for concern.
We often, I think Chris talked about access, and we talk about Medicare sort of in the abstract, but the thing that we have to acknowledge about Medicare is that it's established as a universal payment system.
That term ‘universal’ is what underpins Medicare. It means it doesn't matter whether young or old, doesn't matter whether you're rich or poor, doesn't matter whether you live in a regional area or in the middle of a capital city, you should expect to get the same healthcare as your neighbour.
And our system currently doesn't do it.
If I can perhaps be a little cheeky, Harry, I always worry when I hear about terms like ‘Medicare-plus’ because what that says to me, I think you're right to acknowledge that we need to find a better word for it, for the proposal from government, but Medicare is Medicare and Medicare is universal, and we don't want to create two streams or three streams or four streams of Medicare.
That principle of universality of access is actually what underpins Medicare. For the government to at least acknowledge, at least in the last term of Parliament, came up with what we thought was certainly something worth pursuing, the healthcare home trials. Because what it did do is it said, look, we've got a problem with the way we reimburse the services offered by general practice and we need to look at alternative ways of reimbursing GPs and medical practices before the growing burden of chronic disease that we know isn't suited to a strict fee-for-service model.
Unfortunately, the trial was abandoned. We were critical of the investment in the trial and a range of other things, but it's an acknowledgment that we have to look for different and more innovative ways of funding general practice services, and we welcome the initiative for over-70s to look , at least as a trial, to look at how we do this better.
We need to look at reform around whether we move to a system of bundled payments so that we can start to deal with what is, you know, one of the issues confronting all of you in this room: how do you and your practice deliver innovative healthcare services that don't fit within the strict fee-for-service models?
So we want to see a big investment in that area. We want to see big investment in prevention.
Last term of Parliament I convened and led Senate inquiry into obesity. We have to redouble our efforts at investing in prevention; again, a much more cost-effective use of the taxpayer dollar.
And we know what works when it comes prevention. We've just got to start funding it.
Let me just conclude by talking about the issue of GP workforce. And I was talking to some members of the college earlier about the real concerns of declining numbers of GP registrars.
Being a GP is a bloody tough gig; it's the hardest job in medicine. It's very easy to be an expert in a very small subject area and, indeed, we're seeing with sub-specialties people becoming experts in areas that are shrinking.
You know, we're getting to the point where you're going to become, you know, a world expert on a very minute area of healthcare and be rewarded for that.
Whereas being a GP, being a competent GP and having to have the breadth of expertise across so many areas, mental ill health, when it comes to chronic disease, when it comes to some rare conditions, rare cancers and so on.
I mean, it's a tough gig and being able to go home at night and know that you've done everything you can for your patients and that the person with a chronic cough that walked through the door that you sent home assuming they had some mild respiratory-tract infection that was resolving and not the early stages of lung cancer, that's a tough burden to have to carry with you each and every day.
It's a tough gig, and of course you're there riding the highs and lows. You're involved in some of the most intimate moments in people's lives, telling someone who's been trying to conceive a child for the first time that they're pregnant or alternatively that they're not pregnant after years and years of struggle, the death of a parent or a loved one, the death of a child.
And this is a heavy burden that all of you have to endure each and every day. I found my job as a GP incredibly rewarding, but hugely emotional. You ride that journey with patients each and every day.
It's a tough gig and we don't reward it or recognise it enough. When you've got the disparity in income between a GP who spends now almost as much time training as most of our specialists do, we need to start rewarding that.
We were very disappointed with the MBS freeze, we oppose that every step of the way. We've got to start recognising that a general practice and primary care is the most cost-effective part of our system and when young graduates are saying, “I don't want to become a GP anymore, the job’s too tough and the pay isn't good enough”, we've got a problem. And looking at the workforce numbers in the report makes for some very worrying reading.
Let me just conclude by saying thank you for what you do. You make a huge contribution in keeping Australia a healthier, safer, more productive place, and I want to thank you for it. Thanks, everyone.
