Minister for Health and Aged Care – interview on ABC Radio Perth – 16 May 2023

Read the transcript of Minister Butler's interview with Nadia Mitsopoulos about Medicare Urgent Care Clinics, bulk billing and strengthening Medicare reforms.

The Hon Mark Butler MP
Minister for Health and Aged Care

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NADIA MITSOPOULOS, HOST: Now you might remember a few months back, the Federal Government announced it will open some new Medicare Urgent Care Clinics in WA. They will bulk bill and they are designed to give people immediate care and keep them out of emergency departments. Well, the first will open in Morley in June to take pressure off hospitals in the city, there'll be another in Joondalup, another in Rockingham, Murdoch, Midland, Bunbury and Broome. Now the Health Minister is in Perth today to explain how they will work, and I spoke to Mark Butler a little earlier this morning.
 
MINISTER FOR HEALTH, MARK BUTLER: Good morning.
 
MITSOPOULOS: You’re here to update us on when those Medicare Urgent Care Clinics will be ready to go. When will the first one be open and where will it be?
 
BUTLER: Well, the first one will be delivering services by the end of June, and it's a clinic in Morley called the Rudloc Road Medical Centre. It was able to win a competitive tender process that was overseen by the WA Government and also the Primary Health Networks in Perth, which are essentially funded by the Commonwealth to oversee general practice and other primary care services. So it will be delivering services by the end of June and the remainder – the other 6 Urgent Care Clinics in WA – will be rolled out over the course of the next several months. But certainly all of them will be delivering services sometime in 2023.
 
MITSOPOULOS: And we should mention those under the other ones are Joondalup, Rockingham, Murdoch, Midland, Bunbury and Broome. Is that right?
 
BUTLER: That’s right.
 
MITSOPOULOS: The concern is that people will go to these clinics rather than their GP, because they'll be free. How do you stop that happening?
 
BUTLER: I remember having a talk with you about this last time I was on your programme, Nadia. We've been very clear in negotiations with all of the state governments to have only limited range of services being delivered by the Urgent Care Clinics. So the sorts of things where you do need, as the name suggests, urgent care. So, your kid falls off the skateboard and busts their arm, or you get a deep cut or you’ve got a very urgent infection. It's not designed to replace the sort of ongoing care you get from your GP, so they will have a clear scope of service. They can only bill certain items on the Medicare Benefits Schedule. So the sorts of things I talked about: those non-life-threatening emergencies. And frankly, if people are rolling up to these clinics to get the sort of standard care you would get from your GP, they'll be politely asked to go back to their GP.
 
MITSOPOULOS: Ok, that when that was another concern that it could there be an issue with continue continuity of care. So if you need a script refilled or if you're, I don't know, if there might be a mental health issue, for instance, or something like that, you cannot go to an urgent care clinic for those kind of things.
 
BUTLER: That's right, they've got a very clear set of operational guidelines that we negotiated with state governments. But the problem is, as you’d know and your listeners would know, when there's something that's urgent and you need care within a couple of hours it's often just impossible to get into your own GP within 2 hours. I mean, people are finding it difficult to get into their GP within a day or 2 and if it's after hours or if it's on the weekend, because there's no obvious access point in primary care for a general practice or something, so often around the country people are ending up in emergency departments and often waiting hours and hours and putting even more pressure on the hospital system that across the country – indeed, across the world really – is under real pressure after 3 years of a pandemic.
 
MITSOPOULOS: What will the capacity be of these clinics? I mean, how many patients will they be able to see? Will there be a minimum amount of doctors?
 
BUTLER: It will vary according to where it is. Obviously will be a bit different in the regions compared to what you would expect to be quite a busy centre in the cities, but they're going to have quite substantial capacity. There's been a good tender process. We've allocated additional money in this year's Budget that we delivered last week to the money that we originally intended to use to fund these clinics. Because as we talked through the process with state governments and with other primary care providers, it was clear that a full range of services - not just the care from a doctor and a nurse – that we would have pathology, diagnostic imaging, obviously if your kid’s fallen on their skateboard, you want to know whether the fracture their arm. So X-ray facilities, sometimes other diagnostic imaging as well, will be available. It’s quite a new model for Australia. It's very common in other countries, to have this idea of a service somewhere between standard general practice on the one hand and a fully-equipped hospital emergency department, on the other. I think I said when I was last on your program, in America, for example, there are more urgent care clinics than there are Starbucks coffee houses. So this is very common in other parts of the world. But we want to step it up properly evaluate the make sure we've got the model right, and then hopefully a little while down the track, we will be in a position to expand the model further.
 
