Radio interview with Minister Butler, Stacy Lee and David Bevan, ABC Adelaide - 11 October 2022

Read the transcript of the radio interview with Minister Butler, David Bevan and Stacy Lee on general practice; South Australian women's and children's hospitals and COVID-19.

The Hon Mark Butler MP
Minister for Health and Aged Care

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DAVID BEVAN, PRESENTER: Mark Butler, Federal Health Minister, joins us now. Good morning, Mark Butler.


BEVAN: You know, there's a problem, and that is that we've got a whole lot of kids who are going to med school, but very few of them want to be GPs.

But you've also got another problem that is you haven't got any money; you've got a very tight budget. How are you going to solve this?

BUTLER: Firstly, let's just lay out the problem. You're right, right now, only about one out of every eight medical graduates is choosing a career in general practice. Not too long ago, it used to be four out of every eight.

So, we've got a very serious problem with the pipeline of new general practitioners replacing those who are who are retiring. Already patients tell us it's never been harder to see a doctor than it is right now.

Doctors are saying that they feel incredibly squeezed financially and are worried about the viability of their businesses. And I was meeting with state health ministers last week and they were telling me all of this is placing even more pressure on an already strained hospital system.

So, we've got a real challenge right now and a challenge that might get much worse if we don't reverse the trend in the decisions medical graduates are taking.

That's why Strengthening Medicare was the centre piece of our election policy platform.  We've got $750 million we're reinvesting into Medicare, and I'm sitting down every few weeks right now with doctors and nursing groups and patient groups to work out the best way to invest that money.

We're providing $220 million of grants to GPs to allow them to improve their IT systems, building Urgent Care Centres and things like that. We have made this the centrepiece of our election policy because of all the pressures on the health care system.

And there are many, as your listeners know, this is the one that worries me the most.

BEVAN: But it is about money, isn't it? I mean, ultimately, if you're looking at being a GP, or specialising, and you look at the specialising option, you go that’s a fair bit more money. That's the problem, isn't it?

BUTLER: I think money is at the heart of it. You know, the Medicare rebate freeze was frozen for six years under the last government and that effectively froze the wage of GPs while the wages of hospital specialists were continuing to climb.

So that wage gap is obviously a very big issue, but there are other issues as well. I know talking to GPs, there's just a sense that the sector has been run down, which is why we made investment back in that sector the centrepiece of our policy platform. 

We want to tell GPs and patients that for us we have no higher priority in health than rebuilding general practice.

There are also some other industrial issues not related just to wages that young GPs in training talk to me about. For example, in their six years of specialist training as GPs, they might move through a whole range of different employers over that period of time, so they don't accrue leave entitlements particularly that don't accrue parental leave entitlements often, and this is the sort of late twenties into their early thirties, so a time when they might be thinking about raising a family. 

We're looking at single employer models of care so that over that period they're employed by a single employer accruing those leave entitlements and expanding the policy, including into South Australia.

I was only talking to Chris Picton about this last week.

BEVAN: You say there’s no higher priority than rebuilding general practice, but again not to harp on the point, that means you have to put more money in their pockets.

BUTLER: And if you look at the financial commitments we made to health at the last election, leaving aside aged care, which was a very big priority for us as well in the health system. 

The biggest investments that we committed to were in Medicare. Now, I don't pretend that the work that we're doing over the next couple of months to inform the government's decision in the budget next year is going to turn things around in and of itself. 

But it's an important start. I took the view talking to doctors’ groups and nursing and patient groups. Medicare needs a shot in the arm immediately, and that's what we're doing right now.

But I don't pretend that we're not going to need a much longer-term effort to turn this around, particularly if you put on the minds of. 

BEVAN: If you put on your old union cap, you used to run a union, the Miscellaneous Workers Union. What sort of a pay increase would you need for GPs to attract people into that sector?

BUTLER: I think there are a range of things that that motivate young medical graduates into whether or not to choose a career in general practice. It's an exciting area to work in. The work is varied, you get a very deep connection to your patients and their families over a long period of time, a deep connection to your community that you don't necessarily get in the same way as a hospital.

BEVAN:  You think you can solve this with marketing, telling people what a really good job you ought to go ahead and try?

BUTLER: I don't think I said that, David, but I think what I did say is, is that I sense that there is a future in general practice, that we're modernising the way in which general practice operates to deliver the sort of care that patients and doctors tell me that that it is necessary nowadays, which with much more complex chronic disease using digital health much better. 