Krystyna de Lange
Since commencing his role as the Minister for Health, our next speaker has worked closely with the RACGP and has always had an open door for general practitioners.
Minister Greg Hunt has been a strong advocate for general practice and introduced many positive measures for primary healthcare. This includes a commitment to invest in patient voluntary enrolment for people aged over 70, the gradual lifting of the Medicare freeze, which began with general practice, and the return of general practice training to the RACGP.
Please join me in welcoming the Honorable Minister Hunt.
Thanks very much to Krystyna, in particular to you for your work in indigenous Australia and health in remote areas. It's an immensely important part of what the RACGP does, what our doctors do, what our health system does.
To Harry and to Zena, to have people with whom we can work, develop ideas and then turn them into policy is just immensely valuable.
Harry and I will pick up the phone and talk to each other. He’s a fearless advocate for the general practice community, but a constructive advocate. And the flexible care model to which Krystyna referred is something that we worked on together with others in the profession, but designed from the ground up by listening to and working with the medical profession.
To Chris, I have to say at some stage I was considering calling my electorate outreach days surgeries. My office looked at me and said, “Health Minister offering 20-minute surgeries”, I don't think so. So, they wisely knocked that idea on the head.
And of course to all of our MPs and everybody here today, obviously Mike Freelander and Katie Allen, and I see Nola Marino who's been such an advocate for rural health.
But to everybody who's here today let me start with a very simple proposition. What this report sets out, the General Practice: Health of the Nation report, is no surprise but it's immensely important.
It's important because what it says is that the most common reason for people to visit the GP is mental health. Let's start with that point. That says that something that we suspected, something that we understood, is confirmed with hard evidence, and that reminds us of the immense importance of this issue.
Whether it's for a dairy farmer, whether it's for a student, whether it's for a doctor or nurse themselves, these are the, you know, extraordinarily powerful messages that come from this.
There's also a very important issue about access which I want to address and whilst it can be very, very strong in the cities, and bulk-billing rates are at a record, all-time high and about 4% higher than when we came to government, nevertheless, there are clearly areas, especially in rural and remote Australia, where things are not even.
And that's what we want to address during the course of this term, building on what we did together last term. The Secretary of the Department Glenys Beauchamp is here, and this is one of our most fundamental joint tasks together.
So having said that, I want to briefly address three things.
One is primary care and preventive health, the second is rural health and indigenous health, and the third is mental health for the medical workforce themselves.
In terms of the primary care, what we've achieved together is we started out, and with Harry's predecessor developed the compact with the RACGP, and that's been a very important base for our work together.
As a consequence of that, what we've seen is the progressive indexation as Krystyna has said of all of the GP items, culminating on the first of July of this year.
The second thing is we've seen the Medicare budget grow and be guaranteed. It's literally the first call by law for the federal budget; so when people pay their taxes, the first thing under the Medicare Guarantee Act is that the funds are placed for Medicare and the PBS. And it's very interesting and I think worthy statement of the place of healthcare within the Australian Parliament and the Australian Government.
And funds have gone from 19 billion when we came in to, over the course of the current budget cycle, 26, 27, 29 and 31 billion dollars. Most importantly, though, that result had not just in more services but in new services. Services such as new MRIs for 14,000 women a year for breast cancer, a new prostate cancer MRIs for 26,000 males, both are uncapped programs in terms of whoever needs them will receive them. New indigenous Australia renal dialysis Medicare items.
So fundamental expansions right across Medicare in not just the number of services but, most importantly, the range of services and that will continue, as it does with medicines.
So then we look at the heart of what we're looking to do together going forwards, and this is where Harry has stepped in, together we negotiated a package of just over a billion dollars for primary care. And the heart of that is the flexible care mode.
It begins with the over-70s, but exactly as, you know, we deal with other professions and whether it's, you know, somebody who's your plumber, your lawyer, your accountant, you can deal with them, text, phone, email, all of the different modern communications mechanisms, you can do a FaceTime call.
