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Speaker 1: I do want to take you across well to a

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Speaker 1: topic that was raised with you our listeners on the

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Speaker 1: tech line and also on the phone line. In recent

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Speaker 1: days we had a number of listeners calling in and

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Speaker 1: saying that all of a sudden they've been charged to

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Speaker 1: see a doctor to give a bit of an update

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Speaker 1: and well and let us know what.

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Speaker 2: The situation is.

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Speaker 1: But on the GPS in general is Michael Clements from

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Speaker 1: the Royal Australian College of General Practitioners.

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Speaker 2: Good morning to you, Michael, Good morning.

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Speaker 3: How is it Dan?

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Speaker 2: Yeah, really well, thank you so much for your time.

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Speaker 1: Now, Michael, do you know why some patients have noticed

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Speaker 1: billing changes at the doctors?

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Speaker 3: Well, the short term answer is that the Medicare rebate

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Speaker 3: having kept pace with the cost of business. So I'm

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Speaker 3: a practice owner myself and I run a couple of practices.

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Speaker 3: Year on year inflation goes up, we have pay more

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Speaker 3: in rent, wetuff more and cost more to keep the

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Speaker 3: lights turned on. But Medicare has been held back by

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Speaker 3: successive government for the last fifteen years and is far.

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Speaker 4: Below what it actually costs to provide a serve.

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Speaker 3: So sadly, the federal governments decided that people need to

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Speaker 3: start contributing themselves.

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Speaker 2: Michael, why is that?

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Speaker 4: You know?

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Speaker 2: Why have that? Look, why hasn't.

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Speaker 1: It gone up over fifteen years?

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Speaker 3: Yeah, well, it seems that the governments have really decided

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Speaker 3: to withdraw money from medicare by still.

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Speaker 4: The clearest example is this year.

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Speaker 3: When the Medicare rebate that a patient gets for seeing

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Speaker 3: us was only increased by one point sixty six. But

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Speaker 3: we all know the headline inflation to give this year

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Speaker 3: as above six. And if Medicare rebates had just kept

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Speaker 3: pace with inflation with no other increases other than inflation

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Speaker 3: from when it was brought in, the current rebate would

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Speaker 3: be double what they are now.

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Speaker 1: All right, we've learned that some gps here in the territory,

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Speaker 1: and I'm assuming across the nation as well, some of

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Speaker 1: the big local practices have moved to mixed billing.

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Speaker 2: What exactly does that mean?

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Speaker 3: Yeah, well, remembering that as small businesses that most general

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Speaker 3: practices are.

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Speaker 4: If we've got a rebate.

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Speaker 3: That's getting lower and lower year on year, we either

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Speaker 3: have to increase the number of patients we see per

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Speaker 3: hour and go from going to quicker medicine and try

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Speaker 3: and get people in and out as quickly as possible.

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Speaker 3: All we've got to ask them to contribute to the fee.

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Speaker 3: So what's happening more and more now is practices are

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Speaker 3: asking patients to reach into their pocket and actually contribute

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Speaker 3: to that consultation. So if Medicare had been indexed with inflation,

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Speaker 3: that the fee would be about eighty to eighty five dollars,

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Speaker 3: And in fact, that's what a lot of people are

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Speaker 3: now paying to see their GP. So that the patiental

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Speaker 3: pay the clinic eighty or eighty five dollars and now

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Speaker 3: get forty dollars back from Medicare.

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Speaker 1: Okay, And have these changes impacted our seniors and those

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Speaker 1: that are maybe on pension and concession cars or does

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Speaker 1: it not affect them?

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Speaker 3: It's been creeping towards the pensioners and those that are

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Speaker 3: most honorable. Many people, professionals would be used to paying

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Speaker 3: when they see their GP, and for a long time

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Speaker 3: GP practices where you're poessentially using that money to subsidize

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Speaker 3: the care for pensioners.

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Speaker 4: And age care and children.

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Speaker 3: And we'd love to love nothing more than to be

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Speaker 3: able to bulkle everybody that walks through the door, but

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Speaker 3: we just can't recruit, and we just can't afford to

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Speaker 3: pay the staff if we accepted that. So more and

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Speaker 3: more practices now are asking pensioners and children to actually

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Speaker 3: check their wallets before they see their doctor. And this

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Speaker 3: is well within the realm of the federal government to fix,

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Speaker 3: but the government act the government has chosen not to

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Speaker 3: do so.

