Is the number of GP consultations going down?

A review of recent Medicare statistics uncovers a trend that may cause some concern to GPs: namely, that standard item 23 consultations have fallen almost 20% since the start of the pandemic.
 
During the last full financial year before COVID-19, 2018–19, there were 95.96 million item 23 consultations claimed, which dropped to 71.2 million in 2021–22, followed by a rise to 77.7 million in 2022–23.
 
Even when accounting for population changes during the same period, the numbers reveal that total item 23 services have fallen from 377,053 per 100,000 people in 2018–19 to 292,705 in the last financial year.
 
But for Dr Emil Djakic, a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), the figures may not tell the full story.
 
While he recognises the impact of the cost of living, he says a profound systemic change ushered in by the pandemic – the introduction of telehealth – is also likely having a significant influence on the data.
 
He points out that with the inclusion of the standard telehealth phone consultation, item 91891, the figures for the most recent financial year are much closer to how they stood before the pandemic.
 
‘We had a huge game-changing event that was accelerated by COVID,’ he told newsGP.
 
‘We needed to finally realise that care in some situations could be delivered by general practices over a telephone.
 
‘The Government [were] already planning to do this at some point, and it finally pushed into allowing us to come into the 21st century.’
 
There were 25.94 million MBS item 91891s claimed in the past financial year – making a total of 103.64 million standard length items when face-to-face care and phone consultations are combined.
 
‘There are some transactions which are happily appropriate over the phone in terms of some of the follow-up, that improve the efficiency,’ Dr Djakic said.
 
‘GPs have to value themselves just as much when they’re on the phone as they do when they’re sitting here face to face.’
 
He also believes that the increase in item 23s in the past financial year compared to 2021–22 reflects the return to a more ‘business as usual’ approach.
 
However, he has little doubt that patients are feeling the impact of previous decisions, along with the rising costs of living – and believes stalled or low MBS rate increases continue to have an effect.
 
‘What were they trying to achieve [with the freeze on Medicare]? Find out how far it was to the bottom of the barrel?’ he said.
 
‘What they found is they’ve gone through the bottom of the barrel, and patients are hurting as a result of political policy.’
 
Dr Djakic says the failure of MBS rebates to keep pace has meant a rising number of clinics have either cut services or started passing on more costs.
 
In the past two years, there has been a significant decline in the level of GP consultations being bulk billed as more clinics have moved to private or mixed billing.
 
Quarterly data published by the Federal Government in May indicates non-referred GP attendances had a bulk-billing rate of 78.1% in the first quarter of this year, down from 88% for the same timeframe last year.
 
It also showed the lowest quarterly rate in the past 15 years in the datasets published by the Department of Health and Aged Care.
 
However, on Monday Federal Health and Aged Care Minister Mark Butler told reporters that he believes increases to bulk-billing incentives and improved MBS indexation will offer relief to general practice.
 
‘We made an investment of more than $6 billion in the May Budget in general practice,’ he said.
 
‘Not only tripling the bulk-billing incentive … but also ushering in a range of reforms that reflect the changing nature of work in general practice.
 
‘We are focused on making sure that our Medicare system reflects [the] need for more continuous wraparound care from multidisciplinary teams led by GPs.’ 
 
Dr Djakic meanwhile noted that the implementation of the tripled bulk-billing incentive, which was announced in the Federal Budget in May, is not coming into effect until 1 November this year.
 
He says the changes cannot come into effect soon enough.
 
‘In the meantime, we’ve got practices going under,’ he said.
 
‘There are businesses out there that are continuing to be stressed and their populations are continuing to be stressed.’
 
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bulk-billing incentives item 23 MBS Medicare telehealth