Minister for Health and Aged Care - press conference - 9 January 2024

Read the transcript from Minister Butler's press conference on Medicare Urgent Care Clinics, bulk billing and COVID-19.

The Hon Mark Butler MP
Minister for Health and Aged Care

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CEO, FORHEALTH, ANDREW COHEN: Good morning everyone. My name is Andrew Cohen. I'm the CEO of ForHealth. I'm joined here today by Dr. Carolyn Roesler, our regional clinical director; Michele Mackay the CEO of the Adelaide PHN and we welcome the Honourable Mark Butler, Minister for Health and Aged Care and local Member for Hindmarsh. Before I begin, I just want to acknowledge the traditional owners of the land, the Kaurna people and pay my respects to elders past, present and emerging.
 
ForHealth is the second largest general practice provider in Australia, serving more than 7 million patients every year. We're also the largest Urgent Care Clinic provider in Australia. And so we see, from a frontline perspective, the community impact that these clinics are having every day. Our clinics see typically 30 and often 50 patients every day. This is especially true in regional areas. And we've seen unprecedented demand over the recent seasonal period. Of those patients, nine out of 10 of them would highly recommend the service. And a patient typically commences care, after triage, in about 35 minutes on average. 60% of the patients state that they would otherwise have gone to the ED and we are starting to see a meaningful impact to triage category four and five presentations in many of the adjacent hospitals to our clinics.
 
For example, in Logan hospital, the category for five presentations were down 10% adjacent to one of our clinics. And at Ipswich hospital, category four and five presentations were down more than 25%. But beyond the numbers, I think it's really the many kind of written letters of thanks that flow into the practices from patients that really tell the story of the community impact. Letters like one at Royal Park here received just last week from the parents of an eight-year-old girl, who came in with a serious rash and upper respiratory tract infection on Christmas Day. Within 15 minutes, this eight-year-old was triaged by the nurse on arrival. Within 34 minutes later, she was seen by the doctor and 26 minutes later, she was discharged back to her holiday and back to her Christmas. And within that process, our team consulted with the Women's and Children's Hospital. They uploaded her treatment to My Health Record. And then they had a detailed discharge summary to her regular GP, for follow up. These are really meaningful changes to the community. I just really want to thank the PHN for partnering with us and establishing this clinic here in Royal Park, which is making a real difference here but also, the work that they're doing across Adelaide. I really want to just commend the Albanese Government for this important investment in patient access and the 58 Medicare Urgent Care Clinics nationwide. I'll now hand over to Minister Butler.

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Thank you, Andrew, Dr. Roesler and Michelle for being with us today. When we were in the last election campaign, the Labor Party promised to stand up a network of 50 Urgent Care Clinics over the course of 2023. By the end of last calendar year, we had stood up 58 Urgent Care Clinics. As Andrew says, many of them are operated by ForHealth. What we said at the time back in the election campaign was that there was quite a clear gap in health care in Australia. That gap sat somewhere between traditional general practice and hospital emergency department. So when you needed urgent care for a non-life threatening emergency - so care that could not wait for a GP appointment that may take days and days to get - there was no primary care model that was delivering that care out in the community. And as a result, people who had a kid fall off a skateboard and break their arm ended up having to go to a hospital emergency department, even though they could be cared for, in a fully appropriate sense, out in the community if there was a service that was available to offer that urgent care.
 
This is a model of care that's very common in other countries to which we usually compare ourselves. Across the ditch in New Zealand it's been operating for a number of decades and has a very sophisticated model of urgent care. And as a result, you see hospital emergency department presentation data in New Zealand, very significantly lower than the number of presentations to emergency departments that you typically see here in Australia. So our commitment at the last election was designed, as Andrew said, to do two things: to make it easier for people to get the care they needed - the urgent care for non-life threatening emergencies that they needed - in their community, when and where they needed it. But also, importantly, to take pressure off hospital emergency departments, which, particularly after three or four years of a once in a century pandemic, are under very serious pressure, not just right across Australia, but right across the world. And I'm delighted that the Labor government was able to meet its commitment and make sure that by the end of 2023, that network of 58 clinics is up and open and operating, including, as Andrew said, on Christmas Day. The last two of those clinics opened on the 28th of December and we now have a network operating seven days a week, right across the country. These clinics operate on extended hours. Now, I've been quite open that a number of the clinics will take a little while to attract the workforce to ensure that they operate at every single hour that we'd like them to. But in the meantime, we're working very closely with local hospital systems and with the Primary Health Networks like Adelaide PHN, that's represented here today by Michelle, to make sure that the opening hours do match the peak levels or peak times of demand at local hospital emergency departments.
 
