Radio interview with Minister Butler and Leon Compton, ABC Tasmania – 20 May 2024

Read the transcript of Minister Butler's interview with Leon Compton on the new Medicare Urgent Care Clinic for Tasmania and a social media ban for children.

The Hon Mark Butler MP
Minister for Health and Aged Care

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LEON COMPTON, HOST: The Federal Government has announced that one of the new Medicare Urgent Care Clinics promised in the Federal Budget will be set up in Tasmania, in Bridgewater, in the south of the state. What will that mean for your community, if you're listening in, around Bridgewater, Brighton, Ravenswood, Old Beach this morning? What will it mean for you? How do they actually work? How many people – given, we've had some for a little while now – does it actually keep people out of hospital or at least out of the emergency department? And I suppose at a personal level, how valuable are they when your kid's sick? Or you realise that thing you thought might have just been a cold turns into something more serious at 6 o’clock on a Friday? How effective are they in actually getting you some support without having to turn up at a hospital? Mark Butler, Federal Health Minister, good morning to you.
COMPTON: Thank you for coming into the studio this morning.
BUTLER: My pleasure.
COMPTON: You've announced another Medicare Urgent Care Clinic for Bridgewater, when will it open?
BUTLER: We're hoping it will open in 2024–25, the funding is for the next financial year, but I'd love to see it open before the end of this year. We stood up 58 of them last year across the country, including 4 here in Tasmania. We've got a pretty good record at standing them up quickly, but we've got to go to a tender process, so it'll take a little bit of time. But as I say, I'd really like to see it open before the end of the year.
COMPTON: For people tuning into this story for the first time, if you're listening in Bridgewater, maybe you've checked out on it because it's been happening in Devonport and Launceston, parts of inner suburban Hobart. What is a Medicare Urgent Care Clinic?
BUTLER: It's a clinic that is designed to be there when you need care urgently, but you don't necessarily need to go to a hospital emergency department. I know here in Tasmania, right across Australia, people are finding it harder to get into their GP than they might have several years ago. Often if your kid falls off the skateboard or gets a sporting injury on the weekend, your GP is not open. If your GP is open, it's often just hard to get in, some people might be waiting days for a urinary tract infection or something that you can't wait to have seen. These clinics are primary care clinics, they're staffed by very highly qualified doctors and nurses, often they've spent time in emergency departments themselves, and they're there on a fully bulk billed basis, completely free of charge, 7 days a week, designed to give you the urgent care out in the community and stop you having to go to a hospital emergency department. It really ticks 2 boxes: more convenient, free of charge, care for the patient, and relieving pressure off our crowded emergency departments.
COMPTON: Do they cannibalise other GP practices locally? Is there any evidence at this point that you open an Urgent Care Clinic and then the GP that's been in business down the road for years closes?
BUTLER: No, there's no evidence of that at all. We've been very, very careful to make sure that the clinics are not there for run-of-the-mill GP work. If you come in, for example, and you just want a check-up, you will be encouraged to go and see your usual GP at the usual time. There are very clear operational protocols that we negotiated with all of the state health departments and state ministries. There's a very clear understanding between the hospital system, the ambulance services, and the Medicare Urgent Care Clinics, exactly where a patient should go. There are some cases of people coming through the front door, they're attracted to the idea, it's a bulk billing clinic, they just want to see a doctor for a check-up, they're referred back to their usual GP.
COMPTON: They're actually turning people away if they're deemed to just be turning up for ordinary day-to-day business?
BUTLER: It's not happening very often, is my experience, because we're very clear that this is for urgent care, it's for stuff you need to have seen very, very urgently. But they only get Medicare billed for those urgent care items, so they won't, for example, get a billing for a, you know, a chronic disease check-up, which you can wait several days for.