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Speaker 1: Yeah, right, so doctor clements, you know, I mean, what's

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Speaker 1: the message for the federal government here? Is it time

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Speaker 1: for our gps to sort of step up and go, hey,

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Speaker 1: enough's enough. We actually need this man care rebate to change.

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Speaker 3: Well, we've got to remember the many care rebate is

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Speaker 3: the patients. It's not a to the doctor. It's actually

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Speaker 3: what the patient receives from the government as a support

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Speaker 3: and like an.

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Speaker 4: Insurance to see the doctor.

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Speaker 3: The federal government needs to listen to the constituents and

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Speaker 3: listen to these vulnerable patients and how hard is getting

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Speaker 3: for them to see a GP and how much it's

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Speaker 3: costing them. And if the federal government wants to support

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Speaker 3: these most vulnerable patients, it needs to give them a

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Speaker 3: higher rebate. That'll certainly be something that improves their access.

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Speaker 3: But there's another raft of things. There's no one syllabullet

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Speaker 3: that's going to work towards increasing the number of gps

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Speaker 3: in the workforce.

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Speaker 1: What kind of impact do you reckon that it is

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Speaker 1: going to have. Presumably some people, and I know that

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Speaker 1: they shouldn't, But for some people, they might think, well, look,

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Speaker 1: I actually can't afford to go to the GP, so

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Speaker 1: I'm just going to front up an emergency.

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Speaker 2: Do you think that there's.

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Speaker 1: Going to be an impact in terms of greater pressure

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Speaker 1: on emergency and on our hospitals.

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Speaker 3: Well, there already is, so you're right. So some people

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Speaker 3: absolutely choosing not to see their GP because they can't

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Speaker 3: afford that out of proper cross and that's very sad,

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Speaker 3: and we really wish to settle government hadn't chosen the path.

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Speaker 3: What we'd prefer is that the federal government subsidize them

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Speaker 3: so that they could see US. And so two things

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Speaker 3: are happening, and it's already happening at different parts of

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Speaker 3: the country. People will present to the emergent departments for

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Speaker 3: non urgent things.

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Speaker 4: But that's actually not a big deal.

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Speaker 3: The biggest deal is when people don't see us as

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Speaker 3: their GP early on in their blood pressure gen or

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Speaker 3: their mental health journey, or with their shortness of breath

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Speaker 3: then we can't prevent that first heart attack of CROW

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Speaker 3: or admission to pneumonia. So with all these people not

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Speaker 3: seeing their GP when they should, now they're actually getting

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Speaker 3: further down the track of chronic disease. With their heart

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Speaker 3: disease are their diabetes, and they're actually more likely to

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Speaker 3: end up in hospital with admissions or dying from disease. Now,

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Speaker 3: this is already happening and we need it to stop.

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Speaker 1: Yeah, well, and it's quite a worry, you know, if

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Speaker 1: that is the case. Now, I do want to ask

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Speaker 1: you how's the Northern Territory going in regards to doctors.

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Speaker 1: Is there still a shortage?

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Speaker 4: Yes, sainly there's a shortage. There's an absolute shortage.

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Speaker 3: Of doctors in the Northern Territory and in the country,

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Speaker 3: but certainly felt strongly in the Northern Territory. I mean,

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Speaker 3: you've actually trained in the Northern Territory as a GP register

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Speaker 3: and Catherine and I really remember my time very fondly.

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Speaker 3: It was a very rich experience. But we know that

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Speaker 3: lesson less doctors are choosing general practice, and so we

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Speaker 3: are looking pulling out all stops, trying to find out

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Speaker 3: the incentives to get people to try out the Northern

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Speaker 3: Territory had mentioned too, it's not just the doctors, your

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Speaker 3: remote area nurses which are crucial for the workforce out

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Speaker 3: there are in very short supply, Aboriginal health workers and

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Speaker 3: all the other alloyed health So this in Northern Territory

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Speaker 3: is certainly feeling the crisis that's going on nationally more

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Speaker 3: and we really do need the government, through its Primary

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Speaker 3: Care Plan which is underway, to recognize and actually invest

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Speaker 3: some new and real resources into fixing it.