The current structure of Medicare is essentially – not exclusively, but essentially – built on the face-to-face model. Now that obviously stays as the bedrock, but what we have to do is build it out.
Now you're the ones that have said this to me. My own, you know, my own GPs in Mount Martha and elsewhere, Wally, who I just want to gently something Richard said is leading healthcare homes trials with his Hills Medical Practice, so we're building options but the flexible care option is on top of and in addition to Medicare.
And what it does is it allows patients, and we begin with the over-70s, but our goal over the course of the coming years is to expand it to every patient in Australia so as at any time the doctor can be remunerated for, you know, non-traditional consultations and the patient has much greater continuity of care and access.
And that's a system that we think on the advice of the medical community themselves will lead, in particular, to better outcomes in chronic care, better outcomes for middle-aged males who are not as good at going to the doctor historically, and to people in rural and remote areas. It's coupled with the expansion of telehealth.
The other thing that we want to do here is make a really strong push in preventive healthcare, and the RACGP will help lead, with Harry as the lead nominee or his representative, on both the preventive health task force and the 10-year primary care task force and, in particular, on preventive health.
What we're doing now is working on the expansion of screening and I've referred the issue of targeted lung screening to Cancer Australia to build on our extraordinary world-leading cancer-screening system in Australia.
Secondly, we're working on lifting and meeting and beating the 95% immunisation target. We're at 94.8%, which is a tribute to everybody here.
And then going forwards, working in particular on obesity and anti-tobacco education amongst other things.
The other great area of activity is in terms of rural health and indigenous health. Again, in rural health we put together a $550 million package, but going forwards the next great thing to work on is, how do we create a model that will work for the doctors themselves, plus the nurses and the allied health practitioners, to operate in rural and remote Australia?
We know that so many towns have said we're struggling to get a doctor. Let's say a town such as Kimber, where I was on the Yorke Peninsula area only a few weeks ago, where they were struggling to get a doctor in a town of just over 1000 people.
And the answer, which the medical profession has put to us, is let's work together to develop an integrated primary care model where we provide incentives for practitioners to work in maybe a hub and then to have a permanent placement around a series of smaller towns; where there’s a group of doctors, nurses, allied health professionals.
It's a flexible model, it's to be developed together, but this is what you have said will change the practice for young doctors coming through. And just recognise where we are in terms of history, and social needs.
And I know Anne Webster came to me with this idea amongst others, but it's an idea which is percolating and brewing right around Australia, and whether it's in Kimber, whether it's the South Australian premier who was talking to me yesterday, whether it's Harry or doctors from right around the country, this is what's brewing as the next idea in which we're developing with you.
In indigenous Australia, our joint task is to embark upon a series of next-wave goals – ending avoidable indigenous blindness by 2025, ending avoidable indigenous deafness by 2025, ending rheumatic heart disease in Australia by 2030.
These are real and achievable outcomes and we've set that task and we're now going about the task of delivering it with government, opposition, with the medical community, with the health workforce community.
Finally, the last thing I want to address is your health, the health and mental wellbeing of our medical workforce and, in particular, our doctors. We know that the suicide rates are significantly higher than the national average, we know that the mental health stresses are absolutely real.
And so already we've worked together on the mandatory reporting issue, and it was a slow process through COAG but we got there, to make sure that doctors can seek treatment in the same way that, whether it's MPs or plumbers or others, without having to be fearful of what it would mean for their professional career.
And I think that that's a long overdue outcome, and I'm slightly astonished taht it hadn't happened before but together it's been done.
The second thing is we've put so far $2 million into support for doctors and medical workforce health, but in the coming weeks we'll be announcing the national framework for the health and wellbeing of doctors and medical students, and I'm delighted to announce that we will add $1 million to that to support specifically services for doctors and mental health students going forwards.
But our great task together is to provide the support and to provide the education to ensure that those who are caregivers have access to care and a belief that that care applies to them themselves.
And with that, I am genuinely delighted to officially launch the General Practice: Health of the Nation report for 2019.