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October 2022 Budget in detail: The impact on general practice


Jolyon Attwooll


26/10/2022 4:45:08 PM

While there was no immediate hike in MBS rebates, there were a number of announcements in Tuesday’s Budget that will affect primary care.

Federal Budget documents
The Budget did not include the increases in MBS rebates that many GPs were hoping for. (Image: AAP)

For GPs, the takeaway from the first Budget under the new Federal Government is most likely to focus on what happened – or perhaps more accurately, did not happen – to Medicare.
 
There will be no immediate increase to MBS rebates, no rise in remuneration for longer consultations, and no reinstatement of longer telephone consultations – for now at least.
 
With the Strengthening Medicare Taskforce underway, it perhaps is no surprise that the focus has been elsewhere, principally on the new Federal Government confirming funding for many of its election commitments.
 
There was still much in the Budget, however, that will have an impact on general practice and primary care more broadly.
 
The RACGP response describes the Budget as ‘a first step from a new government’ and states that the college will continue to engage the Government through the Taskforce and directly ‘to ensure that appropriately targeted reforms are prioritised in the next Federal Budget’.
 
Here, newsGP summarises the main areas of interest for GPs, as well as the RACGP’s response as outlined in its formal overview of the Federal Budget 2022–23.
 
Primary care
As previously outlined in the Australian Labor Party’s election commitments, there will be a significant amount of funding for general practice grants, with $229.7 million committed over two years under the Strengthening Medicare General Practice Grants Program.
 
This is designed to provide funding for training, equipment and minor capital works to enhance digital health capability, infection prevention and control arrangements, and support practices’ accreditation.
 
There will also be $235 million over four years for another election commitment, the rollout of 50 Urgent Care Clinics.
 
This policy now has $100 million more funding allocated than originally indicated, with the extra sum to be used to develop and pilot models with states and territories.
 
‘While grants for general practice are welcome, urgent care clinics remain problematic,’ the RACGP’s formal overview states.
 
‘Coordinated long-term preventive care and chronic disease management delivered to patients by their trusted GP will prevent expensive hospital presentations and admissions and improve patient health outcomes, not new buildings and siloed urgent care services.’
 
The RACGP stated its intent to continue advocating for improvements to MBS indexation, increased patient rebates for longer consultations, and reinstating Medicare rebates for longer phone consultations.
 
Rural health
The Budget set out $143.3 million to be provided over four years to improve access to remote and regional healthcare.
 
The funding announcements include, among others:

  • $74.1 million over four years for incentive payments to recognise doctors with additional skills in rural and remote regions as part of the Workforce Incentive Program
  • $29.4 million over four years to expand the list of eligible health professionals and increase the rural loading in the practice stream of the Workforce Incentive Program
  • $24.7 million over four years to trial new primary care models
  • $8.4 million over three years from 2023–24 to provide 15 more hospital-based training posts for rural generalists and rural GPs
  • $5.6 million in 2025–26 (and $11.2 million per year ongoing) for extra rural primary care training rotations through the John Flynn Prevocational Doctor Program
The expanded Distribution Priority Areas will also continue for a further 12 months.
 
The Budget announcement follows RACGP advocacy for further Workforce Incentive Program funding to help rural GPs and practices.
 
‘These, and other initiatives encompassing remote, rural and regional health, are welcome measures to address workforce shortage,’ the college overview states.
 
‘However, far more support is needed to address the healthcare crisis.’
 
There will also be $61.8 million over six years for health projects in rural and regional locations including, among others:
  • $28.7 million to restore the GP Access After Hours program in the Hunter Region of NSW
  • $4.4 million over two years from 2022–23 to reopen the Minor Accident and Illness Centre at the Morayfield Health Hub in Queensland
A total of $13.2 million is to go to James Cook University for 20 additional Commonwealth-supported medical training places and to establish a new medical training campus in Cairns.
 
COVID-19 response
The Budget includes funding for the extension of COVID-related MBS items until the end of 2022, most of which ($145.1 million) is for PCR testing.

There is also $6.3 million for telehealth consultations to evaluate patients’ suitability for COVID-19 oral antivirals, and $5.7 million to extend MBS item 93715, which supports GPs managing COVID-positive patients in the community.
 
A further $5.4 million will be provided for telehealth MBS rebates for patients with COVID-19, regardless of whether they have an existing clinical relationship with the GP.
 
The extensions were supported by the RACGP, with the college set to advocate for the extension of the measures beyond the end of this year.
 
Funding for emergency responses was also set out in the Budget, including:
  • $759.9 million to extend the National Partnership on COVID-19 Response
  • $410.3 million in 2022–23 for rapid antigen tests and personal protective equipment (PPE)
  • $355.8 million in 2022–23 for the distribution and uptake of COVID-19 vaccines
  • $48.3 million in 2022–23 to extend the GP-led Respiratory Clinics program
  • extending medical indemnity legislative arrangements to support eligible doctors returning to the workforce to help shortages arising from the pandemic.
The RACGP said it will keep advocating for patient rebates for phone consultations lasting more than 20 minutes to be reinstated as a permanent part of the telehealth model.
 
‘These consultations would support patients with more complex care needs to safely access GP care, particularly while the pandemic remains ongoing,’ the college overview states.

It also said the distribution of PPE requires ongoing support.
 
