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Speaker 1: Now we know that a fifth COVID vaccine's now being

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Speaker 1: offered to certain age groups, and we were contacted by

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Speaker 1: listeners yesterday and the day before wanting to know where

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Speaker 1: they can go, and well we can get that jab now.

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Speaker 1: Robin Carl joins me on the line right now to

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Speaker 1: give us a bit of an update. She is indeed

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Speaker 1: from the Palmeston GP Superclinic. She is the CEO. Good

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Speaker 1: morning to you.

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Speaker 2: Robin, Good morning Katie.

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Speaker 1: Great to have you on the show. Robin. Who's eligible

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Speaker 1: for the fifth dose of the vaccine?

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Speaker 2: So anyone over the age of eighteen who has not

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Speaker 2: had an active case confirmed case of COVID in the

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Speaker 2: previous six months, or who hasn't had a COVID vaccination

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Speaker 2: in the previous six months are able to access this

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Speaker 2: fifth dose after the twentieth of February.

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Speaker 1: So after the twentieth of February, and Robin, have you

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Speaker 1: had many people getting in contact with you sort of

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Speaker 1: wondering more about it.

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Speaker 2: We have had quite a few calls because, as you know,

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Speaker 2: when the government has rolled out previous doses, there's been

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Speaker 2: so many conditions attached to them. You know, you had

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Speaker 2: to be over a certain age you had to be

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Speaker 2: suffering from a particular condition or a whole range of

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Speaker 2: other things, and there was this very staggered approach to

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Speaker 2: providing access for the vaccines to people. This time, they've

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Speaker 2: just gone over eighteen haven't had COVID in the last

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Speaker 2: six months, haven't had a COVID vaccine in the last

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Speaker 2: six months. And it doesn't matter where you're up to

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Speaker 2: in your COVID vaccination cycle. They're saying you should have

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Speaker 2: this dose.

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Speaker 1: Yeah right, and so can people get it anywhere? What's

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Speaker 1: the process?

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Speaker 2: So there are a significant number of general practices now

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Speaker 2: in the Darwin and Alice Springs area who are doing

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Speaker 2: COVID vaccines. It's changed a little bit for us because

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Speaker 2: up until the end of last year we were an

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Speaker 2: Australian Government vaccination center, but they ceased that to the

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Speaker 2: end of last year, so we're now just providing the

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Speaker 2: service as per usual general practice services. So anyone can

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Speaker 2: ring up and book in or go online and book in,

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Speaker 2: and most practices, I think their usual GPS, if people inquire,

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Speaker 2: will actually be able to provide that service for them.

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Speaker 2: If they can't, they're more than welcome to come out.

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Speaker 1: Yeah right. Robin speaking of you know of GPS, and

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Speaker 1: we've been getting quite a few or we've sort of

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Speaker 1: been getting quite a constant number of calls and hearing

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Speaker 1: quite a few stories about concerns from seniors claiming that

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Speaker 1: they're no longer being bulk billed. I know that there

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Speaker 1: has been a process change. You and I have spoken

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Speaker 1: about it before, but what is the situation right across

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Speaker 1: the territory and right around Australia at the moment when

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Speaker 1: it comes to that bulk billing.

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Speaker 2: I think the challenge has been that for a very

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Speaker 2: long time, the rebate that people get, so people get

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Speaker 2: confused that Medicare is the funding system for general practice care,

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Speaker 2: but it's not. It's actually the amount of money that

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Speaker 2: the federal government are saying to us, we are happy

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Speaker 2: to subsidize your healthcare to the amount of and it

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Speaker 2: varies depending on what you have done. The problem with

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Speaker 2: it is that it's been out of step with the

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Speaker 2: cost of living and cost of delivering services for probably

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Speaker 2: two decades. There was the review done in the late

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Speaker 2: nineteen eighties where they looked at what was happening in

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Speaker 2: general practice and what the rebates were, and at the

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Speaker 2: time they said it was significantly out of step, and

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Speaker 2: to be honest, it hasn't increased a lot since then,

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Speaker 2: so it's been out of step with the cost of

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Speaker 2: providing services and the cost that people are dealing with

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Speaker 2: on a day to day basis, just in terms of

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Speaker 2: daily living for a very long time.

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Speaker 1: So in the national news, I know that this morning

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Speaker 1: there were some reports that a lot of gps are

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Speaker 1: going to soon stop that bolt billing all together, citing

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Speaker 1: that Medicare has not sort of increased in line with inflation.

