1 00:00:00,080 --> 00:00:02,960 Speaker 1: Now we've been contacted by a number of listeners raising 2 00:00:03,000 --> 00:00:06,280 Speaker 1: concerns over recent days and weeks about being charged to 3 00:00:06,320 --> 00:00:09,120 Speaker 1: go to the doctors when they normally wouldn't be as 4 00:00:09,200 --> 00:00:13,440 Speaker 1: pensioners and concession holders. It is another strain on people's budgets. 5 00:00:13,440 --> 00:00:16,040 Speaker 1: With Christmas just around the corner. Joining me on the 6 00:00:16,079 --> 00:00:19,720 Speaker 1: line right now is doctor Sam Hurd, who is indeed 7 00:00:19,760 --> 00:00:23,960 Speaker 1: from the Royal College of General Practitioners, the Northern Territory Chair. 8 00:00:24,400 --> 00:00:30,400 Speaker 1: Good morning to you, doctor Herd. Hello, Hello, thanks so 9 00:00:30,520 --> 00:00:34,320 Speaker 1: much for your time this morning. Now, doctor, do you 10 00:00:34,400 --> 00:00:38,000 Speaker 1: know there are women there? Obviously is some occasions where 11 00:00:38,000 --> 00:00:40,840 Speaker 1: concession card holders and pensioners are all of a sudden 12 00:00:40,920 --> 00:00:44,479 Speaker 1: being charged to see a doctor in Darwin. Is that 13 00:00:45,000 --> 00:00:49,760 Speaker 1: Is that happening from your perspective, Yeah. 14 00:00:49,560 --> 00:00:56,000 Speaker 2: I guess it's rare. Most practices would bill a bulk 15 00:00:56,080 --> 00:01:04,680 Speaker 2: bill group generally, and you do get you do get 16 00:01:04,720 --> 00:01:08,240 Speaker 2: an extra bolt building fee to do that, Yeah, ten 17 00:01:08,319 --> 00:01:12,880 Speaker 2: dollars or so eleven dollars, So it's there's a little 18 00:01:12,920 --> 00:01:15,480 Speaker 2: bit of incentive to bolt build that group. So I 19 00:01:15,520 --> 00:01:18,240 Speaker 2: think the main change, honestly is not in that group. 20 00:01:18,280 --> 00:01:21,800 Speaker 2: It's in the people that don't have those cards probably 21 00:01:21,800 --> 00:01:24,640 Speaker 2: where the big change has been I think, yeah. 22 00:01:24,600 --> 00:01:27,880 Speaker 1: Right, So talk us through that change and why it 23 00:01:27,959 --> 00:01:30,720 Speaker 1: has come into play. 24 00:01:30,880 --> 00:01:35,040 Speaker 2: So you know, historically in Darwin, if we go back 25 00:01:35,080 --> 00:01:39,399 Speaker 2: twenty years that the main people will bolt build if 26 00:01:39,400 --> 00:01:44,040 Speaker 2: they were confession cardholders, elderly children, they were the groups 27 00:01:44,040 --> 00:01:46,600 Speaker 2: that were and that's that's the group now that have 28 00:01:46,680 --> 00:01:50,080 Speaker 2: a bit of an incentive to do that. What happened 29 00:01:50,080 --> 00:01:52,640 Speaker 2: then was we've got bolt building clinics in Darwin. So 30 00:01:52,720 --> 00:01:55,360 Speaker 2: that's a new disruptive thing that happened all over the 31 00:01:55,400 --> 00:02:00,520 Speaker 2: country and they would see most of the light is stuff. 32 00:02:01,600 --> 00:02:04,080 Speaker 2: People who are sicker might go there, or they might 33 00:02:04,200 --> 00:02:08,640 Speaker 2: choose to go to general practitioner that was working in 34 00:02:08,680 --> 00:02:13,040 Speaker 2: a billing practice. And the doctors who came in were 35 00:02:13,080 --> 00:02:17,400 Speaker 2: in training. A lot of them they weren't qualified GPS, 36 00:02:18,720 --> 00:02:21,920 Speaker 2: and they I guess had a high throughput and made 37 00:02:22,040 --> 00:02:23,880 Speaker 2: quite a lot of money by having a high throughput. 