‘Strong perception that MBS rates are inadequate’: Inquiry

‘It is time for action, and reform that is funded.’
 
That is according to Justice Richard Beasley – tasked with conducting the Special Commission of Inquiry into Healthcare Funding in New South Wales.
 
Following 226 written submissions, including from the RACGP, and testimony from 225 witnesses over 70 days of hearings, his final 1000-page report was released on Friday.
 
While the investigation is NSW-specific, it lays bare barriers, frustrations, and red tape felt by healthcare staff across Australia, including GPs.
 
The inquiry was tasked with investigating the funding of NSW’s health services to support safe delivery of high-quality, equitable and patient-centred care in both public hospitals and community settings, governance and accountability structures, workforce and education.
 
The report made 41 recommendations for change, with its top call being that ‘preventive health should be made, and remain over the long term, a standing whole-of-NSW-Government priority.’
 
‘The NSW health system is a good one. It comprises doctors, nurses, and other clinicians and workers who are well trained, highly skilled, and dedicated. It is well managed,’ the report found.
 
‘The system, however, has failings. One significant failure is that adequate and timely primary care is not available to parts of the NSW population.
 
‘There has been a failure to embed prevention in all its forms into the health system, despite repeated and evidence-based recommendations to do so.’
 
The report said there was an ‘overwhelming body of evidence’ before the Special Commission that the primary care system in the state is under severe pressure.
 
Turning to GPs, the inquiry heard of the ‘inherent challenges associated with the operation of general practice’, which it says includes increasing patient complexity, inadequacy of current Medicare Benefits Schedule (MBS) rates, and pressures associated with operating a small business.
 
‘The excessive workload on GPs (particularly in regional and rural areas) was described in startling detail in the evidence,’ the report said.
 
‘There is a strong perception that MBS rates are inadequate (and likely have been for many years). This is particularly so for GPs who treat, or want to effectively treat, patients with chronic disease. The treatment of chronic disease is not suited to “15-minute medicine”.
 
‘Moreover, the MBS itself is not enough to ensure availability of the kind of integrated care that might be needed.
 
‘This is deeply unfortunate given the importance of primary care to better population health outcomes, and to the prevention of chronic conditions, as well as to earlier intervention into, and proper management of, people experiencing such diseases.’
 
RACGP NSW Chair Dr Rebekah Hoffman said the report’s findings are ‘something we definitely see replicated in every state and territory across Australia’.
 
‘Because there’s a funding crisis and people are struggling with money, they have to understand where they choose to spend their money and that means they need to understand, when you go to a GP, what the costs are and what the rebates are,’ she told newsGP.
 
‘But also, they’re getting angry that the rebates aren’t covering the cost as much as they were 30 years ago.
 
‘There needs to actually be an increase funding into the preventative care space as an opportunity to reduce the costs of tertiary care.’
 
The Special Commission visited each of the state’s six local health districts, finding comprehensive primary care is ‘not available as it should be in parts of the metropolitan area of Sydney, or in the regions’.
 
The report also spoke to a ‘serious limitation’ of the Single Digital Patient Record (SDPR), saying there is no current plan for it to interface with primary care providers, including GPs.
 
‘One great advantage of linking the SDPR to primary healthcare providers, and in particular GPs, is that it will enable data to be collected about services provided by GPs, including preventive and chronic disease management services,’ it said.
 
‘It will enable greater connection and information sharing between those providing primary care services, and those providing acute services to the same patients.
 
‘No one has identified a reason why access to the SDPR by primary care providers is anything other than a benefit – to the individual and the system.’
 
It also points to ‘somewhat anecdotal’ suggestions that there have been changes to the way in which some GPs are choosing to work, particularly since the COVID-19 pandemic.
 
‘The consequence is that it is likely that a greater number of GPs will be required to meet the population’s primary care needs into the future,’ it said.
 
The report also recommends NSW Health provide the training and support to those contributing to the delivery of primary care ‘to harness their full range of skills, including by working to the top of their scope of practice wherever clinically appropriate’.
 
NSW Health Minister Ryan Park said he believes the state’s health system is ‘one of the highest performing in the world’.
 
‘It doesn’t mean that we don’t have our challenges, and it doesn’t mean we can’t find more ways to improve,’ he said.
 
‘It is now time to give the findings and recommendations of this report the consideration it deserves.’
 
The inquiry’s findings echo many of the RACGP’s key advocacy asks, including for a 40% increase to all Medicare rebates for Level C and Level D consultations and a 25% increase to Medicare rebates for GP mental health items.

The RACGP has also long called for funding and initiatives to train more GPs by attracting more medical students to specialise in general practice.
 
But Dr Hoffman said overall, she is happy to see the ‘narrative around general practice changing at both the state and federal level’.
 
‘Recently, we’ve really experienced the perception of GPs’ worth and value improving,’ she said.
 
‘I’m ever an optimist but I think that even just having the conversation is a good first step.’
 
The NSW Government said it will now carefully ‘consider these findings and respond in due course’.
 
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MBS Medicare Medicare Benefits Schedule New South Wales