Analysis

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How does the unprecedented 2020–21 Federal Budget affect GPs?

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The Federal Government this week handed down its 2020–21 budget in a bid to fight off the coronavirus recession and address economic and health challenges emerging from the pandemic, such as mental health and suicide prevention, telehealth extension, respiratory clinics, pathology testing and aged care support.  
 
Here are the biggest measures affecting GPs, with RACGP responses adapted from the college’s formal budget overview.
 
Telehealth
The Federal Government will provide a total of $2.4 billion for Medicare-subsidised telehealth services, including $111.6 million for the extension of temporary COVID-19 telehealth services until 31 March 2021.
 
The Government announced it is developing options for the long-term adoption of telehealth beyond the COVID-19 pandemic, and the budget includes $18.6 million for the preparation of permanent telehealth infrastructure beyond March.
 
The RACGP believes that while telehealth is not a substitute for face-to-face care, it provides greater flexibility for patients, helps access for hard-to-reach groups, and will be key to addressing the long-term health impacts of COVID-19. The college has said it will work with the Government on a long-term solution for telehealth.
 
GP-led respiratory clinics
The budget lists $377.5 million in funding since the start of the pandemic for 150 GP-led respiratory clinics.
 
This funding total includes $170.8 million to extend respiratory clinics until 31 March 2021. These clinics have been established to reduce pressure on hospitals by managing and diagnosing COVID-19 cases.
 
COVID-19 vaccine
A total of $2.3 billion from 2019–20 to 2021–22 has been allocated to provide for vaccine doses and research. Of this, $1.9 billion is provided for COVID-19 supply and production of vaccine doses, including $1.7 billion to secure early access to the Oxford vaccine (33.8 million doses) and the University of Queensland vaccine (51 million doses). And $123.2 million is allocated for an initial investment to access vaccine doses through the self-financing component of the Gavi COVAX Facility (up to 25.5 million doses).
 
In addition, $95.2 million will go to the Medical Research Future Fund (MRFF) for diagnostics, vaccine development, antiviral development, clinical trials, digital health research infrastructure and research into the human immune response to COVID-19 infection.
 
A further $80 million will go to secure COVID-19 vaccines for developing countries through the advance market commitment component of Gavi COVAX Facility.
 
The RACGP has said it welcomes, and is reassured by, the clear investment in COVID-19 treatment and vaccination.
 
‘It is important that GPs are at the forefront of preparing the public for a new vaccination, and supporting uptake once it is available,’ the college wrote in its budget overview. ‘The safe and efficient delivery of the COVID-19 vaccination will not be possible without general practice.
 
‘The COVID-19 vaccination will have no post-marketing safety data and will need to be administered with full medical supervision to protect the Australian public. GPs are a trusted source of medical information and will be highly influential in encouraging vaccine uptake.
 
‘It is vitally important with a new vaccine that record keeping is of the highest order, and patients are closely monitored by a qualified medical practitioner for potential adverse events, in the short and long term.’
 
Mental health
Ten extra Medicare-subsidised psychological therapy sessions will be made available each year for patients with an existing Mental Health Treatment Plan, boosting the total to 20 for eligible patients. This measure will cost $101 million.
 
The RACGP understands these will to come into effect on Friday 9 October, according to Federal Health Minister Greg Hunt.
 
The college believes appropriate safeguards and measures are needed to prevent any unintended negative consequences when increasing the number of Medicare Benefits Schedule (MBS)-related psychological therapy sessions. Inappropriately increasing the maximum number of sessions could drive up the number of patients who do not obtain any meaningful benefit from these referrals and potentially decreasing access for other people.
 
New medicines on the Pharmaceutical Benefits Scheme
Over the four years from 2020–21, the Federal Government will provide $375.5 million for new and amended PBS listings.
 
This funding also includes changes to the National Immunisation Program (NIP), including:

• access to meningococcal B vaccines for Aboriginal and Torres Strait Islander infants two years and younger
• access to pneumococcal vaccines for people 70 years and older and Aboriginal and Torres Strait Islander people aged 50 years and older
• increased access to free pneumococcal, meningococcal ACWY and the Haemophilus influenzae type b (Hib) vaccines for people with specific medical conditions.

