Budget significant for general practice

Transcript: AMA Queensland President Dr Maria Boulton, 4BC, Afternoons with Sofie Formica, Wednesday 10 May 2023

Subjects: Federal budget, Queensland regional health workforce incentives

SOFIE FORMICA:   Certainly plenty to digest in the last 24 hours when it comes to changes in the health sector for Queensland. Not only has there been a raft of new measures and initiatives handed down in the federal budget last night, but just today, the Queensland government has also announced their incentives to attract more healthcare workers to Queensland. It's not dissimilar to the announcements that were made to incentivise more people to join the police force. Health workers who come from interstate will receive payments up to $20,000 to move to Queensland. Doctors who take up a position in regional areas could receive up to $70,000 in extras.

And in the federal budget, well, there's been a major overhaul for Medicare. Health Minister Mark Butler called the plan the largest increase to the incentive in the 40-year history of Medicare. Doctors are going to be paid three times as much to bulk bill families with young children, pensioners, and concession card holders as part of a plan to improve GP access with no out-of-pocket costs for about 11.6 million people. It'll come at the cost of $3.5 billion.

Now to be clear, again, from what I understand, this is only available for pensioners, concession card holders, and people under the age of 16. Joining me now to better understand what these changes mean for us, Queenslanders, I'm joined now by Australian Medical Association of Queensland President, Maria Boulton. Thanks again as always for your time, Maria.

DR MARIA BOULTON:   Thank you.

SOFIE FORMICA:   Okay. Let's talk about the federal budget first. What has been the reaction from your association?

DR MARIA BOULTON:   This is a really significant budget when it comes to ensuring that general practice remains financially viable and that patients continue to have access to their GP. As we know in Australia, we've been enjoying some of the best general practice in the world. If not top three, definitely the best. Well, I think it's the best. But we've been finding issues with the lack of indexation of the Medicare rebate. Patients have been having to pay more out-of-pocket gaps to access their GPs.

Also, we've seen a drop in the number of doctors who want to train as GPs and we're seeing those workforce pressures that every other part of the health system is experiencing at the moment. What we saw last night was a true acknowledgement of the crisis that general practice is in and, also, some movement towards ensuring that people continue to have access to their GPs, particularly vulnerable people and particularly people in rural and remote Queensland.

SOFIE FORMICA:   So it sounds like a tick, Maria. I do want to just talk to you about the targeted nature of this assistance. We've been told that it is a bulk billing incentive. It does mean that the onus is really on the practitioner, on the GP to decide who would get this additional help when it comes to a bulk billing fee.

DR MARIA BOULTON:   Currently there's two things that help you access your GP. One is the Medicare rebate that the federal government gives to you to access your GP. At the moment, that's just under $40 for a standard consultation. If you are under 16 years of age and on a concession card and if you are bulk billed, then you get access to a bulk billing incentive, which is about $7 to $14 depending on where you live in Queensland. The further you are from cities, the more that incentive is. What the government announced yesterday was a tripling of the bulk-billing incentive, so not your rebate. So not the $40, just the bulk-billing incentive for people who are eligible for that. Basically, that would increase it if you live in the city to about $20, and if you live in a remote Queensland town to about $40.

But sadly, if you look at the $20 just on its own, when you think about how much on average gap payments people are having to pay at the moment to access their GP, which is on average $40, that $20 falls a little bit short of cash. I work at a private billing practice. We have vulnerable patients that we bulk bill because we know they cannot possibly afford to pay us. Certainly, it will let us provide care for those very vulnerable patients and certainly, practices that were perhaps considering moving away from bulk billing, maybe this will buy them some time, but we're yet to see all the details on the rest of the funding to see what effect it'll have on those bulk billing rates.

SOFIE FORMICA:   But just as I said, from a practical perspective, it still does mean that it would be up to the GP to make that determination or is it just when you show your healthcare card, your aged care card, or if you're on the family tax benefit that falls under this umbrella that you would get the additional assistance? What I'm saying is when somebody walks into a practice, it may be they're not aware of how it works, would they be asking for the additional assistance or would it be the doctor that would determine it?

