April 17, 2022



DAVID SPEERS, HOST: Mark Butler, welcome to the program.

SPEERS: And to you. The Australian Medical Association has called this policy barely coherent. One of their biggest concerns is if you have government-subsidised clinics, they will be competing unfairly with other GP practices who will then struggle to keep their doors open after hours. What's your response to that?
BUTLER: We are very confident that this policy will make a real difference to local communities. It will make it easier for people to see a doctor, particularly for those minor emergencies where families are spending hours and hours lining up in hospital emergency departments. And also, by extension, take real pressure off our hospitals which are heaving under unprecedented levels of demand through this pandemic.

We know it's never been harder to see a doctor, it’s never been more expensive to see a doctor, and we need that intermediate level of care between a standard General Practice and a hospital emergency department - when your kid falls off their skateboard and busts their arm or you have a very deep cut that needs stitching. Currently people can't get into a GP, particularly after hours, and they spend hours and hours instead in hospital emergency departments that were built for once-in-a-lifetime emergencies like heart attacks, and strokes, and car accidents, not these emergencies that could be quite adequately dealt with outside in the community, if only that service were available.
SPEERS: Just back to that question and the concern from the AMA, tell us how this works. If you have one GP practice getting a couple million bucks from the Government, and others in that suburb are saying, "hang on, this is unfair." How does that work? What happens to their business?
BUTLER: This will be a competitive process overseen by the Department. We will identify particular regions where we know there is huge pressure on hospital emergency departments, population growth and the like. GP practices who want to take their practice to the next level will be able to apply for the additional funding that we know is necessary to make these services viable. The service will be open seven days a week, fully bulk-billed, so no co-contribution or gap fee at all –
SPEERS: Just on that, is that everybody who walks through the doors of that practice all day long? They will all have to be bulk-billed at that practice?
BUTLER: No, this will be a service particularly targeted at minor emergencies. There will be a triage process and we will talk to state governments about this.
SPEERS: So it would depend on the nature of the injury as to whether you will be bulk-billed or not? If you have a broken arm, it is bulk-billed. If you have a broken finger, maybe not?
BUTLER: These are decisions that will be taken clinically. There is a lot of engagement that will need to take place with local state departments but also PHNs, to make sure we get this model right. We've seen overseas this model has had a really serious impact in making it easier to see a doctor and taking pressure off hospital emergency departments. We've seen it in the US, the UK and probably most importantly, the most advanced model, in New Zealand. They have the lowest level of emergency department presentation in the entire developed world, really taking pressure off hospitals. We know here in Australia emergency departments are heaving under unprecedented demand. This allows a family to take their kid who has fallen off their skateboard to a local doctor to get the care that they need, free of charge, when they need it, instead of spending hours lining up in the hospital.
SPEERS: They won't know it is free of charge until they get there, right?
BUTLER: We intend to publicise this policy very widely. We know this is the sort of policy that patients want. In the days since the announcement, I've been contacted by a number of different GP organisations that I've been speaking to over the last several months. They want to take their practice to the next level. They know there is a level of demand for that.
SPEERS: Will the family know they will be bulk-billed if their kid has fallen offer the skateboard, to use that example, will that be clear or will they only know when they turn up?
BUTLER: We’d hope of course that people understand that this service is available in their community. We will do everything we possibly can to publicise it.
SPEERES: Will they be bulk-billed?
BUTLER: Yes, the condition of this funding would be that the service is open 7 days a week, it is open from at least 8:00am to 10:00pm when we know the vast bulk of these minor emergencies take place, and it is fully bulk-billed.
SPEERS: But it depends on the nature of the injury whether they are bulk-billed?
BUTLER: This is a service set up for urgent care. There is GP practices in place for your standard consultation, there are hospitals to deal with the once in a lifetime emergencies I've talked about. This is the missing middle in Australia. We've seen it operate really well in other countries. We want to expand Medicare, we want to make it easier to see a doctor when these sorts of things inevitably arise in households, so that people get the care when and where they need it instead of spending hours in already overcrowded hospital emergency departments.
SPEERS: One of the issues with this policy is finding more GPs when there is already a shortage of GPs and nurses. Your colleague Clare O'Neil was asked whether nurses would be brought in from overseas. She said, "No, no, no." Will they?
BUTLER: For this and for aged care, we are confident that a vote of confidence in the aged care system, and we've made that in the Budget Reply, a vote of confidence in the Medicare system, which we are making through this urgent care announcement, will tell nurses, will tell GPs that this is an exciting, innovative place to work. What we’ve seen over the last 10 years –
SPEERS: Sorry to come back to the question: Will they be brought in from overseas?