COMPTON: On Mornings around Tasmania, lots of you texting in this morning, and thank you, everyone's keeping it pithy today, no one's using voice to text I appreciate that. If you've just jumped in the car, my guest is Mark Butler, the federal Health Minister. We're talking about news that an Urgent Care Clinic, another one, Tasmania's fifth, has been announced for Bridgewater in the south of the state. David in Kingston has a question. Minister, can you ask if any others are planned for Tasmania next financial year? That's from David.
BUTLER: No this is the one we've funded in the Budget last year. It's part of a $28 million health package for Tasmania, which will deliver this Urgent Care Clinic in Bridgewater. It will also deliver additional funding to the existing 4 clinics just to improve their level of service, and a substantial amount of money for better care for older Australians here in Tasmania. So preventing them having to go to hospital in the first place, virtual care services for them, particularly in aged care facilities, geriatric outreach into those and better care to ensure they're able to move through the hospital system more quickly. That's something I know the Tasmanian Government here, has been very vocal about, but frankly, it's an issue across the country.
COMPTON: It's not an issue – and we see this from health dashboards – it's not an issue in other parts of the country, to the extent that it is here. We know when we look at tables of emergency surgery waiting lists, when we look at performances of emergency departments, when we look at issues around bed blocks, it's an issue in other places. But all too often we're at the bottom of the table, why?
BUTLER: Tasmania is older than the rest of the country, I come from South Australia, a reasonably similar demographic. We're older, we have a higher burden of chronic disease, so there is more pressure on our hospital systems here in Tasmania and to a degree in South Australia, as well than some of the other parts of the country that are relatively younger. That's just a product of the population –
COMPTON: But given that we know that, if we know that there's more need, why aren't we doing more to help? Or are we just all too easily accepting this as the way things are Minister?
BUTLER: No, I don't think we do. The package I've announced, part of which is the Urgent Care Clinic, is proportionally more than Tasmania's population share. There is substantial funds going into support that flow of older Australians through the Tasmanian hospital system. The Tasmanian Government has come up with some really innovative ideas. We asked them for proposals from December last year where the Prime Minister put this $1.2 billion on the table, for precisely this purpose, and the Tasmanian Government’s been thinking very carefully about that: ways in which you can get really good bang for buck, better care for older Australians here, but also helping relieve that pressure on the hospital system.
COMPTON: Again, these are the problems that we have in Tasmania, but I mean, on this program we talk all the time about major delays in emergency, major problems with ambulance ramping, a lack of nursing staff in this state, a reliance or overreliance on locum doctors, a lack of pharmacists also contributing to problems, a lack of GPs – we'll hear from one in a moment – bed block delays, seeing specialist elective surgery waiting list problems. How does the federal and state government look at all this and say, this system is working?
BUTLER: I don't think anyone is satisfied with what's happening in our health system anywhere in the country and frankly, anywhere in the world. You know, the health systems, after several years of the COVID pandemic, are under enormous pressure.  Over and above that, you've got the pressures of an ageing population, which all Western countries are dealing with, and much more chronic disease and mental illness than maybe we had 10 or 20 years ago. There's no question there is much, much more demand pressure on the health care system. There's a workforce supply challenge as well. I mean, we just don't have enough nurses in the world, frankly, not just here in Tasmania or here in Australia, we've got really a bit of a perfect storm happening in the healthcare system. The states and territories and the Commonwealth are sitting down now, in a much more constructive, mature way than relations happened when we were last in government. I was a health minister in the last Labor government, they were all Labor governments, but we could not come to a deal about a better hospital and healthcare system as much, frankly, as we tried. There's a very different attitude to the way in which governments work together now, maybe that was because we learned to work together through COVID, but we're right now really progressing very well on negotiations for a new hospital funding agreement. It's not just going to be about money, it's going to be about thinking carefully about how we can get the system working better. It genuinely –
COMPTON: Can it not also be about money?
BUTLER: It is about money as well. Last year, we put at least 13 billion additional dollars on the table so that we would lift the share that the Commonwealth pays of hospital operating budgets. That's going to be a big win for the small jurisdictions like Tasmania, the territories and South Australia.
