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Expand after-hours rebate window: RACGP


Matt Woodley


14/06/2024 4:29:18 PM

The college has said patients should be able to access higher subsidies from 6 pm on weeknights and midday on Saturdays.

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The RACGP has said directing more funding to the General Practice After Hours Incentive Program would allow clinics to stay open longer.

A recent RACGP submission has called for changes to after-hours care that would increase the window in which patients can receive higher Medicare rebates when attending a general practice.
 
Delivered in response to the Department of Health and Aged Care’s Review of After Hours Primary Care Policies and Programs, the submission also says any new services should be incorporated into existing general practice infrastructure, as GPs ‘must be’ a part of any after-hours care.
 
‘Funding drives results,’ RACGP President Dr Nicole Higgins said in response to the submission. ‘By supporting GPs to provide this care, we can expand what we do, and keep more patients out of hospital.’
 
Dr Higgins also cautioned against pouring funding into other, less efficient areas of the healthcare system.
 
Last year, the Federal Government committed almost $144 million to improve access to primary care after-hours services, including $25.4 million for a Homelessness Support Program, $15.3 million for a PHN Multicultural Access Program and $7 million to support Healthdirect’s after-hours GP helpline.
 
It is also spending more than half a billion dollars on establishing 87 urgent care clinics, which the college has called ‘window dressing’ and said could provide more value for money if invested directly into general practice.
 
‘In my home of Mackay, there was previously an after-hours clinic that provided 24-hour care,’ she said.
 
‘However, after the Government made changes to the funding model, it’s now operated by emergency doctors, costs patients three times as much, and closes at 10 pm.
 
‘So, getting the funding model right is vital.’
 
The college submission states that increased funding via the General Practice After Hours Incentive Program would enable more clinics to operate outside of typical opening times, and that the six features of high-performing general practice – patient-centred, continuous, comprehensive, coordinated, high-quality and accessible – should be taken into consideration.
 
It also warns that providing after-hours care should not add to the administrative burden currently experienced by GPs and practices, adding that digital interoperability, including the streamlining of all administrative aspects of service delivery, must be a priority.
 
‘It’s vital that GPs and practice teams are included in the design, operation, and evaluation of all after-hours primary care services,’ Dr Higgins said.
 
‘These services must be available to all patients, including those living in rural and regional areas, with special consideration given to vulnerable populations, and programs should be tailored to fit the needs of local communities.’
 
She also said the college is ‘ready to work with the Government to make this happen’, and reinforced that the primary aim should be ensuring the best long-term health outcomes for all patients.
 
‘Patients would prefer to see their usual GP and practice team,’ Dr Higgins said.
 
‘General practice acts as a central point of care for patients who are accessing care from multiple sources, and this is why we have expressed concern regarding existing after-hours models.
 
‘Best practice multidisciplinary care teams include GPs working alongside other healthcare professionals to achieve the best possible care.’
 
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Dr Gihan De Mel   15/06/2024 8:58:59 AM

As a GP who looks after patients during the day and visits aged care facilities after hours, caring for nearly 100 residents, I find the derived fee criteria highly misleading for patients. For those who may not be familiar, the derived fee criteria within the MBS refers to a system where the rebate amount for a patient's consultation varies depending on how many patients their doctor sees at one location, such as a nursing home, during a single visit. The "ready reckoner" is a tool used to calculate these rebates.

Essentially, the more patients a doctor sees in one session, the lower the rebate each individual patient receives.

It’s important to remember that the Medicare rebate is not the doctor’s pay but the patient's rebate. How is it fair or equitable for patients to receive lower rebates depending on the number of other patients their doctor chooses to see on the same occasion?

As we continue to assess the structure and impact of these items, I feel compelled to raise concerns regarding the potential constitutional and ACCC implications of the current derived fee rebate framework, which lies beyond the control of consumers (patients). Additionally, it is troubling to note that these item numbers, particularly within the aged care sector, appear to assume inherently that GPs will bulk bill them. This assumption is problematic given the challenges associated with setting private fees and obtaining financial consent from patients, as the rebate amount varies depending on the number of patients seen on a single occasion. Such an assumption may not align with the diverse needs and circumstances of healthcare providers and could inadvertently undervalue the services rendered. Furthermore, the impending initiation of MyMedicare may exacerbate this issue, as many GPs stand to lose access to the General Practitioner Aged Care Access Incentive, potentially leading to increased reliance on private fees.


Dr Tan Quoc Le Tran   15/06/2024 3:33:29 PM

After hours rebate should be all day on Saturday as we have weekend rate for our staff. Poor rebate has led me to close Saturday indefinitely


Dr Bryan Joe Kim Buttery   15/06/2024 8:28:33 PM

They have to do something, my young doctors in the 30 something age group are simply not engaging in after hours care at the current remuneration.
An increased Pip to the practice to pay the higher gazetted after hour fees for receptionist and nurses would also be needed if practice owners are going to engage.


Dr Bradley Arthur Olsen   16/06/2024 6:52:04 PM

Yesterday (saturday) I could not work , as I usually do every Saturday . The result , the practice closed and those 30 odd patients may well have gone to DEM instead . I agree with DR Tran it should be all day Saturday if they are in any way serious about attracting GPs to work weekends


Dr Jacqueline Anne Barry   17/06/2024 4:18:09 PM

Should be all day Saturday. The staff costs are the same all day, and every award with "afterhours" starts at 6pm weekdays and includes all day Saturday, with an even higher rate on Sundays/Public holidays. These are the costs for opening on those days - any wonder many just don't bother


Dr Patricia Montanaro   23/06/2024 9:00:21 AM

I would greatly appreciate a reply from RACGP. Why is after hours outside 8-6 pm?
I believe the standard is now 9- 5 pm Monday to Friday. These are community/government standards of normal time. They should apply to rebates.