State and territory leaders are urging the federal government to fix Australia's "broken" GP system, saying they want to make healthcare the top priority of 2023's first meeting of national cabinet.
For years doctors have been warning of a crisis in primary healthcare, with GPs struggling to meet demand.
In 2014 the Abbott government froze Medicare rebates for GP consults, and most doctors argue the rebate is not high enough to cover the costs of providing primary medical care.
This means today fewer patients are getting bulk-billed, which state leaders like Acting Queensland Premier Steven Miles say is putting pressure on hospitals instead.
"When people can't access primary health care, they wait until it's too late, they wait until they get sicker. And so they present to hospital at a higher level of acuity than if they were able to access good primary health care with a general practitioner," he said.
The Victorian and New South Wales premiers united across party lines to call for a major overhaul of the GP system on Wednesday, putting the issue back in the national spotlight ahead of the next national cabinet meeting in February.
"If you can't fix the health system and make substantial changes and have better integration after a pandemic, you never will," NSW Premier Dominic Perrottet said.
"Now's the time to do it."
On Thursday morning Mr Perrottet said "there is not a Premier in this country who does not believe the change needs to happen at a federal level to the GP network to improve health outcomes for people across this country".
All state and territory leaders have since responded, saying primary healthcare needs to be prioritised.
Billions needed, not just millions: AMA
Calls to reform the primary healthcare system go back years, but experts say the COVID-19 pandemic exacerbated the problem and put it under immense pressure.
The Albanese government's October budget included a $750 million Strengthening Medicare Fund.
But the promised funding is unlikely to cover the reforms health experts and state leaders say are desperately needed.
The professional body representing doctors, the Australian Medical Association (AMA), said some of the simplest Medicare rebate items for GPs had been underfunded by an estimated $8 billion over the past 20 years.
"There is going to have to be a substantial injection if we're to meet the Premiers' requests for increases in bulk billing of the most vulnerable patients," AMA president Steve Robson said.
Because GP rebates are funded through Medicare, which is a federal government responsibility, state and territory governments say the measures they can take are limited.
The ACT government has been urging the Commonwealth to appropriately fund Medicare and ensure access to affordable GP services "for years", Chief Minister Andrew Barr said.
"These issues have been raised every year since the Abbott government started cutting Medicare. There is nothing new here," he said.
"The only thing that has changed is the Federal government.
"They have an opportunity to start to repair the damage that has been inflicted over the past decade."
Tasmania's Acting Premier Michael Ferguson said the state government had been calling for better GP access for years too.
"There's no state in Australia more regional than ours. We are absolutely reliant on strong [GP] access in city, suburban and regional areas ... and we're struggling," he said.
"In four months' time [the Albanese government] would have been in office for a year and they haven't lifted a finger for GP access in Tasmania."
Primary and hospital system not working together, premiers say
South Australian Premier Peter Malinauskas said the state of the public health system was a "material crisis" which must be fixed.
"We've got a primary healthcare system and a hospital system that aren't working with each other, and in some instances they actively work against each other," he said.
"Every time a patient who should ordinarily be seen by a GP ends up in an emergency department, it ultimately costs state and federal governments more.
"I think this should be the primary focus for national cabinet throughout the course of 2023."
A WA state government spokesperson said while it would be inappropriate to pre-empt what national cabinet discusses, some changes to Medicare were a priority.
"WA continues to work with other jurisdictions, through the Health Ministers Meeting, on this important reform, while also advocating for our Primary Care needs," they said.
NT Chief Minister and Health Minister Natasha Fyles agreed GPs were an integral part of the health system and that "modernising Medicare was important".
"Any improvements to the Medicare system that support our GPs to provide greater access to health care in the community will be supported by the Northern Territory," she said.
Fixes won't be easy
Experts and state leaders have proposed a long list of reforms, including boosting Medicare rebates for GP consults and increasing investment in multidisciplinary care.
"We know what the solutions to Australia's broken primary care system are," Victorian Premier Daniel Andrews said.
"We urgently need to pay GPs more, increase university places to get a pipeline of new doctors across the nation, attract GPs from overseas to Australia faster — and break down the barriers between primary care and our hospital system."
At a press conference on Thursday, Federal Health Minister Mark Butler agreed the health system needed improvements.
"The constant advice we have received across the country is that after nine years of neglect and cuts to Medicare, it has never been harder to see a doctor or more expensive," he said.
The federal government established a Strengthening Medicare Taskforce in July 2022, which has been tasked with recommending how to spend the $750 million Strengthening Medicare Fund.
Emeritus Professor Stephen Duckett, an experienced health economist who sits on the task force, warned the fix won't be cheap, fast, or easy and will need to include the whole healthcare system.
"We need to actually address the primary care system, which is not just about doctors in primary care, but it's also about multidisciplinary teams to make sure that people with chronic illness can get the care that they need."
Mr Butler said the task force's work was "largely" complete and a report was expected to be published in the coming weeks.
