ANDREW LEIGH, ASSISTANT MINISTER FOR PRODUCTIVITY, COMPETITION, CHARITIES AND TREASURY, MEMBER FOR FENNER: Thank you everyone for being here today on the Ngunnawal lands in Ngunnawal. My name is Andrew Leigh, the Federal Member for Fenner, and it's a real pleasure to be here at this practice for today's important announcement. I'd like to thank Pushpani and her team for hosting us today, and Minister Butler and my ACT colleagues for being here.
Labor built Medicare, and Labor wants to strengthen Medicare. Today's announcement goes to the importance of ensuring that Canberrans have access to bulk billing. We know bulk billing rates in Canberra are too low. They were falling of the former government, and it's taken the Labor Government to do something about that. This is about ensuring that Canberrans can walk into doctors’ practice with just their Medicare card, not their credit card. It's about ensuring that the promise of universal free healthcare is available to Canberrans.
I'll hand over now to Minister Butler, who'll hand over to colleagues.
MARK BUTLER, MINISTER FOR HEALTH AND AGEING, MINISTER FOR DISABILITY AND THE NDIS: Thank you, Andrew, and to Dave and Alicia, and obviously, also Minister Gallagher, who will have something to say about some ACT-specific proposals that are part of our big Strengthening Medicare package. But to Dr Pushpani, thank you so much for hosting us today and for the work that you and your practice do every day for this part of the ACT.
For Labor, bulk billing is the beating heart of Medicare, and when we came to government a few years ago, bulk billing was in freefall. And budget after budget has seen Labor seek to do everything we can to turn that situation around. In 2023, we tripled the bulk billing incentive for concession cardholders, for pensioners, and for children because even those patients who have been told increasingly around Australia they weren't going to be bulk billed because of the cuts that have been made to Medicare over the previous decade. Tripling that bulk billing incentive has turned the bulk billing rate around for those Australians, and that sits now at about 92 per cent, very much as a result of the investment that we made.
But as the doctor and I and my colleagues were talking about just before we came into this press conference, for people who do not have a concession card, bulk billing continues to slide around the country. It's now down at about 60 per cent, and as Katy will point out, it's even lower here in the ACT. And these Australians are not on high incomes. The healthcare card cuts out at around $40,000 per year for a single or $80,000 a year for a couple. And that's why the package that we took to the last election, the Strengthening Medicare policy that the Prime Minister announced in February down in Launceston, was so squarely focused on middle Australia because we are determined to provide affordable healthcare to that part of our community. It's the big focus of our cheaper medicines policies that come into effect on 1 January that will see their medicine scripts cost no more than $25 per script, the same rate it was back in 2004 and it's why that cohort is the focus of the latest bulk billing investments that we'll be making that take effect on 1 November.
For the first time, bulk billing incentives will be paid to GPs who bulk bill every single Australian, not just those Australians who have a concession card. This is a huge investment in affordable healthcare for Australia. And on top of that, we'll also be paying a practice incentive payment of 12.5 per cent on top of their MBS income to practices that bulk bill every single patient that comes through their front door. And today, we're launching 2 initiatives to further that investment. The first is a calculator that general practices can use, it's available online from today, to work out very, very specifically what this investment will mean for them. We have access to their billing history, to their patient profile that they will be able to calculate very precisely what our investment will mean for them if they become a full bulk billing practice and how that compares to their current income. We're very confident that thousands of general practices will be better off if they become full bulk billing practices from 1 November, and they can use that calculator to check that almost down to the single dollar.
The other thing that we’re launching today is an expression of interest process for practices to submit an application to the government to become a full bulk billing practice. It’ll be a very significant promotion of your practice if you become a bulk billing practice. You'll be able to check on the calculator just how much better off the practice will be, but also individual GPs will be as well if they move their business model to becoming fully bulk billing.
This is a very big down payment on perhaps the most significant promise the Albanese Government made to the Australian people at the last election because we are determined, as Andrew said, not just to protect Medicare but to strengthen it, and bulk billing is right at the beating heart of that agenda that we have. Now we know, as Andrew said, bulk billing has been lower in the ACT than other parts of the country for some considerable time, and we are absolutely determined to bring bulk billing back to Canberra as well. I'll hand it up to Katy now to say a few words about that.
SENATOR KATY GALLAGHER, MINISTER FOR FINANCE, MINISTER FOR WOMEN, MINISTER FOR THE PUBLIC SERVICE AND MINISTER FOR GOVERNMENT SERVICES: Thanks very much, Mark, and I acknowledge everyone here today, my colleagues. And of course, thank you to the Ngunnawal Family Practice, to the doctors and staff here, for letting us intrude on your what would be no doubt a very busy beginning to the working week.
