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Butler (left) with Anthony Albanese at a pharmacy in September.Credit:Alex Ellinghausen

Butler welcomed the joint call of premiers Dominic Perrottet and Daniel Andrews for more bulk-billing clinics,reportedin this masthead,but stopped short of committing to their push to increase doctors’ payments. He also declined to say whether the government needed to spend more than the $750 million allocated to improving Medicare,a figure health leaders claim is insufficient.

“This is not going to be something we can fix in one budget,” Butler said.

“For the first time in the history of Medicare,the average gap fee for a standard GP consult is more than the Medicare rebate itself ... And that’s having a real impact on the general operation of our health system.

“The constant advice we have received across the country is that after nine years of cuts and neglect to Medicare,it has never been harder to see a doctor,and never more expensive - with bulk billing rates in decline,and gap fees constantly going up - than it is right now.”

Anthony Albanese and Premier of South Australia,Peter Malinauskas,meet in May.Credit:Alex Ellinghausen

The push for change led by Perrottet and Andrews was backed in on Thursday by the governments of Queensland,Western Australia and South Australia,whose Labor premier Peter Malinauskas argued repairing the primary care system should be national cabinet’s top issue in 2023.

The lobbying from state and territory leaders across Australia has heightened pressure on the cash-strapped Commonwealth to invest in ambitious changes.

In a statement toThe Sydney Morning Herald andThe Age,Malinauskas said he had put national health reform at the centre of his conversations with the Commonwealth since he was elected in March.

“The performance of our public health system presents a material crisis which we must confront. Ordinarily,the summer is a quieter time in our hospitals. Right now,they’re full. Ambulance ramping is a problem across the country. Our staff are exhausted,” he said.

Queensland’s acting premier Steven Miles said there had been a “slow choking” of the primary healthcare system for a decade,while a WA government spokeswoman said “it is clear some changes are needed to Medicare as a priority”.

Butler told reporters on Thursday a key focus of the federal government’s expert taskforce was the concept of multidisciplinary care. This model,supported bythe Grattan Institute,would allow health professionals other than doctors to treat patients with complex needs.

“Australia’s healthcare system is grappling with much more chronic disease,much more complex disease,which requires multidisciplinary care. And our system is not working well to deliver that multidisciplinary care,with health professionals working as teams,” Butler said.

Royal Australian College of General Practitioners president Dr Nicole Higgins said it would be a “significant problem” for her association if the government opted for a model that stopped GPs from playing what she described as a gatekeeper role in the provision of care.

“Medicare is accessed by GPs and nurse practitioners,and allied health professionals under certain conditions. Very few people have access to Medicare ... We have seen what has happened with the NDIS,” she said. “We just don’t want a free-for-all on Medicare. It is a precious resource.”

Former Australian Medical Association president Dr Mukesh Haikerwal said the last major Commonwealth investment into Medicare was a $2.2 billion injection in mid-2000s.

He warned the Albanese government would probably need to invest more than that amount. “Otherwise you are not going to make a significant impact. It’s not as simple as increasing one rebate - there needs to be structural reform,” he said.

Cut through the noise of federal politics with news,views and expert analysis from Jacqueline Maley.Subscribers can sign up to our weekly Inside Politics newsletter here.

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