$2.2 billion Medicare investment ‘just what the doctor ordered’

Anastasia Tsirtsakis

28/04/2023 2:24:27 PM

Rebuilding general practice was a key focus of National Cabinet, which introduced a number of measures to make healthcare more accessible and affordable.

Prime Minister Anthony Albanese.
Prime Minister Anthony Albanese during the National Cabinet meeting in Brisbane on 28 April. (Image: AAP)

The RACGP has welcomed the Federal Government’s $2.2 billion commitment to strengthen Medicare, announced by Prime Minister Anthony Albanese following Friday’s National Cabinet meeting in Brisbane.
A number of measures to make healthcare more accessible and affordable were announced, including extended funding for practices operating after-hours, which was due to end in June, along with potential changes to visa eligibility rules for international medical graduates (IMGs).
RACGP President Dr Nicole Higgins welcomed several of the measures, saying they are ‘just what the doctor ordered’.
‘Greater support for general practice is the key to relieving the strain on our entire health system,’ she said.
‘This new funding program enabling practices to open longer hours will mean fewer people turning up in crowded emergency departments seeking help for health concerns that could and should have been managed by a GP.
‘The last thing we want is people turning up again and again to hospital emergency departments without their underlying conditions being properly addressed and today’s announcement will help remedy that.’
The funding will also support new Primary Health Network programs to increase access to primary care services for culturally and linguistically diverse Australians and people experiencing homelessness.
Other measures agreed upon in response to the Strengthening Medicare taskforce report include:

  • introducing MyMedicare (patient ID) to support wrap around care for patients registered with their local GP through new blended payment models
  • expanding the nursing workforce to improve access to primary care
  • providing flexible funding for multi-disciplinary team-based models to improve quality of care
  • supporting workforces to work at top of scope
  • investing in digital health to improve health outcomes.
Dr Higgins cautiously welcomed the announcement about MyMedicare. While she acknowledged that voluntary patient enrolment could be particularly valuable for older patients and those with multiple chronic conditions, she pointed to the UK experience as a warning for Australia.
‘This is targeted at “frequent flyer” high risk patients who are often in and out of hospital with poorly managed conditions,’ she said.
‘The devil is in the detail, and we will work with Government on a suitable model.’
The RACGP President did welcome additional funding for GPs in residential aged care as part of MyMedicare, but again said that it would be important to first learn how the funding system will operate.
National Cabinet also unveiled a substantial increase to the Workforce Incentive Program (WIP), which Dr Higgins said will be particularly beneficial to improving access to healthcare outside of major cities.
‘The RACGP is always keenly focused on boosting general practice care in the bush,’ she said.
‘The college also supports greater investment in digital health to improve a range of health outcomes. We have made massive inroads on this front in recent years and the sky is the limit on how far we can go.’
Meanwhile, National Cabinet endorsed the Independent Review of Overseas Health Practitioner Regulatory Settings Interim Report, which recommends measures to immediately boost the health workforce and ensure Australia is a competitive destination for the global health workforce into the future.
Dr Higgins urged the Government to make this an ‘urgent priority’, saying that Australia ‘must cut red tape’ that is holding back more IMGs from working in Australia.
‘It’s particularly important for rural and remote areas, which rely disproportionately on foreign doctors,’ she said.
‘Go to any rural or remote practice and ask a GP or practice manager how difficult it can be to bring in a GP from overseas and get them set up to actually start working – it can take up to two years and this time consuming process leaves many practices desperately short of GPs with nowhere else to turn.’
Health workforces working at the top of their scope of practice was also a focus at the meeting. In light of this, pharmacy will see a boost in the number of vaccinations they can deliver under the National Immunisation program, as well as increased access to opioid dependency therapy.
However, Dr Higgins said that expanding pharmacists’ scope of practice should be approached with caution.
‘We must be careful not to fragment care because the last thing we want is the left hand not knowing what the right hand is doing, and that is exactly what can happen if pharmacists and GPs are both performing functions such as prescribing medications and delivering vaccines,’ she said.
The college president went on to dispel any claims that this stance is about a turf war.
‘GPs and practice teams absolutely value the vital role that pharmacists perform in communities across Australia,’ Dr Higgins said.
‘The RACGP is right behind GPs working hand in glove with a range of allied health professionals, including pharmacists, and we believe that they should be supported within general practice.
‘It is positive that the Government has recognised that only general practice has the right systems in place for delivering vaccines to children five and under.’
While Dr Higgins said the college is supportive of increased access to opioid dependency therapy through pharmacy, she said more must be done to expand access to these treatments, noting the private dispensing fee of $5–$15 per day.
‘Many people simply can’t afford these sums and go without, so that is something that Government must address,’ she said.
‘People with opioid dependency need help to get their lives on track and we must remove all roadblocks stopping them from doing so.’
Also on the agenda for National Cabinet was the future sustainability of the National Disability Insurance Scheme (NDIS), with the Government committing more than $720 million in the 2023–24 Budget to lift the National Disability Insurance Agency’s capability, capacity and systems to better support participants.
The Prime Minister, Premiers and Chief Ministers also committed to an NDIS Financial Sustainability Framework, and will provide an annual growth target in the total costs of the scheme of no more than 8% by 1 July 2026, with further growth moderation as the scheme matures.
Federal Health and Aged Care Minister Mark Butler said that after nine years of cuts and neglect – including the six-year rebate freeze – that Medicare is in its ‘worst shape in 40 years’.
‘We said at the election that there was no higher priority for Labor in the health portfolio than strengthening Medicare and rebuilding general practice,’ he said.
‘The Albanese Government is making it easier for Australians to see a doctor when they need it. Being able to access a doctor after hours is critical for patients to get the [help] they need, when they need it, taking the pressure off hospitals.’
It was the last National Cabinet meeting before the Federal Budget is handed down in May. National Cabinet has agreed to another meeting dedicated to health reform in the second half of 2023.
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Dr Elizabeth Catherine Chappel   29/04/2023 5:47:03 AM

