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Federal Budget 2023–24: The detailed breakdown for GPs


Jolyon Attwooll


10/05/2023 4:21:29 PM

The long-awaited Budget contained some unequivocally good news for general practice, following long-term RACGP advocacy.

Budget 2023-24
Described as a game-changer for GPs, this year's Budget includes a number of measures that need further detail. (Image: AAP)

This year’s Federal Budget has long been considered crucial for GPs, with the backdrop of a widely recognised crisis in general practice, a change in government, and the findings of the Strengthening Medicare Taskforce published in February.
 
While some Budget items had already been made public, the new measures that were revealed for the first time led RACGP President Dr Nicole Higgins to describe the Budget as a ‘game-changer’ for general practice, with many of the college’s pre-budget submissions confirmed.
 
Here, newsGP looks at each of the main measures affecting GPs, including details of the college’s responses in its formal Budget overview.
 
Indexation
After decades of MBS underfunding, the Federal Government has confirmed an indexation boost to MBS patient rebates, with more than $1.5 billion allocated from this November.
 
The sum is described in a Budget statement from Federal Health and Aged Care Minister Mark Butler as ‘delivering the biggest increase in 30 years’. The RACGP said the increase follows sustained advocacy from the college for increased investment in rebates.
 
In real terms, this will mean the rebate for a Level B consultation increases from $39.75 to $41.10 from 1 July.
 
Bulk billing
Bulk billing rates have fallen dramatically in recent years as general practices struggle to keep their businesses sustainable. One of the standout items in the Budget is the measure to triple bulk-billing incentives, a move which reflects exactly a request made in the RACGP’s pre-budget submission.
 
It will apply to all face-to-face consultations of more than six minutes, as well as Level B telehealth consultations, and longer telehealth consultations for patients with GPs through MyMedicare.
 
‘The Budget commitments for general practice clearly show that Government has listened and responded to the RACGP’s calls to support our GPs, practice teams and the patients so that everyone can access a strong primary care system,’ the college response states.
 
Multidisciplinary team care
The theme of multidisciplinary team care, emphasised by the Strengthening Medicare Taskforce report, was also widely addressed in the Budget, including $445.1 million over five years to increase the Workforce Incentive Payment – Practice Stream. This will raise the maximum payment per practice to $130,000, with Minister Butler also committing to annual indexation of the payment.
 
There is also $98.9 million set aside over four years to connect frequently hospitalised patients to general practices for multidisciplinary care in the community. Further measures on the same theme include $79.4 million to support Primary Health Networks (PHNs) to commission allied health services, and a 30% increase for MBS patient rebates for standard consultations with nurse practitioners.
 
The RACGP said it welcomed Budget measures to support coordinated, culturally safe multidisciplinary general practice team-based care, and that it looks forward to working with practices and other stakeholders.
 
Extension of Practice Incentive Program – Quality Improvement
A total of $60.2 million was committed to extend Practice Incentive Program – Quality Improvement payments until 30 June next year, along with a review of all general practice incentive programs.
 
The RACGP said it is looking forward to providing feedback on reforms to general practice incentive programs.
 
‘It is critical that incentives are targeted towards improving patient care with their usual GP, and do not overburden general practices with administrative burdens that take GPs away from patient-facing activities,’ the college also stated.
 
Non-VR doctor MBS rebates
Nearly $35 million will be spent over two years from 2023–24 to allow non-vocationally recognised doctors to receive MBS rebates, with the RACGP acknowledging the support for GPs in training, while saying further detail is needed to fully understand the impact.
 
A broader move to ensure the MBS remains ‘clinically appropriate’, with $10.9 million committed to the MBS Continuous Review program, was welcomed by the RACGP.
 
New ‘Level E’ consultations; changes to Level B
The Budget includes $99.1 million set aside over five years to establish a new MBS item for longer consultations over 60 minutes, a step that has repeatedly been advocated by the RACGP to support an increasing number of patients with chronic disease.
 
However, the Budget also acknowledges funding for this measure will achieved through ‘efficiencies’ totalling $250.8 million with a minimum consultation time for Level B items – a move previously opposed by the RACGP, with concerns it will act as a disincentive to efficient practices.  
 
‘We will be carefully considering the implications of this change for GPs and patients and will respond in due course,’ the college overview states.
 