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Speaker 1: And you've just discussed the different reasons and some of

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Speaker 1: the concerns historically, what is your understanding of what's going

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Speaker 1: to happen. Do you think we'll wind up in a

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Speaker 1: situation where there are a lot of clinics that do

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Speaker 1: phase it out.

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Speaker 2: I certainly hope not. The whole intention of the Medicare

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Speaker 2: system when it was first rolled out several decades ago

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Speaker 2: now was to assist those people who couldn't afford care

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Speaker 2: to access care, and the expectation was that those of

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Speaker 2: us who earned a reasonable living, who could afford to

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Speaker 2: spend a few dollars on our own health, would actually

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Speaker 2: pay a private fee. Unfortunately, the advent of fully bolt

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Speaker 2: willing clinics really created some major issues in that area

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Speaker 2: because people who were quite happy and willing and used

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Speaker 2: to paying a little bit of an out of pocket

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Speaker 2: became unused to paying it, and then there became this

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Speaker 2: expectation that basically, you get that service and you don't

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Speaker 2: have to pay for it, and then what we saw

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Speaker 2: was people over using the service. For some people, it

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Speaker 2: almost becomes the social outing to go regularly to see

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Speaker 2: their GP. So I really hope that what most general

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Speaker 2: practiceeople do will look at what they're doing and still

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Speaker 2: look after those people who are under also pensioners, healthcare cardholders, people,

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Speaker 2: young children, people, and if you've got three or four kids,

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Speaker 2: going to the doctor and having to pay for that

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Speaker 2: is very expensive.

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Speaker 1: Yeah, you spot on.

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Speaker 2: Yeah. So we've always been a mixed felling practice, and

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Speaker 2: there are a number of mixed filling practices around And

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Speaker 2: basically that means that we've got a core group of

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Speaker 2: patients that we will automatically bulk build. So we bold

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Speaker 2: build anyone up to the age of sixtent or actually

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Speaker 2: until they leave high school. We also bill our pensioners,

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Speaker 2: our healthcare cardholders and so on, and we charge a

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Speaker 2: private fee for people who don't fall into those categories.

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Speaker 2: More recently, we've introduced a new patient fee irrespective of

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Speaker 2: whether the people fall into those characters. Categoristically, because we've

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Speaker 2: been overwhelmed and because we offer services that are available

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Speaker 2: when other services are often closed, we found we have

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Speaker 2: this influx of people looking for assistance, so it became

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Speaker 2: very unmanageable for us. I think most of the practices

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Speaker 2: around at the moment are still looking to build, for example,

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Speaker 2: pensmus so I hope they don't move away from that.

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Speaker 2: It does take a little bit of balancing. It is

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Speaker 2: a difficult environment to be in, but it's not impossible.

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Speaker 1: Yeah, and Robert, where are things that I know that

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Speaker 1: there was going to be that review into medicare? Where

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Speaker 1: are things that with that from your understanding? And what

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Speaker 1: do your hope comes out of that review?

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Speaker 2: I have to be honest, I was a little bit

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Speaker 2: amused when the main discussion point that came out was

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Speaker 2: that they would provide Medicare billing for non GPS SO

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Speaker 2: nursing and paramedics, et cetera, et cetera. Not amused because

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Speaker 2: those people shouldn't be involved in the care, but because

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Speaker 2: they've done that previously, and surprisingly people utilize those services

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Speaker 2: and they went, oh, my goodness, we didn't expect it

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Speaker 2: to be this popular, so I stopped funding it. So

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Speaker 2: I think that what they really should be looking at

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Speaker 2: is the bigger picture, which is one, why don't we

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Speaker 2: have enough general practitioners? Why are people leaving general practice?

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Speaker 2: And if we had more GPS in the mix and

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Speaker 2: greater access to people, then you get a more equitable

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Speaker 2: spread of who's prepared to bolt build the vulnerable groups

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Speaker 2: and who's not. I think the very simple solution to

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Speaker 2: all of this. The biggest impediment for general practitions is

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Speaker 2: they probably don't want to charge the scene is, say,

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Speaker 2: for example, sixty dollars instead of just bolt billing them.

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Speaker 2: The outer pocket on that is only about twenty dollars.

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Speaker 2: But to get that charge through, the doctor has to

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Speaker 2: ask the patient to pay the entire amounts and then

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Speaker 2: they get the rebate back. So to come up with

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Speaker 2: the sixty dollars not just the twenty. If the federal

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Speaker 2: government would actually stop and have a think about the

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Speaker 2: fact that a copayment capacity would make it far more

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Speaker 2: manageable for everybody, it would be a much easier solution

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Speaker 2: so that would mean that, for example, you might charge

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Speaker 2: sixty dollars the patient paste twenty and the balance of

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Speaker 2: it is bill directly to Medicare. But at this point

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Speaker 2: in time, doing that is illegal. If they really are

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Speaker 2: genuinely serious about making healthcare affordable, making Medicare work better

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Speaker 2: for everybody, that's where they should be looking.