DR MARIA BOULTON:   It would be the practice fee structure that determines it, and that fee structure depends on the cost of running that practice. Some practices just cannot afford to bulk bill and won't be able to afford to bulk bill even with the increase in the bulk billing incentive. So it really depends on the cost of running the practice.

Those eligible though are determined by the government, and they're the kids who are under 16 and those people on concession cards. But at the end of the day, the practice needs to ensure that the fees do cover costs so that they can stay open because we've seen too many practices close down. We would've liked for that incentive from the government to go a little bit further to cover the cost of actually providing those consultations. It seems that GPs have been subsidising care for a very, very long time for patients and it seems that we will continue to have to do that for some of our patients, but certainly, it will help a lot for those vulnerable communities.

SOFIE FORMICA:   Yeah. I guess now we have to wait to see how it gets rolled out and whether or not there are still areas where there is a gap that will need to be out of pocket even for those most vulnerable. But hopefully, we'll see more opportunities when it comes to covering the cost completely as you already mentioned.

I also wanted to talk about the changes that were announced by the Queensland government today, this $20,000 incentive for health workers to move to Queensland, up to $70,000 for some doctors to move to regions. It really does give us an indication of just how short-staffed we are statewide.

DR MARIA BOULTON:   Correct. And we're competing against the world. When you look at the WHO data, they say that by the year 2032, we'll be short of 15 million healthcare workers across the world. So not only are we competing against other states, but we're also competing against the world when it comes to healthcare workers. At the moment, we are short of health workforce and Queensland does need to be competitive.

We also need to ensure, though, that the workforce we do have in Queensland is being supported so that we can retain them and not lose them to other states. We also need to ensure that we're training enough domestically to fill all those new beds that we know are coming and ensure that whatever workforce plan Queensland Health is working on, and I know they're working on one at the moment, not only includes public hospitals, but also private hospitals, aged care, NDIS, primary care to ensure that we know exactly how many workers we need, but also that we're training enough and recruiting enough.

But retention is also really important. Sadly at the moment, there are many workers that are feeling unsupported and we know that we've lost a few to interstate, which we cannot afford to lose. But certainly, the announcement today by the Premier is welcomed and it makes us more competitive when it comes to recruiting workforce.

SOFIE FORMICA:   Yeah, it's such a complex issue because as you mentioned, it's a national and an international problem. If we get people to move here to Queensland, we're only going to be making it worse for some other Australians, which I find really hard to come to terms with. We also know that we're going to deal then with a population increase that is only going to continue. It looks like Queensland, it will tip 5.5 million Queenslanders at some point in the middle of next year.

You mentioned beds. We know that we are likely to see some of these satellite hospitals, and I use the word hospitals very loosely, come online soon, Maria. Is that going to be enough or are you still pushing very much to see the Queensland government and Queensland Health work towards better supply when it comes to the beds that we need to support our population?

DR MARIA BOULTON:   It's not going to be enough. We're still looking towards the thousands of beds that were promised, but not only that, but also the workforce too. For every hospital bed, you need 10 different healthcare workers to staff those beds. It's a big workforce that is needed and we need to ensure that we're not pulling from aged care and primary care as well because we know that those areas are also short.

I would've liked to have seen more in the funding announcement yesterday from the federal treasurer about our hospitals. We know that we're still having issues with ramping, bed access. Our poor paramedics are waiting in emergency departments trying to get their patients looked after so that they can be on the road. We also know that our elective surgery wait lists are still not where they should be. So we would've liked to have seen more investment there.

So far, we've had recognition of general practice being the cornerstone of healthcare. We know that general practice does keep people healthy and out of hospital, so we hope that by increasing the funding somewhat, and as I said, we're still going through the details - there was another announcement about some blended payments coming in to practices to look after people with chronic disease and some workforce incentive payments - we're yet looking to see what the detail will be, where it's going to be enough. But yeah, I think time will tell.

SOFIE FORMICA:   Yeah, absolutely. Maria, it certainly sounds like there's still plenty of work to be done. Thank you for your time this afternoon. Really appreciate it.

DR MARIA BOULTON:   Thank you.