38 00:02:24,680 --> 00:02:28,919 Speaker 2: As that's sort of change. People have now done their 39 00:02:28,960 --> 00:02:33,320 Speaker 2: training specialized taking on more complex things. I think just 40 00:02:33,440 --> 00:02:37,720 Speaker 2: generally as a standard list, you can't deal with things 41 00:02:37,760 --> 00:02:40,560 Speaker 2: in five or ten minutes. You've got to actually do things. 42 00:02:40,520 --> 00:02:43,800 Speaker 2: Stop leaves and tests off and see what's going on. 43 00:02:43,919 --> 00:02:49,120 Speaker 2: So that group are now I guess, seeking to build 44 00:02:49,200 --> 00:02:52,720 Speaker 2: people because Medicare, which was frozen to ten years, I think, 45 00:02:52,760 --> 00:02:56,840 Speaker 2: you know, just can't cover the costs for a practice. 46 00:02:56,880 --> 00:02:59,799 Speaker 2: It's got to cover the cost of receptionist running the 47 00:03:00,160 --> 00:03:03,280 Speaker 2: practice doing you know, it's not just going to the 48 00:03:03,320 --> 00:03:05,880 Speaker 2: doctor when you get thirty five dollar bill, it's going 49 00:03:05,960 --> 00:03:11,359 Speaker 2: to the whole system that's running that. You can imagine 50 00:03:12,200 --> 00:03:14,560 Speaker 2: in most practices that will be thirty or forty percent 51 00:03:14,600 --> 00:03:17,240 Speaker 2: of the overhead. It include your dressing to get on 52 00:03:17,280 --> 00:03:20,680 Speaker 2: all that sort of thing. The rest goes to the GP. 53 00:03:20,960 --> 00:03:24,160 Speaker 2: So forty percent of thirty five dollars, quarter of an 54 00:03:24,160 --> 00:03:27,480 Speaker 2: hour times four to work that out, it's not you know, 55 00:03:27,480 --> 00:03:30,600 Speaker 2: it's maybe eighty dollars an hour or something like that. 56 00:03:31,240 --> 00:03:33,560 Speaker 2: And I know that I think four people are now. 57 00:03:34,080 --> 00:03:37,720 Speaker 1: I know that there has been some some more serious discussion, 58 00:03:37,760 --> 00:03:39,920 Speaker 1: I guess, about the way in which Medicare works. Over 59 00:03:39,920 --> 00:03:42,040 Speaker 1: the last couple of days, there was that review from 60 00:03:42,080 --> 00:03:45,640 Speaker 1: the Gratten Institute yesterday that found that Medicare needs an 61 00:03:45,800 --> 00:03:50,800 Speaker 1: urgent overhaul. They're saying a complete change needed to the 62 00:03:50,840 --> 00:03:54,720 Speaker 1: way that practitioner practitioners work and get paid. What are 63 00:03:54,760 --> 00:03:58,720 Speaker 1: your thoughts on those findings from the Gratten Institute report 64 00:03:59,120 --> 00:04:01,800 Speaker 1: and the why in which Medicare does work. 65 00:04:03,240 --> 00:04:05,880 Speaker 2: Okay, so I actually went over to the UK and 66 00:04:06,000 --> 00:04:09,080 Speaker 2: train to Mandi between theres a long while ago. Came 67 00:04:09,120 --> 00:04:13,840 Speaker 2: back to Darwin thirty years ago and over there they 68 00:04:13,880 --> 00:04:17,120 Speaker 2: fought to get some FIFA service. There's no FEAFA services, 69 00:04:17,200 --> 00:04:19,719 Speaker 2: just to a capital payment, and they fought very hard 70 00:04:19,760 --> 00:04:22,360 Speaker 2: to get a fee for serve and now they're really 71 00:04:22,440 --> 00:04:26,200 Speaker 2: struggling because people are coming nine or ten times a 72 00:04:26,279 --> 00:04:30,040 Speaker 2: year instead of three, which was thirty years ago. And 73 00:04:30,080 --> 00:04:33,839 Speaker 2: so that's thinking under the no fee for service arrangements. 