Government must ‘urgently and substantially’ invest in general practice: RACGP President-elect

Doug Hendrie

3/09/2018 3:34:52 PM

Dr Harry Nespolon predicts a bleak future for Australian healthcare without major Government investment in general practice.

RACGP President-elect Dr Harry Nespolon believes that while general practice is at the centre of Australian healthcare, ‘it continues to be taken for granted by governments’.
RACGP President-elect Dr Harry Nespolon believes that while general practice is at the centre of Australian healthcare, ‘it continues to be taken for granted by governments’.

Out-of-pocket costs of more than $40 per GP visit and declining bulk billing rates.
That’s the future for Australian healthcare unless the government ‘urgently and substantially’ invests in general practice, according to RACGP President-elect Dr Harry Nespolon.
New RACGP analysis of Medicare data shows that the status quo will result in a total reversal of the recent increase in bulk billing, with the increase to slow to zero and an average out-of-pocket cost of $40.69 per visit by 2020. 
‘General practice is the cornerstone of Australians’ healthcare. Unfortunately, it continues to be taken for granted by governments,’ Dr Nespolon said.
‘Although we welcome the return of yearly indexation of patient Medicare rebates, it still does not catch general practice up on the past five years, which has seen an erosion of the patient rebate in real terms.
‘We believe that urgent investment is required.’

Projected out-of-pocket patient costs

Adapted from the Department of Health. Annual Medicare statistics Financial year 1984–85 to 2017–18. Canberra: DoH, 2018.

In its 2017 budget, the Federal Government began phasing out the controversial Medicare rebate freeze after five years.
‘Without a significant increase to the rebate and real results from the MBS review, I am concerned about what the patient experience will look like in the near future,’ Dr Nespolon said.
‘Patients want to spend more time with their GP, and it has been shown that the more time a patient spends with their GP the better their long-term health will be.
‘More effort must be made to keep patients out of hospitals and protected from costly out-of-pocket expenses.’
A recent report found that Australians are now spending almost $3 billion a year on out-of-pocket non-hospital healthcare.
The new analysis comes soon after the latest official Medicare data showed bulk-billing rates were at a historic high of 86.1%.
Dr Nespolon said long and complex general practice consultations are not being adequately supported by Medicare, an issue of increasing importance as Australia ages, bringing with it a rising rate of a host of chronic diseases.
‘An extra 10–30 minutes in a GP consultation, particularly for patients with chronic and complex needs, can mean that a condition is identified earlier or health risks, like obesity and mental health issues, receive proper preventive treatment before a patient ends up with a more serious lifelong condition,’ he said.
‘When a GP has the proper amount of time with a patient, we are able to properly treat the whole patient.’

healthcare funding medicare out-of-pocket costs

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Liz Romeo   4/09/2018 10:24:24 AM

I hate reading stats like this that have no supporting data. Practices that bulk bill may be increasing costs to patients for out of pocket expenses, like procedures and incidentals. They can still say they bulk bill, and the government can spout high percentages of bulk billing. Less payers may also be attending the doctor. In areas like ours, this is because of the doctor shortage, they cannot get an appointment for preventative care, only for acute presentations.

Peter Bradley   4/09/2018 10:41:13 AM

To be honest, I'm over worrying about the out of pocket costs for patients. In my view the Australian public have had it too good, for too long.
What concerns me is that by neglecting to inflation index Medicare in even a token realistic way, we GPs have, in effect, been receiving pay cuts over the last several decades. Something I am becoming bitterly aware of as I now (semi) retire, woefully unprepared for the venture, even though I've worked until nigh on 72.
Sure, the govt can do the Pontius Pilate thing by saying they are not Drs rebates but patient rebates, (when it suits), but then they turn around and bray about the 86% bulk-billing rate, and how well Medicare is therefore doing.
So, if about ~ 86% of our income is from Medicare - for many even more than that - then failure to CPI equals pay cuts, pure and simple.

So anyone contemplating entering GP right needs to have a careful re-think, and I now (sadly) regret I have squandered my chance at financial security by taking GP up in the first place. Something I suspect more and more will find they echo in the years to come. But that was 40 odd years ago, and GPs did ok then. However, unless, as Harry states, something DRASTIC is done to save the situation..?

Anonymous GP Trainee   4/09/2018 3:06:46 PM

I could not agree more about the need to seriously invest in General Practice. I am in training, working long hours in a lower socioeconomic area with complex health needs. It is not lost on me how financially disadvantaged I am compared to my colleagues who continue in hospital work. Between bulk billing rates, the woefully low National Terms and Conditions of Employment for Registrars and the complex patients I see who have often been turned away by other doctors, my pay is deplorable. I calculated that over this semester, with the hours I work and mandatory costs of training and registration, I would have earned more per hour working at McDonalds. It is not feasible to expect good doctors to continue to work in areas of need for such unjust pay. Something does need to drastically change to support doctors taking on difficult patients and working to a high standard, particularly in areas of need.