Royal Australian College of General Practitioners Conference
Minister for Health, Greg Hunt's speech to the Royal Australian College of General Practitioners Conference 27 October 2017.
The Hon Greg Hunt MP
Minister for Health
27 October 2017
Thanks very much to Dr Bastian Seidel, to Dr Guan Yeo, to my parliamentary colleagues, Catherine King and Richard Di Natale, who are genuinely passionate about continued improvement in healthcare in Australia, and to all of the council members and members of the RACGP here today and to those around Australia.
It’s a real privilege to be here, and I particularly want to acknowledge what Bastian said about Indigenous Australia and the fact that one of our great collective tasks is to help close that gap.
We are making progress but we have not closed that gap yet in terms of Indigenous health outcomes, and that remains a personal passion and a commitment at the policy level.
Now, shortly after I was announced in the current role, in my first few minutes I spoke with Bastian and we had a tremendous conversation, and he talked about the need to have somebody who became a champion for GPs, but not as GPs, but for the GPs, as champions in turn for patients and patient care.
For me, it was a very important start and a very important eye-opener. And he asked me about my own family history and I said, well, my mother was a nurse, my wife is a nurse, my grandmother was a pharmacist, my uncle was a dentist. He said, so, no one smart enough to be a GP?
I learnt about Bastian’s unique sense of humour at a very early moment in our relationship. But we have had a very constructive relationship.
He’s absolutely fearless in putting forward the views of the GPs, and we won’t necessarily agree on everything, but he’s absolutely sincere and I’ve found the College an outstanding professional body.
And of course, when you look at the College, 35,000 members, 90 per cent of the GP workforce, over 21 million Australians a year who are serviced by RACGP members, and that is an extraordinary testament to who you are and what you do, because at the end of the day your ultimate focus is patient care.
Now, having said all of those nice things, there is, I have to say Bastian, one thing I was a bit concerned about in terms of your judgement.
When I looked at the running list for today, it had speaking time, 30 minutes. I thought that has a certain Castro-like air about it and it’s in breach of a large number of UN conventions on inhumane and improper treatment.
So I will try to speak for less than 30 minutes and instead open myself up for questions.
But other than that, the first thing we agreed on was to try to work in partnership to improve healthcare outcomes in Australia, and the second thing, was that there was a need for a long-term national health plan.
So in the very first statement I made at Frankston Hospital, my view, then and now, is that I wanted to be the minister for GPs, to represent their views and interests, not without challenge, but what I have found is that those views through the College have been overwhelmingly and extraordinarily valuable and constructive.
The second thing was the belief that we have one of the world’s best health systems, but we can be the world’s best healthcare system over the course of the coming decade, but in order to do that we need a Long-Term National Health Plan.
So today I want to run you through very briefly the four pillars of that Long-Term National Health Plan, but then the three stages of implementing it and how that applies to the general practitioners.
In particular, let me begin with the proposition that our Long-Term National Health Plan is about taking what is an outstanding system, with its strengths and its weaknesses, but when you look at all of the global comparisons, an outstanding system and elevating it by continuous improvement.
There are four pillars to that. The first is a very simple proposition, it’s the idea of guaranteeing Medicare and guaranteeing the Pharmaceutical Benefits Scheme.
But in human terms, beyond the systems, that’s a clear proposition, and that proposition is that people have access to the doctors and nurses that they need and the medicines they need. That is really, ultimately what is fundamental.
Now, in order to do that, we struck, within the first few months, a series of compacts with the RACGP, the AMA, the Pharmacy Guild, Medicines Australia, and in addition the Generic and Biomedicines Association.
I just want to mention one of those before coming back to the work of the College in a few minutes. One of the great challenges in the health system is the listing of new drugs.
To my surprise when I came into the role, I discovered that in about 2010 the contingency for the listing of new drugs had been stripped out of the Budget, therefore, there was no headroom for provision for new drugs, and there was a fiction built into the system that there would never be a new Opdivo, there would never be a new Keytruda, there would never be a new Entresto or Epclusa.
So when you go back to issues such as freezes or proposals for co-payments or other things, they all stemmed from the new monthly listings of drugs and the need to find savings.
So we went right to the core challenge and struck an agreement with Medicines Australia, where they accepted, the pharmaceutical companies, $1.8 billion of reductions for statutory payments over the course of the next five years on the basis that all of that money was reinvested into the listing of new medicines and to create a contingency reserve for that.
