MBS mental health gap must be addressed: RACGP

Matt Woodley

14/04/2021 5:07:20 PM

GPs are ‘effectively discouraged’ from providing quality mental health care under the current system, a college submission has stated.

GP talking to patient.
The RACGP is advocating that GPs be funded to engage in longer mental health consultations.

GPs should be afforded the same opportunity as other mental health professionals to routinely provide longer patient consultations, according to a new RACGP submission to the Select Committee Inquiry on Mental Health and Suicide Prevention.
It states that funding in general practice should better reflect the time spent caring for people with mental health needs, as providing sufficient support to allow patients to spend more time with their GP will result in better health outcomes.
‘The current inequity where general mental health Medicare Benefits Schedule [MBS] consultation items are valued lower than the equivalent physical health MBS items must be addressed,’ the submission states.
‘Shorter consultations leave less time for planning and discourages comprehensive assessment of the patient’s mental health.
‘An appropriately remunerated MBS item number for longer consultation time, and general mental health MBS consultation items which are equivalent to physical health MBS items will go a long way in ensuring GPs are supported to deliver the best care for their patients.’
To support its position, the submission cites the college’s 2020 General Practice: Health of the Nation Report, which found that psychological issues remain the most common reason for patient presentation reported by GPs.
In 2018–19, more than 10% of the population received MBS-supported mental health specific care – almost doubling the rate from the previous 10 years – and the majority (8.7%) of these services were provided by a GP.
‘This is still likely to be an under-representation of the true magnitude of GP mental health presentations, as longer mental health consultations in general practice do not have a specific [unrestricted] MBS item number, and therefore are often billed as a general consultation,’ the college submission states.
It also points out that while many other private and public healthcare settings draw a distinction between physical and mental health, the two are ‘inseparable’ and the assessment and treatment of mental illness should be informed by a holistic, whole-of-person approach.
‘It is essential mental health be included as part of the overall wellbeing of the community and not considered as a separate issue,’ the submission states.
‘People living with mental illness often have poorer physical health. Addressing the physical health of people living with mental illness requires integration of mental health and physical health care, across the public, private [including general practice] and community sectors.
‘It is critical that financial support for national, cross-sector coordination is provided. The RACGP supports the implementation of the Equally Well National Consensus Statement to address this issue.’
Other areas of reform highlighted by the submission include:

  • incentive schemes for rural GPs equivalent to those for procedural skills that would support them to develop or refresh advanced skills in mental health
  • not counting mental health treatments provided by Focussed Psychological Strategies (FPS) registered GPs as part of the capped number of psychologist services that are available to patients
  • allowing other mental health professionals, such as mental health nurses, to provide mental health care services in the general practice environment
  • greater GP access to support and advice from relevant mental health specialists, such as psychiatrists, on the management of patients with mental health issues
  • improving integration between primary care and the rest of the mental health system.
‘Good quality integrated systems where primary, secondary and tertiary care work in concert ensures the population as a whole has early access to the mental health care they need and gives people the best chance of good health outcomes,’ the submission states.
‘Currently, the mental health services available for patients are not well-connected, creating significant inefficiencies to the mental health care system.
‘The RACGP advocates for systems that do not bypass, but promote and support general practice to deliver sustainable, equitable and high-value healthcare.’
The RACGP submission is the latest in a series of contributions made to recent inquiries into Australia’s mental health system, including the Productivity Commission inquiry into mental health, aged care royal commission, Senate Select Committee inquiry into the Federal Government’s response to the COVID-19 pandemic, and the royal commission into natural disaster arrangements.

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Dr Kodikkakathu Saratchandran   15/04/2021 10:16:20 AM

Is this the only area we have been marginalized? There is a list of things one can mention in the same regard. It is, 'boiling the frog slowly' is the adapted method by all concerned. Gps' mild manner objections usually go unnoticed and the aggressive ones get what they want at our cost!

Dr Louise Marie Edwards   15/04/2021 4:13:19 PM

Consultations with patients who have chronic pain are the perfect example of the interdependence of physical and mental health. Medicare remuneration is sadly inadequate for the time required in providing patient centred , complex care in the community setting. If not included under this proposal, then there is also an urgent need to provide for increased funding for patients who have chronic pain to be helped to access their GP Team in the community setting.