74 00:04:34,240 --> 00:04:38,120 Speaker 2: The important thing to recognize is we need various funding 75 00:04:39,680 --> 00:04:42,320 Speaker 2: to do this job properly, not just feef for service. 76 00:04:42,360 --> 00:04:44,680 Speaker 2: We don't just have fee for service. Now we get 77 00:04:45,200 --> 00:04:48,159 Speaker 2: as much as forty percent of the practice income comes 78 00:04:48,200 --> 00:04:51,960 Speaker 2: through channels like support for nurses and other things that 79 00:04:52,440 --> 00:04:56,800 Speaker 2: Medicare needs reform. There's no doubt about that. The Gratton Institute, 80 00:04:57,160 --> 00:05:00,880 Speaker 2: they didn't talk to a College of GPS about that report, 81 00:05:01,080 --> 00:05:03,840 Speaker 2: but didn't ask anybody. You know, it's just kind of 82 00:05:04,720 --> 00:05:09,440 Speaker 2: madness to come out with the revolutionary, high profile news 83 00:05:10,160 --> 00:05:13,599 Speaker 2: kind of aimed at things without doing a job properly. 84 00:05:13,720 --> 00:05:16,880 Speaker 2: So I'm just very skeptical about that. If we're not 85 00:05:16,880 --> 00:05:20,400 Speaker 2: going to make sure GPS get carried along in this reform, 86 00:05:21,320 --> 00:05:24,200 Speaker 2: then you know everybody's going to be in a mess. 87 00:05:24,920 --> 00:05:27,679 Speaker 2: People will say, you know, having a physiotherapy, you're having 88 00:05:27,680 --> 00:05:30,239 Speaker 2: this access to all these things. I agree, it's great, 89 00:05:30,279 --> 00:05:32,919 Speaker 2: but you've still got to have something at the heart 90 00:05:33,000 --> 00:05:35,159 Speaker 2: of it. You know, if you take your ankle to 91 00:05:35,160 --> 00:05:37,920 Speaker 2: the physiotherapist and it's gout, they can't help you at all. 92 00:05:39,440 --> 00:05:41,599 Speaker 2: I heard a lot it feels like your ankle problem. 93 00:05:41,600 --> 00:05:44,320 Speaker 2: But you know you've got to have a medical heart 94 00:05:44,520 --> 00:05:48,039 Speaker 2: of primary care being a generous and primary care is tough. 95 00:05:48,160 --> 00:05:53,000 Speaker 2: You know, it's really demanding a knowledge basis high. So 96 00:05:53,560 --> 00:05:56,240 Speaker 2: you know, we'd be saying, yes, change things, but let's 97 00:05:56,240 --> 00:05:59,919 Speaker 2: get more resources into primary care so most care can happen. 98 00:06:00,920 --> 00:06:03,400 Speaker 2: That's where ninety five percent of care can have an 99 00:06:03,440 --> 00:06:05,000 Speaker 2: in primary care forget it right. 100 00:06:05,520 --> 00:06:07,680 Speaker 1: And so do you think that's what does need to 101 00:06:07,720 --> 00:06:10,719 Speaker 1: be happening, that there does need to be more resources 102 00:06:10,880 --> 00:06:13,640 Speaker 1: into primary care or how do you think things could 103 00:06:13,680 --> 00:06:14,800 Speaker 1: be shaken up a little bit? 104 00:06:16,120 --> 00:06:18,640 Speaker 2: I think so, you know, if you look in Denmark, 105 00:06:18,800 --> 00:06:22,720 Speaker 2: it's turned on its head really that primary care