"Australians
enjoy access to a world class health system
with primary care at its centre. Our vital and valued
primary care workforce includes Australia’s hard working
general practitioners, allied health professionals, primary care
nurses, nurse practitioners and midwives, pharmacists, Aboriginal
health workers, practice managers and other practice staff. Primary
care provides the foundation for universal health care, working hard
to keep all Australians healthy and well in the community, and to
deliver care that meets the needs of people and communities at all
stages of life, no matter where they live.....
Modernising primary care
Recommendations
•
Modernise
My Health Record to significantly increase the health information
available to individuals and their health care professionals,
including by requiring ‘sharing by default’ for private and
public practitioners and services, and make it easier for people and
their health care teams to use at the point of care.
•
Better
connect health data across all parts of the health system,
underpinned by robust national governance and legislative frameworks,
regulation of clinical software and improved technology.
•
Invest
in better health data for research and evaluation of models of care
and to support health system planning. This includes ensuring
patients can give informed consent and withdraw it, and ensuring
sensitive health information is protected from breach or misuse.
•
Provide
an uplift in primary care IT infrastructure, and education and
support to primary care practices including comparative feedback on
their practice, so that they can maximise the benefits of data and
digital reforms, mitigate risks and undertake continuous quality
improvement.
•
Make
it easier for all Australians to access, manage, understand and share
their own health information and find the right care to keep them
healthy for longer through strengthened digital health literacy and navigation."
[Strengthening
Medicare Taskforce Report
December 2022, Introduction
opening sentences, p.2 & Modernising primary care, one of four recommendation clusters, p.9]
Last
week I 'phoned the GP practice I normally attend when I am unwell
seeking an appointment.
Rather
than the expected two to three week wait for an appointment I was
given a choice of appointment dates that week.
When
I entered the four-doctor
practice it only had two patients sitting in the waiting room and I
made a third.
The
situation was almost
self-explanatory
when I read the signs at reception. The practice was now charging
fees payable at time of visit.
A
Standard
Consultation
is
$84 (which
includes a $10 medical centre
facility
fee).
There is a federal government rebate
of $39.75 for
patients with a Medicare Card –
payable electronically after the $84 is handed over.
The
Facility Tax For Professional Services also includes as or when required –
a medical centre treatment room fee of $20 and a medical centre
consumables fee of $20. There
may also possibly be a surcharge applied for public holidays.
There
is no bulkbilling of DVA
Gold Card Holders
and Pension Card
Holders
until they are over 75 years of age.
As
the The
Australian Government Actuary
is currently not expecting
the
average 67 year-old to live more than somewhere
in the vicinity of another
20.1 years, it would appear that a number of GPs are now willing to lock a significant number older patients out
of bulk billing for all but the last 12 years of their remaining lifespans.
So
is it any wonder that everyone from the prime minister & state
premiers to patients are wondering just how far this corporatisation
of primary health care will go and,
what workable solutions might be found to correct a dysfunctional
primary care system.
An
excerpt from
The
Sydney Morning Herald Economics
Editor Ross
Gittens’
perspective on the recently updated final
report
of the Strengthening
Medicare Taskforce,
8
February 2023:
According
to the doctors’ union, the AMA, the reason GPs have become so hard
to find is that the federal government isn’t paying them enough.
Whereas in the old days half of all medical graduates became GPs, now
it’s down to about 15 per cent.
So,
pay them more. Problem solved.
What
the report’s saying is: sorry, not that simple. It’s true the
Coalition government inherited a temporary freeze in Medicare rebates
– the amount of a doctor’s bill that’s paid by the feds – in
2013, and continued it until 2018. And although the schedule of
rebate payments has been increased annually since then, the increases
have been much smaller than inflation.
Why?
Partly because the Liberals were trying to prove they could cut taxes
without damaging “essential services” such as Medicare.
But
also because they knew something was wrong with the way general
practice works. They needed to pay GPs differently to do different
things. Rather than pay more and more the old way, they’d hold back
until they – or some future government – worked up the courage to
make changes.
Over
the almost 40 years of Medicare, there’s been a big change in the
problems people bring to their GPs. Because we’re living longer,
healthier lives, much more of our problems are chronic – someone
with heart trouble or diabetes has to wrestle with it for the rest of
their lives – rather than acute: something that’s easily and
quickly fixed.
But
the present (subsidised) fee-for-service way of remunerating doctors
is designed to suit acute problems, not chronic conditions. It
involves waiting for problems to arise, not early diagnosis or
stopping chronic conditions getting worse.
It
encourages GPs to keep consultations short, avoiding long discussions
of multiple problems.
A
change no one wants to talk about is the way sole practitioners or
partnerships of doctors are giving way to companies owning chains of
practices staffed by doctors they employ.
When
you separate the person delivering the care from the person watching
the bottom line, you increase the likelihood doctors are pressured to
keep consultations short and order many tests – a further reason to
be cautious about reinforcing GPs’ dependence on fee-for-service.
The
report wants to move to “blended” funding, with acute
consultations continuing to be fee-for-service, but GPs paid lump
sums for developing and managing “care plans” for particular
patients with chronic conditions.
While
it’s true fewer medical graduates are becoming GPs, it’s not the
whole truth. As the Grattan Institute reveals,
“Australia has more GPs per person than ever before, more GPs than
most wealthy countries, and record numbers of GPs in training”.
How
do other countries with good healthcare get by with fewer GPs? By
making sure their GPs can’t insist on doing things that could be
done by other health workers – nurses, nurse practitioners (nurses
trained to do some of the more routine things doctors do),
pharmacists and physios.
This
is what “co-ordinated, multidisciplinary team-based care” means.
Changing GPs’ surgeries into more wide-ranging “primary care
clinics” is also about making it easier for patients to move
between different kinds of care, with GPs taking more responsibility
for the total package, and all the various doctors and
paraprofessionals having access to a patient’s medical history.
There’s
nothing new about this. Federal governments have been trying to
improve the performance of primary care for decades – with little
success. Why? Because they’ve had so little co-operation from the
premiers and the GPs themselves.
The
true message of the latest report is: Medicare reform must not just
be about more money to do the same things the same way.
The full 10-page plus cover sheets Strengthening Medicare Taskforce Report can be found at:
https://www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf
The taskforce was formed by the Albanese Labor Government and has 17 members. Its first meeting was held on 29 July 2022 and the taskforce has issued 6 communiques containing meeting minutes.
