Strengthening Medicare report recommends funding longer consultations

Matt Woodley

3/02/2023 4:19:59 PM

Greater investment to support multidisciplinary teams in general practice has also been proposed, but increased Medicare rebates are not mentioned.

Federal Health and Aged Care Minister Mark Butler
Federal Health and Aged Care Minister Mark Butler at a press conference launching the Strengthening Medicare Taskforce report. (Image: AAP)

The RACGP has cautiously welcomed many of the long-term reforms contained in the Strengthening Medicare Taskforce report, which was publicly released after being presented to state and territory leaders at National Cabinet earlier in the day.

The report, which took more than six months to develop, lays out significant reforms to modernise Medicare and bolster general practice, as well as provide high-level guidance to the Federal Government on where it should invest the $750 million it pledged ahead of last year’s election.

Following today’s meeting, Prime Minister Anthony Albanese told reporters that health reform is a ‘first priority issue’ for National Cabinet, and that better integration will be a major focus of the planned changes.

‘The key, going forward, is to better integrate the systems,’ he said. ‘We know that the earlier the care is provided, the cheaper that care will be as well.

‘That is a common position which we have, and we’ll be prioritising that throughout 2023.’

Specific Taskforce recommendations welcomed by the RACGP include:

  • funding for longer consultations to reflect the fact that chronic and complex care requires more time than is funded for in a standard consultation
  • increasing investment to support multidisciplinary teams in general practice that are responsive to local needs – as long as patients are accessing centrally coordinated care via their general practice 
  • ‘blended funding models’ integrated with fee-for-service, including incentives to promote better care for people who need it most
  • introducing a streamlined and straightforward voluntary patient registration scheme, which enables patients to sign up to a practice that receives extra funding to coordinate care
  • better use of data and digital technology to share critical patient information and support superior patient healthcare
  • investing in Aboriginal Community Controlled Health Organisations to commission primary care services, building on their expertise and exploring new funding models that are locally relevant for rural and remote practice
  • investing in primary care research.
Speaking after its release, RACGP President Dr Nicole Higgins said the report contains many promising elements, but that more action is needed to secure the future viability of general practice care.

‘The RACGP is pleased to have participated in the Taskforce and we are committed to working alongside government to implement reform,’ she said.

‘It is very positive that health reform is, as the Prime Minister said today, a first priority issue for 2023 and to see the states and territories come to the table with the Federal Government to discuss these vital issues. 

‘We welcome many aspects of the report but there is a high level of ambiguity, and the devil will be in the detail on many of the recommendations.’

Dr Higgins also said reform without proper investment is ‘hollow’, and that short-term action is needed to ‘stem the bleeding’.

‘GPs and practice teams have experienced many years of neglect and underfunding that has left general practice care in urgent need of an investment boost,’ she said.

‘General practice is the answer to relieving pressure on the entire healthcare system, including our over-burdened hospitals, and improving the health and wellbeing of people in communities everywhere.

‘We look forward to working constructively with the Government, because there is too much at stake to get this wrong.’ 

At a press conference launching the report, Federal Health and Aged Care Minister Mark Butler said improving access to general practice and primary care, particularly outside usual business hours, is a ‘key message’ that emerged from the Taskforce.

He also referenced the need to provide support for longer general practice consultations and establish ‘sustainable models of care’ in rural and remote areas.

‘This report and the recommendations contained in it will guide the deliberations of Government between now and [the] Budget to frame particular investments needed to deliver our commitment to rebuild general practice and, more broadly, strengthen Medicare,’ Minister Butler said.

‘The report recommends supporting this with new blended funding models, integrated with the existing fee-for-service model, allowing teams of GPs, nurses, midwives, and allied health professionals to work together to deliver the care people need.

‘The Taskforce found that strengthening primary care with a greater range of health professionals working to their full scope of practice will optimise use of the health workforce across a stretched primary care sector.’

In response, the RACGP President reaffirmed the college’s position that any reforms need to reinforce the role of GPs as the custodians of patient care.