And just in those six months, as we've been scaling up that network of 58 clinics, already there have been 130,000 services delivered by this network. And every single one of them, importantly, has been fully bulk billed. All you need to do at one of these Urgent Care Clinics is bring your Medicare card. You can leave your credit card at home, all you need is your Medicare card. Importantly, also we know that almost a third of the 130,000 presentations have been for children under the age of 15. As I've often said, kids falling off their skateboards with a closed fracture or something caught in the ear, an urgent ear infection, something in the eye, a deep laceration. So something that needs urgent attention, but not necessarily the sort of high level attention you would get in a hospital emergency department. Also, about a third of them have been on the weekend, when often people find it very, very difficult to get into their usual GP. So as a result also end up at the hospital emergency department.
 
This is making a real difference in the community. You know, tens of thousands of people getting that care, free of charge, when and where they need it in their own community. But also, as Andrew said, already making a material difference to the pressure on hospital emergency departments. But we recognise there is more to do. We need to continue to scale up those 58 clinics where they're not yet able to operate every single hour service that we'd like them to operate. But also at National Cabinet last month, the Prime Minister put on the table $1.2 billion dollars in further investments to strengthen Medicare, starting this year in 2024. And part of that money will be dedicated to a continued or a further expansion of our Urgent Care Clinic network. Happy to take questions on urgent care. But before I do that, I'd like to say a couple of words about bulk billing.
 
Yesterday, there was some coverage of some data released by a private company called Cleanbill that showed a decline in bulk billing rates according to its particular mode of measurement. I want to be clear, because there's been a little bit of confusion over coverage of that report. Cleanbills data measures how many practices fully bulk bill every single patient that comes through their door for every single service. Now that is one measure of bulk billing, but it's not in our view, the most significant measure. We have been publishing now over the course of the last 12 months, much more transparent data on bulk billing than was ever published under the former government. I said that we needed to know the true picture. Because everyone out there in the community, doctors and patients alike, were saying the bulk billing was in very serious decline and no surprise really given that there was a 6-year freeze on Medicare rebates for general practices.
 
The actual rate of bulk billing in the most significant way, is not what was reported yesterday. We say - and we published this only relatively recently - the government data shows that our standard GP consults, so the standard visit to your local GP, about 73% of those services are currently bulk billed. Now that figure has been in decline. I've been talking about this for two or three years now, saying that that was one of the most significant concerns that Labor had about the state of our current healthcare system. And that's why in the May Budget, we put in place the most significant investment in bulk billing in the history of Medicare, a tripling of the bulk billing incentive that took effect in November, only several weeks ago now, which we are confident will have a material impact on the level of bulk billing that GPs are able to offer, particularly to the 11 million pensioners, concession card holders, and children under the age of 16. Happy to take questions.
 
JOURNALIST: So, do you expect bulk billing rates to go the other way? Like do you have a bit of an indication of when you might see that trend away from bulk billing, perhaps reversing?
 
BUTLER: As the Treasurer said yesterday, after 10 years of cuts and neglect to Medicare, you're not going to get a change overnight. I mean, there is a very significant process of strengthening Medicare that we've started really from the time we came to government not just putting more money into bulk billing, but also starting to re-gear the general practice system in particular to reflect the patient needs of the 21st century, rather than the patient needs that were very different back in the 1980s and 1990s. We're determined to turn this around after 10 years of cuts and neglect. Already, we're hearing some anecdotal reports about practices that had moved to charging gap fees, including to pensioners and concession cardholders, moving back to bulk billing. It'll be some time before we get the full system wide data. But we're confident the biggest investment in bulk billing in the history of Medicare is going to have a material difference.
 
