RACGP calls for ‘more action’ following reproductive healthcare report

Anastasia Tsirtsakis

26/05/2023 3:40:55 PM

President Dr Nicole Higgins says the Government needs to act now to end Australia’s ‘postcode lottery’.

A GP preparing a female patient for Implanon.
The Federal Government has been recommended to work with the RACGP to improve access to workforce training for the insertion and removal of LARCs.

The Senate Community Affairs References Committee (the Committee) has made 36 recommendations to the Federal Government following its inquiry into universal access to reproductive healthcare.
The report, handed down on Thursday, features a number of RACGP proposals taken from its submission to the inquiry in December, including:

  • adequate remuneration for GPs, nurses, and midwives to provide contraceptive services, including insertion and removal of long-acting reversible contraceptives (LARCs)
  • working with the RACGP to improve access to workforce training for the insertion and removal of LARCs
  • improved access to a broader range of hormonal contraceptives not currently PBS subsidised
  • continuing current MBS telehealth items for sexual and reproductive healthcare, including pregnancy support counselling and termination care
  • consideration and implementation of a separate MBS item number for contraceptive counselling and advice for all prescribers
  • options to make contraception more affordable for all people.
RACGP President Dr Nicole Higgins, who represented the college at a public hearing earlier this year, said the recommendations are ‘promising’, and called for the Government to act on them ‘without delay’.
‘It is great news the report has recommended training support for GPs for the insertion and removal of LARCs, as well as adequate remuneration for GPs, nurses, and midwives to provide contraceptive services,’ she said.
‘It’s also very positive to see the committee calling for the Government to put in place options to make contraception more affordable.’
Dr Higgins said this is a particularly salient issue given the cost-of-living pressures many households are facing across Australia, and that choosing the most appropriate contraceptive option should not be dependent on cost.
‘The recommendation for a separate MBS item number for contraceptive counselling and advice will help achieve this if it is set at a level that reflects the work involved,’ she said.
‘In addition, I welcome the Committee recommending the Government review Medicare arrangements which support medical termination consultations with the aim of ensuring adequate remuneration for practitioners to deliver these services.’
However, while Dr Higgins acknowledged the report as a step in the right direction, she noted the increased challenges around access to reproductive services in regional and remote parts of the country, and said more needs to be done to ensure all women have access ‘no matter their postcode or income’.
As a GP based in Mackay, North Queensland, the college president says she has witnessed the barriers patients face firsthand, with those who require a surgical abortion having to travel more than 1000 km for care.
‘That is not acceptable,’ Dr Higgins said.
She did note that the Committee’s recommendation for permanent sexual and reproductive healthcare telehealth item numbers could help to ease some access issues, but called out the Department of Health and Aged Care’s plan to make a long-term decision only once a post-implementation telehealth review has been undertaken.
‘These telehealth items provide choice to women in communities where healthcare access is harder,’ she said.
‘So, let’s make them permanent now – it’s the right call.’
Professor Danielle Mazza, who represented the college at a public hearing alongside Dr Higgins, agrees that the recommendation around telehealth is vital.
The Head of General Practice at Monash University and a Chief Investigator and Director of SPHERE Centre of Research Excellence in Women’s Sexual and Reproductive Health in Primary Care told newsGP there are a lot of positives about the inquiry process and the report itself.
‘One thing that [it] achieved was putting a spotlight on the issues and getting lots of different perspectives,’ Professor Mazza said.
‘It reinforced what the significant issues were – and the fact that it’s bipartisan support for the recommendations is also excellent. It means that hopefully the recommendations will be implemented.’
In addition to the focus on greater access through primary care, Professor Mazza was happy to see consideration given to the complex issues that need to be addressed to make contraception and abortion services more affordable. She also supports calls to establish a national hotline for the navigation of services, as well as education programs to improve sexual reproductive health literacy more broadly.
‘They were very clear about all public hospitals needing to provide abortions and they heard the message that we need service provision in our major hospitals to also enable training of our future workforce in that area,’ Professor Mazza said.
‘So, they recognise that, and they talked about adequate remuneration for practitioners, both for contraception and abortion, which was also important.’
However, with cost of contraception and abortion services a major barrier for many women, Professor Mazza said she would have liked to have seen a call to make access free.
‘The words “more affordable” leaves a little bit of wiggle room so that they didn’t go the no cost approach, when we know that in countries overseas these services are at no cost to women,’ she said.
‘That was that was a little bit disappointing.’
In the meantime, Dr Higgins says there are other steps she would like to see the Government take to improve access, including:
  • adding medicines for medical termination to the Prescriber Bag
  • making copper IUDs available through the PBS for all women
  • ensuring the Medicare rebate for insertion be increased to reduce – or eliminate – gap fees.
Similarly, Professor Mazza says she would like to see the Government commit adequate funding to support the RACGP to step up in improving access to training the future GP workforce in sexual reproductive health.
‘That would be a wonderful thing,’ she said. ‘There are real opportunities there, particularly with the consolidation of the GP training program back to the RACGP.’
However, the women’s health advocate fears that Australian women will have to wait a while longer before any of the recommendations, if endorsed, result in actual outcomes.
‘The mechanisms to achieve the outcomes weren’t outlined in the recommendations … and working out the mechanism is quite complex – so, it will take a lot of work,’ Professor Mazza said.
‘There’s also been no distinct budget set aside for the implementation of these recommendations in this Budget that’s just gone.’
Other notable recommendations include:
  • a review of the availability, timing, and quality of sexual and reproductive healthcare training in undergraduate and postgraduate tertiary health professional courses, including vasectomy procedures, terminations and insertion of LARCs
  • working with the relevant medical and professional colleges to support the development and delivery of training to health practitioners providing sexual, reproductive and maternal healthcare to people with disability, and to provide culturally aware and trauma-informed services
  • commissioning research into reproductive coercion and abuse with a view to developing clinical guidelines, resources and training for primary care providers.
The RACGP is also continuing to push the Government to amend rules to allow GPs to bill MBS Level C and D time-based attendance items for antenatal attendances that extend beyond 20 minutes. As it stands, there is a fixed MBS fee no matter how long the appointment takes.
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abortion services antenatal care LARCs reproductive healthcare senate inquiry sexual health

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