‘The report states that responsibility for providing care should be shared across primary care teams and that high-quality primary care depends on harnessing the skills of a diverse health workforce including nurses, nurse practitioners and pharmacists,’ she said.

RACGP President Dr Nicole Higgins says the report contains many promising elements, but that more action is needed.

‘The devil is in the detail here. If the current model is broken and GPs – the specialists in coordinating complex care, with well over 10 years of training in diagnostics, treatment, and quality care – are no longer at the centre of care management, patient care will be compromised. 

‘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.’

Dr Higgins also raised concerns about the report identifying a ‘strengthened role’ for Primary Health Networks (PHNs) to drive organisational and cultural change. 

‘Again, general practice needs to be at the centre of any changes and if you ask many GPs, they will tell you that adding another layer of bureaucracy by further empowering and funding PHNs is not the best solution,’ she said.

Nonetheless, Dr Higgins said the fact that many of the college’s recommendations to the Government featured in the report is something that bodes well for the future of general practice care.

‘Voluntary patient enrolment could well be beneficial for many patients and the college awaits further detail on the proposed model,’ she said. 

‘In the United Kingdom, the capitation approach has seen many GPs doing a lot more for less, at the expense of patient care, and that must be avoided at all costs. 

We have previously warned in our submission to the Primary Healthcare 10-Year Plan that any voluntary patient enrolment model must be fit-for-purpose for the Australian health system and align with the flexibility required in general practice care. 

‘Digital modernisation also holds great promise, and we are keen to work with Government to make sure we get this right, including privacy and security concerns. 

‘As the report makes clear, it’s no use having vital patient health information locked away in different information systems and not shared easily – no one wins in that scenario.’

Progress on payroll tax
Aside from reviewing the Strengthening Medicare Taskforce report, National Cabinet also heard from Queensland Premier Annastacia Palaszczuk in regard to her state’s plan to institute a two-year moratorium on the collection of payroll tax from tenant doctors.

‘I said that we are planning, and that Queensland’s committed to, doing that amnesty until the middle of 2025,’ she told reporters following the meeting.

RACGP Vice President and Queensland Chair Dr Bruce Willett told newsGP the move represents ‘a huge win’, but that the college will still push for nationwide exemptions for tenant doctors.

‘This comes as a great relief for GPs. It gives them time to adjust to this changed interpretation of the laws and it’s come at after months of intensive negotiations with the QRO [Queensland Revenue Office], and the Treasurer [Cameron Dick],’ he said.

‘We’re grateful to the Queensland Treasurer for recognising the problem that this is causing for general practices. We now need to call on the other states and territories to quickly follow suit to provide certainty.

‘The word of caution is that this is just kicking the can down the road – we need a more long-term resolution in the form of an exemption for the tenant doctor arrangements.’

National Cabinet is next due to meet in late April. 

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Dr Dhara Prathmesh Contractor   4/02/2023 4:58:08 AM

More funding for coordination of chronic and complex patients. Will that funding be to GP, GP practice and GP nurse’s?? As almost each allied health- physio, dietitian, occupational therapist, podiatrist, psychologists, nurse practitioners they all have higher and usually double consultation charges than any standard private GP consultation fee.
Sorry, where is this funding going towards?

Don’t understand why every time on TV it’s advertised patients cannot afford GP consultation.
Having an orthotics for complex diabetes foot is expensive. Patients cannot afford that. Diabetic educator access is not just difficult to get but expensive too.
Please compare private fees of allied health services and their businesses to GP( Doctors) and please review into the situation appropriately.

If pharmacy can see patients and prescribe. Why are we training doctors in general practice? What funding will pharmacy receive when they prescribe? Please highlight.
Complex situations!

