Recommendations for improving Australians’ access to specialist care, implementation of the National Agreement on Closing the Gap, tackling elder abuse, and addressing healthcare inequities in rural and remote areas are compiled in The Zap this week.
As the Department of Health, Disability and Ageing releases a childhood immunisation video hub to answer questions about the childhood immunisation schedule, an expert warns that the United States is “on the verge of losing vaccines for this country, from this country”.
The Australian Physiotherapy Association and other allied health groups are campaigning against proposed National Disability Insurance Agency pricing changes they say “will make it financially unsustainable for many allied health NDIS service providers to continue delivering the complex, high-quality support participants rely on”.
The quotable?
…expanding and investing in midwifery models of care is one of the most effective strategies to improve maternal and newborn health globally.”
Charles Maskell-Knight writes:
Since this column was first published in January last year, I have reported regularly on the Australian Institute of Health and Welfare Medicare Benefits Scheme data showing the MBS benefit for specialist consultations as a proportion of the fee charged slipping to a little over 50 percent in January this year.
This compares with 83 percent for GP services.
However, public debate about Medicare has revolved around the GP bulkbilling rate as if it is the only measure of the adequacy of Medicare as a means of universal access to healthcare.
The Grattan Institute has now released a report Special treatment: Improving Australians’ access to specialist care by the health team led by Peter Breadon.
Croakey has republished an article from The Conversation by Breadon and colleague Elizabeth Baldwin summarising the report.
According to Grattan, there are several dimensions to the problem.
“Millions of Australians face an unenviable choice when they need to see a specialist doctor: pay high fees or wait too long for care… On average, patients who pay a fee are charged $300 a year.
“Even poor people can face huge costs. One in 10 low-income patients who are billed pay almost $500 a year. The problem is getting worse: fees have soared by 73 percent since 2010.
“Almost a million people delay or skip specialist care because of the cost. They are risking missed diagnoses and delayed treatment. That leads to avoidable suffering and adds pressure on hospitals.
“Public hospitals run free clinics, but they provide just a third of all specialist care, and their wait times are often far too long. In many parts of Australia, wait times for urgent appointments are months longer than clinical guidelines recommend.”
Grattan sets out five areas for action. At a very high level, these are:
- Expand the workforce by training more specialists in the right specialties and areas, and making it easier for overseas trained specialists to work in Australia
- Spend $470 million a year to provide a million more public specialist consultations in areas of need
- Improve the efficiency of public clinics
- Introduce a system to allow GPs to obtain specialist advice without referring a patient for an appointment
- Combat “extreme fees” by clawing back public subsidies from specialists who charge more than three times the MBS schedule fee.
Private Healthcare Australia (PHA, the private health insurers lobby group), which has been arguing for some months that high specialist fees are impacting private hospital admissions, welcomed the Grattan report and “called on the Government to urgently act” on its recommendations.
PHA CEO Dr Rachel David said “if the Government wants to help private hospitals delivering essential care in areas of need, it needs to address the cost to see some specialist doctors”.
“Health insurers cannot keep paying private hospitals more and more to help them through a difficult period if the key to their survival rests with doctors,” she said.
The Australian Medical Association (AMA) said the Grattan report “highlights the urgent need for reforms to ensure Medicare rebates keep pace with the rising costs of delivering timely, high-quality healthcare to all Australians”.
AMA President Dr Danielle McMullen said the AMA welcomed the report’s recognition of the need for “a review of Medicare rebates to ensure they reflect the real costs of providing care”.
But she added that “the report goes too far in suggesting the Government should deny patients access to their Medicare rebate simply because of their choice of specialist”.
(I think the report was actually suggesting that specialists should be denied access to Medicare because of their choice to charge over three times the MBS fee.)
The Royal Australasian College of Physicians (RACP) said that the report “highlights the complex challenges Australia faces in ensuring timely access to specialist care, and the need for long-term thinking and collaborative solutions”.
RACP President Professor Jennifer Martin said the college welcomed the report’s recommendation about training, and supports investment in public and bulk-billed specialist clinics for under-represented specialties to ease hospital pressures.
She also said the RACP was “a strong supporter of collaborative care models with GPs and other health professionals to ensure support for primary care and timely access to specialist advice”.
