Dr McMullen: Today, we've seen the largest announcement of funding for general practice since the advent of Medicare. Importantly, this shows that the government understands the quantum of funding that's needed to reverse decades of underinvestment and to start to shift the dial on accessible and affordable general practice care. This will make a difference to the sustainability of bulk billing, general practices and in areas where practices and GPs have recently had to introduce small out-of-pocket charges, this will improve things for their situation and potentially mean that they can reverse those out-of-pocket charges for patients. I really hope that this helps more Australians access general practice care early, and make sure that we can keep people healthy and keep them out of hospital. It won't mean that all general GPs will be able to bulk bill all patients. In some areas, the cost of providing care will still be too great, and so I really encourage Australians to have a conversation with their general practice about what this might mean for them.
Importantly, we can't afford to keep ignoring the growing complexity of care in general practice. More chronic disease, more mental illness and ageing population all mean we need to spend longer with our GP. It's why the AMA has proposed modernising Medicare, and we'd like to see a restructure of the way Medicare works, so that we better fund those longer consultations with your GP.
Excitingly, today we've seen some excellent announcements about workforce support for general practice. We're seeing more training places, a sign-on bonus for doctors who choose to become GPs, and paid parental leave and study leave for general practice trainees. These really exciting changes are things the AMA has been pushing for years and will really help to address the workforce shortages we're seeing in general practice and encourage more doctors to choose general practice as a career.
QUESTION: But actually is the 90 per cent target achievable?
Dr MCMULLEN: I think in some parts of Australia this will see a shift in the rates of no out-of-pocket consultations. In other parts, it's unlikely to make a huge difference. We know in some of our metropolitan centres and in some of our better off suburbs, the average out-of-pocket cost is now above $40 and so the $20 bulk billing incentive still doesn't come close to meeting those costs, but really, I do hope this will make a difference in rural and regional communities and in our areas of socioeconomic disadvantage, where GP's have been really trying as hard as they can to keep those costs down and we'll be able to bulk bill more patients.
QUESTION: It seems that to sweeten the deal, so to speak, the government's offering these quarterly incentives as well, 12.5 per cent of your rebate. Why wouldn't that be enough to tip the balance for those places that are now charging the $40 gap?
Dr MCMULLEN: That will again help the sustainability of practices where they bulk bill 100 per cent of their patients. We know that it's those practices, in particular, where the decades of underfunding have just left this really wide gap between the cost of providing care and those are the practices and the doctors and the patients doing it toughest. So, in those areas where there's high rates and 100 per cent rates of bulk billing, that extra incentive helps them keep the doors open, helps them hire nurses, reception staff, allied health staff and pay for the equipment that's needed in a general practice and will be a welcome relief for those practices.
QUESTION: We're told that a lot of people are putting off visiting the GP because of that additional cost. How much of a latent demand do you think this will activate? How much more demand do you think there'll be on GPs when people realise that they can go essentially for free?
Dr MCMULLEN: We have seen people delaying care and as a GP myself, it is really sad when we hear stories of people who've had minor symptoms but have been putting off and putting off seeing the GP until their condition is much more serious. I do hope that incentives like this, and the focus on needing to fund general practice properly, does help bring people back to our clinics. We do everything we can to reduce the
out-of-pocket costs or bulk bill patients who we know really need it, and this decision does make it easier for us to do that.
QUESTION: And what sort of assurances do you think that the AMA and doctors generally can give that they won't use this to over service, to draw people back more frequently than they require, because they can be bulk billed?
Dr MCMULLEN: GP clinics are already really busy, and our books are booked up many days in advance in a lot of parts of this country, so we don't need to be seeing patients any more often than is necessary. And I think it's really important that these incentives open up access to patients who weren't already coming to see us because GPs are busy enough. And I think we'll be using this to see more patients rather than see the same patients more often.
QUESTION: What did the consultation process look like? Was this something that the AMA came to government with? Or did government come to the AMA? How long have you been discussing this?