My understanding of the main issue affecting general practice is the shortage of GPs . I can’t see how these changes improve on that. How can we extend hours if we don’t have any more GPs

Dr Abdul Ahad Khan   29/04/2023 11:25:55 AM

Elizabeth, you are right.
The RACGP & the ACRRM can conduct a Survey
of all fresh MBBS Graduates, asking them just 2 simple Questions :
1. Is pursuing a Career as a GP appealing to you ?
2. What are your Reasons for shunning a Career as a GP ?
The Answers to these 2 simple Questions will awaken the Colleges & the Govt. of the Day & the Populace, to REALITY !!!
Dr. Ahad Khan

A.Prof Christopher David Hogan   29/04/2023 11:40:28 AM

Definitely the devil is in the detail.
The people who need to be encouraged to work at the top of their scope of practice are GPs.
The deskilling & illogical restraints of trade we have suffered since the 1990s must be reversed. For example,the loss of skills posts in paediatrics is criminal & has directly led to the flooding of paediatric EDs.
Multidisciplinary care is excellent but must be coordinated thru a GP.
Contiuity of care by a GP or one GP practice is vital for optimal patient outcomes.

RURAL GP   29/04/2023 12:53:26 PM

I am despondent. Does the RACGP really represent me? I am an advocate of the fee for service model, as this rewards my professional standards and efforts We are now more dependant than ever on the handouts (with strings) and will find it harder than ever. Smaller rural practices don't have the infrastructure, staff, doctors or an appetite for risk, to embrace these big changes. Be aware that pathology through My Health will mean You the GP will be tasked with coding the tests , not pathology. Like extra after hours , these measure should fail because they do not address issues of manpower and MBS parity. With respect IMG's ( though valued) represent a failure of our own peak bodies.

Dr Anne Saunders   29/04/2023 1:15:21 PM

I am concerned that these measures target general practices as a business and as most GPs are not business owners this is effectively a misdirection. GPs as individuals will now be in the position of having to negotiate how much of this funding goes to addressing their stagnant wages versus how much is directed into funding extra patient care. It also plays into the difficulties around payroll tax as income not explicitly attatched to a fee for service payment looks a lot like a salary and so how much of the just flows straight back to the states as payroll tax???

Dr Nathan Michael Cooney   29/04/2023 2:15:45 PM

Absolutely agree Elizabeth. No mention here of incentivizing more Australian trained doctors to go into general practice. Pay GPs more and they will come. Oh and by the way, don't pay us more by encouraging us to produce more GP management plan 'pieces of paper' which good doctors do every consult anyway without the 'piece of paper'.

Dr Andrew Milne   30/04/2023 4:56:09 PM

So the answer that the RACGP and government has come up with is for GPs to work longer hours and to import more foreign trained doctors? These and the other details about PIP's and outsourcing our roles to allied health will not make GP training any more palatable to medical graduates. Unless we start producing (not just importing) our own GPs, we are kidding ourselves about any health reforms.

Dr Abdul Ahad Khan   2/05/2023 11:19:13 AM

Dr. Milne, you say: " Unless we start producing (not just importing) our own GPs, we are kidding ourselves about any health reforms. "
How do we produce GPs is the Question ?
The current crop of our locally produced MBBS Graduates , do not find General Practice as appealing - the Majority want to become Specialists.
The reasons are many :
* The ever increasing Hoops that the Colleges are adding each year, for an MBBS to
become a GP .
* The encroachment of Non-MBBSs into the Domain of General Practice .
* The Serious Attempts to remove the GP as the Lynchpin of Primary
Care .
* The ever-increasing UNPAID Non-Clinical Work a GP has to do.
* The Heavy-handedness of AHPRA & the ever increasing Spurious Litigations
against GPs .
* The Slave Hours a GP has to do.
* The ' Ice-age ' we GPs are living in - more than a Decade of Medicare Rebates
FREEZE has left fresh MBBS Graduates with ' Cold Feet ' !!!

Dr Nicholas Kunzer   6/05/2023 4:10:19 PM

I agree with many of the above sentiments and the overall scepticism about where the additional funding will be allocated..

I still believe the ideal model for a good general practice it is still the small community focused 5 doctor practice (all partners) with a couple of nurses and reception staff, a practice manager and a registrar. I believe the opposite of this model is a greedy CEO throwing IMGs and registrars without support into rural areas as employees and employing admin staff to tick the boxes to make the practice look good on paper.

I support the increase to WIP as a measure to increase GP and nursing staff numbers rurally as well as an end to the rebate freeze

Additional funding and changes to support the latter big business model will only further erode the image of general practice in the community and keep prospective general practice registrars away.

Dr Tieu Minh Tat   7/05/2023 9:13:34 AM

I agree with Dr Andrew Milne & Dr Ahad Khan.
We can't work any longer hours in a day, we're already finishing 8-9pm most night.
We had already given up on the carrot stick, the PIP payment.
The government should cut down on our monster CPD requirement red tape, created by the APHRA & the RACGP is going along with it. 50 hours each year, it's going to kill General Practice for sure, more GP will retire & less new doctors will join the GP force.
On top of this the "Sick Tax" may be coming & will kill more GP off & the After hours Clinic.
GP workforces work on top of the scope--low Bulk billing rate, unworkable CPD hours requirements, coming ?Sick Tax.
What happen to the theme the college always mention "GP work life balance", that mean all GP have to close their door to do the CPD hours.