RACGP: Medicare reform must have patients front and centre

Royal Australian College of GPs

The Royal Australian College of GPs (RACGP) has warned that any reform of Medicare and general practice care must have GPs and general practice teams front and centre so that no patients are left behind.

It comes following the release of the Grattan Institute’s A new Medicare: strengthening general practice report, which argues that Australia’s universal healthcare system has failed to keep up with changes to complex health needs.

RACGP President Nicole Higgins said that while the report had promising elements, many of the recommendations should be approached with caution.

“General practice care is the answer to relieving pressures on the entire healthcare system and improving the health and wellbeing of people in communities across Australia,” she said.

“The report blithely states that Australia ‘has many GPs, with more on the way’. This is a disappointingly simplistic take on a very complex problem that if not properly addressed will result in compromised patient care across the nation. Australia does have a maldistribution of GPs that disproportionately affects rural and remote areas and given more GPs expect to retire in five to ten years and that less than 15% of future doctors are choosing general practice as a career, there are enormous workforce challenges looming on the horizon. We can’t stick our heads in the sand and hope a shortage of GPs won’t hurt communities in need, particularly since we have an ageing population and a mental health crisis.

“Australians deserve and need a well-supported and high functioning primary healthcare system. While we acknowledge that investment through the current Medicare structure will not fix all the existing challenges in general practice, it will help to guarantee access for patients until significant reforms can be implemented. It is true that we ‘survived’ the rebate freeze, but we should not just be aiming for general practice care to be surviving, we need it to be thriving.

“Medicare rebates have not kept pace with the cost of providing high-quality care many practices are under financial strain. Unfortunately, the Grattan Institute’s report doesn’t properly investigate the longer-term financial viability of general practice care in Australia or consider the impact it has on patients when more GPs close their doors because they can’t afford to continue to provide care.

“In terms of how to fund GP care – we must proceed carefully. Certainly, the college agrees with the report’s conclusions that the Medicare Benefits Schedule is too complex, and that less micromanagement through complex MBS rules would be beneficial. However, we need to be wary of diving head-first into a capitation model because evidence from overseas is mixed at best. For example, in the United Kingdom many GPs and their teams end up doing a lot more for less, at the expense of patient care, so we must avoid that. We have flagged these concerns before, including in our submission to the Primary Healthcare 10 Year Plan, and will continue to caution against models that do not align with the flexibility required in general practice.

“The RACGP does cautiously support funding reforms that introduce flexible and blended payment models to support the delivery of quality healthcare in an equitable manner. However, we note these models should retain a simplified core approach of fee-for-service payments. Further, any new funding model should be co-designed with GPs and patients to ensure they are effective and fit-for-purpose within the complexity of the health system. Both patients and GPs must be front and centre and consulted on any changes in the years ahead.”

The RACGP President said that working as part of a “team” must be managed carefully.

“Empowering multidisciplinary teams as part of a ‘team sport’ is important, but this must be GP-led, or we risk fragmenting patient care,” she said.

“GPs and general practice teams are always open to working with other healthcare workers, rather than models such as expanding the scope of pharmacists in a retail setting separate from general practice. But it must be GP-led and consider too that there are shortages of other healthcare workers such as nurses and pharmacists, so we can’t just pluck them off of a tree and hope to resolve healthcare challenges – we have a broader staff crisis across the entire health system.”

Dr Higgins also said that the future of the general practice deserve close attention.

“The RACGP agrees that government needs to provide a clear vision about where general practice is heading so that no patients are left behind,” she said.

“Having Primary Health Networks, or PHNs, rolling out measures to improve the system sounds good in theory; however, there are concerns that in reality it will add another layer of bureaucracy. I respect the work of PHNs but many of them have variable relationships with GPs in different communities, so in many ways it makes more sense to be funding patient care directly through general practice.”

The new RACGP Advocacy Priorities set out our short term recommendations to address the current challenges in general practice.

Our Vision for general practice and a sustainable healthcare system outlines the urgent need to restructure the healthcare system into one that provides the right care for patients at the right time and in the right place, and that is sustainably funded into the future.

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