RACGP pushes for antenatal care funding increase

Queensland GP Dr Wendy Burton has been offering antenatal care for more than 30 years.
 
Over the course of her career, she has seen routine care become more and more complex, from conversations on mental health and domestic violence, to genetic carrier screening and stillbirth awareness – all of which take in excess of 20 minutes.
 
‘In the 34 years since I graduated, the pace of change has been extraordinary; there’s a whole lot more we’re being asked to do,’ Dr Burton told newsGP.
 
‘I built an entire website to make my antenatal visits more efficient. I ask women to go and read or watch this post or that video and then come back so we can talk it through.
 
‘But even having outsourced my brain to the web, it still takes more than 20 minutes to do my routine antenatal care.’
 
Despite the increased complexity of the care GPs are providing, they are only permitted to use the Medicare Benefits Schedule (MBS) items 16500 (face-to-face), 91853 (video) or 91858 (phone) for antenatal attendances, each of which carries a rebate of $41.70 – regardless of the duration and complexity of the consultation.
 
Dr Burton, who is also Chair of RACGP Specific Interests Antenatal and Postnatal Care, says it is ‘absurd beyond all imagining’ that the only time a person is not entitled to a higher MBS rebate for care that takes longer and is more complex is during pregnancy.
 
‘An essential principle of the MBS is that the longer and more complex a consultation, the higher the rebate; there’s level A, B, C and D,’ she said.
 
‘But a $41.70 rebate buys a woman less than 20 minutes – you cannot do quality antenatal care in that timeframe. So, either the woman has a big gap or a short consultation – neither of which is patient-centred – or GPs who provide antenatal care go broke.
 
‘For every other time in that woman’s life, if a consultation took longer and was more complex, she would be entitled to a higher rebate. Why on earth would antenatal care be the only condition where Medicare does not allow access to higher rebates?’
 
In a letter sent to Federal Health Minister Greg Hunt on 10 March, RACGP President Dr Karen Price called for amendments to the MBS to better support longer consultations for antenatal care, saying that the current model is ‘not adequate to achieve the best outcomes for patients’.
 
‘GPs are well placed to provide holistic, individualised care in line with the Department of Health’s Pregnancy Care Guidelines, however they must be financially supported to do so,’ Dr Price wrote.
 
‘Advances in science and technology have seen the provision of antenatal care evolve significantly over the years. We now have much higher expectations of care provision and a greater awareness of mental health issues and the health impacts of domestic violence.
 
‘Antenatal consultations involve extensive monitoring of health problems and potential complications [eg, diabetes, anaemia], providing advice on nutrition and physical activity, and preparing the mother for childbirth and breastfeeding.
 
‘As such, they are often complex consultations and can extend well beyond 20 minutes. This is particularly true among vulnerable and disadvantaged patient groups, such as those in rural and remote communities, Aboriginal and Torres Strait Islander patients and culturally and linguistically diverse patients.’
 
Dr Burton conducted a private survey on the matter in 2021, and found that of the more than 1000 GP respondents from across Australia, 89.4% think antenatal care has become more complex over the course of their medical lifetime.
 
More than 99% think the current Medicare rebate for an antenatal attendance is insufficient, and 99.1% believe GPs should be able to co-claim time- or complexity-based Medicare rebates for elements of antenatal attendances.
 
‘A number of comments came back saying the MBS is just too complicated; it’s getting harder to know all the rules, and then you find yourself on the wrong side of it and you’re going to get audited,’ she said.
 
‘The MBS needs to be explicitly clear, so GPs know what to do.’

Chair of RACGP Specific Interests Antenatal and Postnatal Care Dr Wendy Burton. 
 
To resolve the issue, the RACGP is recommending that MBS item descriptors for Level C and D time-based attendance items (36, 44, 91801, 91802, 92746, 91894) be amended ‘as a matter of priority’ to allow GPs to use them for antenatal attendances that extend beyond 20 minutes.
 
‘Patients should be able to access a higher rebate if a consultation is longer or more complex, just as they can for other consultations or conditions,’ Dr Price wrote.
 
‘As the COVID-19 pandemic continues, it is more important than ever that we have a well-resourced … general practice workforce able to support our midwifery and obstetric colleagues.’
 
If action isn’t taken on the RACGP’s calls, Dr Burton fears the profession will face a deepening workforce crisis, leaving patients vulnerable.
 
‘The antenatal attendance numbers are nowhere near enough,’ one survey participant said.
 
‘Over time I’ve been referring more to antenatal clinical or private obstetricians to reduce my load of shared care, even though I love it, as it is not financially sustainable, and a good antenatal consult takes time.’
 
Dr Burton says this sentiment emerged as a common theme throughout the research.  
 
‘That’s the nub of it,’ she said.
 
‘We are losing well-skilled, well-placed, trained healthcare professionals, some of whom have long-term relationships with women who can continue to provide appropriate care to low-risk antenatal women.
 
‘But we’re losing them to the inadequacy of the funding and the complexity of the schedule, and we cannot afford to not have this workforce in place, especially during COVID.’
 
Dr Price said it is critical that MBS policy and funding keeps up to date with evidence-based care to ‘ensure the best health outcomes for patients’.
 
‘GPs who provide antenatal care play a pivotal role in areas where there is a lack of other specialists due to workforce shortages, as well as reducing demand on busy hospital outpatient departments,’ she wrote.
 
‘During the pandemic, many patients who previously received antenatal care in a hospital setting have instead accessed this care through the primary care sector.
 
‘GPs have augmented the work of hospital-based doctors and must be appropriately supported to deliver this critical care.’
 
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