News

Budget breakdown: What can GPs expect?


Matt Woodley


12/05/2021 4:13:03 PM

This year’s Federal Budget is heavily focused on post-pandemic recovery, as well as addressing gaps identified in aged care and mental health.

Three Budget front covers
RACGP President Dr Karen Price said there remains a need for greater investment to support broader general practice reform. (Image: AAP)

As RACGP President Dr Karen Price said immediately following the release of the 2021–22 Federal Budget, additional funding for primary care, aged care and mental health is welcome, but the finer details ‘make all the difference’.
 
Here are the major measures affecting GPs, with RACGP responses adapted from the college’s formal Budget overview.
 
Primary care
The $1.8 billion for primary care (to be spread over the next four years) includes $204.6 million to extend telehealth arrangements until 31 December, which is predicted to bring total spending on the service to a total of $3.6 billion since it was first introduced.
 
Certain services will be exempt from the existing relationship requirement for telehealth, including:

  • smoking cessation consultations
  • section 100 PBS prescriptions
  • sexual and reproductive health consultations
  • pregnancy counselling
  • drug and alcohol counselling.
While the RACGP says it is supportive of the existing relationship requirement, it has welcomed the decision to exempt these patient cohorts in an effort to improve access across a range of specific services.
 
The college has stated it will also continue to advocate for longer telephone consultations (Level Cs and Ds), and has maintained – in line with the evidence – that care provided over the phone is of high quality when a patient is known to the practice.
 
Support for practices to meet infrastructure costs of telehealth – such as new software, licensing and hardware – was not funded in this Federal Budget, despite calls from the RACGP.
 
Meanwhile, $50.7 million will go towards developing MyGP, an information and communications technology (ICT) system that enables a voluntary patient registration (VPR) initiative.
 
The college been advocating for voluntary patient enrolment since 2015 as a means of enhancing continuity of care and further strengthening the GP–patient relationship. It has stated that any new IT systems should integrate with general practices’ electronic clinical and administrative systems and support GPs to provide essential medical care.
 
Finally, $71.9 million in new funding has been earmarked for the Primary Health Network (PHN) After Hours Program.
 
COVID-19 response
Funding for general practice respiratory clinics (GPRCs) has been extended until 31 December in the form of an additional $87.5 million, bringing total spending to $446.9 million since March 2020.
 
The Federal Government will also provide $253.1 million for temporary MBS items to assess a patient’s suitability to receive a COVID-19 vaccine, and Practice Incentives Program (PIP) payments for accredited general practices that complete two assessment services for a patient.
 
However, no new item numbers were introduced to reflect the increasing time required for vaccine counselling, and the RACGP is calling for further support.
 
Elsewhere, the Government will provide $155.9 million in direct funding for the administration of COVID vaccines at Commonwealth vaccine centres (formerly GP-led respiratory clinics), which will be equivalent to the relevant MBS and PIP payments for GPs.
 
Other key measures include:
  • $510.8 million for a new COVID-19 vaccines schedule for states and territory health systems as part of the National Partnership on COVID-19 Response
  • $1.7 million for the national COVID-19 vaccination training program
  • $233.8 million to ensure the safe distribution of vaccine doses around Australia, including cold chain storage, and logistics and the supply of necessary consumables
  • $557.1 million to extend the temporary MBS pathology testing items for COVID-19 p until 31 December
  • $29.9 million over the next two years for the national medical stockpile.
Medicare
The Government will provide $711.7 million over four years for new and amended listings on the MBS, including:
  • $288.5 million to include repetitive Transcranial Magnetic Stimulation (rTMS) therapy for patients with medication-resistant major depressive disorder
  • $111.4 million to support the take up of group therapy sessions and participation of family and carers in treatment provided under the Medicare Better Access to Psychiatrists, Psychologists and General Practitioners initiative
  • $22 million for gynaecological procedures, including long-term reversible contraceptives, rebates for gonadotrophin-stimulated ovulation induction, and restructuring gynaecological oncology services to align with clinical practice
  • $40.5 million for ambulatory blood pressure monitoring, a new service for diagnosing high blood pressure that is more accurate through continuous monitoring over 24 hours
  • $14.2 million for new MBS items for allied health professionals who participate in case conferences organised by a patient’s GP.
A further $55.1 million will support other amendments to the MBS, including items for heart health, cancers, pain management, and irritable bowel syndrome, while $22.6 million will help reform the Practice Incentives Program – Indigenous Health Incentive (PIP–IHI).
 
The RACGP has stated it will continue to advocate for the following measures, which were not included in this year’s Budget:
  • Improvements to MBS indexation
  • Increases to patient rebates for longer consultations
  • The introduction of Level E consultations
Finally, the Government will provide $2.1 million for point-of-care quantitation of HbA1c for the monitoring of diabetes in diagnosed patients, which is expected to fund around 47,000 tests a year.
 
Aged care
Around $17.7 billion will be spent on aged care over five years (2020–21 to 2024–25). The funding is split into five pillars:
  • $698.3 million for governance and regional access
  • $7.5 billion for home care
  • $942 million (over four years) to support residential aged care quality and safety
  • $7.8 billion towards residential aged care services and sustainability
  • $652.1 million (over four years) dedicated to the workforce
However, while the RACGP has welcomed the ‘significant’ funding allocation, it says several key issues have not been addressed. These include ongoing concerns regarding the aged care royal commission’s proposed primary care model; support for unremunerated work by GPs in the aged care sector; and MBS support for GP services provided via telehealth at residential aged care facilities (RACFs) without patients being present.
 
