Federal Government reveals long-awaited Better Access response

After more than 18 months, the Federal Government has handed down its official response to an independent evaluation of Better Access.
 
Each year, around 1.3 million people receive psychological therapy through the scheme, at a time when GPs are seeing more patients with mental health issues than ever before.
 
In 2022, independent evaluators handed down their investigation of the initiative, which was designed to determine whether it was improving health outcomes, increasing access to mental health care, and how it could be improved.
 
The review made 16 recommendations, focusing on building multidisciplinary and complementary models of care, aligning treatment with clinical need, and better supporting GPs to refer patients.
 
It went on to support the use of GP-led mental health treatment plans after significant gaps in access linked to socio-economic status and location were identified, as well as calling for ‘simplified’ treatment plans that support GPs to work collaboratively to meet individual patient needs.
 
On Friday, the Commonwealth finally responded to those recommendations, revealing it supports seven of them, and two in principle.
 
The evaluation had specifically recommended funding for 10 additional psychological therapy sessions, introduced during COVID-19, to continue, but the Federal Government has rejected this plan.
 
‘While the evaluation recommended reinstating the additional 10 sessions it also showed the number of new people accessing Better Access reduced while the additional 10 sessions were in effect,’ the Federal Government said.
 
‘Increasing session numbers as part of a tiered model of treatment carries a high-risk of further entrenching inequities.’
 
It did support recommendations for Better Access to be supplemented by multidisciplinary models providing intensive, longer-term clinical care as well as holistic support, and increasing workforce capacity and distribution.
 
It also backed a call for mental health treatment plans to be ‘standardised, simplified and used to help GPs understand the needs of individual consumers and work collaboratively with other providers’.
 
Dr Cathy Andronis, Chair of RACGP Specific Interests Psychological Medicine, told newsGP the response was ‘not surprising’, but said it remains unclear what will happen next.
 
‘As GPs, we want to maintain our autonomy, we want to be able to look after patients in a way that is in their best interest, and so they’re not influenced by Government outcomes and Government ideas about how things should be,’ she said.
 
‘More importantly, we want to keep patients empowered in their mental health.
 
‘Empowering patients is the most important thing we can help them achieve, and placing responsibility on providers through incentives to improve mental health is completely counterproductive.’
 
However, the Government only ‘noted’ a recommendation for the appropriate level for schedule fees be determined in a standardised, transparent way, and that rules around the Extended Medicare Safety Net be modified to increase the affordability of Better Access services.
 
‘There are significant gaps in services for people with mild mental health concerns and limited supports available for people with complex needs,’ the Government response states.
 
‘The system needs to evolve and move away from episodic care to holistic, person-centred and integrated care.’
 
The Federal Government has since bolstered its funding into mental health and the expansion of services, but the RACGP has warned this must not take investment from GPs, but instead should be accompanied by similar investment in GP services.
 
GPs have also become not only critical to delivering mental health care, but also in coordinating between different services.
 
In its 2024–25 pre-Budget submission, the RACGP specifically advocated for the decoupling of GP Focussed Psychological Strategy items from the Better Access Initiative.
 
‘Increasing support for mental health care in general practice will improve health outcomes without impacting access to other mental health professionals,’ the submission said.
 
It also called for a 20% increase to Medicare rebates for GP mental health items, saying funding for these consultations will improve health outcomes and substantially contribute to sustainability.
 
GP, psychotherapist and Chair of RACGP Victoria’s GP and Psychiatry Liaison Committee Dr James Antoniadis told newsGP he would have liked to see more information on the program’s efficacy and its long-term benefits.
 
He also said it is vital changes are made to ensure patients of all socioeconomic backgrounds can access the same care and treatment.
 
‘The solution is to create a level playing field where the rich and poor people are not seen as good or bad patients based on their ability to pay,’ Dr Antoniadis said.
 
‘The more you incentivise practitioners to practise in wealthy areas … the less incentive there is for people to work in in rural and remote and poor areas.
 
‘Allowing out-of-pocket expenses in a system that was initially intended to be free has caused a misalignment of what the funds are going to, as opposed to what they were intended to go to.’
 
The RACGP was previously left disappointed after just one spot on a new, 15-person Mental Health Reform Advisory Committee was given to a GP.
 
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