And thanks very much to Bruce (Willet), to incoming president Harry Nespolon, to Zenia for her work, to [indistinct] for giving people a sense of the future. That’s the reality that I look at and grapple with every day in talking with Karen, with Zenia, with Bastian (Seidel) who’s finishing. These are the sorts of issues that we look at. So, a test of reality for our amazing human practitioners and the future and the way we need to pave the way so as those extraordinary developments which were outlined can be integrated into general practice and ultimately, improve the health of your patients.
I want to acknowledge all of our general practitioners here – 36,000 around Australia – people who save lives and protect lives on a daily basis. Particularly Harry, I want to acknowledge you, your predecessor, you and Bastian did a great job in working for an agreement which was quite transformative and I’ll examine that today. And Harry landed immediately on not just day one, not even in hour one but within our first minutes, said ‘I want to shakeup general practice and give our people a better model’. Nice to meet you, Harry.
And so, in a sense he and Bastian have been very complementary, a little bit like The Odd Couple, Oscar and Felix – you can make your own judgements.
But they provide complementary skills. One who set the agreement, one who’s building up the future of general practice which is what I really want to discuss with you today: to talk for a little bit and then to open myself up to questions, criticisms, comments, suggestions – all of the things you’d like to discuss today.
And Harry also stepped into the My Health Record question, provided practical suggestions for additional support and additional protections around privacy. And he did that within his, I think, first week on the job, and it was a sort of a rapid baptism. And for me, I saw somebody who was practical, decisive, he delivered on what he said he would do and we delivered on what we said we would do. And I thought that was a fantastic basis for the relationship.
Let me begin with some good news. I’ve just – before stepping up here on stage – received the figures on the flu season to 11 October. Flu numbers this year are down over 85 per cent. But perhaps even more significantly, to 11 October 2017, 1108 people have lost their lives in Australia, so a terrible figure. As at this stage this year, 53 people have been recorded to have lost their lives to flu. So an over 95 per cent reduction.
Now, some of that has to do with the nature of this year’s flu, of course, and the fact that it was neither as virulent, nor had it mutated away from the vaccines much. Some of it has to do with the vaccine and combination of vaccines, in fact, which were better targeted. But a lot of it – a lot of it – has to do with the people in this room. What you have done is you’ve helped lift the national vaccination rate dramatically from 8.4 million last year to over 11 million this year. You’ve helped identify earlier the signs and the symptoms and worked with patients on their practices, so as there will be less contagion by improving infection control. And all of those things come together and are measured in the fact that this year we are 1250 lives better off than we were last year.
And that is, when you think about your work, something extraordinary, that’s something which would not have happened without our general practitioners and would not have happened without your leadership. So, I want to thank you and acknowledge you for that. Give yourselves a clap.
The second thing is to take you to a very individual example of a young lady I met yesterday named Jenny. This was at a launch of $10 million as part of the Australian Brain Cancer Mission here in Queensland. And at Lady Cilento Hospital, what we saw was the Children’s Hospital Foundation contribute $10 million for a paediatric brain cancer centre in South East Queensland.
Interestingly or most importantly, one of the people we met was Jenny and we know that there are roughly 95 (inaudible) children and teenagers who are diagnosed with brain cancer each year and we lose over 30. We know that around Australia, we lose about 1195 people with brain cancer every year and it’s one of our national challenges and it’s a global challenge. Our rates of survival are as good as any in the world, but the world hasn’t made much progress in the last 30 years as opposed to something like leukaemia.
This young girl, Jenny, was diagnosed with a tumour just over a year ago at aged 16. And she was diagnosed because of early intervention by an alert GP who saw signs which may not necessarily have led to a test, but that GP – coupled with an eagle-eyed mum – meant that Jenny was given the appropriate diagnostics. A tumour was diagnosed and she’s been through hell. She’s been through surgery. She’s been through radiation therapy. And she’s been through chemotherapy. But as of this moment, she’s clear and she’s got a bright future ahead of her. You may have seen she was featured on television last night.
But you look at those two examples of the 1250 people who are on the planet today, in part because of the condition of the flu virus in Australia this year, in part because of (inaudible) vaccine, but a significant portion because of our general practitioners. We look at a young lady with an incredibly promising future such as Jenny, and you think, that is why we do what we do. It’s why I do what I do. But you’re the ones that are actually delivering that patient care and in the end that’s the motivating force for all of us.
