Radio interview with Minister Butler and Leon Compton, ABC Hobart Mornings - 18 April 2023

Read the transcript of Minister Butler's radio interview with Leon Compton on Tasmania's Urgent Care Clinic; vaping.

The Hon Mark Butler MP
Minister for Health and Aged Care

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LEON COMPTON, HOST: Mark Butler is the Federal Health Minister and joins us this morning. Minister, good morning to you. 


COMPTON: Minister, if GP numbers in Tasmania are adequate and bulk-billing actually worked as it was intended, would these clinics even be necessary in the first place? 

BUTLER: Yes, I think they would. Because if you look around health systems around the world, there is usually a level of care somewhere between what we understand to be standard general practice on the one hand, and hospital emergency departments on the other. So, for cases where people need urgent care of a particular type - beyond the sort of care that many general practices provide nowadays - but don't need this sort of very high-level hospital care you get an emergency department. I've used as an example your kid falling off a skateboard and doing their wrist, or their arm, when they don't need to go to a hospital emergency department, but they obviously need care very urgently, and they may need access to X-ray machines and that sort of thing. As I said this is a type of care that's provided quite routinely around the rest of the world, New Zealand across the other ditch is one of the best examples. It means people get access to care out in their community when they need it, but it also takes huge pressure off hospital emergency departments. If you look at the rate of emergency department presentation in New Zealand, it's not just lower than Australia’s - it's much, much lower. It means that hospitals are then able to spend their time and energy dealing with those once-in-a-lifetime emergencies that they're really equipped to deal with.  

COMPTON: But with respect, Minister, isn't that just potentially a reflection that then whatever their Medicare system equivalent is actually works, and people can get access to GPs when they need them? 

BUTLER: I think general practice just isn't really set up to do that in the way that we're envisaging with these Urgent Care Clinics. So, we're seeing these - it's not just about the fact they'll be free of charge it’s that they'll be available 8am to 10pm, they'll be available 7 days a week, there will be requirements on them to be staffed up and equipped to deal with the sorts of emergencies, the non-life-threatening emergencies that I've talked about. That’s not the bread-and-butter of general practice.  

COMPTON: Minister, with respect, how are they not going be flooded with people who simply can't get timely appointment to see their GP, or can't afford to go - given that bulk-billing won't be offered at their local GP? 

BUTLER: Yeah, I've seen this canvassed in the Mercury this morning by one of your state MPs. 

COMPTON: Yeah, it’s an idea our audience is presenting to us this morning. 

BUTLER: It is a really important question, and we want to be very clear that this is not a place to go to because you can't get into your local GP with a relatively routine matter that is not urgent. We've worked very hard over the last several months with state and territory governments, including Tasmania, which is probably ahead of the pack, really, our announcement yesterday that I was able to make with the Prime Minister, with Premier Rockliff, is really the first of all of the jurisdictions getting out of the blocks, getting this done very quickly. But one of the key issues - there are two key issues we've negotiated with states - the first is to make sure that what we call the scope of practice for these centres is clearly focused on non-life-threatening emergencies. You can't just go there to get a routine script or to do the sorts of things you want to do with your GP. It will be very clear that the patients presenting there will be admitted to that care if they have a non-life-threatening emergency: a need for urgent care. 

COMPTON: So, to be clear, for people that simply can't get into their GP for weeks or for people who can't afford to see their local GP - 

BUTLER: It’s not for them - 

COMPTON: This will not do anything to help the issues for those that are struggling, for example, with the cost of seeing a non-bulk-billing GP in Tasmania? 

BUTLER: This is not for them. Now that doesn't mean we're not very squarely focused on those needs, Leon, I think you and I have talked before about the Strengthening Medicare process that I led with nurses’ groups and doctors’ groups and patients last year, and that will be reflected in the Budget in a few weeks, with a range of other measures that we will be announcing that are intended to strengthen Medicare and rebuild general practice. But that is not what this is focused on, this is focused on the need for urgent care in the community that at the moment is leading people to front up to emergency departments. I mean, we heard yesterday that more than 40% of emergency department presentations in Tasmania are classified as non-urgent or semi-urgent, they don't need to be at the hospitals, but they are there because they can't get care in the community and that's what this is intended to address. The second thing we've been negotiating with states - the first was that scope of practice - the second thing we've been negotiating with the states is to make sure these centres have very clear operational guidelines to work with local hospitals and to work with local ambulance services, so, we make sure that people are going to the right place. 

