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GP role vital in LARC services expansion: RACGP
It says it’s imperative procedures occur in the context of a multidisciplinary team, with GPs at the centre of coordinated care.
‘Any practitioner performing these procedures must be held to the same standards of training, credentialling, indemnity and insurance as expected of other medical professionals.’
The RACGP has urged the Federal Government to support the role of GPs in reproductive healthcare as it considers further steps to improve access to long-acting reversible contraceptives (LARCs).
The call comes as part of an RACGP submission to the Medicare Benefits Schedule (MBS) Review Advisory Committee (MRAC), tasked last year with advising Government on the ‘appropriateness and accessibility’ of existing MBS support for LARC insertion and removal.
Initial MRAC recommendations informed the women’s health package announced in February this year, including increased fees for LARC items and loading items to support GPs, nurse practitioners (NPs) and other specialists.
In its second phase, the committee’s LARC Working Group (LARCWC) considered extending MBS access to endorsed midwives (EMs) for insertion and removal of LARC, as well as expanding access to other provider groups.
In its draft report released in September, the group made two recommendations:
- That it is appropriate to expand MBS access to endorsed midwives for hormonal (etonogestrel) implant insertion and removal, and for intrauterine device (IUD) insertion and removal (except for complex removal under anaesthetic), for the primary purpose of contraceptive care
- Access to MBS items for LARC administration should not be extended to any other provider groups (other than NPs and EMs) at this time
‘The LARCWG concluded that it is safe and appropriate for EMs to access MBS items for the insertion and removal of hormonal implants (Implanon) and of IUDs for contraceptive purposes only,’ the draft report said.
‘This conclusion is based on insertion and removal of LARCs, including Implanon and IUDs, being within EMs’ scope of practice once appropriate training has been undertaken.’
However, in a
submission issued to MRAC this week, the RACGP says it does not support expanding MBS access to endorsed midwives in its current form.
‘Where non-medical practitioners perform these procedures in the primary care setting it must occur within the context of a multidisciplinary team including a medical practitioner to ensure ongoing, coordinated care, ensuring continuity, follow-up, and alignment with the patient’s broader health and fertility goals’, the RACGP wrote.
‘It is imperative that insertion and removal of long-acting reversible contraception is performed by a qualified medical practitioner with appropriate clinical knowledge, competency and experience.
‘This includes the ability to counsel a patient regarding all their contraceptive options, including the benefits and risks of each in relation to a person’s medical history and risk profile and the ability to manage potential side effects.’
The RACGP noted expanded access could be introduced safely but must be done as part of a multidisciplinary team involving the patient’s GP.
‘It is possible that endorsed midwives could be upskilled in Implanon insertion and removal, but for patient safety these procedures would need to be performed in a multidisciplinary team which includes a specialist GP for safe management of any complications,’ the RACGP wrote.
‘If MRAC does introduce MBS items for IUD/Implanon insertion/removal to be claimed by endorsed midwives, there must include requirements that the activity must be communicated back to the patient’s regular GP.’
The RACGP also emphasised that, given the invasive nature of LARC procedures, MBS item access should remain limited to qualified practitioners, with any future expansion contingent on clear evidence of equivalent training, competency, and safety.
‘Any practitioner performing these procedures must be held to the same standards of training, credentialling, indemnity and insurance as expected of other medical professionals.’
The college also notes an ‘urgent need’ for interoperable medical records to effectively support multidisciplinary teams, particularly in pregnancy and reproductive health care.
‘Appropriate information sharing between all health professionals involved in a woman’s care is essential to ensure continuity, safety, and quality of care by a GP who knows them best.’
With rising out-of-pocket costs limiting patient access, appropriately funding GP services is a cost-effective way to deliver care, the RACGP said.
‘State and Commonwealth initiatives that establish alternative funded services often place greater expense on the overall health system.
‘Supporting GPs to provide services such as pregnancy care, termination services, and LARC provision, including through bulk billing and improved rebates, provides best-practice and sustainable care for women within the community.’
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