I just wanted to start with those elevating points.
But, really I want to do address three things with you today. One, is the long-term national health plan and the progress we’ve made in the last year and the direction that we’re heading as it pertains to general practice. Two, is to focus on how we deliver the plan, supporting general practice going forward and new models that we’ve been working on with Harry and Zenia and others. And three, is to look at some of the forms of private health insurance that should help you and your work and help patients have better coverage and better experience going forward.
So, if you look at the Long Term National Health Plan, there are four pillars to that. The first is primary care – and that’s access to our doctors, our nurses and our medicine. As part of that, over the last year there have been three big things that we’ve done in relation to general practice and to Medicare personally.
We have legislated to guarantee Medicare with a Medicare fund which is the first call on the Budget of all the items within the Budget. And that’s, I think, a very powerful message as well as a very important guarantee that the first thing funded in the Australian Budget – by law now – is Medicare.
The second thing I wanted to note is that the funding overall for Medicare has been locked in for the next four years and it increases from $25 to $26 to $27 to $29 billion a year. Now, that’s an important investment and I think it’s important for everybody in this room to understand.
And the third, of course - and you will live this - is that we continue to refine and increase the services and treatments that are available under new Medicare (inaudible). Just to give you three examples. We’ve introduced a new 3D mammography item to which you can refer your patients and (inaudible) protect patients against the impact of breast cancer through early diagnosis. This should help over 200,000 women a year. A new prostate diagnostic for men, which will help over 20,000 men a year. And new renal dialysis in remote and rural areas which will really help with Indigenous Australia, with its huge challenges in relation to renal conditions. And they’re the sort of things that are coming through. But I do want to say to this room, that you can actually mold and shape the future directions of MBS items through working with Harry and the RACGP Clinical Committee. You can have a critical role going forward.
Linked with that is what we’ve done with medicine. Now every day, you will see new medicines coming onto the PBS. Literally, I think it’s about 1900 new or amended listings since we’ve come to government but (inaudible) investment, but most importantly – in the last week, we listed a medicine called Simponi. Simponi for chronic spinal arthritis and that will help over 3,000 patients in Australia have access to a medicine that can be prescribed to deal with an agonising and debilitating condition.
Many of you will have cystic fibrosis patients, and only a few weeks ago, we listed a medicine that would have cost over $300,000 a year for cystic fibrosis patients. And young children and young adults who would otherwise have been facing a very bleak future, you can now offer them the hope that with the medicine such as Orkambi, they’ll have an extra 20 years. And we know that within three years we are likely to have the next generation of that, because that was part of our agreement, which will be brought to Australia as the first jurisdictions in the world. And that is likely to give people back 85 to 90 per cent of their lung functions. Essentially, they would be able to lead – if they have cystic fibrosis and the medicine works for them – a near to normal life. And that’s an unbelievable gift. So these different medicines – whether it’s Kisqali for breast cancer, whether it is Spinraza for the agonising condition of spinal muscular atrophy – are all coming through. And they give you extra weapons.
The second of our pillars outside primary care is what we’re doing in with hospitals. Now, our hospitals as you know better than anybody are a mixture of public and private. And therefore, private health insurance is such are critical component of allowing that balance. We’ve added $30 billion to hospitals for the next hospital agreement. But most significantly, the key part of the hospital (inaudible) agreement is to focus on prevention and keeping people out of hospitals. And what we will do – and this won’t happen overnight because it’s a difficult process to calculate, but it’s utterly achievable when you look at some of the best models – is to provide incentives for our GPs and for our general medical community, to help keep people out of hospital.
And for you, that’s a more satisfying outcome, but for the patient, that’s a better outcome. For the system and the country it means any savings can be reinvested in new medical research, so it’s a wonderful combination. And what we will be working on over the coming months and beyond is that notion of how we are able to keep people out of our hospitals by providing the right mixture of incentives for our general practice and for our hospitals. And that, ultimately, is about a healthier population. That’s what we all want to see.
Related to that is the set of private health insurance reforms which are about keeping prices down and increasing transparency. I’ll go into those in a few short moments.
But the third variance is something, the third pillar is something, which is of relevance for absolutely everybody in this room. I know from talking to Carrie, I know from the work of the RACGP, that there is no other condition which bring more people through your doors into your practices than mental health challenges. In any one year, four million Australians have some form of mental health challenge. It could be, we see that anxiety, depression, bipolar, schizophrenia, eating disorders – which have been a very, very hidden area of mental health, because of the nature of it, fewer role models than other areas in terms of recovery. And of course, suicide, which remains and continues to be, a giant national tragedy and challenge.