COMPTON: So, they could literally be plugged in to the ambulance network, in that, if you call an ambulance, it may take you to one of these centres rather than ramping at emergency at one of our major hospitals? 

BUTLER: That's right, and Healthdirect, which is also a national triage service - telephone service - co-funded by the Commonwealth and the states, it's a phone number that many of your listeners might be familiar with. That will also have very clear guidelines about working out what it is that you're ringing about, for example, has your kid sprained their wrist, or is there a very serious emergency that needs you to be taken to the hospital immediately. That's really why this has taken a few months to get out and hopefully once this detail is out it will alleviate or answer some of the questions that your listeners have, that I've seen written about in the Hobart Mercury this morning, to make clear that this is a service that's intended to deal with quite a discrete level of need out in the community. One which at the moment is placing real pressure on our hospitals, but also means that people are presenting at emergency departments, and are waiting 6 to 8 hours right across the country - this isn’t particularly a Tasmanian issue - waiting 6 to 8 hours to be seen in relation to a non-life-threatening emergency. If you are in there with something that's classified as non-urgent, of course you're going to keep getting pushed down the queue as people come in the front door with a heart attack, or a stroke, or a car accident. This is about providing better care options for the community as well as obviously taking that much-needed pressure off our hospital system. I really want to really want to shout out the level of cooperation we've got from the Tasmanian State Government here, we've been able to do some really important work to take that pressure off hospital systems and some other announcements we've made over the course of the early part of this year to improve the pipeline of new young GPs coming into the system. This sort of stuff only works when there's a mature level of cooperation between the Commonwealth and the state governments and we've got that right now, right across the country, including in your state of Tasmania, Leon. 

COMPTON: It is interesting that only 14% of medical students are choosing general practice at the moment. The GPs, Minister, that we talk to say: if you significantly lifted the Medicare payment to GPs you would start solving a lot of these problems, more GPs would bulk bill again and perhaps it would become more lucrative - more people, more doctors would choose general practice. Is that what you're planning to do in this Federal Budget? 

BUTLER: It's more than interesting that its 14%, frankly, it’s terrifying, I have used that word before. In the past we used to see about anywhere between 40% and 50% of our young medical graduates going to general practice. So, if we don't turn that number around it's going to be even harder to see a GP than it is right now -  

COMPTON: And so, to the question about the Medicare -  

BUTLER: To your question, of course we've been in discussions with doctors' groups and others about those issues - the level of the rebate, it was frozen for 6 years, which has placed enormous financial pressure on general practice. We've seen, including over the weekend, reports about the level of bulk-billing across the country, it's incredibly poor in Tasmania. There are other parts of the country that have very low bulk-billing rates, but Tasmania is a real standout for some reason - bulk-billing rates are some of the worst in the country in Tasmania. The gap fees are some of the highest in Tasmania, we saw that reported over the weekend. So, in the May Budget we will have a response to that Strengthening Medicare Taskforce report that I talked about that was published a couple of months ago. We've obviously been giving that very deep consideration in the Budget process.  

COMPTON: Ok, so doctors and the customers – us, our audience - right around Tasmania would like to hear that there'll be a significant lift in what doctors make per consultation, so those gap payments disappear increasingly, is that what you're saying will happen? 

BUTLER: I’m not going to announce what we're doing in the Budget today, Leon, you know that - you've been around a while. I'm just saying that in the May Budget there will be a response to all of those measures around Medicare that I've been engaging with those groups about. And I’ve said it’s not just about more money into the existing system, anyone who's working in that system understands that the system is not set up well to deal with the patients' needs – the average patients' needs - in the 2020s. It still is very much a system built around what the community needed in the 1980s and 90s. So I'm not going to just put more money into the existing system, what everyone agrees with, I think, is we've got to also reform the system to make sure it provides better wraparound care for the sort of needs people have now - were an older population, we've got more complex and chronic disease and the Medicare system is not well set up to deal with those needs. So it’s not just about more money, it's also about reform.  

COMPTON: Ok, so might not be about more money, it might be about reform -  

BUTLER: No, I said it’s not about one or the other, it’s about both. 

COMPTON: So, let's turn that around a little and ask the question a different way. What is the desirable bulk-billing rate for seeing a doctor in Tasmania? If you're doing your job well, Minister, what percentage of Tasmanians will be able to go see a doctor and not have an out-of-pocket cost? 