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Speaker 1: Well, and you know it's going to make it like

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Speaker 1: it makes it better for everybody. Then if you've got

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Speaker 1: people that are actually going to their GP and they're

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Speaker 1: able to see their GP rather than maybe even presenting

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Speaker 1: to emergency because they can't afford to go to.

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Speaker 2: The GP exactly, we're seeing a significant increase in presentations

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Speaker 2: to emergency departments, which is really concerning. The Other part

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Speaker 2: of that is that even if somebody goes to the

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Speaker 2: ED and has an initial consultation there is there's something

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Speaker 2: that they need longer term managed, they've then still got

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Speaker 2: to connect with someone in a primary health care arena

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Speaker 2: because you can't keep going back to ED for your

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Speaker 2: long term chronic disease care. So it's really the main

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Speaker 2: questions are why are new grad not wanting to b GPS.

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Speaker 2: I think it's partly the bad publicity around the fee schedules,

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Speaker 2: et cetera. But it's also there's a huge amount of

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Speaker 2: red tape associated with being a general practitioner that is

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Speaker 2: not required of any other specialty. So the justification processes

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Speaker 2: for providing good care in the crime and health arena

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Speaker 2: are really burdensome, and that's one of the things that

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Speaker 2: makes it very difficult for doctors to consider stay in

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Speaker 2: general practice. So as for example, our doctors might do

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Speaker 2: a good eight hour day seeing their patients and then

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Speaker 2: I'll spend another two or three hours into the evening

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Speaker 2: just trying to keep on top of all the paperwork.

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Speaker 2: As I've said, no other practice specialty requires that, and

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Speaker 2: that needs to be looked at very specially as well.

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Speaker 1: Yeah, hey Robin, before I let you go, we are

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Speaker 1: we're getting fed fit here at mix one O four

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Speaker 1: nine this month, and we're spending we're all spending a

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Speaker 1: bit more time, I guess out in the sun. So

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Speaker 1: it has got a lot of us thinking about whether

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Speaker 1: and how often you need to go for a skin check.

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Speaker 1: How often is it something you know? Is that something

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Speaker 1: that we should be doing, and do you reckon that?

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Speaker 1: It's something that people often forget to do.

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Speaker 2: I think people forget to do it all the time

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Speaker 2: because we get a little bit blase about it. You should,

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Speaker 2: at a minimum be doing an annual skin check. If

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Speaker 2: you're like me and blessed with Irish heritage, you probably

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Speaker 2: should do it a little more often, especially here in

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Speaker 2: the territory, because we have very very high v ratings

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Speaker 2: and we forget that because we're so used to it.

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Speaker 2: So I think that's very important. Your GP can do

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Speaker 2: it for you. There's quite a few skin clinics around

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Speaker 2: if your GP is not comfortable doing skin checks, but

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Speaker 2: a simple skin check will help you keep an eye

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Speaker 2: on anything that might be changing on your skin and

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Speaker 2: your body and just yourself. If you see something on

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Speaker 2: your skin and you're worried about it, don't be embarrassed

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Speaker 2: about asking about it. If it turns out to be nothing,

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Speaker 2: that's fantastic. But if it turns out to be something,

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Speaker 2: it's so important to catch it early because too often

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Speaker 2: people read it way too late, and the first they

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Speaker 2: know that they've got an issue when they're diagnosed with

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Speaker 2: a memoonom a WIT is very poor outlook. So get

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Speaker 2: your skin checked at least annually, and keep it on

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Speaker 2: your kids too. I think we in Australia have set

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Speaker 2: the standard for growing your skin cancers when we're quite

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Speaker 2: young as we're older, so really think about the time

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Speaker 2: they spend in the sun. That Slip Slap Slop campaign

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Speaker 2: was probably one of the best ones that we're ever

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Speaker 2: done in terms of marketing and promotion. And just if

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Speaker 2: you're concerned, see something that doesn't look quite right, just

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Speaker 2: get your GP to have a look at it for

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Speaker 2: you and get a chat.

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Speaker 1: Very good advice, Robin Carl, it's always great to speak

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Speaker 1: with you. Thank you so much for having a chat

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Speaker 1: with us this morning.

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Speaker 2: Most welcome. Kadi, it's always good to talk to you

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Speaker 2: as well.

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Speaker 1: Thank you. We'll talk again soon.