Medicare taskforce report to be out soon; GPs express concerns

The Royal Australian College of General Practitioners (RACGP) has cautioned Medicare reforms must focus on GP stewardship of care rather than shifting patient management to a blended approach that would see other health professionals given greater responsibility.

Minister for Health and Aged Care Mark Butler said that the idea of moving from a purely fee-for-service model to a more blended approach with ‘wraparound funding’ for patients with more complex needs was not a new one.

In a recent press conference, Butler declined to divulge details of what a modernised Medicare might entail but said, “I've been clear that Medicare is in, I think, the worst shape it's been in 40 years.”

He said, “We need to strengthen Medicare, we need to modernise primary care, in particular, to deal with that changed disease profile that’s developed over the last 40 years.” A report to showcase plans for a strengthened Medicare is expected in “the next couple of weeks”.

The RACGP announced a revised action plan for governments to address the current health crisis and ensure the future of GP care, 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, reinstating 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.
   

Butler stated that the Albanese government would not simply be adding more money to the existing system since the current structure of Medicare was built around episodic care and doesn’t serve Australian patients with complex needs.

He suggested that the reform could continue fee-for-service, but with a flexible funding component that might involve nurses and other health professionals.

Acting Australian Nursing and Midwifery Federation Federal Secretary Lori-Anne Sharp said reforms to Medicare were long overdue and will be welcomed by the union’s members.

“While Medicare is a vital scheme, after 40 years it is no longer fit for purpose. We welcome the government’s focus on making the system work better and committing to crucial reform needed to improve patient outcomes and equitable access to primary health care,” Sharp said.

“It has been a welcome shift to have a government recognise the importance of nurses and midwives in building a system that is more patient-focused and our members are well prepared to play a bigger role in helping to create this change.

Butler continued, “I’ve seen some coverage today, for example, about the work that paramedics could contribute to primary care. We just don’t have that happening in Australia, there are too many regulations, too many constraints within the MBS system, too many turf wars that constrain the ability of people who want to deliver their full range of skills and training.”

RACGP President Dr Nicole Higgins said GP stewardship of patient care in the community needs to be central to any long-term reforms.

“Australia also needs long-term reforms that build the role of GPs as the stewards of patient care in multidisciplinary teams, because one person needs to be responsible for managing a patient’s care and GPs are best placed to do this.

“We have seen other countries such as the United Kingdom try to address GP shortages by broadening delivery of primary care to other health professionals — this approach failed to meaningfully improve patient health and wellbeing. Instead, it further fragmented the health system, which leads to worse health outcomes, inefficiencies, and wastage.

“GPs are best placed to manage patient care because we have the required training and expertise in generalist care and diagnostics. The evidence shows seeing the same GP over time, also known as ‘continuity of care’, leads to fewer hospital visits, lower mortality and reduced costs to the health budget.

“While it’s great that our nation’s leaders recognise the need for reform, I am concerned the government’s proposed new model to overhaul Medicare will not go far enough to improve the situation for patients and may make matters worse.”

Higgins concluded, “There is no substitute for GP care, that path results in worse health outcomes for patients, and longer wait times at already overstretched hospitals.

“Our nation’s leaders need to recognise this, and make the changes needed to ensure that all Australians can access high-quality GP care, regardless of their postcode and income. Anything less is not enough.”

Image credit: iStock.com/sturti