Suicide prevention
The budget contains a $62 million funding announcement for suicide prevention, including $22 million for Headspace centres in the Pilbara, WA, and regional Queensland, and $13 million to extend the National Suicide Prevention Trials for a year and enhance the evaluation of various other suicide prevention trials.
 
Aged care
An extra $746 million has been announced to boost the aged care sector’s response to the COVID-19 pandemic.
 
This funding is primarily aimed at workforce, with major items including $440 million for the Aged Care Workforce Retention Bonus Payment and $245 million to mandate trained infection-control officers in residential facilities, support facilities in rural and remote areas, and support care for people who are homeless or at risk of becoming homeless.
 
In addition, $92 million will go to supporting staff working at a single site, and $81 million is for a surge workforce and increased training.
 
COVID-19 testing
The Federal Government will provide $711.7 million in funding for COVID-19 testing to 31 March 2021, including funding bulk-billed tests for patients referred by their GP and $42 million for dedicated ‘in-reach’ COVID-19 pathology collection and testing services for residential aged care facilities.
 
The Government removed the moratorium on opening new approved pathology collection centres on 30 June. This was done following RACGP calls for its scrapping based on members’ feedback that the moratorium had placed them in a difficult position while negotiating pathology collection centre rent reductions.
 
MBS Review implementation
Continued implementation of reforms from the MBS Review and building a continuous review mechanism will cost $17.3 million over two years from 2020–21 to 2021–22.
 
While supporting the principles, the RACGP has to date been concerned about MBS Review engagement, and is pushing for more constructive dialogue with the Department of Health to ensure changes arising from the review do not adversely affect GPs and their patients.
 
Preventive health
This area will see a small boost to funding, including $50 million to help establish the Victorian Melanoma and Clinical Trials Centre at the Alfred Hospital, $21.2 million over four years for pilot initiatives for hearing health in aged care and for Aboriginal and Torres Strait Islander children, and $600,000 for the Leukemia Foundation to implement a national plan for blood cancer.
 
The Government is expected to publicise its draft of a 10-Year Preventive Health Care Plan before year’s end, which may have additional initiatives.
 
Aboriginal and Torres Strait Islander health
The budget contains $33 million over three years for Aboriginal and Torres Strait Islander primary healthcare services to expand in areas of greater need or high population growth, or where there are service gaps.
 
Though welcome, the RACGP believes further investment in infrastructure is needed to strengthen sector capacity. This announcement comes after the long-awaited new funding model for Aboriginal Community Controlled Health Organisations commenced on 1 July 2020.
 
Following commitments to fund Aboriginal and Torres Strait Islander health research in the 2019–20 budget, $34.2 million has been allocated to research projects investigating areas such as ending avoidable deafness and blindness in Aboriginal and Torres Strait Islander people, and helping to eradicate chronic kidney disease.
 
However, the RACGP believes the budget is a missed opportunity for the Government to strengthen its commitment to the new Closing the Gap National Agreement, with no further funding announced for specific measures. 
 
Rural health
The budget contains $125 million over four years to fund clinical trials in rural regional and remote Australia, including $75.2 million for a teletrial program in Queensland, and $30.6 million for clinical trials improving access to healthcare in non-urban areas of NSW and the ACT.
 
In addition, $3.3 million will go to trial new models of primary care to address rural workforce shortages in western and southern NSW, and $50.3 million over four years to expand the Rural Health Multidisciplinary Training Program.
 
Veteran mental health
The budget includes increases to veteran mental health support, including a one-off increase to fees paid to Department of Veterans’ Affairs mental health, social work and community nursing providers and a simplified fee structure for these services, as part of a 123% increase to veteran mental health – $101.7 million over four years. 
 
Medical research
Around $424 million in new grants and research programs has been allocated to fund researchers from the MRFF and the National Health and Medical Research Council.
 
The RACGP applauds the funding but notes that, with the exception of $10 million for primary healthcare research data infrastructure, no new funds are targeted at general practice research, which remains underfunded.
 
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budget COVID-19 primary care

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