Ministers and government
Health Minister Mark Butler spoke at the Lowitja Institute’s 4th International Indigenous Health and Wellbeing Conference in Adelaide, listing a wide range of First Nations health programs established or expanded by the Government.
The Croakey Conference News Service is covering #Lowijta2025, with these articles published so far:
- Strong, Fearless, Together: honouring a legacy
- How Indigenous peoples are leading the way in climate litigation
- Health services face legal risk over poor quality care for Aboriginal and Torres Strait Islander patients.
Bookmark this link to track the ongoing coverage.
Minister Butler also launched the Chronic Wound Consumables Scheme, saying older Australians with diabetes will save millions of dollars on chronic wound products.
(The scheme was originally scheduled to start on 1 May, but this was deferred due to the election.)
The AMA issued a statement welcoming the start of the scheme, as well as taking credit for raising the issue with then Minister Greg Hunt in 2017.
AMA President Dr McMullen said while the scheme “was an excellent step forward” for older people with diabetes, the AMA “would obviously like to see the scheme expanded to all patients with chronic wounds, which would result in a further reduction in wound-related complications and hospital admissions”.
Following last week’s announcement of the National Immunisation Strategy, the Department of Health, Disability and Ageing released a childhood immunisation video hub with 18 expert videos to help answer questions about the childhood immunisation schedule; every childhood disease and vaccine on the schedule; and what to expect when children are immunised.
The Department released a Request for Tender (RFT) “seeking proposals from interested service providers to implement and deliver a new national digital mental health service, currently referred to as the National Early Intervention Service”.
The new service is to operate from 1 January 2026, and will provide “low-intensity cognitive behavioural therapy via phone and video, along with a curated set of online tools and resources to support mental health and wellbeing”.
The RFT closes on 21 July.
The Department also announced it was conducting a national survey of the qualification and training experiences of personal care workers in the aged care sector. The survey closes on 17 July.
Now winter is well under way and respiratory diseases are spreading, the interim Centre for Disease Control issued a statement: Antibiotics won’t do for colds and flu.
The Therapeutic Goods Administration (TGA) announced it had begun Federal Court proceedings against a number of defendants including Mamamia (Mamamia.com.au Pty Ltd) and the publisher of the Body + Soul website (News Life Media Pty Ltd) for allegedly advertising medicinal cannabis in contravention of the Therapeutic Goods Act.
The Australian Institute of Health and Welfare (AIHW) released a number of papers and reports though the Indigenous Mental Health and Suicide Prevention Clearinghouse, including:
- Preventing suicides of First Nations people
- Relationship between systemic anti-Indigenous racism and social and emotional wellbeing and mental health
- Themes in contemporary Indigenous mental health and suicide prevention research
- Flourishing in later life: promoting older Aboriginal and Torres Strait Islander peoples’ mental health and suicide prevention
- Indigenous evaluation: best practices for social and emotional wellbeing and suicide prevention.
The AIHW also released a series of fact sheets and data visualisations on Vaccine-preventable diseases in Australia.
The Independent Health and Aged Care Pricing Authority (IHACPA) released its Work Program and Corporate Plan 2025-26. Work for the year ahead will include investigating virtual models of service delivery and care, refining hospital classification systems, and progressing aged care cost collections and pricing advice.
Ahpra issued “its first ever public statement under new legislation designed to protect public health and safety”, naming “suspended Western Australian practitioner Peter Terzi, also known as Peter Taylor, who Ahpra believes poses a serious risk to persons because of his conduct”.
Ahpra said “Peter Terzi/Taylor, who held dual registration as a dentist and a nurse, has been suspended from practising in both professions since 26 February this year”.
“He remains under investigation and Ahpra believes he may be continuing to present himself as a registered dentist or nurse while he is suspended and unregistered.”
First Nations
The Commonwealth, State and Territory Ministers responsible for Indigenous Affairs met via videoconference on 16 June and welcomed the West Australian Minister Donald Punch to his first Indigenous Affairs Ministers Meeting.
In her opening address, the Federal Minister for Indigenous Australians Malarndirri McCarthy spoke about recent deaths in custody in the Northern Territory and the need for greater action by all jurisdictions to reduce deaths in custody.