COMPTON: Can I ask you about that? We have a health economist analyst called Martyn Goddard in Tasmania who consistently analyses this. His allegation is that the Tasmanian Government, in the past, has syphoned some of that off and put it into consolidated revenue. Have you had concerns about that as, the federal Minister?
BUTLER: No, I haven't had that reported to me. There's a pretty transparent process of state governments having to report on the activity in their hospitals, and then they essentially send the bill to the hospital financing authority. We set this up a little more than a decade ago to get that transparency in place and, frankly, to get some efficiencies in the way in which states ran the hospitals. That's working well, but there are some perverse incentives there. For example, we don't contribute to the cost of care provided, perhaps, in the home. A hospital in the home became a very big thing through COVID, it's a much more efficient way to provide care after the back end of a person's hospital stay. We're thinking through ways in which we can just make this a much more modern financing system. But I haven't heard those concerns, I've got no advice about that. It's a pretty good transparent system I think, that we have in Australia now.
COMPTON: On Mornings around Tasmania, Mark Butler, federal Health Minister, is our guest here on ABC Radio Hobart and ABC Northern Tasmania. Doctor Liz Grey has given us a call from the east coast. Doctor Liz Grey, you've got Mark Butler, the federal Health Minister here with you. What's your question? What's your perspective based on your own experience in general practice?
DOCTOR LIZ GREY, CALLER: Good morning, Leon, and good morning, Minister Butler. I've got 4 points, I've actually got more, but –
COMPTON: Keep them punchy Liz.
BUTLER: Four is enough on a Monday morning, surely.
GREY: I'm really concerned, Leon talked about where are the GPs coming from when we've got a shortage of GPs throughout our country, without taking them from other areas? – Is one point. The next is the nurse practitioner Medicare rebate is inadequate to recompense the cost of a bulk billing clinic. How is that done, if you're using nurse practitioners? Because you don't have adequate GPs and, you know, obviously they work well as a team. And what is the long-term strategy for training, recruiting and retaining rural doctors? And an invitation to Minister Butler to come to the rural health conference this weekend in Devonport.
COMPTON: Thank you, Liz, I really appreciate your perspectives this morning, thanks for sharing them. We know that you work in general practice and live these stories, so thank you for getting in touch this morning. What's your diary look like? Start with the Rural Health Conference in Devonport.
BUTLER: My diary is chockers this weekend unfortunately Liz, so I have to decline that. On your other points, though, in no particular order, we completely agree about the adequacy of the nurse practitioner Medicare rebate. Nurse practitioners can provide really important parts of team-based care. We increased their rebate last year by 30% in the Budget that will take effect this year. We made some other changes in last week's Budget to improve or expand the work that nurse practitioners can do as well, some referrals and things like that. I'm a big believer in the role that nurse practitioners can play. There's only 2,000 of them in the country, there were 2,000 back when I was last a Health Minister more than a decade ago. We've got to grow that workforce as well –
COMPTON: Can I just hold you there? Liz, based on your experience, Doctor Liz Grey, is that enough, a 30% increase from the federal government? I mean, is that improving the issue that you say makes nurse practitioners or creates, you know, challenges employing nurse practitioners in general practice?
GREY: Look, nurse practitioners aren't affordable in general practice. If you're running your own general practice and trying to make ends meet, practice nurses are used and they're generally kind of retiring – sorry, I'm just walking to work, so it's a bit noisy – I don't know how, I don't think it's feasible for, a general practice to be a private practice anymore.