JOURNALIST: Do you have any statistics or proof that these clinics are helping relieve pressure on hospitals at the moment?
 
BUTLER: As Andrew said, the Queensland State Government has already published some data, because it's very early days, many of these clinics have only been operating for weeks, or at most, a few months. But the Queensland State Government, as Andrew said, already published some data around the Logan Hospital, which is an area where we've opened an Urgent Care Clinic that showed that category four and category five presentations, which are the non-urgent or semi-urgent presentations that are the particular focus of this model of care, were down by 10% in the period after we opened the Urgent Care Clinic. In Ipswich, which is just west of Brisbane, that figure was even higher at around 25%, as the reduction in category four and five presentations. But again, it will take a little bit of time for hospitals to get their data and start reporting them. Anecdotally, we're also hearing the same. I do make the point though, that the last few weeks are sometimes the busiest period in emergency departments. Winter is obviously a peak as well, because of flu season. But that peak festive season where kids aren't at school, many people aren't at work, a lot of general practices are closed for the Christmas and New Year period, you do see a big spike in presentations to hospital emergency departments. And we've seen that as well to Urgent Care Clinics, which shows again, just how important this model of care is.
 
JOURNALIST: You mentioned that workforce is a barrier to ensuring all the clinics can open for as long as you'd like them to. But how many staff are you needing to fully start all these clinics across the country?
 
BUTLER: That obviously differs according to each clinic. The Primary Health Networks that are funded by the Commonwealth Government to coordinate primary care in particular regions are taking the lead on that. Already, as I said, these clinics are operating seven days a week. Now they might not be operating fully into the evening of 10pm, which was the commitment we made. But they are operating extended hours, seven days a week. As Andrew said this one was open on Christmas Day, able to care for an eight-year-old child who needed urgent care, who otherwise would have had to go to a hospital emergency department. They were able to do that within a relatively short period of time. I'm delighted at how quickly we've been able to stand up what is a new model of care for Australia, and meet our commitment to opening at least 50 of them by the end of 2023. But I want to be honest that not every one of those clinics has been able to click their fingers and employ exactly the number of nurses and doctors that they need to deliver the commitment on that full span of hours. But we're working very closely with every single one of those clinics to do that.
 
JOURNALIST: We've heard that some clinics, the number of patients that are trying to access a service exceeds the patient cap for those clinics. What are you doing to address that exceeding demand and patients not being able to access the services?
 
BUTLER: This is a this as a new model of care, the Primary Health Networks, governments are working very closely with the operators to just make sure we've got these settings right. I did say that the last couple of weeks have unsurprisingly been very busy. They always are at this period of time, as I said, for the reasons that people understand: the usual GPs are closed; kids aren’t at school; workers often aren't at work. They are relying much more on hospital emergency departments and services like this. We need to get through that unusually busy period of the Christmas, New Year season to get a real understanding. But as Andrew said, I think for his clinics, the average waiting time is so much less than your wait at a hospital emergency department. If you've got a kid who's sprained their wrist, because they've fallen off the skateboard, at a local hospital ED, you will be waiting hours and hours and hours, putting even more pressure on that hospital system.
 
JOURNALIST: We've heard from a few people who have actually told us that when they come to an Urgent Care Clinic, needing urgent care, they need to wait hours, they're told to go and come back or they need to create an appointment. What do you say to that?
 
BUTLER: We will be working with all of these operators to make sure this service works in the way in which it was intended. I mean Andrew’s data indicates that the average wait time for these clinics is a very, very positive measurement. Now, that doesn't mean at peak periods there aren’t going to be people who do need to wait longer periods. But we're monitoring this very, very closely. As I said, it's a new model of care. We're determined to make sure it works for the community, we're determined to back in the operators who've taken the brave decision to put their practices forward to embark upon a new exciting, innovative model of care for Australia. But these are early days, and we're going to make sure that that some of those issues are dealt with.
 
JOURNALIST: Last week, we've heard about the death of the 54 year old man Eddie, was waiting ten hours for an ambulance. What are your thoughts about the ramping situation in South Australia?
 