As a consequence, we have been able to list a billion dollar lung cancer and renal cancer drugs, such as Opdivo, we’ve been able to make a commitment of nearly half a billion for Entresto for chronic heart failure, Stelara for Crohn’s and colitis, 370 million, and many other magnificent life-saving medicines over the last few months, whilst also being able to reinvest into the GP and practitioner space and the medical research space.
So that was, in a way, the enabler for all of the other changes which were required. It was the fundamental reform which underpinned everything else.
Second of our pillars, beyond the access to doctors and nurses and medicines, is supporting the hospital system, and that’s the combination of the public, the private, and the private health.
There are two parts to that. One is in terms of the public system, the reinvestment of just over $7.5 billion in the last 18 months for supporting our magnificent public hospitals, but also knowing that if the private hospitals are not supported with a strong private health insurance system, then we will see a significant reduction in their capacity to do work and a significant increase in the waiting lists and the pressures on the public hospitals.
So that’s why we have just worked on and delivered the private health insurance reforms, which will take the pressure out of costs, which will increase the ability of people to maintain or attain private health insurance, which in turn will support the private hospitals and in turn will support the public hospitals.
Part of that, one thing I’m particularly pleased about, is the ability to end the waiting time to upgrade to better mental health coverage for the first time.
So there is no waiting period for somebody who needs additional mental health coverage, and that is a unique moment in Australian health coverage and something that I think is really of immense importance. I especially want to thank the College for their input to that process.
The third of the pillars, beyond the primary care, the hospital care, is mental health and preventive health. Now, we know the challenge in mental health in Australia, that there are 4 million Australians a year who have some form of chronic or episodic mental health challenge in the course of a 12 month period.
That means in this room, in every room, there are people who are struggling with depression and anxiety and eating disorders, with bipolar or manic depression, or many of the other indications within the mental health space.
People get on and live their day to day lives, but they live it with a challenge, an impairment, a deep-seated condition which means that they have to, in many cases, bear it in silence. And it’s that silence that we first seek to end.
The ability of people to seek help, the ability of people to talk about the challenge, and normalising mental health in the way that your patients will talk openly about many of their challenges and conditions in relation to hips or knees or they may have the flu or chronic conditions, but to be able to talk about a mental health challenge, so as everyone feels that they can seek the help that they need when they need it.
Related to that is the preventive work, and we are just about to embark on very significant preventive work in Indigenous Australia as well as right across Australia, and physical activity as well as consumption are critical parts of that.
In relation to physical activity, we’ll soon be launching the Prime Minister’s Walk for Life, the million steps walk, which we’ve done in conjunction with the Heart Foundation, which will be trying to bring people into lower-level physical activities who are outside of the usual activity base. And whether that’s older Australians, whether that’s those from particular health backgrounds, or those from particular cultural backgrounds who’ve not been engaged, it’s just a fundamentally important task of getting people moving and keeping people moving. And we are working with the RACGP especially on that project.
The fourth of the pillars is medical research, and we’re going through a golden moment in Australian medical research history.
Obviously you think of Florey, Burnet, Gustav Nossal, Ian Frazer, Elizabeth Blackburn, Fiona Wood, Fiona Stanley, so, that amazing Australian tradition.
But right now, we’re aiding to the National Health and Medical Research Council with the Biomedical Translation Fund which is $500 million fund for taking Australian medical research and translating it, taking it from bench to bedside, as it were.
Translating it into new devices, new treatments, new drugs, and it will be available here in Australia and all Australian patients, but also to collaborate internationally.
And then especially the Medical Research Future Fund, and that’s going through a doubling of medical research right around the country over the course of the next five years, from $60 million to $120 million to $220 million to $380 to $640 million.
But most importantly, it’s not about the money, it’s the focus on patients through the rare cancers, rare diseases clinical trials program.
The focus on researchers, clinical fellowships, and then frontier science, one and five year projects for breakthrough Australian projects, the focus on national missions, which is about Indigenous health as Bastian talked acknowledged, when he acknowledged the traditional owners, the brain cancer mission, and then the genomics mission.
And then we go to the translation, so additional support for translation of Australian research, but also translation and improvement of our primary health care and our hospital systems.
So that’s the broader framework. Let me then apply that to all of you and your work, and what you’re seeking to do.