BUTLER: I'm not going to nominate a particular figure. There is a huge variance across the country, often for very little apparent reason, so the rates in Tasmania are some of the worst in the country, if you go to parts of Sydney, they're well north of 90%, in some areas 95%. You’d think that operating a general practice - the overheads in Sydney would be higher than they are in Tasmania or in my state of South Australia. Yet the bulk-billing rates in that jurisdiction are much, much better than Tasmania. The gap fees in Tasmania, the gap that patient pays, are some of the highest in the country. Again, given the operating costs for general practice, why is that the case? So, I think we need to have a very close look at what is driving some of this behaviour in general practice because some of it, given that GPs get the same rebates in Sydney as they do in Hobart or Adelaide or Melbourne, why is there such variants in the bulk-billing rates and the gap fees in different parts of the country? That's why I'm not going to nominate a particular figure for a state or for the country as a whole. What we can agree on, though, is the trend in bulk-billing is deeply disturbing. The fact particularly that pensioners and concession card holders in some parts of the country is starting to be charged a gap as well is a particular concern, as you'd imagine it would be to a Labor Government. 

COMPTON: On mornings around Tasmania, one of our listeners has just texted a question and I'll put it straight to you, this is from Bec: if existing GP clinics are becoming these Urgent Care Clinics, what happens to the patient list of the existing GP clinic, aren’t they essentially reducing the number of regular GP appointments to become part of this new program? 

BUTLER: What we've done – and in Tasmania we've done it through the state government - is to seek Expressions of Interest from existing practices who want to take that sort of step up and generally, in my experience, talking to practices - and there's huge interest across the country in being a part of this - they would generally see this as a sort of a part of their practice, so, a part of their clinic would be dedicated to this service, there might be a separate entrance constructed for it, that in many cases will allow an ambulance to pull up, for example. So, it's not like their whole practice would become this service, it would become a smaller part of the service, and in all of the cases I've discussed with general practices around the country having an interest in this, they would keep their existing practice in place as well. 

COMPTON: What matters is the number of doctors that are actually staffing the existing practice. Can you guarantee that they'll be adding new staff to service these customers rather than sort of realigning existing doctors and their existing books to help become part of these critical care centres? 

BUTLER: These Expressions of Interest and applications are being worked through by the Tasmanian Government - in your state’s case - and I am talking to general practices about this across the country. It's been very clear to me that all of the practices with an interest in this area want to keep their existing books going, so want to keep their existing patients serviced as well. This would be an additional service; they'd be adding to their practice, not cutting existing things to do this.  

COMPTON: You’re on mornings around Tasmania, Mark Butler, Federal Health Minister is our guest this morning. Minister, the last time we spoke to you vaping was our real focus. Since that that time a few weeks back you've received a significant report from Australian National University on the harm caused by vaping and the Therapeutic Drugs Administration has released a major consultation paper. When will you introduce reforms based on what you've learnt? 

BUTLER: We only had a roundtable yesterday for several hours that I chaired, with obviously the TGA: the Therapeutic Goods Administration, which as you say has issued a report very recently and that roundtable was the tobacco control groups that have done such a fantastic job in this country over decades, addiction specialists, and the medical peaks - so the AMA, the College of GPs and the like, and we had a great discussion, a really valuable discussion about those recommendations and possible ways forward. I need to work very closely with state and territory Health Ministers as well, so, we've committed as a group, including Premier Rockliff, who is also your Health Minister to having a discussion very soon, making sure we are working together, we can't just do this alone. We need state and territory ministers to come along with us, and as I said on your program before, I think, Leon, we're committed to taking action here. This is a very serious public health menace. 

COMPTON: I think our audience and you, Minister, can agree on that -  


COMPTON: We know teachers, principals, parents are pulling their hair out about this issue at the moment. So, my question to you is when? When are you going to have your policy ducks in a row and make some decisions that will mean fewer young people are vaping? 

BUTLER: I don't have an announcement to make today as I said, the roundtable I had yesterday was a very important step in making sure we get the details of this right, and a detailed discussion with Health Ministers is also an important step which will be doing in the very near future. I don't think your listeners have any reason to think that we're going to let grass grow under our feet on this, I'm determined to take action sooner rather than later. That was the very clear message I got yesterday that this thing is getting worse very, very quickly, so there is an obligation, I think, on all governments to take considered, strong action in this area and to do that as soon as we practicably can. 

COMPTON: Appreciate talking with us this morning as ever. 

BUTLER: Thanks Leon.

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