If last year’s budget was just enough to stop a riot, the Health Minister might want to watch out for pitchforks.
General practice did not get much love in the federal budget this year, with the heftiest funding packages going toward pharmacy, aged care and walk-in clinics.
Initial reactions from peak bodies painted a picture of an unhappy workforce.
RACGP president Dr Nicole Higgins labelled the budget a “missed opportunity”, while AMA vice president Dr Danielle McMullen called it “deflating”.
Australian GP Alliance deputy chair Dr Mukesh Haikerwal was probably the most frank.
“I would say it is an insipid budget, it was lacklustre and uninspiring,” he told The Medical Republic.
One of the biggest questions that organisations have been left with is the fate of mental health treatment plan item 2712.
“The budget details some additional funding for mental health services but we are concerned to see that the critical role of general practice in caring for patients with complex physical and mental health needs will be undermined by the removal of specific Medicare items for the review of a mental health care plan,” AMA president Professor Steve Robson said.
Although it doesn’t appear in the main budget papers, the Department of Health and Aged Care has confirmed with TMR that it will be axing the dedicated mental health care plan review items in November.
GPs will be allowed to use general attendance items to review plans.
This may actually work out in GPs’ favour, given that the indexation on mental health specific items is out of step with time-based general attendance items and aren’t eligible for the bulk-billing incentive.
GP academics like Dr Louise Stone have spoken in the past about the woeful inadequacy of the mental health numbers.
MBS items for the preparation of a mental health care plan are unchanged.
What went to primary care
Health Minister Mark Butler was disconcertingly quiet in the weeks leading up to budget night, but did announce a $227 million package to deliver another 29 new urgent care clinics last week.
This move has already drawn criticism from groups like AGPA, which argued that the money would have been better spent supporting existing GP clinics as they weather the payroll tax storm.
MyMedicare got $16m split over four years, with the money primarily going toward enabling the payment of incentives to GP clinics and to support the frequent hospital users initiative.
“[AGPA] has great concerns about what ‘expanding MyMedicare’ actually means, and to make sure it doesn’t take from patients their ability to choose [their GP],” Dr Haikerwal said.
“It’s more manacles on how we can practice and who we can practice with, and it will take away patient access to services.”
The headline item out of the “strengthening Medicare” section was $882.2m for an aged care preventative health initiative designed to keep older patients out of hospital.
While preventative and chronic health is usually the domain of general practice, this funding will be going to public hospitals to provide community outreach and scale up virtual care capability.
“The government made really strong commitments to general practice last year about strengthening Medicare and … they made a first step toward that with … the tripling of the bulk billing incentive,” Dr McMullen told TMR.
“That was all spoken about as step one in the journey, and we’re disappointed that we haven’t seen step two.”
In the mental health space, $361 million is going toward Medicare Mental Health Centres, which will be built on the already established Head to Health network.
These will apparently be staffed by GPs, psychologists, psychiatrists and potentially also by “psychology assistants” – but more on that later.
The high amount of funding dedicated to subsidised walk-in centres “undermines” the value of continuity of care, Dr McMullen said.
The PIP Quality Improvement incentive payments received a stay of execution and now have an expiry date of 30 June 2025.
In terms of efficiencies, the government plans to save $33.6m over the next three years by reducing the timeframe to submit bulk-billing claims in Medicare from two years to 12 months.
Dr Higgins told TMR that she suspected general practice was passed over this year because of the significant investment made in the 2023 budget.
“This budget doesn’t strengthen Medicare, it fragments it,” she said.
“My fear is that we’ll end up with a two-tier system and that’s not good for anybody.”
She was hopeful that, with an election coming up, next year’s budget would hold a grander gesture for GPs.
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What went to health more broadly
Pharmacy emerged as big winner, with the government confirming it would invest $3.4 billion over five years for new and amended PBS listings, along with a freezing of the maximum out-of-pocket costs for medicines on the PBS.
The maximum co-payment freeze, along with money for dose administration aids, will cost $469.1 million.
These measures are potentially part of the upcoming Eighth Community Pharmacy Agreement, which is now about a month overdue.
While seemingly good for consumers, Dr McMullen said the AMA was disappointed about the phasing out of the $1 discount pharmacies are allowed to apply.
“We are concerned that it will entrench the anti-competitive arrangements that exist in pharmacy,” she said.
The only mention of psychology assistants – presumably people who have completed an undergraduate psychology degree but not gone through a Masters program – as a potential workforce was buried in the budget communication pack for health stakeholders.
“This Budget will diversify the psychology workforce, and explore the role that psychology assistants might play in the mental health workforce,” it read.
This was still enough to startle the Australian Clinical Psychology Association.
“Australia has a soaring need for mental healthcare professionals and the shortage of qualified professionals has been flagged with Government for years however, introducing untrained and unskilled practitioners will not get people the care they need,” ACPA president Professor Caroline Hunt said.
What was missing
The main asks from the peak organisations have been squarely focused on GP and rural generalist training.
Where the RACGP, AMA and GPRA all pitched their own version of a portable leave scheme for GP registrars, the RDAA, ACRRM and GPSA requested better funding for GP supervisors.
Alas, these hopes were in vain.
ACRRM didn’t even get funding it requested for additional training places on the rural generalist pathway.
College president Dr Dan Halliday said the lack of funding for rural generalists was disappointing.
“ACRMM didn’t receive support for any of the initiatives that we were calling for, in addition to what we already knew to be coming forward,” he told TMR.
“Noting that ACRRM did receive additional [ad-hoc] support to train at a higher number of trainees starting this year, there is no long-term commitment that has been put in place at this stage.”
Rural generalism is set to become a fully fledged specialty within the year.
One of the major frustrations across the peaks, Dr Halliday said, was a lack of direction.
“We’re all effectively working in the same areas where, by and large, we have similar approaches to different initiatives,” he said.
“But I think we’re looking for leadership to combine all of those potential initiatives into an overarching vision to drive health … into a firmer direction for the future.”