Those are kind of shifts that are now, but I'm not going to pretend that money is not important as well. And, you know, we are talking about further investment in the system.

What I am particularly committed to doing though, David, is not just as a man of more mature years reading the briefs and talking to the heads of the profession and thinking that I can look into the minds of young medical graduates and understand what's motivating them. I'm sitting down today, as I said I would, with the medical student’s group of the AMA, to try and understand what might shift the dial in their minds.

STACEY LEE, PRESENTER: While we've got you, Minister, we just heard from the state's chief public health officer here, Professor Spurrier, about the expected pre-Christmas wave that the country's expecting if we do see a large increase in Covid case numbers. 

Do you expect that there will be more restrictions put in place, given these decisions are now being made on a national level rather than a state-to-state level? 

Could we see isolation back?

BUTLER: I'm very hopeful that we're going to be able to manage future waves when they come. And they're very likely to come, as I think Professor Spurrier has indicated with our existing arrangements, the new arrangements we've put in place, we're very focused on making sure that people at risk of severe disease or even worse, hospitalisation or death are protected, which is why we've kept the pandemic safe arrangements in place in aged care and disabilities, Aboriginal health services and hospitals.

And we've got to make sure the health care system is able to flex its capability as new waves come along. We're very focused on making sure the health care systems are robust as well.

The advice that I'm getting, and I think I heard Professor Spurrier say this, is that the wave that is projected in some modelling that might take place in summer is likely to be smaller than we’d thought a couple of months ago.

Case numbers, for example, in the wave we've just seen over winter have come down much more quickly than was projected earlier. Hospitalisations are down dramatically, outbreaks in aged care facilities are down dramatically, as well.

I encourage people to get their vaccine doses if you haven't had it. We're working hard to make sure, along with states and territories, that hospitals and aged care systems are robust to cope with future waves.

And if, and when they do come again, people need to consider the covid-safe behaviours of social distancing wearing a mask indoors if you can't socially distance.

This is going to be with us for a while yet.

BEVAN: Before you go, the Women's and Children's Hospital that the Malinauskas Government is planning to put on the Thebarton heritage listed site. There's a real expectation now that this might end up with Tanya Plibersek, the National Heritage Minister.

Are you going to have a whisper in her ear saying, listen, Malinauskas everything to do with this is women's and Children's Hospital? You reckon you can just tick this one off?

BUTLER: Well, I haven't heard that possibility, David, but if it is a possibility, I know that Minister Plibersek will take any decision she needs to take in accordance with the National Heritage Laws, and I wouldn't think about seeking to influence that one way or the other.

BEVAN: But, it wouldn’t be unreasonable for the Federal Government to consider the health needs of South Australians versus the heritage needs, I suppose she would simply be bound by the legislation. The legislation requires her to do X, Y and Z, then that’s it. The merits of health versus heritage which is how Peter Malinauskas has set this debate up, that wouldn’t be for her to consider, it’s how she has to apply the certain rules set out in the law that she is custodian of.

BUTLER: All South Australians want to see a modern women’s and children’s hospital as part of their health care system, and I’m no different. The Australian Government wants to see the continued modernisation of our hospital system across the country. There’s no question about that. I’ve not been briefed, I’m not aware of any questions about heritage on the site, so really, I’m not able to respond to that question David.

BEVAN: Are you able to talk about the Federal Government’s commitment to this hospital in terms of money? Because the state won’t be able to build it on its own it’ll need some help. Are you aware of the federal commitment to this thing?

BUTLER: No, we haven’t received any request as far as I’m aware, at least, about a commitment to this new hospital. Obviously, over the last few months, we’ve committed to a very substantive expansion and modernisation of the Flinders Medical Centre, which was a big part of our election commitment in May, I think the biggest capital commitment we’ve committed to in the hospital system across the country. But I've not received any request about the future of the women’s and children's hospital.

LEE: As the Federal Health Minister, are you aware of any other states that have a women’s and children’s hospital, why does South Australia need to have them co-located?

BUTLER: You’re going to have to talk to Chris Picton about that, I’ve read the reports of the decision that the state government has taken, and as a South Australian I’m delighted of the fact that our women’s and children’s facility is going to be modernised.

LEE: But does any other state have it?

BUTLER: I can’t tell you what exists, what arrangement is in place in every single state.  

LEE: Minister, thanks for your time.  

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