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Speaker 1: And so what's driving it for making it more difficult

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Speaker 1: in the territory than some of our other locations around Australia.

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Speaker 4: Well coming having.

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Speaker 3: Actually grown up a fair bit in the territory and

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Speaker 3: work there. I don't know why everybody knows the territory

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Speaker 3: is the best place in Australia, but we know that

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Speaker 3: some of the remoteness, some of the isolation is a

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Speaker 3: bit can be a bit of a disincentive to some.

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Speaker 3: So that's why we're trying to get those with a

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Speaker 3: sense of adventure. But you know, if you're intended Creek,

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Speaker 3: can you see a GP for your mental health or

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Speaker 3: for your new blood pressure change?

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Speaker 4: The actual medicare rebate.

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Speaker 3: To see you in Greek is exactly the same as

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Speaker 3: in the middle of Sydney. So if you're a doctor

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Speaker 3: and you're thinking about where you want to work, there's

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Speaker 3: actually nothing really pulling you. There's not enough to pull

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Speaker 3: you out to some of those remarkable places. So we

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Speaker 3: do need to see a real shift where the government

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Speaker 3: actually incentivizes doctors to go to the areas that most

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Speaker 3: need them. And once they figure out how to do that,

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Speaker 3: and I guess listen to the advocacy agencies, then we

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Speaker 3: should get much better health care for everywhere from Tennant

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Speaker 3: Creek and Sextimber Creek, for Alice Springs and surrounds.

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Speaker 1: I mean, do you think that we could be doing

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Speaker 1: more in terms of incentives as well to attract doctors

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Speaker 1: to regional and remote parts of the territory.

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Speaker 3: Well, it's not just about money, but money does need

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Speaker 3: to be part.

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Speaker 4: Of the solution.

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Speaker 3: I know one of the practice owners now in Katherine

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Speaker 3: is doing a wonderful job. One of heard and that

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Speaker 3: in fact is it's housing. It can often be housing

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Speaker 3: that's the main barrier. It might be schooling for the

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Speaker 3: children or childcare for very young children. For our doctors' families.

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Speaker 3: It can be thousand, employment and travel and access and

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Speaker 3: all of these things need to be looked at me

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Speaker 3: and that's what the whole community benefits from. So there

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Speaker 3: does need a community based approachach. Community Catherine needs a

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Speaker 3: different solution to everywhere else, to Tennant Creek, to all

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Speaker 3: of the beautiful places in arnam Land, which I know

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Speaker 3: still screaming for doctors. Man and Greed is a beautiful spot,

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Speaker 3: but they're often recruiting as well. We need to find

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Speaker 3: local solutions that cover both financial incentives to the doctor

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Speaker 3: but also community packages that can help recruit.

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Speaker 1: Now, before I let you go, are we attracting overseas

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Speaker 1: doctors as well? Now that those borders have reopened.

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Speaker 3: The borders reopening is certainly going to make it easier

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Speaker 3: for us to recruse, and there's been an expansion in

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Speaker 3: what's called GPA, which means that there's going.

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Speaker 4: To be a lot more places that these doctors can work. Sadly,

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Speaker 4: the whole world is busy.

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Speaker 3: Gps all across the world are really flat chat with

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Speaker 3: the effects of COVID, and so there's been a lot

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Speaker 3: less movement even though the borders are open. So there

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Speaker 3: is movement and we Northern territory and most of the

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Speaker 3: rule Remote Australia relies very heavily on the osea's trained

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Speaker 3: doctors and we would like to see the federal government

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Speaker 3: give a bit more support to them. In fact that

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Speaker 3: they just stopped funding an incentive to help them cover

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Speaker 3: their training costs for these overseas trained doctors. This year

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Speaker 3: they're calling the government to reinstate what's called funding for

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Speaker 3: a f SPS. So we do need to do our

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Speaker 3: best to recruit overseas and support them once they do

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Speaker 3: decide to come out here.

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Speaker 1: Well, doctor Michael Clements, we really appreciate your time this morning.

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Speaker 2: Thanks so much for having a chat with us.

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Speaker 4: Good talking to you.

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Speaker 2: Thank you,