Digital health investment
The Budget included substantial investment in digital health, with $429 million earmarked to modernise My Health Record and create a new platform to support easier, more secure data sharing.
 
The college welcomed the announcement, saying any funding to improve My Health Record access ‘needs to include a focus on the importance of equity of access to digital health for all Australians’.
 
The Budget also reflected a vote of confidence in the Australian Digital Health Agency, which will receive $325.7 million to ‘establish it as an ongoing entity’.
 
MyMedicare
As indicated prior to the Budget, this is the name being given to voluntary patient enrolment – a move endorsed by the Strengthening Medicare Taskforce in support of continuity of care. The development is cautiously endorsed by the college.
 
While the Budget notes the Government will provide $19.7 million over four years from 2023–24 (and $3.2 million per year ongoing), the RACGP Budget overview notes the ‘limited information’ available about how the scheme will operate.
 
‘We continue to highlight the importance of fee-for-service funding for patients and note that this funding should remain at the centre of general practice care,’ the RACGP response states.
 
Longer telephone consultations
A $5.9 million commitment over five years was made for longer telehealth consultations under MyMedicare from November this year, with no bulk billing requirement attached.
 
While the college cautiously welcomed the return of rebates for telehealth consultations lasting longer than 20 minutes, it said the announcement lacks detail and further clarity will be sought.
 
Chronic disease and heart assessments items
The RACGP responded in a similar vein to a move to streamline chronic disease management planning items, with the aim of achieving $301.9 million worth of efficiencies over three years from 2024–25, an MBS Review Taskforce recommendation.
 
Meanwhile, MBS heart health assessment items will be extended for two years until end June 2025, with the RACGP expressing concerns about the disease-specific items.
 
‘As specialist generalists, GPs are trained to treat a patient as a whole person, not a specific illness or issue in isolation,’ the college response states.
 
Medicare integrity
Following the release of the Philip Review of the MBS earlier this year – research prompted by fiercely contested media coverage of Medicare – the Government set out $29.8 million over four years to shore up the integrity of the system.
 
Specific measures include:

  • establishing a taskforce ‘to identify and disrupt’ fraud and serious non-compliance
  • limiting the duration of backdated patient-billed claims through practices to prevent fraudulent claims
  • permitting targeted data sharing with Services Australia to help stop fraudulent claims payments
  • enabling the Department of Health and Aged Care (DoH) to audit providers by removing the requirement for external consultation with peak bodies.
In its Budget response, the college reiterated its support for ethical and responsible billing practices, but again highlighted the unnecessary complexity of the MBS, and the need for compliance to be balanced with education.
 
The RACGP said it will seek further detail at the next quarterly meeting with the DoH’s compliance team in June.
 
Urgent Care Clinics and after-hours care
A total of 58 urgent care clinics will now be funded by the Government, eight more than promised in a pre-election commitment, with $358.5 million in extra funding announced on Tuesday.
 
Noting its support of improving access to GPs for acute illnesses and reducing the strain on hospital emergency departments, the RACGP advocated the funding go towards existing practices rather than new infrastructure.
 
Almost $144 million has been committed over two years from the next financial year to improve access to primary care after-hours programs. This includes $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.
 
The RACGP stated that it supports the move to improve access, particularly to communities who face additional barriers.
 
The Budget also includes a $21.9 million commitment to raise awareness of urgent care clinics and MyMedicare.
 
Aboriginal and Torres Strait Islander health
A series of measures were set out to improved primary care access for Aboriginal and Torres Strait Islander people, with $363.1 million committed over four years, including: 
 
  • $27 million for the provision of primary care and support services in thin markets
  • $16.7 million to promote health assessments for Aboriginal and Torres Strait Islander patients
  • $6.6 million in 2023–24 to continue activities through the national blood-borne viruses and sexually transmissible infections strategies, and extending sexual health services provided by Aboriginal Community Controlled Health Organisations.
The RACGP has backed the funding for the health of Aboriginal and Torres Strait Islander communities and supports measures to allow the Aboriginal Community Controlled health sector to continue to bulk bill.
 
Funding for James Cook University
The Government will provide $4.2 million over two years from 2022–23 to deliver the Australian General Practice Training program, with the college stating that it welcomes any additional investment in GP training.
 
Other measures
A number of other Budget commitments were made with implications for general practice.
 