MITSOPOULOS: Will staffing them be a challenge?
 
BUTLER: This is really up to the providers that have put in a tender. The important thing is: we're not building new clinics. We're really inviting expressions of interest from existing general practices, by and large – or there might be an Aboriginal Medical Service in some regions or a community health centre – but an existing primary care service that wants to take its practice up to the next level. So they'll tap into existing staffing resources they might have to employ some additional people. As I've got around the country, there's a really high level of interest – not just from practices, but from workers, as well. People who might have done some time working as emergency physicians in a hospital setting are telling me they like the idea of deploying those skills in more of a primary care setting out in the community. So I don't think we'll have any trouble getting the workforce to do this, but obviously across the board, there's a real challenge that we're having getting enough doctors and nurses and allied health professionals into the system right now. And that has been made much worse, as you know, by the experience of 3 years of pandemic.
 
MITSOPOULOS: I'm speaking this morning to the federal Health Minister Mark Butler on ABC Radio Perth and WA. Just on another issue: in the Budget last week, you increase the incentive for GPs to bulk bill from $6 to about $21. We did speak to some GPs, including some in the regional areas, who said this will actually not be enough for them to go back to bulk billing. Does that concern you?
 
BUTLER: It does. And unfortunately, you will always find a few businesses that say it's not enough to shift the dial for them. But equally, the Prime Minister and I yesterday were at a practice where they told us, and told the media, that they were on the point of having to introduce a gap fee for children and for other health card holders and because of the decision we made last week, they've shelved that. They’re going to continue to bulk bill all of those patients. I've had other practices tell me exactly the same: the financial pressure really was building on a lot of these practices. But our decision to triple the bulk billing incentive was described by the College of General Practitioners as a 'game changer' is really relieving a lot of that pressure. Now there are thousands of general practice businesses across the country. I don't pretend that every single one is going to take the decision I'd want. But it's been very clear to me from the feedback I've got from the sector that this is – as they describe it – a real game changer.

It’s important also to point out, Nadia, that the increase that you talked about in the bulk billing incentive, from about $7 to about $21 in the cities, is very substantial for those city practices. But it's even bigger in the regions. The increased to the bulk billing incentive increases the further you get away from the major cities. So into some of the more remote parts of WA, it's an increase of, like, about 55% in the fee that a general practice would get for seeing a bulk billed patient. And this is a huge increase and I'm sure make a real difference.
 
MITSOPOULOS: But the impact is going to be, do you agree, rather than getting doctors to reintroduce bulk billing into their clinics, it's going to stop doctors dumping bulk billing. So you're not necessarily going to get more doctors bulk billing.
 
I think you'll see a mix of reactions. I think you will see doctors who have taken a decision that they didn't want to take. No doctor wants to shelve bulk billing that I've ever spoken to. They do it when they utterly feel it's necessary. And so I think there will be our practices that in the very recent past have decided to introduce gap fees, particularly for example for kids or for pensioners, they will revisit that. Because what we're doing now is properly reimbursing them for bulk billing and it's, you know, it's a game changer for the whole sector. It’s a game-changer for millions of mums and dads who want confidence they can take their sick kid to a doctor and be bulk billed and millions of pensioners and others. But also I think a real game-changer for general practice that has felt like it's not been the subject of enough support and respect and attention from Canberra, over the last decade. I hope they now feel that they've got a government in Canberra that sees them as utterly central to a properly functioning healthcare system.
 
MITSOPOULOS: Is this it then, when it comes to tinkering with Medicare, is this all they're going to get for a while now?
 
BUTLER: I don't see this as tinkering. In addition to tripling the bulk billing incentive – a huge investment. We are also delivering the biggest across-the-board increase to rebates. So every single rebate across the Medicare Benefits Schedule - so not just general practice visits, but X-rays and pathology and specialist visits and all the rest. We are delivering the biggest across-the-board increase to Medicare since Paul Keating was Prime Minister more than 30 years ago. And also several billion dollars of additional investment, essentially to deliver real change in the system. I think I said to you when we last talked, I'm not interested in simply putting more money into a system that's not meeting the needs of patients today. I mean, this system just hasn't changed enough since the 1980s when the patient community is very different to what it is today. It's older today, it has more complex, chronic disease. And so there's also a lot in the package we delivered last week to deliver more multidisciplinary care, more care after hours and the sorts of things that doctors and patient groups and nursing groups have been calling for, for a long period of time. It's just never been delivered.
 
MITSOPOULOS: I'll leave it there, Minister, enjoy your time in Perth and thank you for talking to me.
 
BUTLER: Good to talk to you. See you later.

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