The college has said it will continue to advocate for sustainable GP-led aged care on behalf of members. 
 
Other key aged care funding measures featured in the Budget include:
  • $42.8 million to increase the Aged Care Access Incentive from 1 July to increase face-to-face servicing by GPs within RACFs, while the maximum yearly payment received by GPs will double to $10,000
    • The college says this measure will support GPs providing services to older people in residential aged care, but notes further work is necessary to ensure barriers to GPs providing these services are reduced
  • $49.4 million in increased funding will be directed towards training to improve aged care workers’ knowledge and practice in dementia and palliative care – dementia training will target leaders in personal care, GPs and general practice registrars, and improve access to dementia training in regional and rural areas
  • $557 million to support initiatives for Aboriginal and Torres Strait Islander people, including
    • $396.9 million in infrastructure funding and to help aboriginal community controlled organisations (ACCHOs) to expand into aged care
    • $106 million for a workforce of 250 Aboriginal and Torres Strait Islander people to support and assist with access and navigating the aged care system
    • $61.6 million in additional service delivery funding for the 43 National Aboriginal and Torres Strait Islander Flexible Care Services
  • $45.4 million to introduce electronic medication charts in RACFs, increasing utilisation and integration of My Health Records, and establishing digital support for transitioning between aged care and hospital settings.
Rural health
The Government will provide $65.8 million to increase the Rural Bulk Billing Incentive for doctors working in rural towns and remote areas.
 
The RACGP strongly supports increased investment in rural GPs, as the costs to provide general practice care have increased year-on-year, but it says the Government has not matched these increases in patient rebates provided by the MBS.
 
‘The growing gap between the cost of providing care and the Medicare rebate, combined with high external pressure for GPs to bulk bill all services, has had a significant impact on income and general practice sustainability,’ the RACGP budget overview states.
 
‘While this funding is welcome, the investment needs to be part of a wider, holistic policy response.’
 
The Budget also included the following additional funding for rural health:
  • $12.4 million for the John Flynn Prevocational Doctor Training Program to add another 90 FTE rotations by 2025
  • $300,000 funding for the development of a new program to streamline the Rural Procedural Grants Program (RPGP) and the Practice Incentives Program (PIP) Procedural GP payments
  • $2.2 million for additional grants to trial collaborative rural primary care models
  • $3.8 million for upgrading the Bonded Return of Service IT System (BRoSS)
Mental health
The National Mental Health and Suicide Prevention Plan will see $2 billion spent over four years from 2021–22, specifically:
  • $248.6 million on prevention and early intervention
  • $298.1 million on suicide prevention
  • $1.4 billion to support treatment
  • $107 million towards supporting vulnerable people
  • $202 million to fund workforce and governance.
However, the RACGP has said it is concerned that the inequality in MBS patient rebates for mental health and physical health services remains unaddressed. A key advocacy target for the college is ensuring that MBS is modernised to support mental health care.
 
More than $34 million will go directly towards expanding and implementing the Initial Assessment and Referral (IAR) tool in primary care settings to support GPs in their role as a key entry point into the mental health system. The tool will also apply in all Commonwealth-funded services and, with their agreement, in state and territory services, and will deliver a consistent and culturally appropriate approach to clinical assessment and referral.
 
Nearly $16 million will also be used to help GPs and other medical practitioners provide primary mental health care.
 
Meanwhile, funding specific to Aboriginal and Torres Strait Islander people includes:
  • $8.3 million to deliver 40 more scholarships over two years for students studying mental health-related disciplines and training to improve the skillset of the health workforce
  • $79 million to address the impact of suicide and ill-mental health under a renewed suicide prevention strategy.
Disability
More than $13 billion in additional funding will be given to the National Disability Insurance Scheme (NDIS) over four years, bringing total funding for this period up to $122 billion when also taking into consideration contributions from the states and territories.
 
Around $12.7 million will be given to try and improve the health of people with intellectual disability by implementing three priority actions:
  • $6.7 million to improve the uptake and implementation of annual health assessments
  • $1.4 million to enable scoping and co-design of a model for a National Centre of Excellence in Intellectual Disability Health
  • $4.7 million for intellectual disability health curriculum development to support the delivery of specific and specialised content as part of tertiary education curricula
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Dr Sanjeevan Nagulendran   13/05/2021 7:19:44 AM

Working at the coal face of mental health and seeing the increasing numbers of complex presentations that appear in our community I hope the extra money is not wasted. I would urge the government to encourage a more generous rebate for psychiatrists to the see concession card holders as well as those with drug and alcohol problems, as these patients with a mix of complex physical and mental problems can be very tricky for the GP to manage on their own without enough support! The public health system as I understand it through no fault of their own for mental health, as it is not fee for service is not driven or equipped to meet the demands of the clients in the community where I work in western sydney.


Dr Peter JD Spafford   13/05/2021 8:45:23 PM

The RACGP cannot see the forest for the trees. A minute increase in bulk billing incentives for some, more items for certain things with more complexity. This is a non budget for GPs, no change to the same old and essentially no extra funding to enable practices to function as going enterprises.