‘A fundamental issue’: RACGP calls for changes to reproductive healthcare

Anastasia Tsirtsakis

27/02/2023 4:14:16 PM

At a Senate Inquiry, Dr Nicole Higgins and Professor Danielle Mazza will be pushing for greater support for GP training to build workforce capability.

A female doctor speaking to a patient.
The college is advocating for changes to reduce significant barriers to reproductive care.

While Australians have access to universal healthcare, when it comes to reproductive care, travelling hundreds of kilometres and being hundreds of dollars out of pocket is not an uncommon experience – particularly for women in rural and remote parts of the country.
To help remove these barriers and improve access, the RACGP will present its submission on the matter to the Senate Community Affairs Committee on Tuesday, when the Parliamentary Inquiry into universal access to reproductive healthcare will conduct its latest round of public hearings.
The submission highlights a number of key issues and recommendations, including:

  • making the full range of contraceptive options, as well as menopause treatments, accessible and affordable to all who need them
  • increasing the patient rebate for insertion of an IUD (item 35503)
  • financial support for GPs who wish to train in surgical abortion and improved access to skills-based training in the community, such as long-acting reversible contraception (LARC) insertion and removal, and medical abortion
  • the continuation of sexual and reproductive health telehealth item numbers
  • harmonising legislation between states and territories on access to termination of pregnancy services
  • the addition of medicines for medical termination of pregnancy to the Prescriber Bag
  • expanding the Workforce Incentive Program to provide more funding and flexibility to encourage more general practice-based pharmacists and provide more opportunities for pharmacists to work in a setting with medical supervision.
RACGP President Dr Nicole Higgins will represent the college alongside Monash Chair of General Practice and Chief Investigator and Director of SPHERE, Professor Danielle Mazza. Both are also advisers on the National Women’s Health Advisory Council.
Professor Mazza, who contributed to the submission, told newsGP the key message from the college is the need for safe and affordable access to all available contraceptives and abortion – both medical and surgical – for those who need it.
‘That is a very clear message from the college,’ she said. ‘But in order to support women to get contraceptive and abortion services there needs to be a focus on training and building workforce capability.
‘So, the college has called for financial support for GPs who want to train to provide both surgical abortions, as well as support for training in community settings of LARC insertion.’
The college is recommending a range of suggestions for both financial support and building workforce capacity through training.
This includes through ongoing initiatives such as the AusCAPPS (Australian Contraception and Abortion Primary Care Practitioner Support) network, which helps primary care practitioners to both initiate and sustain LARC and medical abortion service provision through an online community of practice.
‘There is a need for a focus on building the capability of general practice to deliver these kinds of services,’ Professor Mazza said.
‘We’ve already had the introduction of sexual and reproductive health telehealth item numbers and these clearly fill a gap where local services are not available – and we want them to continue.
‘But we really are focused here on investment in general practice to be able to deliver the services locally to patients.’
In the bid to improve access, the Pharmacy Guild has been pushing for pharmacists to expand their scope to prescribing, a move the RACGP strongly opposes.
While the college acknowledges in its submission the important role pharmacists play in educating people about correct medication use and potential side effects, it does note that ‘they are not trained to conduct consultations regarding contraceptive options and reproductive health and cannot offer or directly connect patients with the full range of contraceptive options’.
‘Risks of providing these drugs without a prescription from a medical practitioner often outweigh the benefits of increased convenience,’ the submission states.
Among the concerns are that pharmacists working in isolation do not have access to full patient history and medical records, and there is also evidence that community pharmacies lack cultural safety and appropriateness.
While there is particular concern around access for women in rural and remote parts of the country, Professor Mazza says accessibility is proving to be an issue throughout Australia.
‘Women’s health and sexual reproductive health are GPs’ bread and butter and it’s really important that the discipline is supported to deliver high-quality services in this area because it’s such a fundamental issue for women’s lives,’ she said.
‘There’s a lot of people commenting on this in the media around how we need new item numbers for medical abortion, contraception or contraceptive counselling. But the college has come back and said what we need is investment in training and building the skills so that women can get the services.’
With women making up at least half of the population and reproductive health a long-standing concern, the issues facing reproductive healthcare access may come as a surprise.
Professor Mazza says the reasons for this are multifactorial.
‘If you can’t see it, you can’t be it,’ she said.
‘The apprenticeship model where you have a supervisor that gives you a lot of direction in your training and sets the example for practice means that if your supervisor is not delivering these services, you’re unlikely to get that experience.
‘It’s also become increasingly difficult to get the experience. It used to be that hospitals had contraceptive clinics and that as a GP rotating through hospitals you might get to do some of the LARC insertions and practice them there. But hospitals have devolved these services out into the community and there’s very few high-volume settings where GPs can get training.’
Further to that, the Melbourne GP says that there have been significant changes in the space over the last 20–30 years, with guidelines now recommending the use of IUDs for both nulliparous and young women.
‘That wasn’t the case 30 years ago, so there’s a lot more demand and recognition that these forms of contraception should be front and centre of the provision and delivery,’ Professor Mazza said.
‘But there’s a lack of capacity in the system at the moment to provide the training.