Dr Rina Christina Dela Cruz-Sangalang   4/02/2023 5:41:00 AM

It is interesting from what I have heard so far is that pharmacists can prescribe as well now in a new 6 mos trial in Victoria, and will be paid $20 per consult for this. So fractured care is already starting here . I wonder , do they have medical indemnity for this? As well as do they make their own history, physical examination, management plans and send this to the patients regular doctor ? Will they have AHPRA at their backs as well if someone complains and nudge letters ? I wonder…

Dr George Al-Horani   4/02/2023 7:33:03 AM

In summary , it’s time to pack up and go .

Dr Joveria Javaid   4/02/2023 10:30:24 AM

About the payroll tax, it is not success. I will consider it a failure. It is due to our weak stance that medicare is heading towards failure. Politicians do not care because they can always cause diversions and smoke screens to avoid the issues. Nursing unions and pharmacy guild is way more strong then us. I am really worried about future of general practice in Australia.

A.Prof Christopher David Hogan   4/02/2023 1:19:29 PM

Indeed the devil is in the detail- always
PHNs have often been paper tigers compared to Divisions of GP
Patient registration existed informally up to the late 1980s. Continuity of care leads to a significant improvement in patient wellbeing
I devoted years to GP research, multidisciplinary care & effective use of IT & communication in various arenas- all are of critical benefit.
Directly or indirectly , the patient has always paid for medical fees with support from charities & communities in critical circumstances.
The best way to defend a quality fee for GPs is to provide a quality service

Dr Robert William Micallef   4/02/2023 1:52:21 PM

The RACGP should be leading the agenda for Medicare reform not be a passive participant. All these blended funding models don’t result in better care and end up diverting funding away from doctors. The fee for service model is simple to implement and understand and allows patients to decide what they prioritise for their health care. GPs don’t want complicated funding models they just want patients to receive a fair rebate on their medical bills. We need to be strongly opposing complex funding arrangements and be offensive in dealing with things like pharmacy prescribing. How many trials are being run on GP dispensing for example?

Dr Christopher Francis Boyle   4/02/2023 3:44:05 PM

If after hours care is a priority then start after hours at 6pm when the practice closes for the day. The 8pm start for after hours means that the first 2 hours of work is at day time rates rather than at after hours rates. This could be done immediately as a show of good faith from the Government rather than waiting till whenever to do it. They treat us like we are mugs!!

Dr Aiad Alsaad   5/02/2023 7:10:46 AM

This is a joke, someone comes to you with bleeding from an amputated finger ,and you offer him to massage his feet instead not dealing with his amputated finger! wake up people, it is just propaganda for wasting money on projects likes urgent care clinics, allowing pharmacy to treat, but not supporting the GP who is the center of patient care, while the DOH Auditors are bullying GP about the number of patients they can see and look after, or what antibiotics were used to treat each patient, which make many GP sees only limited number a lot below the official allowed numbers to avoid being slaughtered by the Auditors and all the harassments that you get from them. ,Can the pharmacy tell if it is otitis media or externa to decide what treatment to use? We might need to ask the hair dressers to deal with fractured limbs and circumcisions' like one century ago. You have been asked to support the GPs with the billing not waste money somewhere else .I doubt that this will happen.

Dr Suresh Gareth Khirwadkar   11/02/2023 7:23:30 AM

None of this matters when Medicare / PSR still actively pursue, punish, penalise and crucify doctors for daring to spend more than 20 minutes with them.

It’s all smoke and mirrors, obfuscation and otherwise just outright lies.

No GP wants complex funding. We want simple, easy to understand Medicare system, without all the hoops, and without the constant crusade against GPs, audits and PSR activity.

But what is ever increasing? The things which are driving GPs away.

I myself am slowly working my way out of core GP. Soon setting myself up as a fully private GP without Medicare. It’s just too much risk to use Medicare and see patients for the length of time they need, request the tests they need. It’s not worth losing my house over.

I know GPs that have quit for the same reason.

The system is driving away good GPs, driving down care, and driving towards 6 minute medicine. Now it’s even worse, it’s driving towards noctors and phoctors and unskilled workers all to save a buck.