Think of it this way, we’re proceeding along three phases to implement that, or three waves of reform. The first of those waves is in relation to the partnership and we begin with the compact that we struck with the RACGP, and that compact had a very simple message underpinning it, partnership and reform and reinvestment.
On the reinvestment side, I’m really thrilled that we were able to strike an agreement that would add $500 million to general practice over the current four year period.
We would take that to over $1 billion of reinvestment across the medical space, and $2.4 billion of reinvestment into Medicare over the current four year period.
That translates to nearly $8 billion over the next decade of additional funding. That came directly from Bastian’s work and the advocacy of all of those in this room, and I want to thank you and acknowledge you for that.
Relating to the compact which comes out of it is how we use the existing electronic system to further patient outcomes, and to improve population health.
The My Health Record, we struck an agreement with all of the states and territories earlier this year to move to a long-term opt-out process, so what that means is that by early 2019, we should have close to 23 million Australians on the system.
The benefits, if it’s done well, are of course individual patients will have their own lifetime health record. Individual patients will be able to be protected increasingly against adverse drug reactions, against the need to have duplicative testing, and the system will benefit especially from access to population health data.
We’ll be able to identify trends earlier on in a particular region, if there are environmental impacts. We’ll be able to identify the outbreaks of certain communicable diseases in the area.
So we can see both chronic and we can see both episodic patterns as they emerge. And that will be an immensely important tool.
Our shared task, and I would ask for your help with this, is to ensure that we have the data, that we have the material that is available, so as we build that record, and I think we’re endeavouring to make that easier, we’re working with all of the different parts of medical community on that.
Bastian and I have just been talking this morning about making sure that the PIP incentives are crafted to provide a genuine incentive, not to cross any red lights.
And so I heard that message today, and we will complete that process with you, and it’s a dual green light. It has to be the College, and it has to be us working together, but it’s a dual green light, not a single system. And I think that’s an important commitment that I make today.
The other element that Bastian talked about in the agreement struck was in relation to evidence-based medicine, and the evidence on opioids is overwhelming. Opioids are addictive and they can kill people.
And that is why the states, through the Advisory Committee on Medical Scheduling and on the safety through three separate processes, reaffirmed unanimously in 2015 and 2016 that there would be the up-scheduling of opioids in the form of codeine to prescription only.
And that is a decision which was evidence-based, which I stand by, and which I thank the RACGP for in terms of both helping bring to bear and for standing by. And I will maintain the integrity of the evidence based on that.
We know that there are over a hundred lives lost through over-the-counter addiction every year, we know that this is a global challenge, right now in the United States, it’s been identified as a top national emergency and priority, and we also know that there are at least 26 countries, including the United States and the United Kingdom, Germany and Italy, Japan and France, amongst many others, that have already taken the decision. And at this point, Australia is an outlier.
So that is why when the change comes, it is the right thing to do, and I have also listened, though, to the states and others who have said that we need to provide more information. So today I’m announcing an additional million dollars for that transition process.
The RACGP will be one of the leaders, along with the College of Rural and Remote Medicine who will have a particular focus on rural and regional Australia, but that funding will help with the education of patients and consumers, and we’ll be providing materials for yourselves. And if you can assist in that process, that would be greatly appreciated.
That then brings me to the second wave of reform, and the second wave of reform is about the workforce, and within that second wave, you can think of that as teaching, training, and attraction and retention within regional Australia.
In terms of the teaching side, we have for our university-level applicants, what we have done is that we’ve just appointed the first rural workforce and rural health commissioner, Professor Paul Worley.
He has made a great start, he is well respected and he will be working on the training to help the teaching programs within the universities to ensure that the standards are in the highest level, and in particular, looking at the concept of taking the existing rural clinical schools and melding them together into a Murray-Darling Basin network, and I think that this is very important for bringing young people in the bush into training within the bush, and therefore giving ourselves the best chance at keeping them there.
But as everybody who’s involved in this says, they won’t stay unless you then have a genuine unified pathway, a genuine unified pathway to give them the chance to specialise, whilst maintaining their roots and their linkage within rural and regional Australia.
So, in order to do that we have been working with the College, with the RACGP and ACRRM on the unified pathway and the Australian General Practitioner Training Program, and I’m very happy to announce today two things, but it’s built on not just full confidence but deep confidence in the capacity of the RACGP and ACRRM to deliver that training, which you did deliver in the 1990s. That training will now be returning to the College.