Ministers discussed Target 11 of the National Agreement on Closing the Gap – Aboriginal and Torres Strait Islander young people are not over overrepresented in the criminal justice system – and their efforts to coordinate actions across portfolios within their jurisdictions to improve youth justice outcomes.
They discussed the ongoing work to address food security in remote First Nations communities, with Minister McCarthy providing an update on the National Food Security Strategy and the subsidy scheme for 30 essential items, which comes into effect on 1 July.
Other topics on the agenda were redress for Stolen Generations survivors and treat and truth telling processes.
At the Joint Council on Closing the Gap meeting in Darwin on 20 June, the Coalition of Peaks provided a briefing about the Closing the Gap Aboriginal and Torres Strait Islander-led Independent Review.
The review, by Jumbunna Institute for Indigenous Education and Research, involved community forums, surveys, submissions and interviews to explore how Aboriginal and Torres Strait Islander people experience the National Agreement in practice.
It makes 12 key findings:
- The National Agreement is sound – but not being implemented as intended.
- The partnership is unbalanced.
- The Priority Reforms must be implemented together.
- Systems change is not happening.
- Communication with communities is failing.
- Business-as-usual persists within governments.
- Governments must be held accountable.
- The funding system needs reform.
- Our sector must continue to strengthen.
- Racism remains a fundamental barrier.
- Closing the Gap must be above politics.
- This is about human rights and justice.
The review makes 17 recommendations:
- Governments must recommit to the National Agreement and its Priority Reforms
- Transform government systems, not just individual programs
- Fully implement the Priority Reforms
- Embed shared decision-making at all levels
- Establish independent accountability mechanisms
- Reform government funding systems
- Strengthen the community-controlled sector
- Support public servants to deliver on the Agreement
- Improve communication with communities
- Recognise and address systemic racism
- Protect and promote the National Agreement from political changes
- Fund implementation properly
- Strengthen data sovereignty
- Amplify community voices in place-based partnerships
- Embed lived experience in decision-making
- Maintain regular independent reviews
- Take a human rights-based approach.
Meanwhile, National Aboriginal Community Controlled Health Organisation (NACCHO) urged First Nations people to start “vital conversations about bowel cancer screening with their families, communities, and health workers”. Read more on related in The Health Wrap.
Consumer and public health groups
COTA marked World Elder Abuse Day calling on the Government to deliver stronger national action to prevent elder abuse, provide meaningful support to victims, and support older people facing family and domestic violence.
COTA acting Chief Executive Corey Irlam said “more than one in six older Australians will experience elder abuse… [with] devastating consequences, including physical harm, mental health decline, cognitive impairment, premature death and financial devastation”.
COTA said the Government should ensure the forthcoming National Plan to End the Abuse and Mistreatment of Older People 2024–2034 includes clear, funded commitments.
The Australian Banking Association (ABA) joined with COTA to urge older Australians, their families, friends and carers “to have conversations about how to better protect themselves from scams and financial abuse this Elder Abuse Awareness Day”.
The ABA and COTA called for stronger national safeguards to protect older Australians, including:
- harmonisation of Enduring Power of Attorney arrangements across all states and territories
- a national register of power of attorney instruments
- a designated body that can receive and investigate suspected elder abuse.
Lifeblood (aka the Red Cross blood service) announced changes to sexual activity eligibility rules which mean more Australians will be able to donate blood and plasma.
Under current rules many gay and bisexual men and transgender women who have sex with men are prevented from giving blood or plasma if they have had sex in the past three months.
Lifeblood said under the new “world-leading ‘plasma pathway’, most people, including gay and bisexual men, and anyone who takes PrEP, will be able to donate plasma without a wait period, providing they meet all other eligibility criteria”.
“Extensive research and modelling show that there will be no impact to the safety of the plasma supply with this change,” Lifeblood said.
It said it was also progressing changes to blood and platelets donation eligibility.
The ABC reported that Dash Heath-Paynter, CEO of Health Equity Matters, said the change “potentially unlocks thousands of donations of life-saving plasma”.
The Public Health Association of Australia (PHAA) reported on research published in the Australian and New Zealand Journal of Public Health showing that “female teenagers – especially those from lower-socio economic backgrounds – and gender-diverse adolescents are significantly more likely to experience worsening mental health symptoms over their high school years”.