BUTLER: On practice nurses, which – for your listeners, nurse practitioners have a Masters qualification, there's not a big number of them, only a couple of thousand – practice nurses are much more common in general practices. Again, in last year's Budget, we substantially increased the funding that general practices get – it had never been indexed before – so we increased that with a one-off increase, and we will now index that every single year to wage costs, because essentially that's to pay the wages of practice nurses. On the Medicare rebate generally, over the last 2 years now – including last year's Budget – we've increased the Medicare rebate in 2 years by twice as much as the former government did in 9 years. We recognise there are real cost pressures. On top of that, we tripled the bulk billing incentive, which has been a big win for Tasmania, Tasmania has had a bigger increase in bulk billing over the last 5 months than any other state, and here in Hobart it's been even bigger, almost 9% increase in bulk billing. I'm really clear about the pressure general practice is under, but it's been my top priority as the Health Minister over the last two Budgets to put more funds in.
You asked a question, though, Liz, about where we're going to get our future GPs, and I've described this as terrifying. We need to train more junior doctors into general practice, we need to have them see that as an attractive career. I'm really pleased that this year, the number of junior doctors choosing general practice as their training is up by almost 20% against last year. I hope that reflects some of the general vibe that general practice is more valued from their federal government. But it's only a small green shoot of recovery. There's a lot of general practitioners who are retiring. I talked about the fact we’re getting older, we’ve got more chronic disease, we’ve got more mental illness in the community, and general practitioners really are the front line for that as well. We need to encourage more junior doctors that general practice is the career for them, and we’ve got a long way to go. We’ve got some really exciting new programmes here in Tasmania –
COMPTON: We’re doing more rural training, we met some of our rural trainees up in the northwest of the state and the schools there.
BUTLER: Yeah, dealing with some of those industrial issues, so that they're now employed by the state government while they're training as general practitioners. They have continuity of service, they have access to paid parental leave, which they didn't used to have. We're working hard at it, but there's a long way to go.
COMPTON: You're on Mornings around Tasmania, we'd love to keep you for much longer, but we know that there's other issues, I'm looking at doctors and nurses from around Tasmania texting in with their issues. We'd love to have you back at another time. I just do want to talk with you, though, about one of the stories of the morning, and the particularly News Limited has been running a very heavy campaign on. It seems now, like multiple premiers have said, we should consider an age limit ban on access to social media, including Facebook, Instagram, TikTok. If you're 13 or under, students or young people should be banned from it, and parental permission should be required for those who are 14 and 15. You must see and hear the stories around the mental health impacts when social media engagement goes wrong. Minister, would you support the ban?
BUTLER: I do. And the Prime Minister said over the weekend he does as well. I think this has really reached a crisis point in the community, not just our community here in Australia, but communities around the world and the Prime Minister added his voice to that over the weekend. We haven't yet reached a view about what that age should be, we think we need to work through that carefully. In the Budget last week, there was money for some age verification work for access to a whole range of things, not just social media, but online porn and a whole bunch of things that I know are incredibly disturbing for their parents. As the Minister with responsibility for mental health, though, we've seen this steady, steady increase, quite sharp increase in mental distress –
COMPTON: Should we be talking about just keeping kids who are 13 and under off social media entirely?
BUTLER: I think we are of that view, but the question really is whether it’s 13 or 14, or what the age is, we want to work on that carefully. We then have the responsibility to implement it, we've got to work on ways in which it's an effective ban as well and not easy to circumvent. We know how technically adept young people are at using these technologies, as well. We've got to get the age right and we've got to get the technological implementation right. But this is something the Prime Minister has indicated our government is very focused on.
COMPTON: On what time frame?
BUTLER: I'll let them talk about that, this is not my portfolio. The Communications Minister, the Prime Minister and others will have more to say about that. But as I said, there was money in the Budget last week to start the work on this.
COMPTON: Can I just say: it's fascinating looking at our text messages now and the number of people in general practice, in health, who are passionate about the issues that you're involved in. And, you know, Tasmanian’s is are heavily engaged in this story. We’d love to have you back next time you’re in Tasmania. We’ll just take talk back from our professionals and chat to you about it, if you're up for it next time you’re in town.
BUTLER: Sounds great.
COMPTON: Mark Butler, federal Health Minister, thank you for talking to us this morning.  

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