Radio interview with Minister Butler and Nadia Mitsopoulos, ABC Radio Mornings - 20 February 2023

Read the transcript of Minister Butler and Nadia Mitsopoulos on nurse practitioners; silicosis; pharmacists scope of practice; Urgent Care Clinics; bulk billing.

The Hon Mark Butler MP
Minister for Health and Aged Care

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NADIA MITSOPOULOS, HOST:  Mark Butler is in town ahead of a National Cabinet meeting in Port Hedland tomorrow, and he spoke to me a little earlier this morning. Good morning, I will get on to nurse practitioners in a moment. First, though, the unions have launched a major campaign today, renewing their call for engineered stone to be banned because of the risk of deadly silicosis. Is a ban needed?

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: This is really an epidemic of a new version of lung disease that the governments have been working on - the former government, our predecessor – state, territory governments for the last few years, and we're in the process now of rolling out, all of us, rolling out our response to a report that was issued last year about how we deal with this awful, awful disease. I've met with workers who have been impacted by this disease, unions on several occasions over the last 12 or 18 months. I know the Prime Minister has as well. And so what we're doing is rolling out a whole number of responses to that report. But frankly, I've asked our department, I know Tony Burke is asking his department, who has responsibility for workplace safety, whether that response really is sufficient. We're a huge user of these stone kitchen tops and we've got an enormous share of the global market in this area. And I think it's been a shock to people - most obviously people impacted directly, but a shock to the community - at the health toll that's been imposed by this.

MITSOPOULOS: Will your response, though, consider a ban?

BUTLER: We've obviously had discussions with unions. I’m responsible for the health impacts of this. Tony Burke is responsible for managing the workplace health and safety. You know we're taking a very open mind to this to make sure that we have the strongest possible response because we've been meeting with young people, middle-aged people, older people who have been impacted by this disease, and it's just shocking and tragic.

MITSOPOULOS: The concerns are that current safeguards of failing and a lot of companies aren't actually following safety required, and as a result of that, people are dying. If that doesn't improve, at what point would a ban be warranted?

BUTLER: We're only in the very early stage of releasing the response to the report the government received less than 12 months ago, in the very last days of the former federal government, and all state governments have done that as well. So, we're in the process of monitoring that response, which is a whole lot of education, frankly, of the community of health workers to what is a very new disease still, but as the Health Minister of the country, obviously my overarching priority is protecting the health of Australians. So if, frankly, that response is insufficient, if it moves too slowly, then we will have to take further action.

MITSOPOULOS: I am speaking this morning to the Federal Health Minister, Mark Butler. A couple of other issues. Let's look at nurse practitioners. You're committing $11.7 million in WA for 20 more nurse practitioners. Where will they go, what will they do?

BUTLER: They're going to work out in the community in primary care. This is a terrific proposal from the Western Australian Government, particularly the Health Minister, Amber-Jade Sanderson. The Prime Minister put $100 million dollars on the table of National Cabinet a few months ago and asked for really innovative proposals from state governments on how we can make it easier for people out in the community to see a health professional. Firstly, so that they can see them as quickly as possible, but also to take pressure off our hospital systems which are really over stressed right across the country.

So this proposal from the WA government is to use highly specialised nurses - they're called nurse practitioners - they're clinically experienced, they've done additional training in addition of their nursing degree, they've done a master's degree as well. And it's really clear to me that we're just not using them properly, we're not using them to the full extent of their skills and their very substantial training. So this proposal is to have them out in the community in the sort of settings where you might see a GP, but it's hard to see a GP, you get in to see a nurse practitioner who is able to diagnosis referrals to 2.2 x-rays and various other test to prescribe some medication. Well, that make it easier for people to get the care they need when and where they need it and will it make sure that we are using the full range of skills that are held by this case highly specialised nurses who I think are under-utilised but there's a whole range of everyday conditions that we know can be dealt with by specialised nurses, these specialist nurses who are highly skilled, highly trained and very experienced. At the moment we know it's harder than ever to get in to see a GP. That's the case here in WA as it is across the rest of the country, and we want to find innovative ways in which we could make sure people are getting the care they need when we're back to.

MITSOPOULOS: Ok, so do we have 20 nurse practitioners trained up ready to go?

BUTLER: One of the really interesting things having come back into government 10 years ago when I was last in the health portfolio, under the former Rudd and Gillard Governments we had about 2000 nurse practitioners across the country - we don't have many more than that now 10 years on, because we're just not utilising them well enough. So it sort of a question, why would you bother going out and getting a master's degree. If there's not the opportunity to use those skills we know here in WA and in other parts of the country. But particularly here in WA there are quite a number of several dozen nurse practitioners who are not working as nurse practitioners they're working as general registered nurses, so they are not using all of those additional skills that they've picked up with a master's degree. So, we want to give them the opportunity not just to work in the hospital system, where there are some opportunities now, but to work out in the community in climate.

MITSOPOULOS: Yeah, okay, so on that point there Minister, in New South Wales a  trial will allow pharmacists to renew pill prescriptions and be able to give out your urinary tract medication stations without them seeing a GP, is that something you’d like other states to also look at, as another way, as you say, of taking the stress off GPs? yeah this is it.