‘Then there’s also the financial reasons: can you cover costs, let alone make a profit in terms of delivery of these kinds of services? But that’s a whole other area.’
With the recent return of GP training to the RACGP, Professor Mazza says it is a chance for the college to take a leading role in this space.
‘The RACGP’s role as a college is standards and education,’ she said.
‘There’s a real opportunity to ensure that the next generation are well placed to deliver these services. These are the kinds of issues that I’ll be highlighting to the senators on Tuesday.’
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Dr Rod Stephenson   28/02/2023 8:58:57 AM

I am saddened that the college is supporting abortion services as part of reproductive services. I actually thought that the whole idea of reproductive services was to support mother and baby.

Dr DK   28/02/2023 2:12:36 PM

I share Dr Stephenson's aversion to abortion services, but understand that this position is increasingly howled down by pro-abortion advocates who assume that we don't care about women.

Would it be too much to ask for the college to include better access to vasectomy training in their advocacy for contraceptive options? I have tried to access that training, but could only find one commercial course (very poorly reviewed by colleagues who attended, none of whom felt safe to provide vasectomies afterward). Marie Stopes would not provide training (even for a fee) unless I agreed to work for them directly. Two well-known vasectomists would only provide training if I bought a franchise from them and agreed to provide high numbers of vasectomies, more than would be supportable in my community. I just want to provide a high-quality, affordable service to my patients, but do need the training to do it well.

Dr Paul Vernon Jenkinson   1/03/2023 12:03:05 PM

The most "fundamental" issue re abortion is that there are 2 separate and unique lives to consider-not one as is the narrative of the above article,which has not a word about how to better support pregnant women who are finding their pregnancy a burden for whatever reason.
In rural and remote regions the easy solution is termination of life,be it by abortion or by euthanasia at the other extreme of life. Let's be better than that in 2023 and beyond.

Dr Effie Parakilas   1/03/2023 12:45:20 PM

I’m also saddened that contraception is tied in with abortion as though it’s the same thing. More than a bit disingenuous I think.I think the item number for IUD insertion should at least reflect a long consultation.
I hope you find a GP who can help you train up for vasectomies, thanks for being willing.
It would be good if there was a certification process for experienced GPs who would then be able to offer training for their colleagues and registrars.
I won’t be joining any primary care practitioners organisation that includes abortion services but very happy to part of group that support training colleagues in IUD and LARC insertion.
As for menopause training, if you’re experienced in this as a GP place your name on the AMS website and encourage all patients to look there for a doctor for their menopause care.

Dr Emma Boulton   1/03/2023 2:40:16 PM

Any GP who doesn't support a woman's reproductive autonomy is in the wrong profession. Abortion care should be provided in all communities with equitable and affordable access, by GPs who can easily refer to secondary care if necessary. As a proud abortion care provider it is without doubt the most rewarding aspect of my 35 year medical career. Women need support when they face difficult decisions, not judgment.

Dr Paul Vernon Jenkinson   3/03/2023 7:32:08 PM

That’s a lot of GPs Dr Boulton.
Perhaps you’re wrong

Dr Joe   4/03/2023 1:16:22 PM

It is a bit harsh to say that any GP who does not support a woman's reproductive autonomy is in the wrong profession. It is not as black an white. It is due to reproductive autonomy that contraceptive are cheap and widely available . Every pharmacy stores them. But once you get pregnant you are dealing with a life. Not all but many women may regret after having an abortion . All choices should be provided to them including knowing reasons why they want to have an abortion. Is there any support that can be provided to them etc. They may be only choosing to abort due to fear of lack of financial or emotional support to raise a child. Drs are also human after all. Just handing them a referral to go have an abortion is a bit callous. That shows lack of interest in the individual patient.

Dr David Adam   16/03/2023 2:09:21 AM

I agree with Dr Boulton and am happy to be accused of howling down those cannot accept that the provision of termination services is an essential part of women's healthcare.