I'm thrilled to be here with my colleagues, with the Minister for Health, really to kick off the commitment we made in the election campaign, which was to invest specific initiatives into the ACT over and above those initiatives that Mark Butler has talked about this morning. In terms of the practice incentive payments and the tripling of the bulk billing rate, which were huge national investments. Within it, discussions that we have with our constituents, discussions we have with the Minister for Health, it was clear something else needed to happen in the ACT. For too long, we'd seen bulk billing lower than the national average. We knew we had, relatively speaking, lower numbers of GPs in the ACT, and that was presenting some specific challenges here. And so, together, we worked on some solutions to that, and that is what we're kicking off today, which is the EOI, the expressions of interest through the local health network, Capital Health Network, who'll go out to market with $10.5 million as an incentive to bring 3 new totally bulk billing clinics to the ACT.
We know that this model works. It's worked in other parts of the country, particularly in areas where there's a GP shortage or lower bulk billing rates. This will work in conjunction with the work that David did down south, with the interchange practice, with the work that’s been done for a Medicare Urgent Care Clinic run in Woden, with the investments that we made last term in the nurse led walk-in centres across the ACT. You have to see all of these initiatives together, but we’re very confident that in conjunction with the money that we’re putting on the table as an incentive, really to attract that investment to the ACT, plus the tripling of the bulk billing rates, plus the practice incentive payments, that we’ll see more clinics like this.
The reality is the Ngunnawal practice here is one of a few, really, that operate fully bulk billing for their clients, for their patients, and we need to see more of that. This is really about entering a market that’s had specific challenges for a long time, and really putting in place some very specific responses to that to drive up the bulk billing rates. All of us here want to make sure that for our constituents, that we’re able to say to them that we’ve done everything we can to improve access to bulk billing rates. We know people like their choice, we know people love their family doctors, we know many Canberrans are prepared to pay, but we need to make sure that there is a choice there for people, that bulk billing is a viable and accessible option here in the ACT.
DR PUSHPANI HERATH: Thank you for giving us the opportunity for this event here. I worked in Canberra almost the last 14 years as a bulk billing practitioner. I believe in affordable health care. It's very, very important. As I just mentioned a few minutes ago, the group we are ignoring here is the working-class people. Most people, it's hard to afford without bulk billing, and the other group not getting the concession through their general practice. It's not easy to continue bulk billing because of the financial stresses, and we are a very small practice. We have only 2 doctors here. And because of expenses, we take over a lot of admin work as well. More support that we get as practitioners, we can commit more for our clinical work.
My book's closed for last 3 years and I would like to continue my work as a GP rather than worrying about the financial commitments for the practice. Also, commit to my patients without worrying about their financial burden. It's a big clinical freedom in your mind when you work with the patients, thinking that my patient can't see me because of financial restraints. I think general practice is very different. Like we have the families, we know the whole family generations. I have 4 generations and I know their commitments and the hardships. Sometimes when they need to access the healthcare, the financial matters are withholding them to access better healthcare. We live in Australia, and in this country, we should be able to support them more.
I have a PhD in ageing and cognition, and during that time, a lot of research shows the group we need to invest in is around the middle age to get them into the healthy ageing. Then the group in the primary health care, what we're missing is more than that group because of the financial restraint and everything. I think this is a really, really good incentive for the practices to join in, and it's good for the clinicians, it's good for the patients. I'm very, very excited about it. Thank you.
JOURNALIST: You just outlined how it's quite difficult to bulk bill. Do you think that the Medicare rebate needs to be higher?
HERATH: I think with the current incentive it's quite reasonable in my point. I worked for a bulk billing practice before, but I was just a practitioner there. I didn't know about the overheads. When I started here, me and my husband, we do it together, and we know the expenses and the commitments and everything. Incentives are good, but when you're a small practice and it's a bit harder to attract all the incentives as well –
JOURNALIST: Does the rebate need to be higher? Medicare rebate?
HERATH: It would be nice, but Medicare is not, I think there's a limit. Normal Medicare billing is pretty reasonable. We work Saturdays, we open Saturdays and we pay extra rates for the staff who work here, but GPs, if you work in the morning, you get the normal rates. Things like that. I've been asked from the other GPs; how, why, and can you at least increase the rates. Things like that probably should be addressed in future. I think support is there. I think the government is trying to support us as much as they can.