So on that front only yesterday for World Mental Health Day we announced the Million Minds Mental Health Mission under the Medical Research Future Fund. And that is about funding, yes $125 billion, but it’s 10-year program to bring medical help, improved treatment and testing to an additional million people, and for yourselves. So, what does that mean for me? We want to work, not just in the labs, not just in the universities or the large teaching hospitals, but at the level of the general practice. We want to bring general practice into the research community. And in the design of this mission, the first three areas - eating disorders, youth, and Indigenous Australia - are something that we’re seeking to do by working within the general practice, and I think that that’s an important thing.
Historically, there have been too much – not an absolute, but too much – of a separation between the front line of medicine, general practice, and the research. Now is the moment when we have the capacity through data management, through all of our systems, to bring those two together. And that’s one of the things that we want to fundamentally change over the course of the next five years.
In addition to that, what we’ve also done is boost funding for suicide prevention. Whether it’s through Lifeline or very interestingly, for the post-hospital discharge for those who attempted suicide or have been admitted for suicide ideation. Historically, there’s been weak follow up, and it was a big surprise to me on coming into the role, weak follow up for those who have been discharged. Yet we know that cohort is the most likely in the country to ultimately complete suicide. And so there is an enormous task and responsibility to work directly with them. So, we funded beyondblue with a $37 million program and they will be working with the general practitioners to follow up those individuals who are facing these challenges and these crises.
And then finally, on the mental health front, it’s working within the context of aged care and senior Australians where we’ve invested $100 million, but it’s not that, it’s providing the support in the nursing homes and in the community for senior Australians to have additional mental health care.
That brings me to the fourth of our pillars – medical research. Now, medical research, as I said, one of the fundamental changes we want to bring about is to engage that research far more with the general practice on an entirely optional basis. But the opportunities for those in this room are very real, and very significant. We’re working with the college, and the other medical bodies to ensure that all practices in Australia have the capacity to be involved in that. And in particular, in terms of clinical trials, which have also largely been separated from general practice, now we have the opportunity to engage GPs in clinical trials on a far more significant basis.
Across the whole of the Medical Research Future Fund, we’re doubling medical research in this current period. That’s with a $20 billion endowment which 100 years from now, will have grown significantly. And what that means is that we’re able for the first time to have a rare cancers, rare diseases clinical trials program. And when you come across patients, until now there hasn’t been an opportunity and there hasn’t been a solution. This is immensely important, whether it’s the glioblastomas, whether it’s for ataxia, whether it’s for Parkinson’s, whether it’s for some of the rare genetic conditions such as Sanfilippo and so many others. We now have a pathway forward that you can tap into and it’s our task to work with the college to ensure that you have that information at your fingertips in terms of the clinical trials to which people have access.
Secondly, there’s a core program around researchers and building your capacity to drive research projects from the ground up in collaboration with the universities. And then perhaps most significantly, we have the missions under the Medical Research Future Fund.
I mentioned the Brain Cancer Mission, I mentioned the Million Minds Better Health Mission, but building on what (inaudible) had to say, the most significant mission is the 10 Year National Genomics Mission, and this is about laying the foundation for Australia to be the world’s leading nation in terms of the diagnosis, the use and the treatment of genomics and genetic testing to assist with patients.
There’s a mission we’ve got called Mackenzie’s Mission named after a little girl who didn’t make it. Mackenzie had spinal muscular atrophy and she was diagnosed at about three months and she was gone only four months later. And her parents were devastated. What this mission will do is allow for preconception testing for 10,000 families – we’re ultimately paving the way for a Medicare item to cover all families in Australia who wish to take it.
That mission will allow testing to see whether couples have a combination of bio markers that would lead to cystic fibrosis, SMA, fragile x – screening of up to 500 rare genetic conditions. And to identify that and if that’s the case, to offer them IVF, so as fewer children will ultimately be born with these conditions and that’s an extraordinary gift to future generations and its happening on our watch right now. That’s what this mission is about and the diagnostic tools for yourselves.
So then that brings me to how we are working right now, together, to strengthen our general practice and that really runs across a series of different fronts. In particular, we’re looking at the relationship with the patient, the fees that we can offer you and the additional services that you can be engaged in.
