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Key recommendations to overhaul Medicare have been handed in down in the Australian Government’s Strengthening Medicare Taskforce report …
Medicare is set for a shake-up, following the release of the Strengthening Medicare Taskforce report.
The 14-page report recommends significant changes to the way general practices and other primary care providers are funded to improve the delivery of “wrap-around care”.
It also calls for the improved use of digital technology and the design of new funding models to treat patients who are in the hardest to reach areas.
Health Minister Mark Butler, who chaired the Strengthening Medicare Taskforce, said reform was necessary.
“The first message is we need to improve access to general practice and primary care. We need to improve access after usual office hours,” Minister Butler said.
“The report also recommends better access for urgent care. It recommends the ability for GPs to be able to bill for longer consults – particularly reflecting the more complex, chronic nature of so many presentations from their patients.”
The Taskforce comprised many primary health care leaders, including the Australian Medical Association (AMA) Vice President Dr Danielle McMullen, the Royal Australian College of General Practitioners President Dr Nicole Higgins, and National Rural Health Commissioner Adjunct Professor Ruth Stewart.
AMA President Professor Steve Robson welcomed the report but said immediate action needed to be taken.
“The report is high level vision document with little detail, and potentially sets primary care on a pathway to long term reform,” Professor Robson said.
“However, patients can’t wait that long and need more immediate support.”
Although the report acknowledges the role of pharmacies alongside other disciplines in the delivery of primary care, it does not make any specific recommendations on the role of pharmacies.
The Pharmacy Guild National President Professor Trent Twomey, who was not on the Taskforce, has strongly advocated for pharmacists to play a greater role in the overhaul of Medicare.
Professor Twomey has said patients should also be able to access care from pharmacists for colds and skin infections, along with prescriptions for the contraceptive pill and blood pressure and cholesterol tablets.
Pharmacists in New South Wales are able to prescribe medications for urinary tract infections, as part of state government trials, from the first quarter of this year, while pharmacists in Victoria will be able to prescribe medications for treating uncomplicated urinary tract infections and to re-issue contraceptive prescriptions from 1 July 2023.
But the Royal Australian College of General Practitioners has warned that any blended Medicare reforms must support GP stewardship of patient care, which is proven to improve patient health and wellbeing.
“GPs are best placed to manage patient care because we have the required training and expertise in generalist care and diagnostics,” Dr Higgins said.
“The evidence shows seeing the same GP over time, also known as ‘continuity of care’, leads to fewer hospital visits, lower mortality, and reduced costs to the health budget.
“So, we need GPs working hand in glove with allied health professionals, pharmacists, and practice nurses, and they should be supported within general practice, with GPs working as the stewards of patient care.”
Allied health groups are urging the Health Minister to consider new Medicare funding models to enable patients to see nurses, physiotherapists, or counsellors.
Allied Health Professionals Australia national chair Antony Nicholas, who is also on the Taskforce, told The Guardian a shortage of GPs means people need more access points to receive care.
“General practice has served Australia well with quality care but over the last decade it’s been a gradual decline… clearly we need something different,” Nicholas said.
“We have a primary healthcare system hinged on GPs being the gatekeeper to care, and if that’s already challenging and only going to get worse, then there have to be other alternatives.”
The Australian Nursing and Midwifery Federation, represented on the Taskforce by Federal Secretary Annie Butler, said Medicare reforms will be welcomed by nurses.
“While Medicare is a vital scheme, after 40 years it is no longer fit for purpose,” acting ANMF Federal Secretary Lori-Anne Sharp said.
“We welcome the government’s focus on making the system work better and committing to crucial reform needed to improve patient outcomes and equitable access to primary healthcare.
“It has been a welcome shift to have a government recognise the importance of nurses and midwives in building a system that is more patient focussed and our members are well prepared to play a bigger role in helping to create this change.”
Sitting within the federal Department of Health, the Strengthening Medicare Taskforce began work in July last year to provide concrete recommendations to the government by the end of 2022.