BUTLER: No, I don't think they will be, I think it will be very clear that Australian GPs will want to work in this type of practice. I've been inundated by General Practice organisations calling our office, emailing us in the last several days, saying they want to be part of this. They know local GPs will want to work in this type of practice. It is exciting, interesting work and they know it will make a real difference to their local communities. It is the sort of vote of confidence in General Practice that you haven't got from this Government, that has just had cuts and neglect in General Practice over the last 10 years, running down the system instead of expanding it.
SPEERS: So you’re confident you will find these GPs and nurses. When would these 50 clinics be up and running?
BUTLER: If we are elected we want to see them up and running in the next financial year, commencing 1 July 2023.
SPEERS: All 50?
SPEERS: There was confusion, too, about whether the policy has been costed or not. Anthony Albanese said it was fully costed by the Parliamentary Budget Office and then admitted that it wasn't. Two questions: why the confusion, and why aren't you using the Parliamentary Budget Office?
BUTLER: This policy has been fully costed, it has been informed by work of the Parliamentary Budget Office, but the key consultation about the cost has been with General Practices who understand what additional funding they need to make this model work. A lot of GP organisations have been trying to do this, but they've found that the existing Medicare funding arrangements, which are really modelled around standard General Practice, simply don't make the model viable, so I've worked with them very closely. I'm confident that the capped funding that we've allocated, fully costed, will be sufficient to make sure that these 50 practices will deliver care and make it easier to see a doctor.
SPEERS: That’s what I’m asking – who has done the costing?
BUTLER: It’s costing based on organisations that we've been talking to who do this work, who understand this business intimately. All of our costings will be fully released in the usual way through the course of this campaign by Katy Gallagher and Jim Chalmers. There will be no difference between the way in which the Labor Party releases its costings and the Liberal Party. No difference between this election and the last election or the election before it. It will all be very standard, David.
SPEERS: All right, and the same applies with your aged care policy that was announced in the Budget Reply? Has that been costed by the Parliamentary Budget Office?
BUTLER: That’s fully costed, it will be released in exactly the same way as all of our policies and frankly all of the Coalition’s policies as well.
SPEERS: Just not by the Parliamentary Budget Office?
BUTLER: David, our costings will be released in exactly the same way they always have been in these election campaigns and exactly the same way the Coalition's policies, including policies they have announced today. Their costings, I’m confident, will be released in exactly the same way as the Labor Party’s will be.
SPEERS: Just a couple of questions, the Labor Party has promised a national integrity commission will happen by the end of the year if you win. Will it look at pork-barrelling as well as corruption?
BUTLER: We are very clear that we want to clean up the rorts. Three and a half years after the promise from the Prime Minister, hundreds of millions of dollars of taxpayers money spent as if it's Liberal Party funds, it is clear enough is enough and the only way to end those rorts is by changing the government, because the Government itself has walked away from this. I see a whole lot of Liberal MPs in the paper today saying “it is not a big deal”, but that's not the feedback we get.  The feedback we get is Australians are sick of the rorts. They are sick of their money being spent as if it's Liberal Party money and we are committed to making sure there is a tough cop on the beat, that will clean up these rorts, that can act independently, not on the approval of the government of the day. That can look backwards, so can undertake retrospective investigations, and can have public hearings when the independent commission thinks that that is in the public interest.
SPEERS: You did talk earlier when talking about the plan for GP urgent clinics, about a proper process, the Department would look at regions that really need them. Anthony Albanese has already announced one in the marginal seat of Hunter. Your Labor MP in Lyons has announced there will be three in Tasmania, marginal seats there. Have they gone through a proper bidding process?
BUTLER: We've analysed the hospital emergency department data across the country. The Hunter Valley has some of the worst waiting times in emergency departments in New South Wales. That is a very clear area of need. We are identifying broad areas of need. They will run through the whole country, urban and regional, Liberal Party held seats, Independent seats, Labor Party seats, because they will be targeted at areas of need, and then in that broader region that we identify, the Department will have some discussions with local PHNs, the Primary Health Networks that understand how these local services operate, and undertake a fully competitive process so that GP practices, or community health centres in some states, can bid for these services and start making it easier to see a doctor, start taking pressure off these hospital emergency departments.
SPEERS: Final one, Mark Butler, as a leading figure in Labor's left, are you comfortable with the decision not to increase JobSeeker for people living below the poverty line but still back the Stage 3 tax cuts which will deliver tax breaks of more than $9,000 to high-income earners?
BUTLER: We argued very strongly for the $50 per fortnight increase that was made temporarily by the Government during the pandemic to be made permanent. We understood that that was an important measure to improve the living standards of this cohort in the community. We think that was an important measure. We are also focused on a range of other things that will make a real difference to those households in the areas of social housing, access to vocational training and the like. 
SPEERS: Mark Butler, we have to leave it there. Thanks for joining us. 
BUTLER: Thanks, David.