The researchers surveyed 6,600 teenagers multiple times from years 7 to year 10, allowing them to track how mental health symptoms developed over time.
Lead author Dr Scarlett Smout from the Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney, said “by year 10, nearly three in 10 teens in this sample had probable major depression, almost one in four reported high mental distress and nearly one in four had moderate-to-severe anxiety symptoms”.
Co-author Dr Katrina Champion said that compared with males, females and gender diverse teens experienced greater symptoms of distress, anxiety and depression, especially those from less affluent backgrounds, and suggested “more work needs to be done directly with teenagers in these vulnerable groups to develop tailored mental health prevention and support programs”.
PHAA CEO Adjunct Professor Terry Slevin said that more research was also needed “to understand what is driving poor mental health amongst teens and how good mental health can be protected and promoted”.
Trade unions
Following the release of the NDIA’s annual pricing review (covered in last week’s column) Allied Health Professions Australia (AHPA) called for an urgent meeting with the Minister for the National Disability Insurance Scheme Jenny McAllister “to advocate for the thousands of participants who will be disadvantaged by this suite of recommendations”.
AHPA Chief Executive Officer Bronwyn Morris-Donovan said “allied health professionals are essential in supporting NDIS participants in their homes, schools and workplaces…”
“These services are pivotal to a high-quality, accessible disability scheme. It’s time to hit pause on reducing the rate and the cap on provider travel,” she said.
The Australian Physiotherapy Association and seven other allied health groups issued a joint statement on the same issue, saying the proposed changes “will make it financially unsustainable for many allied health NDIS service providers to continue delivering the complex, high-quality support participants rely on”.
The group called for:
- the NDIA to immediately halt and review the NDIS Price changes for allied health professions due to come into effect on 1 July
- the NDIA to immediately reinstate travel and regional loadings for allied health professions
- a commitment from the NDIA to engage in genuine consultation with the allied health community and engage in meaningful co-design with participants who rely on these critical services.
Minister for the NDIS Jenny McAllister to exercise ministerial power and direct the NDIA to halt these changes immediately.
SARRAH (Services for Australian Rural and Remote Allied Health) said the “changes to NDIS provider travel arrangements will have a disproportionate impact on participants living in rural communities, contradicting the findings of the NDIS Review that identified ‘..continuing issues in accessing allied health supports in regional and rural parts of Australia’”.
As well as calling on Minister McAllister and the NDIA to delay implementing the new pricing schedule, SARRAH asked for “a formal review of the potential impact of travel pricing arrangements that includes genuine engagement with providers operating in MMM 4 – 6 locations”.
The AMA acknowledged World Blood Donor Day 2025, saying “it’s a day to say thank you, but also to spotlight the ongoing, urgent need for safe, regular blood donations”.
Australia’s specialist medical colleges are implementing ground-breaking changes to their training selection processes to address the chronic shortage of specialist doctors in rural and remote communities.
The Council of Presidents of Medical Colleges (CPMC) said it had worked with the National Rural Health Commissioner in developing “new guidelines requiring all specialist medical colleges to prioritise candidates with rural backgrounds and experience when selecting new trainees”.
CPMC Chair Associate Professor Sanjay Jeganathan said “too many rural Australians are waiting too long for specialist care, or having to travel hundreds of kilometres to access it”.
He said that medical colleges will now systematically recognise and reward rural experience when selecting new specialist trainees.
Colleges will use “standardised criteria recognising candidates who spent significant childhood years in rural areas, medical students who completed 12+ months of rural placements, and junior doctors who gained experience in rural hospitals”.
National Rural Health Commissioner Professor Jenny May welcomed “the initiative… to apply practical strategies to improve medical workforce distribution to rural and remote communities by recognising the predictors of rural practice in selection processes – being rural origin and positive rural experience prior to training”.
Dieticians Australia marked Dieticians Week, saying that dieticians “are leaders in community health – spearheading initiatives to promote food security, educating diverse populations on healthy eating habits, and advocating for policies that improve nutrition for all”.
The RACP highlighted the latest report from the 2024 Australian Early Childhood Development Census, showing almost a quarter of children are facing developmental difficulties in one or more of physical health and wellbeing, social competence, emotional maturity, language and cognitive skills, communication skills and general knowledge.