Dr MCMULLEN: In our plan for advocacy and general practice we would have preferred to see a restructure of the underlying Medicare structure so that all Australians could have access to better rebates and for longer consultations and we will continue pushing government to reform that underlying Medicare so that every Australian can see their GP for as long as they need to, without needing to worry about the clock or the cost. This announcement by government wasn't in consultation with us but does show their recognition of the amount of funding that really is required to shift the dial in general practice.
QUESTION: I don't know if this was already covered, but do you think the incentive is enough for GP clinics to actually move to a fully bulk billed model or will it not really cover the overheads?
Dr MCMULLEN: In areas that are already fully bulk billing, this really helps sustainability and helps those practices keep their doors open. And in many parts of Australia, where doctors and practices have just introduced quite small out-of-pockets just to keep their businesses alive, this will help them remain open and potentially remove those out-of-pocket costs and improve accessibility for patients. In other parts of Australia, I think we need to recognise that this won't be enough to change billing practices, particularly in our large metropolitan centres where the average out-of-pocket cost is now much more than $40, and so the extra $20 incentive doesn't meet those increased costs of care but does allow us for patients who really can't afford to pay. it does give GPs a bit more flexibility to choose to make that decision. We need to recognise, though, that that's still the GP taking a significant cut in their usual fee to be able to support their patients to access care.
QUESTION: Can you explain why those clinics in some of those metropolitan areas feel the need to charge a higher gap?
Dr MCMULLEN: GPs do our level best to provide the best possible care within the means of the local population and all practices have been doing it tough, but we know that in outer metropolitan and rural and regional and other areas of disadvantage, GPs have been doing it even harder just to be able to support their local communities. So, they've been really holding tight on their fees, recognising they need to provide care to their patients in city areas. We all face these higher costs of hiring nurses. Rents have gone up. The same cost of living pressures that affect all Australians, affect GPs and practices as well. And so, we've seen those costs of keeping the doors open on a business have really skyrocketed.
QUESTION: In your professional and business opinion, do you think this promise of nine out of ten visits to the GP being free by 2030, is that realistic?
Dr MCMULLEN: I think in some parts of Australia we will see a significant increase in bulk billing rates, but it is quite difficult to see how it will make a huge increase in some of our central metropolitan areas. My hope for this is that it really does target some of our more disadvantaged patients, but who weren't eligible for the bulk billing incentives before now, that it will make a difference to the lives of those Australians.
QUESTION: So how much of an increase do you think it will mean in all that?
Dr MCMULLEN: We haven't done the modelling of this proposal. Our strong call is still for government to reform the underlying Medicare items so that we can see better investment in those longer consultations and that more Australians can get to see their GP for that comprehensive care that we know delivers better health outcomes, stops them having to come back as often if we can treat all of their health issues in the initial consultation.
QUESTION: With the number of GPs coming in, this 2000 a year, it sounds like a lot, is that sufficient? Do there need to be changes on allowing GPs who have qualifications from other countries coming in more easily?
Dr MCMULLEN: On the workforce announcements today, there has been strong consultation between the AMA and government, and we're fully supportive of their announcements about extra training places, extra incentives for doctors to choose general practice as a career, and the paid parental leave and study leave for general practice trainees. These are excellent announcements. We do think that the extra training positions in general practice will help close the gap in our shortages. We, of course, will still need internationally trained doctors and GPs, and they're a really valuable part of our healthcare system. There's already been some changes to streamline access and speed up access for internationally trained doctors, and it's really important that we maintain quality and standards and the high level of care that we expect in Australia, while, of course, getting rid of unnecessary red tape and making sure that we're an attractive work environment.
QUESTION: Just to clarify something, when you say that you would prefer they reform the underlying Medicare item, does that essentially mean actually just increasing the rebate for GPs, regardless of whether there's bulk billing or not?
