The Royal Australian College of GPs (RACGP) has cautiously welcomed many measures contained in the Strengthening Medicare Taskforce Report but warned that even greater reform is required to secure the future of general practice care.
The Medicare Taskforce was commissioned by the Federal Minister for Health and Aged Care, the Hon Mark Butler MP, to determine how best to spend the $250 million a year Strengthening Medicare fund that the Albanese Government took to the 2022 federal election. Specific recommendations in the report 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, which the RACGP has been advocating for over many years
- 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 co-ordinate care. This is particularly valuable for older patients and those with multiple chronic conditions that need to be carefully managed
- 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.
The report also broadly recommends strengthened funding to support more affordable care as well as improving access to primary care in the after-hours period and reducing pressure on emergency departments. However, despite repeated RACGP calls for greater investment in general practice care, it is silent on measures such as boosting Medicare rebates and increasing incentives for bulk-billing. The RACGP is encouraged that Minister Butler has not ruled out increases to Medicare rebates in today's press conference following the release of the report.
RACGP President Dr Nicole Higgins said the report held many promising elements, but that more action was 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.
"The promise of reform without proper investment to back it up is hollow. Medicare is almost 40 years old, and we need change; however, today's recommendations will not of themselves go far enough in securing the future of general practice care. The report features several measures to improve our healthcare system and there is some mention of strengthening funding to support affordable care. We are looking forward to working with the federal Government to achieve meaningful new investment in general practice care. This will provide a much-needed boost for GPs and practice teams who are performing such a critical role in serving their communities and it will help attract new future doctors into general practice.
"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. Medicare rebates have not kept pace with the costs of providing high-quality care and the Medicare rebate freeze ripped billions from the sector. 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 need serious investment and long-term reform to secure the future of general practice care, but we also need to stem the bleeding in the sector with short-term action right now. As I said, we look forward to working constructively with the Government, because there is too much at stake to get this wrong."
The RACGP President doubled down on calls for any reforms to reinforce the role of GPs as the stewards 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.
"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 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.
"I'm also slightly concerned that the report identifies a 'strengthened role for 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."
Dr Higgins said that many of the college's recommendations to the Government featured in the report, 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."
The RACGP will continue to fight for long-term reform that ensures the future of GP care for all Australians. The college also calls for short term solutions to stem the bleeding, including:
- improving access to care by tripling bulk billing incentives, increasing Medicare rebates for longer, complex consultations by 20%, funding enhanced primary care services for people over 65, with mental health conditions and disability, and funding patients to see their GP after an unplanned hospital visit.
- boosting the GP workforce by fast-tracking entry for international doctors, re-instating the subsidy for their training, supporting junior doctors to intern in general practice, and introducing payroll tax exemption for independent tenant GPs to prevent more practices closing.
- Long-term reforms based on the RACGP Vision to build the role of GPs as the stewards of patient care in multidisciplinary teams, with serious investment to improve the health of Australians and reduce spending on expensive hospital care.
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