President of Paediatric and Child Health at the RACP Dr Niroshini Kennedy said “too many families are missing the recommended early childhood development checks… and facing long waitlists for assessment because of a shortage of paediatricians and other child health professionals”.
Kennedy said “governments must create more paediatric training places, including in regional and rural areas, to ensure the necessary workforce pipeline for the future demand”.
The Royal Australian College of GPs (RACGP) issued another Men’s Health Week statement calling on the Government “to improve men’s sexual health by boosting investment in general practice care so specialist GPs can provide longer consultations”.
The RACGP also commented on a range of state and territory specific issues, including:
- supporting the ACT Government as it implements an election commitment to allow GPs to diagnose and prescribe for ADHD
- calling on the Victorian and Tasmanian Governments to follow suit
- urging the NSW Government to simplify the workers compensation system to reduce stress on patients
- calling on the SA Government to fund general practices “to stay open later and on weekends to reduce the strain on hospitals and boost access to affordable care”.
The College enthusiastically supported the Victorian Government’s decision to trial a drug testing site in Fitzroy. RACGP Victoria Chair Dr Anita Muñoz described the announcement as a “huge step forward”, and said “this is not about condoning illicit drug use; it’s a sensible harm reduction measure that is proven to work around the world, including in Australia”.
RACGP alcohol and other drug spokesperson Dr Marguerite Tracy said “despite recent setbacks in Queensland, we’re seeing momentum build across Australia. My home state of New South Wales has launched its own drug testing trial, the ACT has been doing so for many years, and other state and territory governments are starting to say more positive things”.
On 18 June, 10 Victorian GPs went to the state Parliament House to provide health checks to MPs, and advocate directly for:
- allowing GPs to diagnose and treat ADHD
- allowing GPs to prescribe oral isotretinoin for people living with severe acne
- ending mandatory reporting so GPs can access mental healthcare without fear of being reported.
The RACGP also encouraged Victorian GPs and nurse practitioners to sign up to training and further improve the healthcare they provide to patients experiencing opioid dependence.
RACGP Victoria regularly runs training including face-to-face and virtual online workshops, with new virtual training workshops facilitated by GP and addiction medicine expert Dr Anne Saunders starting in July.
The Rural Doctors Association of Australia marked Bowel Cancer Awareness Month by encouraging Australians to take part in the National Bowel Cancer Screening Program.
RDAA President Dr RT Lewandowski said “unfortunately people in rural and remote Australia are less likely to use the test kits, and we estimate that around 125,000 tests are being missed each year by people in the bush.
“For patients with indications of bowel cancer there are far less testing services accessible in rural and remote areas, which means that rural patients often have to wait much longer for further investigation, and First Nations patients wait the longest of all.”
Lewandowski said “more work needs to be done to increase access to services like colonoscopy in the bush, and we need more Rural Generalists to train with this skill to increase the availability of these diagnostics outside of major cities”.
Industry groups
The Australian Healthcare and Hospitals Association noted the release of a Policy Perspectives Brief from the Deeble Institute for Health Policy Research, Policy alignment for place-based solutions for better health outcomes in rural and remote communities.
This “provides solutions to address the fragmented funding and policy settings that are challenging the delivery of equitable healthcare in rural and remote Australia”.
The brief suggests:
- aligning federal and state policy and funding to better support place-based solutions
- developing a shared commissioning and evaluation framework to enable integrated care
- establishing nationally coordinated workforce development approaches that reflect the unique needs of rural and remote communities.
The Members Health Fund Alliance (the lobby group for private health insurers that don’t distribute profits) issued a statement ‘Paying Extra Attention’: Aussies called on to use their health insurance extras before EOFY.
This highlights the fact that extras cover is a form of saving, not provision against unexpected events.
The Pharmacy Guild marked continence week by “highlighting the importance of patients speaking with their community pharmacist about their continence challenges”.
The Guild said “community pharmacists are the most accessible frontline healthcare providers and can provide expert advice, support or recommendations for specialist care, including referrals to continence nurses”.
PHA (the private health insurers lobby group) highlighted on social media its “fact check page” which “determines the accuracy of claims made by advocacy groups, commentators, and other public figures about health funds and health insurance”.