BUTLER: As the federal health minister, my job is to do all that I can to support state governments in dealing with the pressure that is being felt by the hospital system right across the country. As I said earlier in my remarks, particularly in a period of such pressure on health systems, that was that was the result of this once in a century pandemic. This is something that's global: there are workforce pressures, there is deferred care, there is increased acuity of people's needs because they weren't getting the care during the pandemic that they probably should have been getting. Hospital systems right across the country, right across the world are under enormous pressure right now. And South Australia obviously is not immune to that. We're working very closely with the state government to make this model work. You know, we're determined to take as much pressure from those lower acuity presentations to emergency departments as we can. We're also - after the National Cabinet meeting in December that the Premiers, Chief Ministers had with the Prime Minister - working very closely with them over the next few months to try and move longer stay older patients out of hospital as quickly as that can appropriately be done, again, another source of pressure on hospitals. But you know, our job as the Commonwealth is to do what we can to clear, through primary care and aged care and National Disability Insurance Scheme, clear that additional pressure on hospitals. The death you've referred to is obviously a real tragedy, as every death is. And my condolences certainly lie with that man's family and his friends. But I know state governments right across the country health systems right across the world are under real pressure right now after three or four years of this unrelenting pandemic.
 
JOURNALIST: And are there any more urgent care clinics in the pipeline?
 
BUTLER: As I said, the National Cabinet took a decision last month to put in place through the Commonwealth another $1.2 billion in funding to strengthen Medicare. One of the focuses of that funding will be on expanding urgent care. And we're currently working on that and we'll start discussions with state governments very, very soon, because we want to see that start to roll out over the course of 2024. In addition to that, as I just said, it will also focus on trying to relieve some pressure from longer stay older patients. Older Australians who could be much more appropriately cared for, after a hospital stay, somewhere else in the system. We'll be working very closely with state governments on that as well. But we see already in very early days, this Urgent Care Clinic model has been very successful. It fills a very significant gap in the Australian healthcare system, delivers care that people need when and where they need it. And it's already demonstrably taking pressure off hospital systems.
 
JOURNALIST: There's a spike in COVID hospitalisations in Victoria. What can you tell us about the situation in Victoria regards to COVID infections, but also that spike in hospitalisations?
 
BUTLER: As I said, I think last week, we are still in the sixth Omicron wave. These this is a sort of regular cycle of waves caused by new Omicron sub-variants. For a couple of years now, the Omicron variant of COVID has been the dominant variant across the globe. But we've seen sub-variant after sub-variant emerge and cause further waves every four or six months here in Australia. But we've seen this globally as well. The latest sub-variant has been identified here in Australia and globally, is known as JN.1, it is yet another sub-variant of Omicron - part of that very large growing Omicron family of sub-variants. It was only a couple of weeks ago determined by the WHO to be a variant of interest, it's still relatively new. There's no evidence yet to show that it is any more transmissible or severe than the myriad other Omicron subvariants that we've all been grappling with over the last couple of years.
 
But we are, as I said, in this sixth wave that started in October and was scaling up over the early period of the festive season. It's not surprising really, given the degree to which people come together over the Christmas and New Year period to celebrate the festive season, that you've seen those case numbers hold up and in some areas increase a little bit over the course of the last few weeks. Hospitalisations are up, there was also a reasonable increase in infections in aged care facilities that we're monitoring closely, as well. But the impact on the hospital system, the impact on fatalities is significantly lower, for example, than the same time last year.
 
I've spoken today with the Chief Medical Officer about this, he's engaging with his Chief Health Officer colleagues at state level, including the Victorian CHO, he's had a discussion with the Victorian Chief Health Officer over the course of this morning. We'll be continuing to monitor this very closely. But this doesn't appear to be any different really to the waves that we saw over the course of 2023 from other Omicron subvariants. In the meantime, I just encourage people again, if you haven't had a booster for some time, get a booster. Make sure you're up to date with your COVID vaccines. We only had a little more than 4 million booster doses delivered over the course of 2023, which is not a big percentage of the whole population. Happily, the rates were much higher for older Australians who are more vulnerable to severe disease. But I do take this opportunity to remind Australians to check when you last had a booster and look at getting one if it’s been some time.
 