Dr MCMULLEN: Our ask was actually for a restructure to modernise Medicare and move (from where) at the moment when patients see the GP, there's a choice of roughly five usual time-based items depending on how long you're in that consultation. But there's a real disincentive to spend longer with the GP because those rebates are just not up to par. Our work in redeveloping a programme to modernise Medicare, was to shift that to a seven-tier structure and smooth the curve so that no matter how long you need to spend with the GP, that Medicare rebate is appropriate and is there for you.
QUESTION: Let us take you back to the changes quickly. What do you see the size of the gap now in how many additional GPs are required?
Dr MCMULLEN: Our modelling shows that we're headed for a shortage of as many as 10,600 GPs by 2031. There's a significant shortage already in play, and that's set to grow over the next few years. That's why we welcome the announcements today of more funded training positions and as well as other measures to attract workforce both locally and internationally.
QUESTION: On face value, is that sufficient to fill that gap?
Dr MCMULLEN: We think it's sufficient to make a significant dent in that gap and it's what we asked for. It's what we think the system can train, because we've also got to remember that we need to be able to train these extra doctors and have the supervision capacity and the capacity in our training sites. And so, we welcome the investment, and it's exactly what we asked for.
QUESTION: Earlier you said in terms of practices switching over to bulk billing, that it's more likely, is not likely to have an impact in some areas rather than others. What areas are we talking about?
Dr MCMULLEN: These bulk billing incentives are scaled for rurality. So, they are… it's a higher payment in rural and regional Australia. And we do think that helps close the gap there and so we expect there will be higher uptake in rural and regional Australia but also areas of socioeconomic disadvantage. We know that there are pockets, even in our metropolitan suburbs where practices have been hanging on to bulk billing, and this really helps them keep their doors open. But there are other practices who have recently gone to charging quite small out-of-pocket costs, $10 or $20 per visit. This will help them, and we may well see those practices go back to charging no out-of-pocket costs to be able to help the really vulnerable communities they work in.
QUESTION: Is it fair to say in summary, it will, in the short term, it will increase bulk billing but until the workforce kind of gap is bridged, it won't necessarily help people who don't already have access to a doctor?
Dr MCMULLEN: I think it will help in some areas of particular disadvantage, but we can't lose sight of the need to reform Medicare more broadly and make sure that we're really supporting Australians with chronic disease, mental illness, our ageing population and reforming the structure so that all Australians have access to appropriate rebates, no matter how long they need to spend with the GP.
QUESTION: And is the AMA's position that you support the universality of this, or would you like to see some sort of means testing approach?
Dr MCMULLEN: Obviously one of our concerns is that come the date of this announcement, our practices will face hordes of patients expecting to be bulk billed no matter where they are and as I've said, there are practices for whom even these extra incentives don't meet the cost of providing care. I am worried about our reception staff, who are often the first line in facing angry patients. So, we would like; we encourage the community to understand that while this does increase the eligibility of these incentives, it doesn't mean that every single practice will be bulk billing overnight, and to obviously treat our staff with kindness and respect, and that this may not mean that you'll always be bulk billed. Targeting of incentives does help mitigate that, but we understand that it's quite tricky at the moment to know who's struggling and who's not. We've got lots of families who are really facing cost of living pressures despite having two incomes, but trying to put kids through school and working multiple jobs. It's really tricky to identify who needs this most. GPs know their patients really well, and we're well placed to have those conversations with people, know who's doing it tough, and we do try to manage our fees in accordance with that, while of course, still keeping the business open.
QUESTION: What will stop doctors reintroducing a cap in a couple of years?
Dr MCMULLEN: We will continue to need ongoing, appropriate investment in general practice. The reason we're in this situation is that successive governments have stripped money out of general practice by failing to index the Medicare rebate appropriately, failing to understand the growing complexity and cost of providing general practice care. To avoid being in this situation again in a few years' time, we do need to keep pressure on whoever's in government after the election to recognise general practice as the cornerstone of our healthcare system, and the urgent need to continue investments to reform Medicare and make sure that we've got GPs for another 40 years into the future.
