General practice spending falls by $800m in one year

Government spending on general practice fell by more than $800 million in real terms in the last financial year, according to a new Productivity Commission report.
 
In its Report on Government Services 2024, the Commission recorded a total spend of $11.04 billion on general practice in the 2022–23, down from $11.87 billion the previous year.
 
That equates to a 7% decline in general practice spending year on year, a figure likely to be linked to a drop in GP services following the main COVID-19 vaccine rollout, as well as a recent decline in bulk billing.
 
Past annual figures are adjusted so they are comparable to more recent data.
 
General practice spending per person also fell to $420.1 in 2022–23, the lowest since 2014–15 –  although that figure predates the start of the tripled bulk billing incentive, the signature reform announced in the Federal Budget last May.
 
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, said the Productivity Commission data reflect a long-term lack of funding, along with systemic inefficiencies.
 
‘These facts and figures are a demonstration of years of neglect to support general practice to reach and maintain its full potential,’ he told newsGP.  
 
‘Prevention, chronic disease management, acute care and shared-care with subspecialist teams are important roles of GP teams.
 
‘Patient rebates have not kept up with the cost of providing expert comprehensive primary care.
 
‘GPs are still bound up by red tape effectively reducing appointment availability.
 
‘Why on earth do we still have an authority script system? GPs are required to work with clunky systems that are shaped around the needs of external organisations so that it rarely feels like a partnership to achieve best patient outcomes.
 
‘Examples include residential aged care homes, out-patient clinics and the crazily expensive medication distribution system.’
 
Workforce challenges and changes
Pressures on the workforce are also highlighted by the Productivity Commission, which reports a fall of more than 1000 in the number of full-time equivalent (FTE) GPs overall, from 31,056 in 2021 down to 29,921 in 2022.
 
While the broader trend may be linked to GPs working more hours during the busiest stages of the vaccine rollout, outer regional, remote and very remote communities all now have fewer GPs than before the pandemic – both in raw numbers and per head of population.
 
In remote communities, for example, there was a total of 212 FTE GPs recorded in 2022 compared to 242 in 2018, a 12% fall.
 
Associate Professor Michael Clements, RACGP Vice President and Rural Chair, said the figures demonstrate the struggle of many more remote practices to remain viable.
 
‘What we’ve seen is that the model of general practice has really had to migrate to bigger practices to try and stay open,’ he told newsGP.
 
‘Some of the smaller towns where there were only one, two or three doctors really weren’t sustainable anymore.
 
‘The doctors may become rural generalists but are often hospital based and away from general practice.
 
‘It’s not really forecast to get much better with the number of GPs that are retiring … and it certainly fits with the lived experience for many of our communities.’
 
He believes local councils and state governments will cotinue using targeted funding packages to try to entice recruits to hard-to-fill areas.
 
‘Also under college training, the Federal Government has given a flexible funding pool to some of these targeted areas,’ he said.
 
‘So we’re seeing more localised ways of solving this as opposed to the big tool, the [Distributed Priority Areas].’
 
Professor Morgan also believes the overall figures may relate to a broader perception of general practice.
 
‘GP workforce threats are inevitable when the relative value of what we do is pegged below that of other specialities,’ he said.  
 
More female GPs but no parity
The growing trend of GPs working part time is also reflected in the figures, particularly among female GPs.
 
In 2022, the number of male GPs went up slightly to 19,900, 78 more than the previous year, with 17,479 FTE.
 
Meanwhile, of the 18,975 female GPs registered in the latest statistics – up from 18,527 in 2021 –  the number of full-time-equivalent stood much lower at 12,441.
 
Only the ACT has more full-time equivalent female GPs than males, with the national figure standing at 41.6 % in 2022 – a slight increase from the previous year, but a significant change from the 35.5% recorded in 2014.
 
Medication spending surges
For the first time in 10 years, Federal Government expenditure on medications – through the PBS and RPBS – outstripped the funding spent on GPs, the Productivity Commission found.
 
It recorded $11.87 billion as being spent on the PBS and RPBS in 2022–23, compared to $11.04 billion on general practice.
 
Associate Professor Clements said the figure reminded him of a talk given by Professor Iona Heath at 2023 WONCA World Conference, warning of an increasing emphasis on medication.
 
‘The evidence is that commercial interests are driving new drugs and spending on more expensive drugs and very old diseases that can be well managed with cheaper drugs, are now having more expensive ways of treating the same thing,’ Associate Professor Clements said.
 
‘We do need to be mindful of the medication spend. We need to make sure that the spend on medications isn’t allowed to outstrip the fact that people still need care and prevention.
 
‘And prevention doesn’t always mean a pill.’
 
However, Professor Morgan is not sure the cost of medications is an effective measure to compare funding.
 
‘As science advances, more therapies come online to support survivorship with more chronic diseases,’ he said.
 
‘To some extent medications are an inevitable consequence. However, they could reach patients more efficiently.’
 
Log in below to join the conversation.

MBS Medicare Medicare reform Productivity Commission