gets 106 00:06:22,720 --> 00:06:26,240 Speaker 2: the majority of funding and deals with most things. So 107 00:06:26,760 --> 00:06:28,520 Speaker 2: you know, we may or may not be quite ready 108 00:06:28,520 --> 00:06:31,680 Speaker 2: for that, but we know emergency department is not the 109 00:06:31,720 --> 00:06:35,760 Speaker 2: place to have your primary care. It's free ambulances whatever, 110 00:06:36,240 --> 00:06:40,200 Speaker 2: so there's no barriers to using their ethnics at waiting time, 111 00:06:40,240 --> 00:06:43,040 Speaker 2: but it's a really bad place to get your primary care. 112 00:06:43,080 --> 00:06:46,080 Speaker 2: You're not going to get good care in an emergency 113 00:06:46,080 --> 00:06:50,280 Speaker 2: department unless you're very sick. You're seeing young people without 114 00:06:50,360 --> 00:06:54,960 Speaker 2: training dealing with just the very superficial symptoms you're coming 115 00:06:55,040 --> 00:06:56,320 Speaker 2: with most of the time. 116 00:06:57,320 --> 00:06:59,720 Speaker 1: And so doctor Hurd, when you talk about that, when 117 00:06:59,720 --> 00:07:02,039 Speaker 1: you're talk talk about then people sort of presenting to 118 00:07:02,120 --> 00:07:04,799 Speaker 1: the emergency ward on things that they could be going 119 00:07:04,839 --> 00:07:09,400 Speaker 1: to their GP on or you know about obviously that 120 00:07:09,480 --> 00:07:12,920 Speaker 1: cost factor is what comes into play sometimes. And do 121 00:07:12,960 --> 00:07:15,160 Speaker 1: you think that we're going to see more people presenting 122 00:07:15,240 --> 00:07:18,080 Speaker 1: to emergency because they can't afford to go and see 123 00:07:18,120 --> 00:07:18,480 Speaker 1: a GP. 124 00:07:20,600 --> 00:07:23,760 Speaker 2: I think that's quite possible. I think you know that 125 00:07:23,840 --> 00:07:26,880 Speaker 2: there's always going to be a gap. The private thing 126 00:07:26,960 --> 00:07:31,720 Speaker 2: isn't very expensive. I think you know we've had a 127 00:07:31,760 --> 00:07:34,160 Speaker 2: culture where a government everyone's been trying to get everyone 128 00:07:34,200 --> 00:07:36,880 Speaker 2: bolt filled. They've frozen Medicare and that's been their way 129 00:07:36,880 --> 00:07:39,160 Speaker 2: of getting the cost of healthcare down. So now we've 130 00:07:39,200 --> 00:07:46,040 Speaker 2: got an underfunded primary care environment. The result is inevitably 131 00:07:46,080 --> 00:07:50,040 Speaker 2: practically going to look to the users to fund that more. So, 132 00:07:50,320 --> 00:07:52,440 Speaker 2: you know it's got to be about So yes is 133 00:07:52,560 --> 00:07:55,560 Speaker 2: the answer to your question. But you know, I think 134 00:07:55,600 --> 00:07:58,120 Speaker 2: the way Medicare is set up, you would expect to 135 00:07:58,160 --> 00:08:01,840 Speaker 2: pay something to go and see your primary care service. 136 00:08:02,320 --> 00:08:05,640 Speaker 2: In New Zealand where it's very so there's a fifty 137 00:08:05,680 --> 00:08:08,560 Speaker 2: dollars kind of notion every time you go to a 138 00:08:08,600 --> 00:08:13,320 Speaker 2: primary care doctor for example, that can be waived by 139 00:08:13,360 --> 00:08:16,920 Speaker 2: the doctor. And you know, general practitioners generally don't go 140 00:08:17,000 --> 00:08:21,080 Speaker 2: on charging people for getting their results back or whatever. 