JOURNALIST: Has there been any time throughout this experience that you guys have been concerned you wouldn't be able to operate further?
HERATH: The first year was a bit hard. I think it was COVID. We had really good support through the CHN, Capital Health Network, and the primary care pilot came along, and it was really good help, and we survived.
JOURNALIST: You said it's 2 doctors? Have you wanted to take on more?
HERATH: I'd love to at the moment. Because it’s been quite a long time and I have patients who have followed me from my previous practices to here. I can't cover Dr Perrera, she can’t cover me, we are up to here. I have a young family, she has a young family, and I work 6 days a week, and then admin work and everything is hard. I would like more doctors to be joining, but the biggest issue is the bulk billing. They don’t want to join. It’s not very attractive to join in the bulk billing practices. But I hope with the high rates and everything, we can attract more because we have the patient load.
JOURNALIST: So you aren’t considering changing and not being a Medicare bulk billing because of the situation at the moment?
HERATH: I won’t, because for 14 years I’ve been doing it. I don’t think I can do it to my patients. I won’t. But the other doctor has the choice, and then I would like someone else to join us as well.
BUTLER: The whole purpose of this policy is to make bulk billing financially attractive to practices and individual GPs. Previous 2 or 3 years ago, all that a GP got was a single bulk billing incentive if they bulk billed a pensioner or a child. We tripled that incentive, and with the changes that take effect on 1 November we also now provide that incentive to bulk bill patients who don’t have a concession card. On top of that, we pay a practice incentive of 12.5 per cent. Whereas 3 or 4 years ago, a bulk billing GP earned literally tens and tens of thousands of dollars less than a GP who mix bills. What we’ll see through this calculator is a fulling bulk billing GP will be better off, by and large, than a GP who does the average amount of mixed billing across the country. It’s a very big investment in bulk billing and it will change that incentive, that small incentive for GPs who in the past were taking a very big financial hit if they were fully bulk billing GPs, or fully bulk billing general practices. That’s going to change on 1 November, and that calculator that we’re launching today will allow an individual GP or an individual practice like this one to go through their numbers and see how much better off they would be if they become a full bulk billing practice.
JOURNALIST: Obviously this sort of announcement, though, relies on commitment from federal government. And change in governments, that sort of creates a bit of uncertainty. Is that something that you would think a practitioner or a GP would still be concerned about that unreliability?
BUTLER: Our government is committed to driving home the message that bulk billing is central to Medicare, particularly in general practice. General practice is the backbone of a well-functioning healthcare system. We’ve wanted to restore the financial integrity of general practice. The 3 biggest general increases to the Medicare rebate in the last 30 years have been in the last 3 years; the first, the second and the third biggest increases. On top of that, all of the investment in bulk billing. We want to get to a position where in the future, no government would think about what Peter Dutton and Sussan Ley did to Medicare by freezing the Medicare rebate and trying to end bulk billing altogether.
JOURNALIST: Minister, can I ask you about the expression of interest process that’s been announced today, the 10.5 million? Yeah, just after some more detail on what practices will be able to spend that on, and are you expecting to get a lot of applications?
BUTLER: All of that will be set out in the expression of interest process. It's largely the establishment cost. We expect new practices to bid for this. If it's an existing mixed billing practice and they want to shift to a full bulk billing model, they'd have to demonstrate the way in which this funding would be used to make that change. Anyway, I encourage potential practice owners or existing practice owners that are interested in this to have a look at the EOI, the expression of interest very closely. We're determined to introduce more competition and more choice into this system, particularly in parts of Canberra that simply don't have access to a bulk billing option. It's very clear to us, and Katy and the ACT Labor team made the case very strongly, that even though the general investment we're making in bulk billing is going to make a huge difference across the country, something additional was needed in the ACT to bring bulk billing back to Canberra.
JOURNALIST: You've acknowledged the particular challenges of running a GP practice in Canberra. One of those issues is workforce. The expression of interest does specify that the person applying needs to be able to find their own staff. Are you anticipating that would be a challenge? It's also the funding, it's about $1 million a year per practice, which will finish after 3 years. Are you concerned that will put people off applying?
BUTLER: We deliberately designed this recognising that new practices needed to have some assistance to get off the ground, if you like. And the investments we're making in bulk billing practices generally we're very confident will sustain a full bulk billing practice into the future. There's something just about the ACT market, and frankly other markets like the Hunter Valley and Newcastle, until recently Tasmania, where bulk billing rates have been substantially below the national level. Whereas you go to Western Sydney or South-Western Sydney where bulk billing rates are over 95 per cent. Not because it's much cheaper to run a business in Sydney, there's just something about the way in which the market operates there. What we’re seeking to do is to just change the market dynamics in places like Canberra. We're confident that 3 years in, a new practice that has got up and running, had some assistance from government for those establishment costs, will through the funding model that we've put in place from 1 November, be very much self-sustaining.