From 2019 to 2021, there’ll be a provisional basis, and that’s a program that will progressively transition. And from 2022 onwards the colleges will have full responsibility, as they always should have had, for the Australian General Practitioner Training Program, and I think that that is an important moment.
There are some details to finalise in terms of the agreement, but they are details. The decision has been made, the direction has been set, and the delivery will occur. So the College is back in charge of training, where it should always have been.
Of course, with all of that training, we need to ensure that there is the attraction and retention, and so the unified pathway will then be considered in terms of the capacity for non-fellow doctors to work in regional Australia on the equivalent of what the overseas-trained doctors are currently able to access.
It’s a proposal that was put to us by the College. We want to work with the College towards that, but I believe that it is a sensible and achievable outcome, and we will progressively reduce the number of overseas-trained doctors and increase the number of Australian doctors who are working in the bush, and I think that that is also an overdue step. We’ll work very carefully on that, because there have been mistakes made historically where the tap has been turned on or off.
What we have to do is provide a glide way to ensure that there’s a progressive reduction of the overseas-trained doctors, and a progressive increase of Australian-trained doctors, who are attracted to and retained in the bush.
This brings me to the last thing, and that is our third wave of reforms, and that is the long term, and only this week we saw the Productivity Commission report come out, which emphasised that the distinction between our primary healthcare and our hospital systems was an artificial one which was not patient-focused, not patient-centric.
It was system-focused and system-centric. That fits with everything that we have been saying since January, where we need to work to a system which has greater emphasis on outcomes, and which has greater emphasis on protecting and improving the patient through improved support for primary care.
So that was also emphasised in the RACGP’s Health of the Nation report only a couple of months ago. Now, that report set out the fact that primary care needs to be strengthened, and in order to do that, there are a number of things.
We know that there has been a threat to patient care, as has been reported by the Bruce Robinson Medicare Taskforce in relation to the corporatized afterhours services. We are meeting with them now.
There will be changes, and what we want to do is to see that access to afterhours is maintained for the genuine need, but that it is not used as a subsidy scheme to take business away, to take patients away, most importantly, from their primary carer and their GP. I think that that is a critical step that we need to take.
We will take it, and those reforms are being worked on now, and we’ll work cooperatively with the Opposition and we will deliver that over the course of the coming months.
The last of the things that I want to mention in relation to the primary care is the primary carers. The notion of mandatory reporting was a surprise to me.
This idea that if you have a doctor, but not an MP, not somebody who’s a business leader, and not somebody who is involved in other areas of life, that doctor, if they want to seek help for an emerging mental health problem, has to report it or has to be reported, and that places a risk on their professional status and their professional standing.
Our commitment, working with the RACGP, ACRRM, the AMA, is to end that process of mandatory reporting for the normal course of seeking treatment.
It’s only where there’s an identified threat to patients that that, of course, has to and should be detailed. But anybody, as I said right at the outset, should be able to seek help for mental health challenges without fear or favour. And if that can’t apply to the medical profession, then who can it apply to?
It has to apply, and so we will be working at the Council of Australian Governments Health Meeting next week to ensure that we make real progress, and that we deliver the West Australian model or equivalent model for protecting doctors.
The very final thing I want to do is ask for your help in an area that I’m just a dumb Australian male. Some of you may say that that’s a tautology, but as I’ve gone through this, I’ve learnt and discovered just the importance of endometriosis as a public health issue and as a health issue for so many Australian women.
I would invite the members in this room, the College generally, the medical fraternity to put forward suggestions and proposals to us as to how we can improve the care and the understanding, the diagnosis and the treatment for endometriosis. It’s in many ways been a submerged public health issue.
I think this is the moment where it’s been put to me by many good people on all sides of the parliamentary divide and all sides of the medical community that more needs to be done. We will be coming forward with a strategy on this shortly, but we want that to be informed by medical professionals.
So let me just finish with a very simple proposition, on my first day I said I wanted to represent the GPs and their concerns, and I hope that I’ve continued to do that, but most importantly, what Bastian has just said to me reminded me that your job and our job is to represent and deliver the best healthcare for patients.
Through the Long Term National Health Plan and the waves of delivering it, I believe that we’re making real progress, but I want to thank you, I want to honour you, and I want to officially welcome everybody to GP17.