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Both my parents were GPs as am I, and my son is considering following in our footsteps. I am doing everything in my power to discourage him. I think he would make an excellent GP, he has the right combination of clinical acumen, passion and personality. But I have seen the erosion of our vocation from being reasonably well paid and respected in my parents day where as now I’m “just a GP” by many patients with an absolute struggle to pay for everything even though I only bill bill pensioners and children. The wait times are unbelievable and patients more demanding as to why don’t I work more and on weekends (currently working 9-6pm daily). I’m 52 and plan to retire once my kids finish school- there’s nothing left in GP and it’s only going to get worse with our responsibilities being outsourced to nurses and pharmacies. I’m glad I can look after my immediate family for the rest of my cognitive days. It’s a sad state of affairs after years of general practice neglect.
Yes, society and how we conduct ourselves today is very different from effectively 50 yrs ago when Medicare (Mark 1) appeared. Society has evolved over that time, the problem is that general practice and GPs haven’t.
Lets talk $: I badly wrenched my ankle some 18 months ago, no fracture, probably better if I had: the result-lots of physio, exercise physiologist and gym. The fee was generally around $ 120 and he’d see me for 10-15 and then I’d do my own exercises, as he moved onto another pt.
He was making , regularly, $400per he
Contrast that with standard consult item 23 -$39
4×40=160 p hr
That’s 400 versus 160 with far lesser overheads
Conclusion
There’s no financial future going forward and now the time to explore other possibilities with your talent
In reply to Stephanie Dawson-Smith
You raise some good points. In relation to urgent GP appointments my comments were based on my own experiences and those of my family, friends, acquaintances and patients in securing such appointments in city and suburban practices in Adelaide, and the historical comparisons I can make. I realise that there are exceptions, such as Dr Dawson-Smith’s example, and regional and rural practices might well be different ( although I read regularly of the difficulties country people have in getting to see a GP.) Obviously COVID introduced a whole new set of issues and problems, from which we are still recovering. One strategy might be to give higher Medicare rebates for urgent consultations ( criteria could be developed for these) and after hours work. I stand by my comment that Governments will look to other health care practitioners ( as they are doing ) if GPs can’t provide the service.
Thanks for your feedback, Nick. We will consider it carefully.
InSight+ Team
I’d like to thank Dr Randal Williams for his comment showing genuine concern about the future of General Practice, as a GP I am also quite concerned. I wanted to respond to some of the interesting issues raised.
He noted that many GPs have waiting lists that are weeks long and that years ago, GPs would keep a few on the day appointments for urgent issues. Actually, GPs still do exactly this, ‘reserved times for urgent appointments on the day’ is an RACGP accreditation standard. These appointments tend to get snapped up each morning, but even then if a patient calls with an urgent GP issue we work hard to try to fit them in.
You raise concerns about afterhours access. Afterhours appointments used to be provided in my home town by a roster of GPs who worked occasional nights in addition to their normal clinic hours. The corporate-run home doctor services boom of the mid 2010s ended this particular service. The 2018 medicare task force noted the boom saying ‘the use of urgent after-hours items had increased by 157% between 2010–11 and 2016–17. The Taskforce found that there was no clinical explanation for the large increase, but rather the growth had been driven by a corporate model of advertising on the basis of convenience, rather than urgent medical need.’
Now, running afterhours services are even harder as practices are told any form of rostering for GPs may make them liable for payroll tax.
The rate of future doctors planning to become GPs has dropped from ~50% to 13.8%. That might explain why some GPs have their non urgent appointments slots filled a few weeks in advance. So why are less doctors becoming GPs? GPs have been systematically defunded and disrespected by our governments.
Defunded? The medicare rebate for a standard consult is less than half what it would be had it been indexed correctly.
Disrespected? When Covid19 vaccinations arrived GPs weren’t considered ‘frontline healthcare workers’ when it came to vaccine eligibility, for more examples see here https://insightplus.mja.com.au/2022/8/gps-are-angry-and-now-is-the-time-to-listen/ . That might have influenced the practice Dr Williams saw which advised patients with respiratory symptoms not to enter – and don’t be too quick to assume – during early covid many practices pivoted to provide carpark consults, phone consults followed by face to face consults in an iso room or directed patients to the Respiratory GP clinics that received government funding to provide care for acute respiratory symptoms.
Dr Williams your concern is welcome, but I wonder if you still believe that the implosion is self-generated.
Dear InSight,
I have concerns about your current poll “Should pharmacists be given the ability to prescribe medications for basic ailments?” Pharmacists currently already have the ability to recommend/prescribe medications within the TGA recommendations and schedule, this includes Schedule 2 and 3 medications. In my opinion the question to ask is whether pharmacists should prescribe beyond the recommendations of TGA, into Schedule 4 medications.