141 00:08:21,200 --> 00:08:23,840 Speaker 2: They don't, you know, charge you every time. I do. 142 00:08:24,800 --> 00:08:28,080 Speaker 2: And some do a very very good job and charge 143 00:08:28,160 --> 00:08:31,080 Speaker 2: for it because they have to be able to do that. 144 00:08:31,600 --> 00:08:33,800 Speaker 2: But the majority will charge you the first time you 145 00:08:33,880 --> 00:08:36,480 Speaker 2: go and then see you with the results and things, 146 00:08:36,520 --> 00:08:39,240 Speaker 2: and not doing you the second time and you can 147 00:08:39,360 --> 00:08:43,040 Speaker 2: ask about it. I mean, it's very interesting that there 148 00:08:43,080 --> 00:08:46,360 Speaker 2: doesn't seem to be any relationship from my experience between 149 00:08:46,400 --> 00:08:48,640 Speaker 2: how well off somebody is and whether they expect to 150 00:08:48,640 --> 00:08:49,679 Speaker 2: be bulk built or not. 151 00:08:51,679 --> 00:08:53,480 Speaker 1: So you mean it doesn't matter, like even if they 152 00:08:53,480 --> 00:08:55,240 Speaker 1: are hired, they still expect to. 153 00:08:55,200 --> 00:08:59,040 Speaker 2: Be bulk built. It's just that rage at some people 154 00:08:59,120 --> 00:09:01,920 Speaker 2: that you and then they'll be a plumber of something 155 00:09:01,960 --> 00:09:04,040 Speaker 2: and they'll charge you like a wounded bullets. You have 156 00:09:04,080 --> 00:09:05,360 Speaker 2: to get to call them out. 157 00:09:05,640 --> 00:09:08,200 Speaker 1: Well, doctor, whod I suppose? So there are there are 158 00:09:08,280 --> 00:09:10,120 Speaker 1: quite a few people who've been in contact with us 159 00:09:10,120 --> 00:09:13,200 Speaker 1: in recent weeks and they are concerned about those the 160 00:09:13,240 --> 00:09:17,600 Speaker 1: pricing structure changing or the payment structure changing. We have 161 00:09:17,760 --> 00:09:20,400 Speaker 1: heard from some pensioners as well who are worried that 162 00:09:20,520 --> 00:09:24,440 Speaker 1: they are now being charged. So are there like, are 163 00:09:24,480 --> 00:09:28,000 Speaker 1: there instances in the territory where that is happening from 164 00:09:28,040 --> 00:09:30,920 Speaker 1: your understanding or what should the situation be? 165 00:09:31,280 --> 00:09:34,120 Speaker 2: I know of, but there may well be. The important 166 00:09:34,160 --> 00:09:37,160 Speaker 2: thing I think is if your pension and your healthcare cardholder, 167 00:09:37,520 --> 00:09:42,280 Speaker 2: you can ring up and let's see a doctor that 168 00:09:42,400 --> 00:09:46,000 Speaker 2: will bolk be you. That's pretty clear. Most practices will. 169 00:09:45,880 --> 00:09:49,560 Speaker 1: Say okay, right, So if you are somebody who's on 170 00:09:50,080 --> 00:09:53,560 Speaker 1: who is one of those cardholders, you can actually call 171 00:09:54,000 --> 00:09:56,040 Speaker 1: and say that you want to see a doctor who 172 00:09:56,120 --> 00:09:57,520 Speaker 1: will bonk bell, you'dn't. 173 00:09:57,240 --> 00:09:59,120 Speaker 2: See a doctor who would do And if they say, 174 00:09:59,200 --> 00:10:01,800 Speaker 2: well we don't do that, here, bring around you're going 175 00:10:01,840 --> 00:10:05,679 Speaker 2: to find the majority of practices do actually do that. 176 00:10:06,280 --> 00:10:09,000 Speaker 2: They might say the first time you come, you're going 177 00:10:09,080 --> 00:10:12,200 Speaker 2: to bitter you, because that can be quite a long 178 00:10:12,360 --> 00:10:15,160 Speaker 2: kind of things. And they might say, you know, just 179 00:10:15,200 --> 00:10:17,439 Speaker 2: to have a transfer of ca it's inevitably going to 180 00:10:17,440 --> 00:10:19,720 Speaker 2: be a big To do it properly is going to 181 00:10:19,720 --> 00:10:21,120 Speaker 2: be a big handover. 