Critical point for general practice

Transcript: AMA Queensland President, Dr Maria Boulton, 4CA, Talk Show with Gavin King, Friday 12 May 2023

Subjects:  Federal budget, regional workforce

GAVIN KING:   We’re going to cross now straight to the AMA to have a little bit of a chat about the budget and the impact for patients here on the ground. As I said, there was a lot made of the support for our hard working and doctors out of that budget on Tuesday night. So very keen just to find out exactly what it means, what's cut through the spin and the politicking, and actually just find out from those who know best, those who are affected by it.

So we've got Dr Maria Boulton on the line. She's the President of AMA Queensland, the Australian Medical Association here in Queensland. Dr Boulton, welcome to the Talk Show.

DR MARIA BOULTON:   Good morning.

GAVIN KING:   Thanks for being with us. I know how busy you are. If you can just give us a quick rundown. What are some of the things that you were impressed by, first of all, from that federal budget?

DR MARIA BOULTON:    Thank you so much. As a GP who has been working as a GP for 20 years and half of that was in regional Queensland, I was really glad to hear that general practice is actually front and centre now of the government's budget, which was badly needed because we've had 20 years of neglect when it comes to funding the Medicare rebates for patients to access their GPs. There was some good news. It’s still a work in progress though, but I think given the gap that the budget needs to fill, I think it's a good first step.

Some of the good news is this tripling of the bulk bill incentive. And, for your listeners, what the bulk bill incentive is, it's not the Medicare rebate. When you see your GP, you receive a Medicare rebate of $39 from the government to access that service. If you are bulk billed, and if you're in the eligible population - so if you're a child under 16 years of age or if you have a Commonwealth concession card - your GP receives an incentive to bulk bill you. That incentive ranges from about $6 to about $14, depending where you live in Queensland.

What the Treasurer announced is a tripling of that incentive, not your rebate. So not the larger part, but the smaller incentive. We all have patients that we bulk bill because they're extremely vulnerable and can't afford general practice care. So this will ensure that we can continue to do that for a little bit longer. Sadly, it's not going to come in until November and people are already feeling the strain. So I'm not sure why we have to wait till November for this. But that was one of the big announcements.

There’s also going to be a little bit of funding to go towards people who have chronic wounds and have diabetes to help with their wound dressings. You know, sometimes with dressings, some people need dressings changed daily or every three days or every week, and it can be quite costly.

There's going to be some funding towards the shingles vaccine. That'll be included in the free National Immunisation Program. There's going to be some funding toward workplace incentives so that we can employ more allied health and nurses et cetera in general practice.

But I think more needs to be done. It’s a great first step, but, yeah, more needs to be done.

GAVIN KING:   More needs to be done. Interestingly, reading in the last couple of days, some saying that bulk billing incentive, it's very targeted, and so some commentary that perhaps it's not actually going to cover much of the cost. It's actually not going to make a huge difference to the bulk of people.

DR MARIA BOULTON:   Yeah, correct. It only will apply to people who are bulk billed in those eligible groups. And it depends where you live too. So if you're in the city, that bulk bill incentive is quite small. But if you live somewhere really remote that bulk billing incentive is a little bit larger. For example, if you're in Cairns, that's considered a Modified Monash Area 2, which is just after 1, which is Brisbane. So that incentive won't be as large as somebody who's living in, for example, Chillagoe.

GAVIN KING:   And so the viability of GP clinics, I mean we've had pharmacies, pharmacists, a little bit Chicken Little in the last week or so saying that they'll go bankrupt due to some changes there, those 60-day prescriptions. But what's it like being a GP? Is it does it still stack up? How hard is it keeping GP clinics open these days?

DR MARIA BOULTON:   Yeah, GPs love what we do. It's such a privilege. At my clinic, we look after four generations of some families, and we're the first person that people come to when they're in stress or when they're sick. We look after their babies, we look after their grandparents, and it is such a privilege, and it's such a wonderful job.

The issue is this Medicare rebate neglect. It has become increasingly difficult to provide that evidence-based great clinical care that GPs do with the amount of funding that Medicare funds patients to access those services with. A lot of GP clinics have closed - there's over 60 that have closed down in the last few years.

That's because they're faced with two options. You have to pay rent, you have to pay wages et cetera, and what's coming in is not enough to pay for those things. So you either close your doors or you start charging a gap. It's really difficult for us because we do have vulnerable patients who we know sometimes can't afford the service so we continue to subsidise them. But that gap between the actual Medicare rebate and the cost of the service just keeps growing and growing.

