Equip GPs to ease strain on non-GP specialists: Report

General practice should be part of the solution to address spiralling non-GP specialist fees and widespread access issues, according to the Grattan Institute.
 
The recommendation comes in a new report, ‘Special treatment: Improving Australians’ access to specialist care’, which was published by the independent policy thinktank on Sunday.
 
It estimates that allowing GPs to get advice from other specialists more easily would avoid 68,000 referrals each year, as well as $4 million in out-of-pocket costs for patients. 
 
‘GPs and other specialists would be paid for their time at a cost of $26 million a year,’ the report’s authors wrote.
 
They describe the existing system as having ‘few easy options’ for getting a second opinion, with GPs reliant on their own professional network or needing to find the right support independently.
 
‘And [GPs] are not directly paid for time spent planning or discussing complex care with other doctors,’ the report says.
 
‘As a result, GPs may refer patients to specialists even when they could manage their care more quickly, more cheaply, and just as well, with some quick advice.’
 
Dr Rashmi Sharma, Chair of the RACGP Expert Committee – Funding and Health System Reform, sees merit in the proposal.
 
‘Better coordination and collaboration helps everyone,’ she told newsGP.
 
‘We would welcome measures that support GPs to manage more care and reduce referrals where possible.
 
‘However, it’s important GPs are appropriately remunerated for this work.’
 
Highlighting how out-of-pocket costs for non-GP specialists have outstripped increases in other Medicare services by 73% in real terms since 2010, the Grattan Institute’s report also exposes huge fees commanded by some specialities.
 
Researchers estimated that more than one in five patients who saw a non-GP specialist in 2023 was charged an ‘extreme fee’ – defined as more than three times the Medicare schedule for the service on average.
 
Psychiatry costs were among the highest, with out-of-pocket fees reaching $670 for an initial consultation among those defined as charging extreme fees.
 
However, the Grattan Institute report found more dermatologists charging extreme fees than any other specialty, with almost half falling into that bracket.
 
The authors also estimated that almost a million people put off non-GP specialist care each year or avoided it all together, with nearly half of them doing so due to the cost.
 
As a result, missed diagnoses and delayed treatment risk causing ‘avoidable suffering’ as well as placing additional pressure on hospitals, they wrote.
 
The Grattan Institute researchers estimate that free clinics run by public hospitals currently only provide a third of all specialist care and criticises their wait times as ‘often far too long’.
 
‘In many parts of Australia, wait times for urgent appointments are months longer than clinical guidelines recommend,’ they said.  
 
‘These problems have festered because the system has been running on autopilot.’
 
They described non-GP specialist care as ‘a postcode lottery’, with people in the worst-served areas receiving about a third fewer services than the best-served areas – an issue they say ‘disproportionately’ affects rural communities.  
 
Rising chronic disease
The ongoing rise in chronic disease provides another key reason for urgent action, according to the policy researchers.

‘GPs can manage most aspects of ongoing patient care,’ the report states.
 
‘But as chronic diseases increase, care is getting more complex, making it harder for GPs to diagnose and decide on treatment plans without advice from specialists.’
 
For Dr Sharma, the analysis reinforces the logic behind the long-held college advocacy position to encourage longer consultations.
 
‘We have been calling for more funding to support GPs in providing care to patients with complex and chronic health conditions,’ she said.
 
‘There needs to be a rebalancing of the MBS to support this type of care.’
 
Dr Sharma also emphasised the importance of trust from non-GP specialist colleagues for GPs to manage care in the community, as well as more support for implementing shared care models – and highlighted the issue of clinical handover back to general practice.
 
‘Many times GPs will send patients for referral, and they will go to the clinic but are not discharged back – this creates fragmentation as well as clogging up clinics, reducing appointments available for new patients,’ she said. 
 
The Grattan Institute report, meanwhile, called for legislation to curb ‘extreme fees’, including publishing a list of ‘extreme-fee specialists’ and laws allowing government to claw back excessive charges.
 
The thinktank’s Health Program Director Peter Breadon said the current system means some patients face a choice between long wait times or over-inflated costs.
 
‘We think those fees are far too high,’ he told the ABC. ‘There’s no justification for them. There’s no evidence that the doctors charging extreme fees are providing better care.’
 
The report also recommends the establishment of a national health workforce planning body, as well as greater investment in public non-GP specialist clinics.
 
Dr Sharma agrees action is required to address access and equity issues.
 
‘Every funding model has its benefits and flaws, and we need to carefully consider any changes to avoid unintended consequences,’ she said.
 
‘We need to consider the findings of this report in line with the various other reforms currently being enacted across the health system.
 
‘We want to see all Australians able to access public outpatient services when they need them. We’ve long called for efficiencies in the outpatient system such as better triaging of referrals.
 
‘We’re also supportive of GP Liaison Officers being rolled out across all jurisdictions to improve collaboration and communication across hospital and primary care services.’
 
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Grattan Institute healthcare funding MBS Medicare non-GP specialists