I’m sure I’m not alone in thinking that the lobby group representing private health insurers is unlikely to be disinterested when fact checking claims about private health insurers.
Politicians and parliamentary committees
Senator Jordon Steele-John, Australian Greens spokesperson for the NDIS, called on the Government and the National Disability Insurance Agency (NDIA) to “engage in urgent and meaningful consultation with health professionals and disability support providers following growing concerns over the changes in the NDIS Annual Pricing Review 2024-25”.
In an interview with Sky News, Shadow Health Minister Anne Ruston criticised the Government’s approach to vaping and tobacco control without offering any coherent alternative policy beyond consultation with “everybody”.
International organisations
The World Health Organization (WHO) released new guidance “to help countries adopt and expand midwifery models of care – where midwives serve as the main care provider for women and babies throughout pregnancy, childbirth, and the postnatal period”.
WHO said “despite progress, maternal and newborn deaths remain unacceptably high –particularly in low-income and fragile settings”.
“Recent modelling suggests that universal access to skilled midwives could prevent over 60 percent of these deaths, amounting to 4.3 million lives saved annually by 2035.”
Dr Anshu Banerjee, Director for Maternal, Newborn, Child and Adolescent Health and Ageing at WHO, said “expanding and investing in midwifery models of care is one of the most effective strategies to improve maternal and newborn health globally”.
Finally
The New York Times reported that University of Pennsylvania vaccinologist Professor Paul Offit, a former member of the Advisory Committee on Immunization Practices and a co-creator of the rotavirus vaccine, believes US Secretary for Health and Human Services Robert F Kennedy Jr will “find an excuse to add autism to the list of compensable vaccine injuries”.
This would make it “immediately untenable” for manufacturers to continue producing or delivering vaccines in the United States.
Offit said “I think we are on the verge of losing vaccines for this country, from this country”.
“And the reason is that Robert F. Kennedy Jr. will hold up a paper, in the next four or five months, that says it’s aluminum in vaccines that are causing a whole swath of problems, including autism.
“I think he is about to destroy vaccines in this country.”
Consultations and inquiries
Here is our weekly list of requests by government bodies and parliamentary committees for responses to consultations or submissions to inquiries, arranged in order of submission deadlines. Please let us know if there are any to add for next week’s column.
Aboriginal and Torres Strait Islander Health Practice Board
Accreditation Consultations
25 June
Chinese Medicine Board of Australia
Accreditation Consultations
25 June
Medical Radiation Practice Board of Australia
Accreditation Consultations
25 June
Podiatry Board of Australia
Accreditation consultations
25 June
Therapeutic Goods Administration
Adoption of International Scientific Guidelines in Australia
30 June
Office of the Gene Technology Regulator
Risk Assessment and Risk Management Plan for a commercial release of a genetically modified (GM) mosquito strain to help prevent dengue outbreaks.
7 July
Australian Technical Advisory Group on Immunisation
Inclusion of the COVID-19 chapter in the Australian Immunisation Handbook
11 July
Australian Commission on Safety and Quality in Health Care
Australian Safety and Quality Medical Imaging Accreditation Scheme
18 July
Independent Health and Aged Care Pricing Authority
Consultation Paper on the Pricing Framework for Australian Support at Home Aged Care Services 2026–27
18 July
Food Standards Australia New Zealand
Application A1324 to permit the voluntary addition of 3-fucosyllactose, a human-identical milk oligosaccharide, in infant formula products
23 July
Queensland Health
Independent review of Stage 1 and Stage 2 hormone therapies in Queensland’s public paediatrics gender services
29 July
Ahpra
Review of the supervised practice framework
31 July
Department of Health, Disability and Ageing
Updating clinical guidelines for dementia care
31 December
Charles Maskell-Knight PSM was a senior public servant in the Commonwealth Department of Health for over 25 years before retiring in 2021. He worked as a senior adviser to the Aged Care Royal Commission in 2019-20. He is a member of Croakey Health Media; we thank and acknowledge him for providing this column as a probono service to our readers. Follow on X/Twitter at @CharlesAndrewMK, and on Bluesky at: @charlesmk.bsky.social.
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