Emergency doctors call for investment in rural GPs

The Australasian College of Emergency Medicine (ACEM) has urged the Federal Government to boost support for independent rural general practices to help shore up the health of Australians living in rural and remote areas.
 
In a submission to the ‘Rural, regional and remote Medicare access and funding’ Senate Inquiry, ACEM highlights the pressures on primary care access as a key factor in avoidable emergency department (ED) presentations.
 
It acknowledges varied reasons for primary care access challenges that are ‘often distinct to each community’.
 
‘Whatever the cause, when patients in [regional, rural and remote] areas struggle to have reliable access to a regular primary care provider, they will likely find themselves presenting to EDs at higher rates for conditions that would ordinarily be managed earlier, including both lower-acuity issues and deteriorations of chronic disease,’ the submission reads.
 
It calls for expanded rebates to support chronic disease management, continuity of care, and preventive intervention, as well as a rise in long consultation Medicare rebates, and an increase in incentives for rural primary care providers.
 
A key recommendation is to ‘improve financial settings to support the sustainability of independently owned rural general practices’.
 
‘Limited access to continuous primary care magnifies these pressures and increases preventable hospital admissions,’ ACEM states.
 
The call echoes the RACGP’s own submission in which it warns that small and medium rural practices are ‘particularly exposed’ to financial risk, and that the sustainability of independently owned clinics is ‘increasingly fragile’.
 
‘To remain financially viable and participate in bulk-billing incentives, some practices may limit or withdraw longer, specialised services,’ the college submission states.  
 
‘Alternatively, practices may elect not to fully commit to incentive arrangements in order to sustain complex and extended-scope care.
 
‘In either case, the current funding structure places small rural practices in a fundamentally different position to larger providers that are better able to distribute risk, absorb financial pressures or cross-subsidise service streams.’
 
The submission also warns of ‘increasing downstream demand on hospital services’ if the issues are not addressed, with RACGP Rural Chair Associate Professor Michael Clements noting how closely the two colleges’ recommendations are aligned.
 
‘ACEM has been consistent for a long time that bed block isn’t because of more sick patients, it’s because of a lack of preventive care,’ he told newsGP.
 
He also referenced a submission to the Inquiry from the Department of Health, Disability and Ageing, and its focus on enhanced bulk-billing incentives. While noting his support for the measures, he said their increased uptake did not tell the complete story.
 
‘Sadly, we see the Government using a billing indicator as a proxy for what the actual healthcare being delivered to communities is and what needs to be delivered,’ he said.
 
As well as noting poorer health outcomes among rural Australians compared to city populations, the RACGP submission highlights significantly less dedicated funding, citing research that suggested a shortfall of $8.35 billion compared to metropolitan areas.
 
It also proposes changes to MyMedicare to give more flexibility for patients, and points to barriers to care from telehealth rules requiring annual face-to-face visits.
 
The RACGP said that any reform must include Aboriginal communities and Aboriginal Community Controlled Health Organisations in design and funding decisions, noting that if Medicare access changes did not do so ‘they risk entrenching inequity’.
 
The Senate Inquiry is due to deliver a report with recommendations in November this year.
 
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ACEM Australasian College of Emergency Medicine rural general practice