Fulfilling an election promise, the Government said an Australian Centre for Disease Control will be established at a cost of $91.1 million over two years from 2023–24, a move welcomed by the RACGP.
 
A national lung cancer screening program costing $263.8 million over four years will also be set up, a move greeted with cautious support by the RACGP.
 
‘General practice should be central to the implementation of the screening program,’ the college stated.
 
The Budget also states that $47.8 million will be provided over five years, with $12.3 million subsequently, for a wound consumables scheme addressing the cost of chronic wound care in the community.
 
A new General Practice in Aged Care incentive payment of $112 million over four years is also being made available to improve GP attendance and continuity of care in residential aged care homes.
 
Meanwhile $12.7 million has been set aside for a network of respiratory clinics that can provide surge capacity in response to outbreaks as required.
 
The Budget also confirmed the extension of telehealth consultations to evaluate the suitability of COVID-positive for oral antiviral, with $14.2 million committed for two years for the measure, a move advocated for by the RACGP.  
 
GPs will likely to have to change their approach to shingle vaccination following a Government announcement of $446.5 million for Shingrix to replace Zostavax on the National Immunisation Program (NIP).
 
Finally, the Budget confirmed that Medicare rebates for telehealth for patients with COVID-19 will remain available, whether or not the patient has an existing clinical relationship with a GP.
 
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Budget MBS Medicare rebate


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Dr Patricia Montanaro   11/05/2023 8:13:22 AM

Yes money to general practice.
Mainly money to patient rather than general practice.
Yes very difficult to get any action in this space.
Is it correct that approximately 50% of the Australian public (?80% of patient consultations) will want a WHOPPING fee reduction
The real needs were
1-increase in rebate, not indexation on a very low base for the future.
2-Level B is 5-12.5 min where current rebate is ok and 12.5- 20 where current rebate is not ok and should attract different fees. Noting that this time is waiting room to waiting room.
3.Time based scales without reducing fees as more time is spent. Ideally 0-5, then 10 min additional blocks
Thankyou from…. Still dudded by reduced worth of GP compared to the partialists and still years of brutal reduced worth( ?40% of initial fees)


Dr Harsh Aggarwal   11/05/2023 9:46:18 AM

Would appreciate some detail on MyMedicare…
Can’t understand why it’s so vague…unless another smokescreen…


Dr Grahame Robert C Deane   11/05/2023 10:26:50 AM

It appears that Item 3 will not attract the tripled BB incentive as this will only be for consultations over 6 minutes. Is this correct? Does the current BB incentive then continue for Item 3 or not? Also the longer Telehealth consultations and the tripled BB incentive seems to only apply if the patient is registered with the GP through MyMedicare. Is this correct? Is this then "capitation by stealth"


Dr Christopher Francis Boyle   11/05/2023 12:55:09 PM

The hype and rhetoric does not match the outcome. The increase in the incentive does not make up for years of not keeping the rebate properly indexed. It is a political fix to make the Government look as though they are doing something.
The increase in the bulk billing incentive makes it possible to continue to bulk bill some - and I stress some - very disadvantaged patients rather than these patients being unable to access care at all. The increase in the fee, taking into account the rebate and the increased incentive makes an item 23 worth $60.40, almost $10 less than our discounted fee. Why would we cease privately billing?
It is the pressure from GPs stopping bulk billing that has forced the Governments hand, allowing the RACGP to talk to the Government on our behalf. This has been well done.
The only way to keep the pressure on the politicians is to get the bulk billing rate lower. So we as a group need to stay firm and drop the bulk billing rate further.


Dr Noela Whitby, AM   11/05/2023 1:17:02 PM

My paranoia exactly. More detail on My Medicare and it’s implications for GPs please


Dr Richard James Lord   11/05/2023 2:56:04 PM

The tripling of the BB incentive is politically astute, but is it also indexed to CPI? If it is not indexed, then we will just be back where we are now in a few short years. Unless it is indexed I see little reason to return to bulk billing, as going through the 'we are stopping bulk billing' process in a few years will again be traumatic for patients and staff.


Dr Fiona Jane Henneuse-Blunt   11/05/2023 7:56:47 PM

I expect patients hearing that the "bulk billing incentive has been tripled" will confuse that with "medicare rebates have tripled " and will demand "rich doctors should be bulk billing everyone now "