Ultimately, doctors, nurses, pharmacists and allied health, work well together in teams and not in isolation. We require the Right Scope, Right Supports, Right Setting.
How many of the allied health professionals have any training in diagnostics.
I walked away from general Practice largely on the basis that my diagnostic skills weren’t adequate. I am certain that they were substantially better than a pharmacist or other allied health worker who has no training in the field.
How long is it since you saw a young GP driving a Mercedes. GPs used to be able to afford to do this. Corporatisation of GP practices & increased compliance costs to practice have eroded the viability of GPs. Why are Doctors not paid extra to work nights & weekends? We could afford to absorb this when we were paid the original rebate with full CPI adjustment.
The other thing which would attract more doctors to general practice is for hospital doctors to stop badmouthing GPs when they don’t understand the limitations of the job. If only they knew what the GPs say about them.
I endorse Dr. Randal William’s statements, especially the desire to see Medicare rebates increased, so as to
make Bulk billing practices viable.
The original Medicare rebate was set at 80% of the common fee and was supposed to be indexed annually
to retain this value. Alas it has not! By now rebates would be lucky to make 40 odd per cent of the common
fee. Accordingly, general bulk billing has become unviable.
The resultant health care cost to the patient affects all, but mainly the elderly, as this group is the one with
chronic health issues and, on average, the least amount of money.
If we think of the primacy of the role of GPs in primary health care on a spectrum of 0 – 10, it probably currently sits on 7. Despite how GPs may think they are the centre of the health universe, in reality they are only at the centre of the ‘government-funded’ health universe. Consider people already seek primary health care from dentists, physiotherapists, pharmacists, psychologists, etc – they just pay for it privately. When Medicare was created GPs were probably sitting on a 9 on my spectrum but there has been an inexorable decline due to a range of factors, not least the rise in quality care provided by other health professions. Why else would the public pay their own money for health services from an alternative provider? The reforms advocated by the Strengthening Medicare Taskforce likely seek to move GPs to the left on my scale by a further two notches, and quickly. I understand this is a shock. Any sudden change is a shock. But it is inevitable and rather than uselessly fighting to protect it all, seemingly primarily for their own benefit, GPs must strengthen their position on what they do better than anyone else and let go of the edges.
Why has there been only limited development of the nurse practitioner role in health care delivery in Australia? Whether or not it is appropriate for pharmacists to fill the gaps in service delivery remains to be seen, but the nurse practitioner role is more widely accepted in the UK and radiographers participate with radiologists in ‘reading’ screening mammograms. A case could be made for expanding these roles in Australia. If we are seeking solutions to crises, then it behoves us to look outside what seems to this non-medically-qualified observer and consumer of health services to be a ‘territorial’ box.
Commenting as a retired surgeon who spent his professional life working alongside GPs, I believe general practice is at a crossroads and not only in relation to Medicare and bulk billing. My observation is that GPs have become progressively less available to see patients promptly or those with urgent problems. Many have waiting lists of weeks, especially women doctors, and many practices no longer offer any after-hours services. This puts enormous pressure on ED’s and invites calls to allow nurses and pharmacists to do basic assessments and prescribing ( pharmacists have an inherent conflict of interest in also selling what they prescribe or recommend and this must be resisted.) Back in the day GPs would keep a couple of appointments free each day to see urgent cases, and many would do some consulting after hours, but that seems to have gone the way of typewriters and video cassettes. COVID also changed the dynamic dramatically, with restricted consultations. A nearby general practice had a sign outside ” do not attend this practice with respiratory symptoms .” This is one of the most common reasons patients consult their GP so it seemed bizarre. My point is that in creating these scenarios ( and also abandoning bulk billing) general practitioners have opened the way for governments to bring in other professionals to fill to the gaps. General practice has always been the cornerstone of community medical care, but it is under threat and some of the threat is self-generated, in my opinion. I fully support increasing Medicare rebates to make general practice financially viable and attract more graduates, but also submit that many practices need to provide more comprehensive care, especially in relation to availability to see acute/urgent cases promptly. I accept that there are exceptions, especially outside the cities and these comments are of a general nature based on the changes I have seen over the past forty years. I have the highest regard for my GP colleagues, and hope my comments will be accepted as genuine concern about the future of general medical practice, at least in its present form. .