High stakes Medicare overhaul 'must support GP stewardship'  

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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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