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Federal Budget breakdown: What GPs need to know

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Following the release of the Government’s highly anticipated Federal Budget, the RACGP has welcomed a number of funding commitments.
 
But President Dr Karen Price has been clear in the college’s continued disappointment at the lack of investment in primary care, in particular the lack of funding for the Primary Health Care 10 Year Plan (the 10-year plan) and support for priority patient groups.
 
The Budget also fails to address many of the critical challenges highlighted by GPs and other primary healthcare workers – from rising rates of chronic disease and a mental health crisis, to the growing costs associated with providing critical primary healthcare services.
 
Here is a breakdown of the key measures that affect GPs, with RACGP responses adapted from the college’s formal Budget overview.
 
Primary Health Care 10 Year Plan
The Government will provide $632.8 million in new funding to support the 10-year plan, including $3 million to build linkages between My Health Record and the myGP system, which will be an integral part of the voluntary patient enrolment scheme.
 
The funding also comprises of $4.9 million to support quality improvement in general practice, including:

• $2 million for the Australian Commission on Safety and Quality in Health Care to continue the National General Practice Accreditation Scheme
• $1.4 million for the Practice Incentive Program (PIP) and Workforce Incentive Program (WIP), allowing additional practices to become accredited and access these payments
• $1 million to implement the initial recommendations of the national general practice accreditation review.

The college has said that it is seeking further information on these measures and will communicate the findings with members in due course.
 
Other key measures include $58 million to improve diagnosis and primary care support for women with endometriosis. This includes:

• $16.4 million to establish new specialised endometriosis and pelvic pain clinics in each state and territory, building on existing general practices specialising in women’s health and pain management
• $5.1 million to develop an Endometriosis Management Plan to support patients in primary care.

The RACGP has said it acknowledges the importance of a multidisciplinary care team when it comes to endometriosis. But with the burden for the detection and referral depending largely on GPs, it is advocating that the college be involved and consulted in the process going forward to ensure the strategies are appropriate and realistic for general practice.
 
Rural health
As part of the 10-year plan funding, the Government has allocated $296.5 million over four years towards the 10 Year Rural Health Strategy. This includes:

• $99.3 million to fund an increase in the number of medical students studying in rural and remote locations
• $36.2 million to fund two new university Departments of Rural Health in the Southwest and Goldfields regions of Western Australia to support rural medical training
• $33.3 million to the Royal Flying Doctor Service (RFDS) to support emergency aeromedical services as part of establishing a new 10-year Strategic Agreement with the RFDS
• $22.1 million to increase CareFlight’s and Little Wings’ capacity to deliver aeromedical services, including patient transport, health clinics and air rescue missions in rural and remote Australia
• $14.8 million to support Charles Sturt University to deliver a Rural Clinical School.

Meanwhile, to reduce patient costs and minimise the need to travel, $66 million will go towards deregulating access to Medicare funded MRI services in MMM 2–7 areas.
 
While the RACGP has welcomed funding to increase the number of medical students studying in rural and remote locations, it is disappointed that its calls for access to relevant specialty MBS items – such as rural GPs with advanced skills in internal medicine, mental health, paediatrics, palliative care, and/or emergency – went unanswered.
 
Telehealth
The Government has provided $512 million for permanent universal telehealth, which will not be linked to any future patient enrolment scheme.
 
The MBS telehealth arrangements have also been changed to enable any GP or other medical practitioner to provide services to patients affected by natural disasters, exempting affected patients to the 12-month face-to-face rule.
 
The RACGP has welcomed the move and also expressed support for the availability of both video and telephone MBS items to give patients choice and allow them to access care when they need it.
 
The college also has plans to continue advocating for the permanent reinstatement of patient rebates for longer telephone consultations.
 
Following calls from the RACGP, the Government will also provide $15.4 million for the Practice and Workforce Incentive Programs (PIP and WIP) to retrospectively include COVID-19 telehealth services in the Standardised Whole Patient Equivalent (SWPE) calculation.
 
Medicare
The Government is providing $133 billion over four years for Medicare, and $170.6 million over four years for new and amended MBS listings.
 
