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RACGP calls for support as patients face ‘impossible choice’


Matt Woodley


31/01/2023 4:51:28 PM

Investment is needed now as long-term reforms will not arrive quickly enough for some people, the college’s pre-Budget submission says.

Older man stressing over bills.
People are being forced to choose between spending money on healthcare and other essentials, RACGP President Dr Nicole Higgins says.

With long-term Medicare reform still being debated, the upcoming Federal Budget is an opportunity to deliver critical support for Australian GPs and their patients, the RACGP has said.
 
The college’s pre-Budget submission, released this week, contains a list of short-term changes it says the Federal Government should prioritise in a bid to ease pressure on the country’s ailing healthcare system.
 
‘We’re in a crisis that demands action now,’ RACGP President Dr Nicole Higgins said.
 
‘Funding has been ripped from general practice patients for decades – the Medicare freeze cost $2 billion and counting – and so now we’re seeing the decline of bulk billing, people across the country are struggling to get in to see their GP, and they’re being turned away from overloaded hospitals.
 
‘It’s [also] a time when spiralling inflation and cost of living pressures are forcing some people to make the impossible choice between spending on healthcare and other essentials.
 
‘Australia prides itself on being the lucky country where everyone has a fair go. But without urgent action to stem the bleeding and improve access to care for Australians, inequality, and the gap between rich and poor will get much worse.’
 
Primarily focused on improving patient access to general practice care, the measures include:

  • tripling bulk billing incentives
  • increasing Medicare patient rebates for longer, complex consultations by 20%
  • funding enhanced primary care services for people over 65, with mental health conditions and disability
  • support for patients to see their GP within seven days of an unplanned hospital or emergency department visit.
The college is also urging the Government to reinstate patient rebates for longer telephone consults for mental health and GP management plans.
 
‘These services were unfairly taken away from patients and new research has found it’s hurting the most disadvantaged – those who are poorer, elderly, vulnerable and in need of complex care,’ Dr Higgins said.
 
‘Meanwhile, GPs have been subsidising longer phone consultations for disadvantaged patients and paying out of their own pocket, so they don’t miss out on care they need.
 
‘This shouldn’t be happening, but our hands are tied.’
 
Another proposal, aimed at boosting the general practice workforce, is the creation of a program supporting junior doctors to intern in general practice.
 
The RACGP submission estimates such a program could create 800 placements over three years at a cost of $37.3 million, which would include $950,000 for program development in 2023–24, as well as ongoing costs from 2024–25 for practice infrastructure and administration, supervision, intern salaries and indirect placement costs.
 
‘We know those who get a taste of it are much more likely to become a GP – it is immensely rewarding work,’ Dr Higgins said.
 
‘But currently, medical students only get a mandatory placement in hospital, which makes no sense when you consider that more Australians visit a GP each year than any other health service.’
 
And while general practice reform is currently at the top of the national agenda, the submission also proposes that Government undertake a feasibility study to assess the economic and health benefits of reforms to pharmacy ownership and location laws, in a bid to improve access to medication.
 
‘Restrictions on retail pharmacy location and ownership appear to be focused on protecting the vested interests of incumbent pharmacists, rather than the interests of people across Australia,’ the submission states.
 
‘The rules limit competition and make it harder for some people to access discounted pharmacy services.
 
‘Individual pharmacists or small groups of pharmacists have been able to monopolise some or all pharmacies in towns, resulting in patients paying more for their medicines and having limited choice of pharmacy services.’
 
It goes on to state that these impacts are particularly felt in rural and remote areas, and suggests that the problem is likely to deteriorate, citing a Pharmaceutical Society of Australia report that indicates there will be as few as 52 pharmacists per 100,000 people in regional and remote areas in less than five years’ time, compared to 113 pharmacists per 100,000 people in major cities.
 
The RACGP President believes pharmacy ownership and location regulations are ‘outdated and extremely anti-competitive’.
 
‘[It] inflates the cost to consumers and makes it harder to get medicines,’ Dr Higgins said.
 
‘Supermarket pharmacies are widespread in most western nations, including the United States, the United Kingdom, and all over Europe. Why not here?
 
‘Government should invest in a feasibility study to reform Australia’s anti-competitive pharmacy ownership and location laws to improve access to medicines and costs to consumers.
 
‘Despite numerous reviews and reports on the need to remove pharmacy location and ownership rules, none of the recommendations have ever been actioned, so we need to revisit this now.’
 
GP stewardship of patient care best for health outcomes
Aside from the short-term measures contained in the college’s pre-Budget submission, Dr Higgins also reiterated the need for long-term reforms that strengthen GP stewardship of patient care.
 
‘I am alarmed and troubled at some of the opportunistic arguments being put forward that the solution to this crisis is circumventing the proven model of GP stewardship of patient care,’ she said.
 
‘It might be a cheaper option at first, but who wants cheaper if it means a serious illness goes undiagnosed?
 
‘If the current model is broken and GPs – the specialists in generalism, with well over 10-years training in diagnostics, treatment, and quality care – are no longer at the centre of patient care management, it’s people seeking care who will suffer most.’
 
She warned such an approach would lead to an ‘NDIS-style cost blowout’ because services will be fragmented, duplicated and contradictory.
 
‘The health of Australians must come first,’ Dr Higgins said.
 
‘We need GPs working hand in glove with allied health professionals, pharmacists, and practice nurses, and they should be supported within general practice, with GPs as the stewards of patient care.  
 
‘It’s even better for patients when multidisciplinary teams are located in the same practice because you can get all your health needs met in one place. Practices across Australia have already been adopting this one stop care model, and it’s popular with patients and practitioners alike.
 
‘I implore our political leaders to stand strong. Band-aid solutions and cheap quick fixes will not work. And frankly, nobody deserves second rate care.’
 
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