Opinion
RACGP President calls for immediate end to co-claiming crackdown
GPs treat each patient as a person, not a statistic. Dr Harry Nespolon has called on the Department of Health to treat GPs with the same respect.
Dr Nespolon has called for an end to the campaign. ‘That will end the fear and anxiety that so many GPs have articulated to us,’ he writes.
Over the past two weeks, many of you have contacted the RACGP with deep concerns over the latest compliance letter sent by the Department of Health (DoH).
It is fair to say that GPs everywhere have been deeply upset by the fact this letter targets something we hold dear – the ability to treat the whole person, mind and body.
The RACGP agrees with the sanctity of genuinely holistic care.
It is for that reason I have sent a letter to Federal Health Minister Greg Hunt, expressing my serious concerns about this myopic campaign.
I have called for two things.
First, the immediate end to this inappropriate and poorly targeted campaign.
Second, amendments to the Medicare Benefits Schedule (MBS) to remove the ambiguities that have caused this mess.
Specifically, we want clarity regarding claiming GP Mental Health Treatment items (2700–2717) and permission for the co-claiming of professional attendances where clinically indicated.
It must be noted that many of the GPs who have written to the RACGP have not received the letter. Regardless, they are angry about the intent of the letter and its condemnation of Australia’s frontline primary care professionals.
What they see in the letter is an attack on comprehensive and holistic patient-centred care. They feel that what drew them to general practice in the first place is now under threat.
We know that patients are increasingly coming to their GP with mental health issues. In fact, it is now the most common reason people visit their GP. We also know many patients do not come to us for a single issue.
That is the point of general practice – we can treat the person as a whole, not as a specific illness or issue in isolation.
While the RACGP supports measures to prevent wrongful and fraudulent claiming, this campaign makes no sense. It must be abandoned.
As we have pointed out in our recent submission to an ANAO audit on the way the DoH undertakes compliance, the reliance on algorithms to detect statistical outliers can get things drastically wrong.
GPs who do a lot of palliative care will prescribe more opioids than average. Should they be punished for that, as some were with a poorly targeted earlier campaign?
GPs who spend significant time with patients seeking help with mental and physical health will co-claim MBS items. Should they be punished for that?
The answer is simple: no, they should not.
Data can give the illusion of truth. But without context – without seeing the GP and the patient cohort – it is just data.
You don’t need to go far to see how this campaign has hurt general practice. Ask any GP and, chances are, they will tell you they have already begun to rethink how they provide care.
If GPs retreat from providing holistic care, it will hurt the community. Perversely, it may even cost Medicare more, if GPs are forced to ask people to come back another day for fear of the crackdown.
That’s to say nothing of the difficulties of scheduling separate consultations in rural and remote areas, or the potential for conditions to go untreated.
What’s really important here? That patients get the care that they need, when they need it? Or GPs ticking each and every box to ensure compliance?
I will be seeking to meet with Minister Hunt urgently.
We must stop the campaign immediately. That will end the fear and anxiety that so many GPs have articulated to us.
We then must take steps to prevent such short-sighted and cynical crusades in the future. We must amend the MBS so that it values and supports what we do, every day, as specialist GPs.
And we must support holistic, high-quality care – now and forever.
Letter to Minister Hunt
Dear Minister,
Re: Concerns with targeted compliance letters on co-claiming mental health and attendance items
I am writing to express the Royal Australian College of General Practitioners’ (RACGP) serious concerns regarding the targeted compliance letters recently sent by the Department of Health (the Department) to GPs who are co-claiming GP Mental Health Treatment Plans and professional attendance items more frequently than their peers.
As we’ve previously stated, measures aimed at preserving the integrity of Medicare and use of health resources by preventing wrongful and fraudulent claiming are supported by the RACGP. However, we are firmly opposed to this latest compliance activity due to the myopic nature of the campaign and the counter-productive message it sends to all GPs.
In the interest of patients and patient care, we ask for:
- the immediate cessation of the inappropriate and targeted campaign for co-claiming professional attendances and GP Mental Health Treatment items (2700–2717)
- amendments to the Medicare Benefits Schedule (MBS) for GP Mental Health Treatment items (2700– 2717) to remove ambiguity and allow co-claiming of professional attendances where clinically indicated.
Widespread effect on access to high-quality holistic general practice care
The RACGP has been inundated with queries from members (many of whom have not received a letter as part of the campaign) who are deeply concerned about the intent of the letters given GPs treat the whole person and many patients do not present for a single issue. Core to their role, GPs provide comprehensive and holistic patient-centred care and understand the interplay between bio-psycho-social contributors to health. Our members consider their ability to provide specialist generalist healthcare has been threatened by the campaign and its intent.
It is well known that more Australians are seeing their GP for mental health concerns, with mental health now the most common reason why people visit their GP. Some GPs have a patient cohort that consists primarily of patients with serious mental health conditions, many of whom also have physical health concerns. GPs do not treat a mental illness or physical ailment in isolation. GPs treat the person, which includes both their physical and mental wellbeing.
This compliance campaign has prompted all GPs to rethink the way they provide care, to the detriment of the community. Requiring GPs to focus on only one condition undermines both patient health and health system efficiency. Forcing patients to schedule a separate consultation for a physical condition often involves significant delays, and sometimes even results in conditions being left untreated, which can develop into more serious conditions in future. Such a result is a poor outcome for both individual patients and the broader community, and can result in significant and avoidable costs to the health system.
Amend the MBS to resolve this issue and support holistic, high-quality care
The RACGP has consistently highlighted that the requirements for claiming certain MBS items are unnecessarily prescriptive, restrictive and focus on process rather than the quality of the healthcare provided.
Therefore, in addition to ceasing the current campaign, we strongly recommend that government review the GP Mental Health Treatment item descriptors to remove the current ambiguity on co-claiming mental health and professional attendance items for the same patient on the same day. Addressing this issue through a descriptor change will support high quality medicine, and ensure people get the best possible outcomes.
We will continue to advocate for the cessation of the inappropriate campaign for co-claiming professional attendances and GP Mental Health Treatment items, and amendments to the descriptors for the mental health items, to ensure that patients can access the type of care they need, when they need it.
I kindly request an urgent meeting with you and/or a representative from your Department so we can discuss the impact of this campaign and our suggested amendments to the GP Mental Health Treatment items.
Yours sincerely,
Dr Harry Nespolon RACGP President
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