In terms of the relationship with the patient, you know better than me the nature of Medicare which is something we’re utterly committed to, is that it’s effectively driven by a face to face engagement now. And yet, if you want to work with a lawyer or somebody in another profession, you can talk with them you can see them face to face, telephone, online, video conference, you can work with their researchers or other (inaudible).
All of those services, all of those patient engagements are the sorts of things that from literally, as I said, not just day one, not just hour one but minute one – Harry set out, about the future of general practice. An entirely optional opt-in model for GPs and an entirely opt-in model for patients. But I know, (inaudible) is here and his practice in Western Sydney is pioneering some of this work on a trial basis. But what we want to do in working with the Medicare taskforce, in working with the RACGP, in working with the other medical bodies, is to lay a new opportunity on the table which is additional and entirely voluntary, but additional to what is already in place. That is the modern, strengthened model which we are looking at right now.
So if we can get your input in it – and it’s a big topic of conversation for the college within itself – and it’s a three green light proposal, it has to be us, it has to be the college and it has to be the other medical bodies. But at the end of the day instead of just a linear, single channel relationship with the patient, if we can open it up so as you can deal with patients throughout the day and be rewarded for it, that’s critical. And I mention reward, it means we have to offer a blended model and that means we have to contribute more – I accept that. And Harry would not have let me out of here alive if I hadn’t mentioned that. But that is what we are currently considering, and it won’t happen overnight. But we’ll provide you with a different way forward.
Now, at the second thing in terms of what we’re doing with our GPs and strengthening the practice, is the overall investment which comes from this. And so as we look at that investment, the agreement delivered an extra billion dollars over four years and an extra $5.5 billion over a 10 year period. So, never enough – I respect and understand that – but very significantly, a major investment in the sector if you think of an addition $5.5 billion.
I am very pleased to be able to say, and of course, the other side in (inaudible) pay out; this morning we’ve just announced as a government that we will (inaudible) the reduction of the small business tax reductions or small business tax decreases – we will bring that forward to 2020 and 2021, which means you will have gone from 30 per cent to 25 per cent, a one-sixth reduction in your outgoings on tax, if you’re under $50 million in your practice. If you’re over $50 million of practice, I think we better have a chat.
And that is also about reducing your costs and in your services and your engagements. So in terms of those services, what I do want to say here is I’ve seen the fee document that you put out today. That is something we are recognising is inevitable. I’ve been in discussion with the pathology companies, they have to recognise that it’s inevitable and patient care, quality, safety is number one. But this is coming down the track.
In terms of training, which is the other area, we announced our rural package recently, and that will see 3000 more doctors and nurses in rural Australia through teaching, training and retention. In particular, we announced last year that the RACGP will regain control of the training process with the general practice training program and that is underway. It’s all proceeding and I am delighted to announce today as part of that, the Government will allocate $29 million to the non-vocational Non-VR GP Fellowship training program. That will assist you in recruiting and that will assist you in ensuring that people have the best training and that we get the best people that are doing that training.
I then want to turn briefly to private health insurance. We’ve released today the private health insurance changes. In terms of services, better mental health coverage which is critical – no waiting times for upgrades, 10 per cent discount for young people, better rural and remote coverage.
In terms of transparency, one of the great things that people face is that people are frustrated – they say: how do I know what’s in and what’s out? Now, in this new transparency model, nobody’s policies will be changed without their agreement. People will still have the same policy but they’ll all be classified according to formal basic areas, of gold, silver, bronze and basic. And everybody will know in one page what’s in and what’s out. And so then there’s a no surprises approach which improves trust, it protects the system and that’s fundamental.
And then finally, this is part of the process of driving down any changes in cost in private health, including the lowest change in 17 years this year. Next year, I am very confident that we will have the lowest change in 18 years and these changes today are cost neutral. And so they I think they’re absolutely critical in giving you more power.
All of this, ultimately, is about trying to help the doctors, help the patients. You do an amazing job and I think again, when I think of those numbers for the flu, when I see what you do in early diagnosis and prevention, we recognise that our GPs are the frontline of our health system in Australia. We’re building on the agreement and whether it’s in terms of investment, whether it’s in terms of strengthening GPs practices or in terms of what we’re doing in relation to teaching and training and retention, we’re working with you to do that.
Thank you, and I honour you and I am delighted to officially declare open the RACGP Conference for 2018.