Now as to workforce, we are training more young GPs in Australia this year than ever before in the nation's history. Last year was a record, this year is another record. At the election we put another several hundred million dollars into training more doctors as well, with a particular focus on general practice. We are going to see more junior doctors coming into the system, and I'm confident that Canberra will benefit from that as well as the rest of the country.
JOURNALIST: But under this expression of interest, there's nothing to stop someone from winning this tender and running a bulk billing practice for 3 years and then switching to a mixed practice and potentially a money-generating business. Is that a concern?
BUTLER: We're very confident that practices will work out that they'll be better off under the model that we're starting on 1 November.
JOURNALIST: Why don't you make it a condition?
BUTLER: The expression of interest is very clear there. We've asked practices to come in established as a fully bulk billing practice. They'll then recruit a patient group on the basis they’re bulk billing. They'll have access to funding arrangements that mean they're better off than if they had an average mixed billing system, particularly because of the 12.5 per cent additional income they'll earn through the practice incentive payment.
JOURNALIST: You mentioned that they'll be promoted widely, is that something the government's undertaking?
BUTLER: There will be the ability to market yourself as a fully bulk billing practice, and there will be very strong signage, other promotion opportunities. We want these practices to be able to present themselves to their community as a fully bulk billing option.
JOURNALIST: And the $10.5 million, can that be used to pay wages? Or is it just for building?
BUTLER: That's very clear in the EOI.
JOURNALIST: Is there a tie between the election and them only being for 3 years? Obviously, you guys go to the next election, what happens then?
BUTLER: No, what we asked for the department to provide advice on is what a reasonable period of establishment was for a new practice, and that was the advice we got.
JOURNALIST: So the 2, I guess, measures, the incentive payment and the bulk billing rate, that was going to be tripled, that's right? That comes in November. So the incentive payment for clinics that bulk bill 100 per cent already came in?
GALLAGHER: No, that's 1 November too.
JOURNALIST: Oh, both of them come in 1 November?
BUTLER: Before 2023, a single incentive payment was paid to general practices for pensioners and kids. We tripled that. Before 1 November, GPs got nothing for bulk billing a non-concession card holder, and for the first time ever, we'll give them that same bulk billing incentive that if they bulk bill a non-concession card holder at a tripled rate. So a general practice will receive the bulk billing incentive for every single Australian who walks through their door and gets bulk billed. On top of that, we're paying a 12.5 per cent practice incentive payment if the whole practice is bulk billing. Now, even if you're not 100 per cent bulk billing, you'll still get that bulk billing incentive payment if you bulk bill a non-concession card holder. So there's still a strong incentive for bulk billing to go up, even if a practice chooses not to become a 100 per cent bulk billing practice. And frankly, we expect some won't across the country, but that additional 12.5 per cent which also comes in on 1 November, we're confident will really tip the scales in favour of the practice and the GPs who work in the practice taking the decision to become a 100 per cent bulk billing practice.
JOURNALIST: Senator, you said to Ross this morning that this incentive has operated successfully elsewhere in Australia. Where has that happened?
GALLAGHER: Minister Butler just spoke briefly about the Hunter, Newcastle, and I think in Rocky. I think, from memory, there was some extra effort that went in there, where we saw similar issues with low numbers of GPs and low bulk billing rates. Part of the idea here is not just bringing in these new clinics, but it's trying to lift the bulk billing rate overall in other practices as well. The tripling the bulk billing rate will do that. They may become or end up being mixed billing practices, but they will still get an additional incentive across the board in Canberra for all general practitioners to bulk bill their existing patients.
Now, this was something that we argued for in the election campaign. I've knocked around health in the ACT for a long time now. Part of the reason we got the nurse-led walk-in centres up and running all those years ago was because of our bulk billing rate. We had to give an option to people where they couldn't afford out-of-pocket expenses, and they needed to see a health practitioner and so the origins of those services come from trying to deal with this problem. Now we've come in, we've had a term in government, we've been rescuing Medicare, which was on life support when we came in. It’s in better shape now, this will add further incentives on top of that.
JOURNALIST: Before the election, it was estimated the number of ACT practices that were bulk billing all their patients would increase from 8 to 25. That's still only a quarter of all the practices here, so it's kind of a drop in the ocean?