GPs are feeling the strain and so are our patients. There's a cost of living crisis at the moment. We know that rents are going up, we know that food is going up and it's really sad when you see a patient come through your door and say, ‘Doctor Maria, what script do I need this month? Because I can't afford them all’. And our heart breaks for them. We know how hard it is for them out there.

GAVIN KING:   Are people, do you think, avoiding visits to their GP because of this rising cost of living across the board?

DR MARIA BOULTON:   I think they are. Or they perhaps just bunch it all up into the one visit and that's absolutely the last thing we want to see. We know that having regular contact with your GP, especially if you have a chronic condition - and half of the population have at least one chronic disease - actually keeps you healthier and out of hospital. The worst thing we want to see is for people not to come and see us when they need to see us. And that's why it's so important for that safety net that the government provides to actually be at the level where those patients can access those services.

GAVIN KING:   You're hearing from Dr Maria Boulton. She's President of the AMA here in Queensland. So I guess, just to finish off then on the bulk billing incentive from that federal budget if we can, essentially it's good news for those targeted groups, but for the bulk of people, they actually won't see much change, much improvement?

DR MARIA BOULTON:   Correct. And it's these targeted groups, in especially in rural and remote areas in clinics that already bulk bill, not every clinic. Every clinic will have different costs, and because that incentive is not a large incentive, it's not going to go the whole way to cover the cost of those services. I guess we'll see in November what the effect of it is. But November is still a long time away, and we know the pressures that people are under already. We would have liked to have seen that come in sooner.

There was also an announcement that the Medicare rebates will increase by a little bit, 3.6 per cent. But when you look at the cost of inflation –

GAVIN KING:  Yeah, inflation is double that.

DR MARIA BOULTON:    And over the last 10 years, those Medicare rebates have gone up by 0.5 per cent on average per year. You can see how, that Medicare rebate for you to access your doctor just has not kept up with the cost of that service.

GAVIN KING:   And finally, the challenges with workforce recruitment, getting GPs into those regional, rural and remote areas, continues to be a challenge. Can you see any light on the horizon there? Do we need to import more GPs? Where's the workforce challenge at the moment?

DR MARIA BOULTON:    We’ve been calling for the State Government to do a workforce plan. Without a workforce plan, we really don't know what how many of each of the healthcare professions we need in all the areas. We know that especially rural and remote and even regional, it's very stretched. We just need to know what our needs are, and we need that workforce plan to cover GPs, allied care, pharmacists, physios, not just include public hospitals, but also private hospitals, aged care, NDIS as well as general practice.

We are competing with the world when it comes to workforce. We had the announcement from the Premier a few days ago of these workforce incentives, which are fantastic news because we do need to be competitive. We’re still trying to get some details as to whether or not that would also cover GPs and the GP workforce and we’re chasing those details down. We know that 50 per cent of the GP workforce comes from overseas and we’re very reliant on them. It needs to be easier for them to get into Australia to work here, like it is in Canada. To go work in Canada, it takes half the time to get all your credentials reviewed et cetera.

So it needs to be easier. But we also need to ensure that we’re training enough through our universities and our hospitals, and making sure that those junior doctors who have great experiences in general practice as medical students get to experience general practice again when they’re in the hospital system so that they get reminded of what a brilliant, brilliant workplace it is.

It is also important that when they graduate from medical school and when they complete their GP training that there are clinics for them to work at. And we need to ensure that all those clinics, especially rural and remote, that there’s support, that they are well-funded, because if they close down, who’s going to look after those people? Who’s going to deliver the babies? Who’s going to provide emergency care?

We’re at a crisis point. What we do today will affect the level of care we receive in 10, 15 years.

GAVIN KING:    Just reading here from the Premier’s media release, they talk about medical doctors and specialists will receive incentives, in some cases up to $70,000, they’re saying that doctors who take the decision to move to regional and remote Queensland will be paid up to an additional $70,000. But perhaps that’s not clear whether these are GPs or are they medical doctors and specialists for hospitals? It’s not quite clear there.

DR MARIA BOULTON:    No, we’re just seeking clarity as to whether it’s just Queensland Health employees or whether it also applies to primary care.

We also need to ensure that whatever workforce we have at the moment is supported. We’re losing too many people to other states and they’re so hard to find. We just need to support them and make sure that their families have jobs, they have access to schools, childcare, housing. Housing is very difficult at the moment. And they have those educational and research opportunities that they do in other states.

GAVIN KING:   Alright, very well said. Keep up the good fight. And, as you said, at least, at the very least, it’s a start of recognising the importance of GPs and primary care after what has been many, many years of neglect in the federal budget. So that at least is a first good step. Dr Maria Boulton, President of the AMA Queensland, thanks for your time.