Minister for Health and Aged Care, speech - 8 October 2024

Read Minister Butler's address to RACGP Health of the Nation Report launch at Parliament House.

The Hon Mark Butler MP
Minister for Health and Aged Care

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*** ACKNOWLEDGEMENTS OMMITTED ***  

Nicole, thank you for your time as College President. It's been an absolute pleasure working with you. We don't always agree, one of my great disappointments is over two years, I haven't convinced you of the merits of the Urgent Care Clinic network. I have to give up and try on Michael now. But you've been a terrific advocate for your profession and your specialty. You should be very proud of your contribution over your time as President, and I hope to work with you still as a past President.
 
I was listening to a podcast on the weekend with an interview with Wes Streeting, the new Health Secretary of the UK, and he's got a bit of a job ahead of him, dealing with the NHS. It was a really interesting little interview. I'm a Labor guy, but he's a pretty impressive fellow. He was saying one of the first things he had done as the Health Secretary is employ another thousand GPs. And I thought, “Oh, I can't do that”. It's actually very hard to get a sense of what is happening in general practice. There are 8,000, or thereabouts, separate practices, and we don't have the BEACH Report, which I worked with when I was last in government, it was a terrific piece of work. So the Health of the Nation report every year is something we all pour over. It is an incredibly important insight into what is happening in the backbone of our health system. Thank you to the College for investing in this. It's a really powerful, insightful piece of work, not always pleasant reading, but there is some really good stuff in this report. Michael and Nicole have talked about those green shoots of recovery, better job satisfaction, more GPs recommending general practice to junior doctors, a material increase in the number of trainees in the program. And I gather 2025 is looking strong as well. There is a big increase in the number of OTDs in general practice, about 60 per cent up on the last pre-COVID years. That is something that we absolutely need, because the modelling that the Department group released only several weeks ago shows that right now, we're about 2,500 FTE short of GPs, and when you convert that to head count, given the average working hours of a GP, that's a number of thousand. That shortage is just going to increase over coming years. So the pipeline is still pretty challenging and that assumes that we don't get older, we don't get sicker, and we know we are going to get both. This is a really valuable report and thank you for doing it.
 
Just to give a bit of a sense, though, of where we are thinking as a government on general practice: I came to this position unapologetically saying that - of all of the pressures in health, and there are many - general practice was my very clear priority. Because I was deeply anxious about the state of general practice. I think it was in the most parlous state it's been in 40-year history of Medicare. We all understand that if general practice continues to decline, then that would reverberate right through the health system. The tenor of the National Cabinet discussions over the last couple of years has given you an insight into that. It's really interesting: National Cabinet, a number of them, over the last couple of years, have been health ministers as well, which has added to the literacy National Cabinet has around health policy. But unlike tradition, where premiers come and treasurers come and ask for more hospital funding, by and large, the discussions in National Cabinet have very much focused on the crisis in general practice. Premiers have come to National Cabinet meetings urging us to do more in general practice, because they are seeing the consequences of the difficulty of getting in to see your GP in different parts of the country, turning up at the front door of their emergency department. Departments which are already strained by the sorts of things you would expect to turn up at an ED. There has been a focus on this sector, but I don't think there has been for too long. I think that's a really important development that I want to see continue. Because although there are green shoots of recovery in this report, the job is far, far from done. I've said from the time I became Minister, this would be a long piece of work that required continuous attention and continuous effort and investment by government, and I remain very much committed to that.
 
I also said from the time I became Minister, that it will not just be investment, there needed to be reform. The Medicare system, I'm not talking about GPs or practice nurses or others working in primary care, but the Medicare system has not kept pace with the change in patient profile. We are now, essentially, a system dealing with chronic disease. As Nicole said, quite complex chronic disease with lots of comorbidities. As this report again highlights, mental health is the bread and butter of general practice now, along with other physical chronic disease. And a system really designed around fee-for-service for episodic care – you fall off your ladder, you get an infectious disease, you go to the doctor, you get patched up, and you don't come back until you fall off the ladder again – I mean, it's very different system now. The hard work, I think, of that Strengthening Medicare Task Force that Nicole was such an important part of, with Karen Booth and others, was to try and think about how to inject some new investment into the system, but also to start to reshape it around the needs of patients in the 21st century: more multi-disciplinary care, more continuous wraparound care. That doesn't just impact general practice or the Medicare system, it was very much at the front of our mind as we were introducing 60-day prescriptions, which really was a prescribing system very much built around the idea of ongoing care. Why require a patient to go to the GP and to go to the pharmacist as regularly as you might have if they were seeking relatively short courses of medicine, where now they're on medicines for years and years and years, if not for the remainder of their lives.
 
We're very much still committed to that job of reform. It's a journey we want to go down with the sector very closely. Today, I'm releasing a few reports that were envisaged by the Taskforce. The After Hours Review is one that I'll be releasing today. The other is the GP Incentives Review. There was a recognition on the Taskforce that package of incentives had really, through accretion, developed into a sort of a long list of things that were - at the point in time of their introduction -important, but hadn't necessarily aged well. And so coming back to that, recognising it's an important part of general practice income, but we need to make sure those incentives are reflecting the needs of the sector today. And also the Distribution Review. Again this morning, I've been lobbied about different implications of the Modified Monash and the DPA system. This is something that I get lobbied about as much as anything in the health sector. I know it's deeply contested and highly complex, but the way in which our workforce is distributed across the country is critically important as well, and so I'm releasing that report. There will be more that work that will come out over the coming few weeks, and I think will lead to a really, really rich, valuable debate within the sector and hopefully the broader community as well, about that ongoing reform process to match the investment that, as Nicole said, came from the 2023 Budget.
 
Thank you all for coming here. I look forward to a very gentle panel discussion befitting of an early Tuesday morning. Congratulations to the College. Congratulations, Nicole again, on your term as President was a great success.

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