BUTLER: This follows a very similar trial that has happened over the last 12,18 months in Queensland as well, particularly around the urinary tract infection prescription of antibiotics of what I've said as a general principle, and the Strengthening Medicare Taskforce recommended this to government last month. As a general principle, it doesn't make sense at a time when the country has got soaring demand - skyrocketing demand - for good health care and a constrained supply of workers. It doesn't make sense not to have everyone operating to the full extent of their skills and training. Right now we've got a whole lot of artificial limits on people, we've talked about masses, but a whole range of other health professionals are not allowed legally to operate to the full extent of their skills and training, what they call their scope of practice often cause of age old turf wars and legal restrictions at state level, or federal level, so states are doing this: they're going through these processes to find innovative ways to better use the skills of pharmacists in this case, in nurses in other cases. And I've said over the weekend we only received the letter about this trial a couple of days ago, so we haven't fully responded to it, but I'm very keen to see these trials continue and to build an evidence base for using our health workforce smarter and more effectively.

MITSOPOULOS: And you talk about turf wars. You're obviously referring there to doctors because they won't like this?

BUTLER: I'm not particularly referring to doctors, but this is a sector as I've described it with loud voices, and sharp elbows, you know, or across the range of different health care groups there have often been quite strong views about what one group should do, what one group shouldn't do, you know, we need as a community to get the best possible return on the huge investment we make as taxpayers to train hundreds and hundreds of thousands of dedicated health professionals. They should all be operating as close to possible at the top of their scope of practice, that is, to the fullest range of the skills and training that they've picked up at university, and then the experience that they've picked up working out on the floor.

MITSOPOULOS: On ABC Radio Perth in WA, I'm speaking to Mark Butler, who is the Federal Health Minister. Just on those it brings me to the Medicare Urgent Care Clinics that the Prime Minister announced, we've got seven that will be established in WA. The concern there is that you may well have to be poaching nurses and doctors from private practices from GP clinics to actually staff them, and what doctors are saying is what you're promising is going to be hard to deliver because you won't be able to get the staff, is that legitimate concern?

BUTLER: The proof of the pudding will be in the eating on this one. There's an expression of interest process under way now. The first 3 centres that we want to open - in Perth, Joondalup and Rockingham - will be open before the middle of the year and then the other four in the second half of the year. What we're doing is we're seeking expressions from existing practices, so we're not building new centres. We're going out to the existing GP practices and other community health centres and saying if you want to take your centre to the next level, just expand its level of service so that people can walk in - some of those non-life-threatening emergencies - extended hours 8am to 10pm on a fully bulk-billed basis, so no charge. Then we will help you do that, we’ll provide you with the funds to be able to deliver that service. The point about these services, though, is they're not discretionary, these are, you know, when your son or daughter falls off their bike and breaks their arm, they are going to have to be serviced somewhere at the moment. Too often, they're being serviced in the emergency departments of hospitals which are already massively overcrowded. We're trying to deliver a new model of care that will allow them to be to be supported and cared for out in the community, and take some of that pressure off the hospitals.

MITSOPOULOS: But the concern is that people will start using these clinics, rather than going to their GP because these clinics will be free and as we know now more and more doctors surgeries are not bulk-billing and so then you're going to start losing continuity of care.

BUTLER: These services will only be available for these non-life-threatening emergencies. If you're under the care of a GP and you normally see them because you have diabetes or some other ongoing health condition, you won't be able to go into this sort of a service.

MITSOPOULOS: So plainly, it will be refused. People can be refused?

BUTLER: Yeah, this is for non-life-threatening emergencies. The name says it all. This is for urgent care. This is not for the care you would normally be getting from your GP at the moment if you bust your arm or you have a very deep cut, the overwhelming likelihood is you can't get into your GP within two hours, the overwhelming likelihood, particularly if that happens after hours or on the weekend and at the moment because of that, people are going to the hospital. People are going to the hospital. But this is a model that you see pretty much all around the world - in America, there are more of these centres - more urgent care centres than there are Starbucks - we've got hardly any here in Australia, and it means that just translates into more pressure on our emergency departments.

MITSOPOULOS: And finally, Minister, fewer than 65% of Australians now have all their GP appointments bulk billed. This is particular issue in WA, particularly regional WA, is an increase in the Medicare rebate off the table?

BUTLER: Nothing's off the table for us, you know, we have no higher priority in health than strengthening Medicare, and what I've done over the last couple of days is I've asked my Department to publish the clearest possible data on what's happening in bulk-billing. Before that, no one knew really what was happening around bulk-billing. I had said that my sense from doctors and patients was that it was in decline. My predecessors said it had never been higher. And what we see now that we've put this data out is that there are some particular pockets of concern and one very big pocket is WA. I mean, the declines in bulk billing over the last 3 years are worse in WA by a long mile than any other part of the country, certainly of any state, so I know that's something that's really hurting people here in WA, they are finding it harder and harder to get in to see a GP. When they do get one, they are more and more likely to be paying a big gap fee so that's why Strengthening Medicare is our overarching priority as a government.

MITSOPOULOS: And doctors will argue the best way to do that is to increase the rebate.

BUTLER: Sure, they've made that argument to me on more than one occasion I can assure you, but I've also said that it's not just the amount of money going into Medicare. It's also the fact that Medicare just isn't delivering the sort of service that patients need in 2023. There just hasn't been enough change, enough reform to the way in which Australians live since the 1980s when the patient profile of Australia was very different. That's why we need to bring in more workers, not just rely on GPs, rely on the skills also of nurses of pharmacists of other allied health professionals and have them working genuinely as a team.

MITSOPOULOS: Minister. I'll leave it there and I thank you very much for your time good to talk to you. 

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