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House of Assembly - Fifty-Second Parliament, First Session (52-1)
2010-07-01 Daily Xml
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KANGAROO ISLAND MEDICAL SERVICES

Mr PENGILLY (Finniss) (15:15): My question is to the Minister for Health. Can the minister explain—

The Hon. P. Caica interjecting:

Mr PENGILLY: Watch it on Facebook, mate. Can the minister explain to the house why, after eight months, there is still no resolution to the dispute between Country Health SA and the Kangaroo Island Medical Practice to provide after hours emergency on-call services by local doctors rather than by locums at considerable taxpayer expense?

The Hon. J.D. HILL (Kaurna—Minister for Health, Minister for Mental Health and Substance Abuse, Minister for the Southern Suburbs, Minister Assisting the Premier in the Arts) (15:15): I thank the honourable member for the question. I am disappointed that he has not pointed out his own potential conflict of interest in asking this question. I understand a member of his family actually works for that clinic—

Mr Pengilly: It's on the record in the house and you know that.

The Hon. J.D. HILL: Well, maybe you should make it plain every time you raise a question about this, because you do it frequently.

Ms CHAPMAN: Point of order. The minister is reflecting on the member and impugning the motive of the member in this question.

The SPEAKER: Yes, I do uphold that point of order. The minister is getting very close and he needs to be very careful. I refer you back to the question, minister.

The Hon. J.D. HILL: Thank you, Madam Speaker, I take your advice.

Mr Pengilly interjecting:

The Hon. J.D. HILL: Well, good on her. I thank the member for the question. I am happy to provide a very full account of the negotiations in relation to the doctors on Kangaroo Island. This may take some time. In February this year, the state government and the Rural Doctors Association of this state reached a groundbreaking agreement on a new deal for country doctors who provide services in country hospitals. The RDA has described the deal as 'currently the best statewide agreement across Australia for rural GPs'.

In the past, there had been ad hoc arrangements in place across country health—different deals; different arrangements in place. Doctors, by and large, did not support that arrangement. They wanted a common deal, and so we negotiated that deal with rural doctors. To this day, I am advised, under the deal, general practitioners would receive a 93 per cent increase in payment for on-call medical cover for local hospitals—and that cover includes emergency, obstetrics and anaesthetics. That is a 93 per cent increase in their pay for just being on call.

This deal increased the annual payment for each service roster covered by a general practitioner for emergency, obstetrics and anaesthetics to $135,000. For each on-call shift in particular, general practitioners would receive a payment of $220 on weekdays for being on call—not for being in attendance but for being on call—and $550 on weekends for being on call—not for being in attendance but for being on call. That is, $550 a day to be at the end of a phone!

General practitioners had until the end of the financial year to accept this offer, which was negotiated by—

Mr Pengilly interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: General practitioners had a deadline of 1 July to accept this offer, which was negotiated by their peak representative body. I am advised that, about two weeks ago (I have not heard a more recent figure), over 307 doctors across the state—that is about 73 per cent—had signed up, and I expect more would have signed up by the end of the financial year. Doctors signing up will receive a payment of the new rates backdated to the beginning of the year. So, it is a good deal for doctors, and most doctors obviously—

Mr Pengilly: But you haven't fixed this one up. That was the question.

The Hon. J.D. HILL: You will get the answer. This new agreement provides a fair and consistent approach for general practitioners providing services in country hospitals. On Kangaroo Island, local general practitioners have agreed to provide on-call obstetric and anaesthetic services as part of the new agreement.

Let me put that in context. What they have agreed to do is to accept $135,000 year to be on call to provide obstetric services. On average, there are somewhere between 25 and 35 babies born on the island a year. Let us assume about half of those babes, or even a third of those babies, are born during normal office hours. That means they are being paid $135,000 to be on call and to be called in approximately a dozen times a year. I think that is a pretty fair payment for those doctors. A $135,000 package has also been accepted by the doctors to be on call to provide anaesthetic services for a very small number of cases that they are actually called in for.

They have agreed to do that and they have agreed to the obstetrics. The contract dictates that general practitioners providing these services will be on call and must be able to reach the hospital within 40 minutes of being contacted about an emergency patient. If you sign up to be on call for obstetrics, anaesthetics or one of the other services, you have to be within 40 minutes. So, you can go a certain distance but you cannot go a long distance. In the negotiations over the obstetrics—

Mr Pengilly: The emergency on-call locum is down the other end of the island, because he was told by your department that he could go down there. Come on, John.