GALLAGHER: We've got a big job to do here. And part of what we've been doing, and working with our constituents who have been raising this with us, is how can we incentivise a different choice or more choice for patients? And we think the combination of the work that Mark talked about, the tripling of the bulk billing incentive to all patients, extra incentives if you choose to go 100 per cent bulk billing, plus these new clinics coming in with additional staff will make a difference.
JOURNALIST: The AMA’s obviously about it, they're concerned about GP numbers and so where are you going to find these GPs to be able to one, want to bulk bill but also even just be in a practice?
GALLAGHER: Sure. I think part of the answer goes to what Minister Butler said before about having to train more GPs and we're doing that. I don't think anyone's standing here today and saying there's a switch that we can flick and everything's going to be fixed tomorrow. But together with a whole range of things on workforce, on the bulk billing incentives, on the EOI process itself so part of that is essentially testing the market. We're saying we want additional GPs. We've already heard just how hard GPs are working right now. It's not a question of asking them to do more. Part of the EOI is really to test some of that before we go to a formal process. But yeah, this is about extra GPs in the ACT as well. Handing over now.
JOURNALIST: Minister, US media is reporting that the Trump Administration will tomorrow announce that the use of paracetamol during pregnancy causes autism. First, your reaction to this? It certainly is already causing alarm in medical circles here in Australia. How will health officials respond to this tomorrow here?
BUTLER: I've asked for some very quick advice on this. Obviously, this is a very recent report. We've only read it in the last couple of hours. This is a very widely used drug as everyone knows. And we want to make sure that we look very closely at any announcement from the US, particularly if it comes through the Food and Drug Administration, the FDA. This is based on research coming out of Mount Sinai Hospital, as I understand it. We'll look at it very closely, our TGA works very closely with the FDA obviously and I want to make sure that we have advice for pregnant women in particular, very quickly.
In the meantime, though I just urge any pregnant women who are concerned about this report to seek some medical advice. Paracetamol is not obviously just a pain killing medication, it's obviously an important treatment for fever which can also be dangerous as well if untreated while you're pregnant. We would caution anyone, any pregnant woman, taking action in response to media reports like this without taking some medical advice first.
JOURNALIST: Can I just ask for an update on a single-employer model rural training initiative? There was some talk of having that trial in ACT?
BUTLER: We're still working with the ACT Government. This was a model that obviously, as its name suggests, or its earlier name suggested, was largely targeted at rural communities but in recognition also of some of the things that Katy's been talking about, we decided with the ACT Government to do a pilot here. We're confident that will provide another incentive for junior doctors who are finishing their medical school training to think about general practice as their career of choice because it will really provide much better industrial arrangements while they're doing their GP training.
Having said that, some of the policies we announced in February will also provide system-wide benefits for junior doctors who are training as GPs that will give them access, for example, to some of those leave entitlements that registrar trainees in hospitals have access to like parental leave, for example. But also close that salary gap that has been there that runs to maybe $30,000 that a GP in training doesn’t get compared to someone training at a hospital.
We do want to continue to work with the ACT Government on a single-employer model here in the ACT, but system-wide, we're looking at some of those disincentives being dealt with as well.
JOURNALIST: Okay. Is there a plan? When would you hope that these clinics in the ACT to be opened?
GALLAGHER: We're hoping that it would be mid-2026. That would allow the EOI process and then a formal tender process. We've put them where the money is available, so we've certainly funded the election promise. It's really now going through the process really to get there and then obviously once that's awarded sometime, it’s established in the clinics. But what we'd like, the timeline we're working towards is mid-2026.
JOURNALIST: Is there specific locations where you are also hoping for these clinics to be in?
GALLAGHER: I don't want to be too prescriptive about it other than to say, I think it would be benefit if they were spread across Canberra. We're a small jurisdiction, but I don't think it makes sense to have them all located in one place.
JOURNALIST: And I know obviously when it came to the amount of GP walk-in practices promise, is this sort of meeting targets, or at least is it a step towards meeting targets for ACT and the amount of bulk billing for the ACT, are you on track?
GALLAGHER: Nationally the investment that we expect is across the board that around 90 per cent of visits will be bulk billed once fully implemented. We understand that in the ACT that target at the moment is not achievable and so this will help guide us on the work that we need to do and the results we need to see to get to that 90 per cent. There should be no reason why the ACT doesn't reach the same averages as the rest of the country but there are some challenges here, workforce, the way the market operates and we believe our interventions, quite specific to the ACT, will help dismantle some of that.
BUTLER: Thanks everyone.
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