Based on recommendations from the independent Medical Services Advisory Committee (MSAC),
the following new services and amendments are being introduced:

• $81.2 million for genetic testing to determine carrier status in people who are planning pregnancy or who are already pregnant and their reproductive partners
• $32.6 million for positron emission tomography (PET) for initial staging for patients diagnosed with rare and uncommon cancers
• $14.8 million for new and amended items for obstetrics and gynaecology – amending one MRI item and introducing one new MRI item and six new ultrasound items to improve the health outcomes of pregnant women and ensure the birth of healthy babies at term
• $14 million for an amendment to the current MRI of the liver item to include all cancer types that have potentially spread to the liver
• $6.6 million for abdominoplasty for surgical repair of rectus diastasis (separation of the large abdominal muscles) following pregnancy
• $400,000 for cryoablation for biopsy-confirmed renal cell carcinoma
• review and reprogramming of neurostimulators for chronic pain by videoconference
• supporting patient access to PET services during radiopharmaceutical supply disruptions, ensuring continuity of treatment
• $10.6 million for an amendment to the current MRI of the breast item for patients at high risk of developing breast cancer, raising the age limit from 50 to 60
• new items for remote programming and monitoring for deep brain stimulation and cardiac internal loop recorders
• $2.7 million for six amended items for the treatment of varicose veins to enable co-claiming with other venography items
• new items for Transcatheter Aortic Valve Implantation (TAVI) in low-risk populations and CEP embolic net insertion
• seven new items to remove confusion around the claims for melanoma excision and support consistent Medicare rebates.

In response to recommendations of the clinician-led MBS Review Taskforce, MBS item amendments include:

• otolaryngology, head and neck surgery – an MBS claiming system that better describes surgeons’ practice and reflects clinical evidence, and new MBS items for a complete medical service rather than variable combinations, ensuring consistent Medicare rebates
• paediatric surgery – increased fees for items that repair inguinal hernias in children younger than 12 months old
• thoracic surgery – changes that restrict inappropriate co-claiming and create new MBS items
• acupuncture – changes that ensure acupuncture items align with contemporary clinical practice and prevent inappropriate claims
• cleft and craniofacial services – removing the age limit of 22 for the Cleft Lip and Cleft Palate Scheme, opening the scheme up to all patients with hereditary cleft and craniofacial conditions so they can access treatment throughout their life.

Other key measures include:

• $946,000 to extend the MBS items for Australians impacted by the 2019–20 Black Summer bushfires for a further six months, until 30 June 2022
• $7.5 million for the MBS continuous review mechanism to ensure the scheme remains clinically appropriate.

The RACGP has indicated it will continue to advocate for the following measures which were not included in this year’s Budget:

• Simplification of the MBS to better support wholistic patient-centred care
• Increases to MBS rebates and regular indexation
• Increases to patient rebates for longer consultations
• Introduction of Level E consultations

This year’s Budget fails to address many of the critical challenges being experiences by GPs and other primary healthcare workers, according to the RACGP. (Image: AAP)

Aboriginal and Torres Strait Islander health
The Government will provide $133.5 million in funding for Aboriginal and Torres Strait Islander health, including:

• $54.7 million to bring forward funding increases for ACCHS, introducing longer-term four-year rolling funding agreements and a 3% annual increase (including indexation) 
• $13.9 million for Puggy Hunter scholarships
• $2.4 million to support local mental health services in ACCHS in response to the floods.

The RACGP has said it is supportive of funding to develop future workforce participation and investment into the National Closing the Gap Policy Partnership on Social and Emotional Wellbeing (Mental Health), but notes that $8.5 million over three years is much less than is needed to solve complex problems.
 
The college also believes that there does not appear to be any strategic direction in funding priorities, with the implementation of the Aboriginal and Torres Strait Islander Health Plan remaining unfunded.
 
COVID-19 response
The Government will provide $4.2 billion over four years towards the COVID-19 response, including $977.4 million over two years to support continued access to vaccines.
Though the RACGP supports COVID-19 vaccines being made free for all patients to boost uptake, it notes that funding should reflect the amount of time it takes to obtain informed patient consent for a new vaccine.
 
Meanwhile, to support the management of COVID-positive patients in the community, the Government has allocated:

• $20.4 million over two years for the extension of temporary MBS telehealth services, including specialist and longer GP telephone consultations
• $4.8 million for a temporary MBS item to support general practices to manage COVID-positive patients in the community.

The RACGP has welcomed the temporary reinstatement of Medicare rebates for Level C telephone consultations, however, its position remains that rebates for longer GP telephone consultations should be made permanent.
 
The college also supports the reintroduction of telephone rebates for mental healthcare and chronic disease management.

More than $248 million has been earmarked to continue funding GP-led respiratory clinics throughout winter, and $55 million will be used to purchase and provide essential PPE for GPs and pharmacists.
 
To ensure the safety of clinicians and patients, more than $1.6 billion will go towards funding equitable access to rapid antigen tests, including for general practice-led respiratory clinics. A new MBS item will also offer medically supervised rapid antigen test screening to patients where clinically appropriate.
 
Cancer screening
To address COVID-19 delays in cancer screening, the Government is providing:

• $9.7 million for breast cancer screening
• $20.2 million for cervical cancer screening and associated promotion
• $10.2 million for colonoscopy triage.

