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There is always more to do in health . Delivery is important ; implementation is important . So that is our big job .
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But while the GP groups have been very warm in their response to his budget billions , financial storms still loom . One of them is the payroll tax threat . It is relevant to Mr Butler ’ s budget because of the view among practice owners that it will wipe out profit margins , stripping practices of the capacity to deliver bulk-billing to concession card holders as the minister hopes .
“ I know the concern and uncertainty are spread right through the country ,” he says .
“ I accept this is a serious pressure on practices , particularly the idea of retrospective [ demands for payroll tax ].”
He stresses that his responsibility lies with Federal Government policy and that general practice viability , the strength of general practice , is his number one priority .
“ Now , states are going to have to make their own decisions about state taxation policy .
“ I am sure that health ministers are having discussions with their state treasurer counterparts about the importance of a vibrant and sustainable primary practice sector .”
But when he meets with state health ministers , is he lobbying for an exemption on payroll tax to protect general practice ?
Does he not feel it is his place to say that ?
“ Well , my place is to say , it is important for our health system to have a vibrant , sustainable general practice .
“ And I think state governments understand that more than ever before …
“ It is not productive or effective , I think , if you look at history , for the Commonwealth to seek to lecture state governments ’ treasuries about what they do with payroll tax .”
What about the potential damage payroll tax demands will inflict on practices ’ capacity to offer bulk-billed care ?
“ When we make the investments we made in the budget a few weeks ago , I want to make sure that that money ends up in the pockets of practices delivering better care to their patients and not necessarily in the coffers of state treasury .
“ I will make that very clear , and I do not think anyone , including my state colleagues , would be surprised at that .”
Pharmacist prescribing
He takes a similar position on that
other issue arising from state governments and their dealings with primary care — the rise of pharmacist prescribing .
With the numerous trials being pushed have come tribulations , not least in North Queensland , where the
State Government wants pharmacists to prescribe a string of S4 medications across a wide range clinical conditions , including diabetes and asthma .
Even the other states — NSW and Victoria — are now keen to open the regulatory doors for pharmacist prescribing and dispensing in the form of oral contraceptives and antibiotics .
Is he not worried by the dismantling of the TGA ’ s drug scheduling system ?
He acknowledges the issue — that specific medicines are scheduled because the TGA says they should only be prescribed by a medical practitioner with skills to keep patients safe .
“ Some of the states are seeking to address a whole range of views in their community about ease of access to primary care — by either putting in place pilots for pharmacy prescribing or , more recently , the more structured or
There is always more to do in health . Delivery is important ; implementation is important . So that is our big job .
— Mark Butler Minister for Health and Aged Care
systemic changes that you are seeing on the eastern seaboard a little bit .
“ Now , ultimately , that is a matter for state governments .
“ But there has been a discussion between health ministers , one that I initiated , about the advisability of us trying to bring those different arrangements together so that there is not a hodgepodge of different arrangements across the country .
“ The pathway forward on this question lies in the scope of practice review that National Cabinet has initiated .
Given that the review process has yet to start , is he concerned that the expansion of roles is happening now and that it is being driven by politics , not by medical regulation or the concept of patient safety ?
“ State governments are taking these decisions , and they are not taking them lightly ,” he says .
“ They are taking them on broad advice , including from the pharmacy sector , but much , much more broadly than that . I am confident about that .
“ As I understand it , they are setting up a range of oversight arrangements or additional training arrangements .
“ We are obviously watching that closely .
“ We are not involved ; we are not engaged , either by the sector or by state governments about that .
“ But I do not accept that these are decisions taken lightly by state governments or that they are decisions taken just through engagement with the pharmacy sector .”
Isn ’ t this being done in North Queensland with no clear medical oversight at all , though ?
“ My sense about the level of doctor involvement [ in these trials ] is that it has chopped and changed a little bit .”
Referring to the decision in 2020 by the AMA , RACGP and ACRRM to quit the expert advisory group for the North Queensland trial , he says : “ In
some areas doctors have been involved with clinical oversight , and they have withdrawn .
“ I make no criticism either way about that .
“ But obviously , it is advisable , I think , whenever there is a change to clinical practice , that there is good clinical oversight , independent monitoring and evaluation to make sure we achieve the objectives that were intended , and it obviously does no harm .”
GP patient enrolment
The interview circles back to the promise of GP patient enrolment , which is due to start in October .
Mr Butler was part of the Rudd Government that pushed out a mangled version in 2010 , unwanted by GP groups at the time , involving capitation payments for patients with diabetes , with the suggestion that patient access to fee-for-service rebates would be restricted .
It was sold as a landmark reform but was withdrawn with the same haste as its creation .
Last year , at the AMA National Conference , Mr Butler started talking to delegates about how he wanted to know enrolment ’ s “ value proposition ”.
It was a little shocking given enrolment had been sold as the new Jerusalem for the past decade . Surely it has been the one thing all the reformers have agreed on — that it would improve care .
The argument is no longer about principles but the nuts and bolts ( and cash ) to make it work .
“ Yes , we have been talking about it for a long time ,” he says .
“ There have been short-term pilots that have fallen over . More pilots than Qantas , the Grattan Institute said in one of its reports late last year .
“ But my objectives here , ambitions here , have been first of all to be able to articulate clearly to patients most importantly , as well as practitioners , what the value of this is .
“ We are not just doing this for the fun of it .”
There is still little concrete detail on what shape the enrolment scheme will take , specifically the administration demands on practices .
We know the scheme will be branded MyMedicare ( it was going to be called MyGP , once upon a time ) and that it will be voluntary and open to all .
But the only specific incentive for now is that general patients who sign up will be able to claim rebates for longer telehealth consults .
It does not seem that tempting , at least at this stage .
Frequent flyer patients
The care revolution , if that is what it becomes , lies with the annual block payments of around $ 2000 to GP practices for enrolling frequent flyer patients — those attending a hospital 10 or more times each year — and working to keep them away from hospital gates .
This will start next year and cover some 14,000 people .
But Mr Butler says he expects this will be extended , possibly to longerstay older patients , as well as National Disability Insurance Scheme participants being managed in the hospital system .
“ There is a clinical hook with the longer telephone consults , but I think it is about demonstrating with a sizeable but not massive cohort of people who present real challenges that you can deliver good health outcomes .
“ If we can demonstrate [ enrolment ] works for frequent flyers , then I think people really will get the confidence that this arrangement is worth investing in .”
The minister ends the interview by saying his focus in the coming months is on delivering the budget promises , including the rollout of the government ’ s urgent care centres .
“ There is a lot there for health , particularly in general practice ,” he says . “ There is always more to do in health . Delivery is important ; implementation is important . So that is our big job .”
The reference to delivery is an obvious point but worth repeating because , as he and everyone else knows , the business of delivery beyond the recent pandemic has been a universal failure of all governments for some time now .
Adjunct Clinical Professor Karen Price .