JOURNALIST: There is no suggestion that this JN.1 has caused the increase in hospitalisations in Victoria?
 
BUTLER: There's no evidence to that effect, at the moment. The number of JN.1 cases that have been formally reported is still relatively minor. But it's quite clear that is becoming a dominant subvariant, not just here in Australia, but around the world. As I said, there's no evidence suggest that it isn't materially any different in terms of transmissibility or severity to the myriad other Omicron subvariants that we've seen over the last couple of years. As I say, though, the degree to which people obviously come together through the Christmas and New Year season, unsurprisingly has kept case numbers up. Visits to aged care facilities by family members to see their loved ones, their mum or grandma, so on and so forth, has also seen an increase in resident infections over the last couple of weeks. That's not surprising either. We're monitoring it very closely. As I said, the pressure on hospital systems is materially less than it was for example, at the same time last year. But that does not mean that this is not something governments across the country are continuing to monitor closely.

JOURNALIST: Dr, can you go through the impact you've seen from the urgent care clinics?

DR CAROLYN ROESLER: Absolutely. I've been now working across all of the urgent care centres that we have. My base is Elizabeth and we all know that NALHN is really grappling with ramping and the patient demand is massive. In my GP space, and obviously, board position, I'm obviously acutely aware of GP shortages and the impact. Perhaps now, I think we're all way more insightful into just the enormity of impact, especially on families in driving around at night, making GP calls desperate to get their children seen. It is a very real fear for parents that they can't get their children seen. But I think also for some of our chronically unwell patients, whilst GPs are at the centre of chronic illness, we all know that acute illness in these people can precipitate an admission. So for me, I think it's been an eye opener in terms of just how successful it's been. I'm not surprised that patients are so appreciative of the care. I think making that impact universally, all the doctors across the centres have said, you know, we've seen some quite sick people reported infections at an early stage and a diabetic patient, for example. And that can only mean you know, less time at home, and obviously, avoidance of very prolonged stays. I think that's something we'll see. We're looking at stats, obviously, on how the impact is affecting ramping but I think also people's general wellbeing, their ability to go back to work. Obviously if you can't see a doctor, absenteeism is rising, the workforce has already been so impacted heavily. I think Urgent Care I would like to stress it's a very complementary model to those services that are available the virtual care systems, the hospital at home avoidance, myhome hospital we work with them and we are definitely supportive, obviously, of GP practices.

JOURNALIST: Have you had to turn people away because of staff shortages at the urgent care clinics?

DR ROESLER: We haven't really ever turned people away; I must note without some informational pathways. Michelle and I from the PHN and ForHealth as a company, are really proactive in looking so if a child comes in, you know at 10 to 8, or 10 to 10 and we’re closing, what pathway or provision of care can we provide. It may be a consultation that, you know, advice on some analgesia, it may be a follow up with an appointment within that next 24 hours. I think pathways are really critical. And also, we have a really strong governance, and that's around turning around x-rays quickly, not having people waiting. We generally don't turn people away, we give people the opportunity to go and get a coffee, if there was an x-ray waiting, rather than have waiting rooms full of people. That's what we want to negate again, it's getting people in, and the x-ray reporting and everything we are aligning to give the quickest, but obviously very, very good, high quality care.

JOURNALIST: Do we need to see more of these facilities pop up?

DR ROESLER: I think so. As I said, as a general practice workforce, we obviously need, you know, a massive injection, we all recognise we are key and central to chronic disease and preventative care. But these models of care are complimentary and supportive of general practice. You know, we're educating patients that emergency departments are not where they need to be. They need to be back with general practitioners. I think even with the most robust general practice workforce, these clinics have a very important role to let hospitals focus on the very, very unwell and those that really do need the level of care they do.

JOURNALIST: And obviously, it's great for a lot of people that it is a bulk billed facility, but are you concerned at all as a GP about maybe the trend away from bulk billing in the broader sense?

DR ROESLER: The triple incentive, especially in areas of needs, such as the North, obviously, where I'm focused, I don't see a detraction from bulk billing is necessarily something which is happening or even predictable. The incentive is obviously availing more GPs to be able to provide bulk billed services especially to children and our most vulnerable.

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