Television interview with Minister Butler and Laura Tingle, ABC 7.30 - 17 January 2023

LAURA TINGLE, HOST: Mark Butler, thank you for your time tonight. There was a lot of focus in that story we have just seen on Medicare rebates being frozen or subject to very low indexation and the impact that's had on general practice. You've been arguing there needs to be a much more comprehensive revamp of Medicare to make general practice viable. Can you give us an idea of what sort of issues need to be addressed?

 

MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: There's no question the cuts, the freezing of the Medicare rebate for six years under the former government has placed enormous financial pressure on general practice in particular. The Medicare system broadly, but particularly general practice. But there are some broader structural issues at play here. We've been working through them with the AMA, the College of General Practice, nursing groups, allied health groups and patient groups as well to come up with some recommendations to strengthen Medicare that will be actioned in our budget later this year. We finished that work just before Christmas. We're finalising the report now which I expect to publish in the next couple of weeks. It's been a very constructive, cooperative process, with all of those groups who, frankly, don't always see eye to eye about the need for a truly 21st century Medicare system that reflects the disease profile of an older population, a population that has more complex chronic disease.



Frankly, I think our general practice system right now is in the worst shape it has been in, in the 40-year history of Medicare. We're no orphans, we're seeing it across the developed world. But there's particular challenges here in Australia that we are determined as a new government to fix.

 

TINGLE: A lot of that seems to be about greater coordination and multi-disciplinary approaches to general practice. Is that correct?

 

BUTLER: Absolutely. We need doctors working hand in glove with practice nurses, allied health professionals and pharmacists. The system is not well designed to allow them to do that. It really is a system that was designed for much more linear episodic care that was more the state of things in the 1980s and 1990s. We also know through this process that the digital health capability of particularly the primary care system’s connection to the hospital system, to aged care, disabilities and others is really not up to scratch. So that will be a particular focus, I think, of the report when we publish it soon.

 

TINGLE: Part of the problem is workforce. People aren't going into general practice because it's seen as poorly remunerated and not viable. Would you consider bringing back undergraduate medical degrees, getting young doctors out into the community earlier and thus changing the award structures between general practice and specialisation?

 

BUTLER: General practice is a specialty in and of itself, a 6-year post graduate course. There's rural generalism that's increasingly popular among medical students. But, you're right to say a smaller share of medical graduates are choosing general practices as their preferred career than ever before. It's less than 14 per cent now of medical graduates choosing general practice. Not too long ago it was half of medical graduates coming out of university were choosing to go into general practice. If we think we've got a problem now getting in to see a GP, think 15 years down the track if we're not able to turn those numbers around. That again was a very focused part of the discussion through the Strengthening Medicare Taskforce and has been an item of discussion at National Cabinet by the country's Prime Minister, premiers and chief ministers. The fact it's escalated to that level I think gives you a sense of how seriously governments are taking this issue.

 

TINGLE: There's a February 1 National Cabinet meeting. The premiers in Victoria and New South Wales are going to put forward their own plan here because of the pressures on hospitals. How much detailed agenda from the Strengthening Medicare Taskforce will go to the National Cabinet meeting?

 

BUTLER: That's ultimately a matter for the Prime Minister in consultation with the premiers and chief ministers but I'm confident there will be a substantial discussion about health policy there. Premiers and our Government have made clear that we think that's in the national interest. There is substantial money already promised for Strengthening Medicare. We're in the process of finalising the location and the protocols associated with our commitment to deliver 50 urgent care centres to take that pressure off the hospital systems that you've mentioned the premiers have been talking about very understandably and we have a package from the October Budget last year into rural general practice but I don't pretend there's not more we need tee do. This is going to take focused effort in consultation with the sector itself obviously and with state governments who realise now I think, they've got a direct interest in rebuilding general practice. For the benefit of their communities and also for the viability, the sustainability of their hospital systems that are under pressure from presentations that frankly could be quite adequately dealt with in the community, if the general practice system was in proper shape to do that.



TINGLE: A lot of the pressures on the health system have been greatly exacerbated by COVID. We have dropped most of the rules here. Our public health strategy is almost solely based on vaccines and antivirals, yet one prominent epidemiologist told me today the strategy seems to be give as little as possible to as few people as possible. Are you considering making another booster available as a fifth dose to all Australians who have had a fourth dose?

 

BUTLER: I don't accept the premise of that question. We have a range of supports in place in the aged care system, in disabilities and the hospital system. Particularly for those who are vulnerable to severe disease. And, a range of other public advice that goes out to the community from time to time, depending upon the status of a particular wave.

But as to a potential fifth dose or additional booster dose, I've made clear the advice to me from ATAGI was that we should expect advice from them very early this year about additional booster dose. They and governments are thinking about our need to be prepared for the next winter. So, as we move into April, May and June, and confront what the Northern Hemisphere is confronting right now, we need to think firstly about an additional booster dose and ATAGI said we should expect the advice earlier this year and need to think about additional communications campaigns to the community about the need for them to consider very seriously getting those additional boosters. That work is under way in Government right now as well.

 

TINGLE: COVID is now the third leading cause of death in Australia and is running at 12 times the national road toll. Everybody's got pandemic fatigue but are we really doing enough here? For example, there is evidence emerging that long COVID is a big economic problem as well as a big health problem. Should we also be expanding the field in which people get antivirals because they help prevent long COVID? Should it be easier for people to get access to those drugs? 



BUTLER: I made the first submission, I think, by the Commonwealth Government to the Pharmaceutical Benefits Advisory Committee, the first submission by a Commonwealth Government try to expand the eligibility for antivirals. That was successful. I'd like to see consideration continued to expand the eligibility where that's clinically effective for people for antivirals. We as a nation bought hundreds of thousands of doses of these highly effective antivirals and they should be as widely available as the clinical advice indicates it. I'd like to see that continue to be under advisement.

 

TINGLE: Thank you for your time.

 

BUTLER: Thanks Laura.