Let’s work together on health: Perrottet

The NSW Premier wants to see ‘collaborative federalism’ as he supports Labor’s planned reforms to Medicare.

NSW Premier Dominic Perrottet will support Labor’s overhaul of Medicare.

NSW Premier Dominic Perrottet has called for a new accord of “collaborative federalism” to drive shared policy responses to unsustainable pressures on Australia’s public hospitals and primary care systems, as NSW pledged its backing of Labor’s planned reforms to Medicare.

Mr Perrottet wants the Medicare reforms, set to open up funding for primary care services to nurses and allied health, to be planned and executed jointly with the states.

States could progress the initiatives through programs such as the expansion of pharmacy prescribing, free state government telehealth services, more urgent care clinics and greater use of nurse practitioners in state-run primary care services.

“We need a pathway for nat­ional change, to have better integration of the federal primary care network and the public health system,” he said.

“We’ve got to move towards a more collaborative federalism, a collaborative federal model rather than one where we’re working against each other and having fin­ancial debates rather than constructive policy discussions.

“We’ve got to move away from who’s responsible for what, we’ve got to move away from the states blaming the federal government and the federal government blaming the states.

“We’ve got to start from a position of how do we build the best health system around the patient, not around archaic government structures. I don’t want to start with funding, I want to start with policy, to look at new ways of doing things.”

Mr Perrottet wants to see greater unity between state and federal governments.

Ahead of a meeting of national cabinet on Friday that will discuss health system reform, Victorian Premier Daniel ­Andrews called for Medicare to be “fast, free and affordable”.

“We know what the solutions to Australia’s broken primary care system are: we 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,” Mr Andrews said.

Mr Perrottet also called for GP rebates to rise but said the primary care and hospital systems, in particular emergency departments, were “so integrally connected” that any policy that tried to reform only one part of the system would fail.

“Over time, we have created a situation through federation where the primary care GP network doesn’t work alongside the public health system,” the NSW Premier said. “It works against it. I believe this is an opportunity coming out of a one-in-100-year pandemic not to have the states debating funding but having the states work constructively in respect of policy to improve the health ­system across the country. If states and territories and the commonwealth government work in isolation from each other, we are not going to ­improve the system.”

Federal Health Minister Mark Butler indicated the release of a report of the Strengthening Medicare taskforce would occur in the days after the national cabinet meeting.

The report is set to call for an expansion of multidisciplinary care and MBS funding to a greater range of health professionals, voluntary patient enrolment with GP practices and digital reforms.

Mr Perrottet said he supported all those initiatives and pledged his government was prepared to step in to run programs that would dovetail with Labor’s primary care reforms.

He said national health reform should be pursued intensively through national cabinet over the course of this year.

NSW and Victoria have already moved to set up their own network of urgent care clinics staffed by salaried GPs, which Mr Andrews said were seeing hundreds of patients every week, ­reducing pressure on emergency departments and giving patients access to the care they needed ­before they become acute.

Mr Perrottet called for pharmacist prescribing trials that are being rolled out in NSW to be ­expanded nationwide.

Queensland also allows pharmacists to work to their scope of practice and prescribe medicines.

The NSW Premier is backing Labor's Medicare reforms.

The NSW Premier also said there was a significant opportunity for state-run telehealth clinics to take the pressure off emergency departments, with a recent NSW telehealth service helpline pilot aimed at people who were unable to access a GP estimated to have kept 60 per cent of the patients it serviced from having to present at emergency departments.

“If you can’t fix the health system nationally after moving through a one-in-100-year pandemic, we never will,” Mr Perrottet said. “This is the time to change. And I believe that the collaborative, constructive nature of national cabinet provides a very strong foundation for us to do it.

“We should be putting everything on the table with a focus of the best patient care in the world – that’s what success should be.”

Mr Perrottet’s comments came as emergency department doctors continued to raise the alarm at critical staffing shortages and overloaded hospitals.

The AMA said the bulk billing crisis was one factor pushing EDs to the limit, warning that patient harms and even deaths were ­occurring as a result of bed block and ambulance ramping.

Australian College of Emergency Medicine president Clare Skinner said clinicians were reporting “some of the busiest shifts of their careers, with significant demand, longstanding and compounding systemic issues, and ongoing staff shortages all contributing to the pressures”.

“Across the system, there are too many sick and injured people, and not enough resources and trained staff, for people to get the affordable and accessible acute care they need, when and where they need it,” Dr Skinner said.

“We can’t fix this alone. Emergency departments are just one part of a complex and increasingly fragmented health system that must be reformed.

“This necessary widespread reform is a massive undertaking which will require a strategic, long-term and collaborative ­approach, to bring all parts of the healthcare system together to create a more equitable way of doing things.”

The Royal Australian College of GPs released its budget submission on Tuesday, warning of “an increasingly unequal Australia” without urgent interventions to shore up primary care and access to bulk billing. It wants a tripling of bulk-billing incentives, increased Medicare patient rebates for longer, complex consultations, more funding for enhanced primary care services for people over 65 with mental health conditions and disability, and more support for patients to see GPs within seven days of an unplanned hospital or emergency department visit.

“We’re in a crisis that ­demands action now,” RACGP president Nicole Higgins said.

“Australia prides itself on being the lucky country where everyone has a fair go. Without urgent action to … improve access to care for Australians, inequality, and the gap between rich and poor, will get much worse.”