182 00:10:21,640 --> 00:10:24,000 Speaker 1: We did have somebody just call through to my producer 183 00:10:24,040 --> 00:10:28,400 Speaker 1: and saying that they were told eighty five dollars for everyone, 184 00:10:28,600 --> 00:10:32,439 Speaker 1: sixty five dollars for concession holder from December tenth at 185 00:10:32,480 --> 00:10:36,280 Speaker 1: one and local practice, and about fifty for kids. That 186 00:10:36,360 --> 00:10:38,160 Speaker 1: person says that he is still a lot of money 187 00:10:38,240 --> 00:10:39,120 Speaker 1: for them. 188 00:10:39,920 --> 00:10:42,920 Speaker 2: Yeah, yeah, Well there will be practices around the do that, 189 00:10:43,000 --> 00:10:45,240 Speaker 2: and the people that go there, I guess they're going 190 00:10:45,240 --> 00:10:48,320 Speaker 2: to have more money or they're going to get a 191 00:10:48,400 --> 00:10:51,840 Speaker 2: much better service when they go there, and it's worth it. 192 00:10:51,960 --> 00:10:55,199 Speaker 2: That's the pressure, you know. They are free to do that. 193 00:10:55,679 --> 00:11:00,160 Speaker 2: It's a commercial arrangement. The Medicare payment is actually to 194 00:11:00,240 --> 00:11:06,160 Speaker 2: the client not to the practice. Legally, they hand it 195 00:11:06,200 --> 00:11:08,200 Speaker 2: over when they go and sign it. So if you're 196 00:11:08,200 --> 00:11:11,440 Speaker 2: bolt doing, it's still really going via the person. If 197 00:11:11,840 --> 00:11:15,240 Speaker 2: you pay immediately, the money goes back into your bank. 198 00:11:16,080 --> 00:11:18,160 Speaker 2: You know, it's to this client. 199 00:11:18,559 --> 00:11:21,720 Speaker 1: What is your advice to people if they can't afford that, like, 200 00:11:21,760 --> 00:11:25,000 Speaker 1: if they if they are in a situation where they can't, 201 00:11:25,280 --> 00:11:25,719 Speaker 1: it's to. 202 00:11:25,760 --> 00:11:29,880 Speaker 2: Ring around and just be upfront. And if you're not 203 00:11:30,000 --> 00:11:33,480 Speaker 2: a healthcare card holder and you need to get a 204 00:11:33,520 --> 00:11:36,840 Speaker 2: relationship and have your fifty dollars or whatever ready to 205 00:11:37,559 --> 00:11:40,960 Speaker 2: just want you know, let's save up and go and 206 00:11:41,000 --> 00:11:44,480 Speaker 2: do it properly if you if you're really strying. Because 207 00:11:44,520 --> 00:11:48,160 Speaker 2: boat doing practices in dah and now real. I think 208 00:11:48,200 --> 00:11:51,520 Speaker 2: there's one in Parmesan. Still we doing. I don't know 209 00:11:51,720 --> 00:11:53,960 Speaker 2: that I've heard that, but it's rare. 210 00:11:54,280 --> 00:11:59,640 Speaker 1: Now Well, Royal College of General Practitioners NT Chair Doctor 211 00:11:59,640 --> 00:12:02,440 Speaker 1: Sam heard. We appreciate your time this morning. Thank you 212 00:12:02,520 --> 00:12:03,600 Speaker 1: for having your chat with us. 213 00:12:03,720 --> 00:12:04,240 Speaker 2: Thank you