The Hon. J.D. HILL: Are you finished?

Ms Chapman interjecting:

The SPEAKER: Order! Question time has finished, so we will allow the minister to finish his answer and then we can all go.

The Hon. J.D. HILL: Thank you. I will try to do it without the interruptions, Madam Speaker. In the negotiations over the obstetrics and the anaesthetics contract, one Kangaroo Island doctor indicated that the general practitioners would prefer to be within 60 minutes of the hospital and the patient rather than the 40 minutes that all the other doctors across South Australia had signed up to. The doctor described the 40 minute requirement as, and I quote, 'a deal breaker', as it would mean that he and his colleagues, and I quote the doctor, 'couldn't go to holiday homes, go bushwalking, go surfing, go fishing or watch footy.'

So, what they wanted us to do was to pay them $135,000 a year to be called in on the small handful of occasions when a baby is born. They did not want to be within 40 minutes of the hospital because that would interrupt with their bushwalking, surfing, fishing or footy. That is what the doctor on Kangaroo Island said to us. Fortunately—

Mr Pengilly interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: —Madam Speaker, the general practitioners did agree in the end to the 40 minute requirement. They have also now agreed to provide general emergency on-call services on Fridays, Saturdays and Sundays under the current contract arrangement. Through this arrangement, each general practitioner who covers on call will receive $550 a shift. That means that, if they are on call, they have to come in within 40 minutes, so that they can wander, go bushwalking, fishing or anything else they would like to do as long as it is within 40 minutes of being in attendance at the hospital. This is to be on call, not actually to do any work, but to be on call.

On top of that, if the general practitioner sees outpatients during this time, they are able to bill Medicare and a gap payment to the patient. Unfortunately, the local doctors have indicated that they will not provide on-call services on weeknights because of the $220 payment. They have requested that they should receive the same payment that a locum would be paid to provide that service. All the other doctors across South Australia have signed up to the—

Mr Pengilly interjecting:

The Hon. J.D. HILL: The majority of doctors across South Australia have signed up to the $220. The Rural Doctors Association—

Mr Pengilly interjecting:

The Hon. J.D. HILL: I said 'the majority'. The majority of doctors signed up to the $220. The Rural Doctors Association has agreed that this is a reasonable package; and, in fact, I have been encouraged by other doctors not to give in on this particular issue because it would undermine the contracts everywhere else in South Australia. I would say to all the other members who represent rural communities, if we give into the blackmail that is being put to us on Kangaroo Island, all the doctors in your communities would want the same thing and the system would fail. We provide locum services where we—

Members interjecting:

The Hon. J.D. HILL: This is a serious issue, and I think the catcalling from the other side indicates their lack of real interest in it. All you are interested in is the politics of the issue, not the provision of services to people.

Ms Chapman interjecting:

The SPEAKER: Order! You are very vocal.

The Hon. J.D. HILL: The unsubstantiated claim by the former deputy leader of the opposition is just outrageous. We cannot close down the Kangaroo Island Hospital; it is obviously absolutely essential to the people on Kangaroo Island to have a health service there because of the remoteness. The reality is that we will do everything we can to make sure that we are able to provide cover. If the local doctors are not prepared to put their hand up to provide cover for the going rate, as are the majority of doctors around South Australia, we will put in locums to cover the times when they will not do it, and that does cost more money.

What we will not do is pay local doctors locum rates to provide the same service, because that would undermine the locum service if we were to pay existing doctors who live in the community, who do not have the inconvenience of being called in from a remote place, to go without permanence of employment to a situation. In the longer term, we will attempt to look at long-term options for on-call hospital services on the island, including establishing a collocated general practice clinic which would be situated within the existing hospital facilities. Country Health SA is also open to further discussions with the local doctors should they decide to participate in the emergency on-call roster in the future and on the other days in the week.

I stress that we have been trying desperately to get a deal with these doctors based on the arrangements that have been put in place across country South Australia with the same pay rates that apply everywhere else in the state, which 73 per cent of doctors two weeks ago had signed up to. If we were to break our arrangements with the doctors on KI we would undermine the arrangements everywhere else, and the problems on KI would transfer to every other part of South Australia. If that is what the opposition wants, then it should keep calling for us to back down in relation to KI. I can assure them we will continue to negotiate with the doctors on KI in good faith, but we will not give in to their blackmail.

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