Aboriginal and Torres Strait Islander health
Nearly $315 million will be invested over five years as part of a commitment to Close the Gap, including:
  • $164.3 million to invest in modern health clinics in large and growing First Nations populations, as well as to build capacity for chronic disease treatment and rehabilitation
  • $54.3 million to deliver up to 500 First Nations Certificate III and IV traineeships in Aboriginal and Torres Strait Islander Primary Health Care
  • $45 million for 30 dialysis units
  • $14.2 million to support rheumatic heart disease treatment, detection and prevention
  • $10.1 million for CareFlight aeromedical services in the Northern Territory
  • $1.9 million for two dialysis treatment buses in NSW and medical equipment upgrades
  • $300,000 for community grants to provide consulting rooms, play areas and gym equipment.
The college overview also welcomed the Government’s commitment to the Uluru Statement from the Heart. However, it said analysis of government budgets ‘has raised the serious issue of the insufficient funding allocation by governments to solve the complex problems afflicting Aboriginal and Torres Strait Islander health communities’.
 
PBS changes
The Budget outlined $2.6 billion funding for cheaper medicines, including the following measures, among others:
  • $787.1 million to reduce the PBS general co-payment from $42.50 to $30
  • $327.7 million for Flash Glucose Monitoring and Continuous Glucose Monitoring devices for Australians with Type 1 Diabetes
  • $73.9 million for prioritised access to Monkeypox vaccines and treatments
  • $22.8 million to extend the listing of oral COVID-19 antivirals
The RACGP said it welcomes ‘any funding that reduces cost and/or increases access to life-changing medicines for Australians’.
 
It also said it hopes the Government will swiftly accept recommendations from the Pharmaceutical Benefits Advisory Committee to COVID-19 oral antivirals to the Prescriber Bag.
 
‘Timely access to these medicines is crucial for improved health outcomes and adding these to the Prescriber Bag will assist patients in rural and remote areas and emergency situations to access these at the time of consultation with their GP,’ the RACGP overview states.
 
Aged care
There was $2.5 billion committed to reform the aged care system, which has been stated as a priority under the new Government.

Among the funding measures announced was $312.6 million for aged care information and communication system maintenance and enhancements, including streamlined reporting, as well as to enable reform of the sector.
 
The RACGP response notes that GPs see more than 90% of permanent aged care residents and welcomes the Government’s digital reform agenda, including the creation of a ‘single source of truth’ accessible to clinicians involved in aged care.
 
Disability reform
Total funding for the National Disability Insurance Scheme (NDIS) will increase by $8.8 billion to $166.6 billion over four years.
 
The college welcomed the funding commitment. While noting the NDIS is not a funding source for general practice patient care, it said college representatives are engaged with the National Disability Insurance Agency about the role of GPs in helping patients navigate the scheme.
 
There will also be $15.9 million over four years to establish and support a National Centre of Excellence in Intellectual Disability Health.
 
Other items of note:
More than $3 million will go towards the establishment of an Australian Centre for Disease Control.
 
A total of $630.4 million was committed to strengthen Australia’s resilience to disasters, with the college urging for GPs to be included in disaster response planning. The overview notes that a lack of general practice representation can lead to ‘inconsistent utilisation of GP skillsets and poor communication with general practice in times of disaster’.
 
There is no significant new funding for primary care research, with the Medical Research Future Fund (MRFF) reaching its maximum annual disbursement of $650 million. The college said it will continue to advocate for the primary care portion to be increased from less than 1% ‘to a proportion that better represents the role of primary care’.
 
In response to the confirmation of an election commitment to provide $1.6 million for an after-hours walk-in clinic in Brighton, Tasmania, the college notes a general practice in the area had since closed due to the challenges of retaining staff. It warned that ‘funding for infrastructure alone will not increase patient access to care’.
 
‘Workforce considerations need to be front and centre of measures aiming to increase access to GP services,’ the RACGP analysis states.
 
The full details of the Budget are available on the Federal Government website. GPs with any further insights or feedback are encouraged to contact the college at healthreform@racgp.org.au.
 
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Budget 2022 MBS Medicare primary care


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Dr Michael Long   27/10/2022 10:29:43 PM

'The RACGP stated its intent to continue advocating for improvements to MBS indexation, increased patient rebates for longer consultations, and reinstating Medicare rebates for longer phone consultations.'
Time to change strategy RACGP.
These Medicare targets have not been successful for the RACGP when advocating lasting change for members. Medicare items and rebates are politically managed to suit the budget and electoral sentiment.
Examples of this are doubling the Medicare Direct Billing Copayment overnight during covid and raising the payment to 100% of scheduled fee for consults when GP was about to revolt at the shrinking rebates, similar to now.
Why not ask why DVA and Workcover payments are higher for the same work. In hospital private insurer payments for the same procedures far outstrip Medicare rebates in rooms.
Where is the sustainability in the 'schedule fee' calculation let alone the non CPI indexation? Why is 15% a legitimate discount for direct billing proceedures?


Dr Dhara Prathmesh Contractor   29/10/2022 8:08:31 AM

Nothing but abuse.
A strategic display of political power. On 7:30 tv!
Millions $ in Budget trimmed where the PSR or no audit to money spent will ever be displayed till decades!
New urgent care units, task force, Telehealths , respiratory clinics, etc.. non as in relation to direct patient consultation!
Telehealth companies and IT are flourishing, and risking the GP practices in midst of the data leak era.

No COVID19 restrictions and no lockdown, no masks, why so much placed into budget towards Telehealth!

Total Rural population and budget allocations does not match!

GP staff, GP and their practices are all going through inflation and they are the ones seeing the patients. Why nothing allocated to people who are actually working in the community.

Government could maybe pay directly to GP clinic staffing as they do in government hospitals and the newly planned out urgent care units. If they find Medicare item numbers and their rebates are all sufficient!