While the RACGP supports this funding, it is not clear how it will be allocated and if any will be available to support GPs.
 
Mental health
In the space of mental health, the Government will provide:

• $15.1 million for new MBS items to allow eligible providers to hold up to four mental health case conferences per calendar year to facilitate collaborative care
• $89.2 million to implement key priorities of the 10 Year National Mental Health Workforce Strategy, including $4.2 million to support headspace centres in regional, rural and remote areas to attract and employ GPs
• $6 million to optimise the existing mental health workforce, including trialling a free national support line service for GPs to access clinical advice and support from psychiatrists.

Given the limited national support available for GPs to undertake these activities since the GP Psych support service was defunded in 2013, the RACGP supports funding for a national service.
 
Aged care
The $18.8 billion over four years allocated to aged care in this year’s Budget largely represents a continuation of previously announced funding by the Government in response to the Royal Commission into Aged Care Quality and Safety. It includes:

• $22.1 million to deliver trials of multidisciplinary outreach services to share costs with states and territories for providing more comprehensive healthcare through multidisciplinary care teams to people in residential aged care, and hospital-led access to specialists and other health practitioners
• $345.7 million to improve medication management and safety for aged care residents through on-site pharmacists and community pharmacy services.

While the RACGP has welcomed funding to improve medication management and safety for aged care residents, it notes the importance of accredited pharmacists and GPs working collaboratively to decide on contraindications that may occur.
 
Disability
The Government will provide $157.8 billion over four years for the National Disability Insurance Scheme (NDIS), which is now supporting 500,000 participants, with $33.9 billion budgeted for 2022–23.
 
This is an increase compared to the $116.1 billion projected over four years in the 2021–22 Budget.
 
Research
The Government has updated the 10 Year Investment Plan for the Medical Research Future Fund (MRFF), which includes:

• $384.2 million to support Australia’s upcoming early to midcareer researchers
• $200 million to support clinician researchers
• $70 million for primary healthcare research.

It is also funding $32 million across 14 new grants to assist clinician researchers around the country to tackle health problems identified at the coalface of primary care.
 
However, the $70 million for primary care research only represents 1.6% of total MRFF funding over 10 years and the RACGP is advocating for an increase to better match expenditure on the primary care sector.
 
The college is also calling for infrastructure funding to support primary care research and translation through general practice-based research networks.
 
Access to medicines
The Government will spend $2.4 billion on new and amended listings on the Pharmaceutical Benefits Scheme (PBS) and $525.3 million over four years to lower the PBS safety net thresholds from 1 July 2022 as follows:

• Concessional patients: from $326.40 to $244.80
• General patients: from $1542.10 to $1457.10

Meanwhile, $600,000 will go towards a feasibility study for non-medical prescribing over two years.
 
The RACGP will be seeking clarification from the Government on the feasibility study as a matter of priority, as the college has concerns for patient safety if non-medical professionals prescribe unsupervised and without appropriate medical training and assessment of competency.
 
Other funding
To help modernise the healthcare system, the Government is investing:

• $107.2 million into new digital services to track and manage Medicare Complex Care Plans digitally and to modernise the Medicare provider number registration process
• $96.8 million for the next phase of the Health Delivery Modernisation Program with the intention to deliver new digital health services and modernise Services Australia’s health payments system.

The Budget also provides more than $4.7 million in funding over two years to ensure continuity of primary care services for flood-affected Australians. This includes:

• $730,000 over six months to employ locums in the Lismore region to create a temporary surge workforce and a longer-term capacity if local practices remain closed for an extended period
• $1.5 million to immediately establish shared temporary business premises in or near Lismore for displaced local primary healthcare providers, including GPs.

The RACGP has welcomed the funding, but is asking Government to further support members impacted by the current flood emergency with access to IT infrastructure to ensure they can access Medicare services.
 
Other key measures include:

• $1 million over one year to continue the implementation of the Healthy Habits program of the RACGP
• $372.4 million for measures to reduce the impact of drug and alcohol use in communities
• $48.7 million over four years to support people who have experienced family, domestic and sexual violence to navigate the health system and access services
• $67.2 million over four years for the Trauma-informed Recovery Care pilot program, to trial a national model of care through PHNs to improve coordination and access to specialised, multidisciplinary recovery services.

The RACGP supports funding for women’s safety measures, but notes the need for ongoing education and peer support groups to help GPs identify and safely work with victims, children, and perpetrators, as well as work with other domestic violence services.
 
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aged care COVID-19 Federal Budget general practice Medicare Primary Health Care 10 Year Plan voluntary patient enrolment

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