Shaping the future of primary care: Budgets and telehealth

Michael Wright

30/10/2020 3:43:43 PM

In the second monthly column on funding advocacy, Dr Michael Wright sees positive change – but also missed opportunities.

road with future years labelled
How can we achieve a stronger future for primary care?

What have we seen this month in the advocacy space? Two main developments: The Federal Budget and the future of telehealth.
Federal Budget
At the start of October, the 2020–21 Budget was handed down. As we expected, there was a significant focus on economic recovery from the COVID-19 pandemic, including economic stimulus and job creation measures.
The health measures announced also focused on immediate needs, ranging from mental health and suicide prevention, the extension of telehealth by six months, as well as respiratory clinics, pathology testing and aged care sector support. The RACGP produced a budget overview, which has more detail.
While we broadly welcome these announcements, and understand the highly unusual economic circumstances driving these measures, we are concerned that much-needed reforms to improve the long-term health of all Australians have not been prioritised.
Of course, COVID recovery is the current priority – but we need to make sure that additional funding is put into general practice to support GPs to provide the high-quality holistic care that patients need.

Our role as preventive health and chronic disease experts will be needed more than ever as we deal with a backlog of health concerns as patients slowly return to usual care. It’s vital that we get the message out to patients who are still staying away that they do need to return to usual care.
That’s a key role for us – we step in and prevent hospitalisations by ensuring chronic conditions are well managed. And this role is needed like never before.
If we were not playing that role, the Government would soon see the result – a tide of patients with acute issues flooding hospitals and requiring much, much more expensive care.
We desperately need more investment in general practice to help us look after our practice population. That’s the big picture, and what our Vision for general practice and a sustainable healthcare system lays out.
To that end, we will advocate strongly for primary care and a long-term vision for the health of our nation in the lead-up to next year’s budget, expected on 11 May.
We are already beginning this advocacy work, to ensure we have the best opportunity to have general practice seen – rightly – as a priority.
Telehealth as a permanent presence in primary care
Adding telehealth items to the Medicare Benefits Schedule has been well-received. Telehealth has improved flexibility in how we deliver care to our patients – and our patients also appreciate that flexibility.
It’s a welcome development, especially after the lean years of the rebate freeze.
A key announcement in the recent budget was an explicit commitment to telehealth becoming a permanent part of Medicare beyond the current expiry date of 31 March. To that end, the Federal Government will spend $18.6 million to prepare permanent telehealth infrastructure.
Beyond that, we simply don’t know the detail.
The introduction of telehealth has been rapid, and we need to understand it better.
When is telephone best? What are video consultations best used for? And when is face-to-face care necessary?
As a GP, I believe all of these modes of care are valuable and they all help patient care. We will be advocating for ongoing freedom of choice for GPs and patients as to what method of contact they choose. After all, GPs and patients are best placed to together judge how care should be provided.
To ensure our patients and primary care get the best outcome possible, we are in ongoing discussion with the Government and Department of Health over what the future of telehealth will look like.
We will shortly submit our formal advice to them. We expect more certainty about the future model will be part of next year’s budget. 
We are seeking your feedback to inform these discussions over the best model for permanent telehealth. Specifically, we’d like to know how the current arrangements have worked for you and your patients, as well as what you think needs to change for a permanent telehealth model to work.
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Dr Oliver Frank   4/11/2020 8:36:28 AM

Medicare benefits and any other third party funding support should be the same for any form of synchronous communication with a patient. 'Synchronous communication' means 'interacting in real time', such as face to face, by telephone or by video. Email and other messaging is asynchronous and has value and should also be supported, possibly with smaller Medicare benefits, because it is somewhat less demanding and not as time critical as to when it is done.

Dr Neville Steer   4/11/2020 7:26:53 PM

One of the many challenges for General Practice has been "short termism" by successive Governments. This view of health amongst other public benefits such as education, arts and culture as a cost rather than an investment in the future. The brakes have been applied to General Practice for many years and Telehealth is a great example. The benefits have long been obvious but perhaps it time has come politically to enable it to remain post Covid.