GP registrars call for national leave fund in budget

Training conditions are a key concern in the pre-budget submissions from various GP organisations this year.

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Budget night is still three months away, but various health organisations and peak bodies have been keen to unveil their vision for primary care funding.

Traditionally, primary care receives about a third of the total health budget, with about 6% of the whole going directly to general practice.

Last year, Health Minister Mark Butler flipped the script by announcing extra GP-specific funding that tripled the Medicare bulk billing incentive and introduced a new patient registration system, MyMedicare.

It’s unclear whether Mr Butler will seek to double down on 2023’s investment this year, but hopes are high.

Here’s a roundup of the budget wishlists released so far.

General Practice Registrars Australia

The peak body for GP registrars, General Practice Registrars Australia, is angling for an independent national GP training leave support fund to equalise leave entitlements across training environments.

This will make general practice training more attractive for young doctors afraid of losing their paid parental, holiday and study leave when switching from a hospital-based environment, it says.  

The proposed fund would be a self-sustaining industry endowment – similar to a police legacy fund – where donors contribute to a pool for eligible members to apply for and access.

It comes with a price tag of $42m delivered over the course of a decade, which includes $17m up front to get it running.

GPRA says it would help establish the fund, but wouldn’t administer it nor derive any profits.

It would only cover study, exam and parental leave; registrars would continue to have only limited access to holiday and sick leave as they move between training posts.

There are two options for parental leave put forward for consideration. Under the first, pregnant trainees could access eight weeks of paid leave at their full salary. Under the second, pregnant trainees would only be able to access eight weeks at 75% of their base salary, but trainees with a pregnant partner could also access two weeks of paid leave, also at 75%. It’s understood that the government would just pick one option.

GPRA proposed setting aside three weeks’ salary for study and exam leave throughout GP specialty training.

“This fund would have independent oversight, would set and monitor the eligibility terms, would be responsible for growing the fund, and would not rely solely on the government footing the entire cost, but rather playing a key contributing role,” GPRA president Dr Karyn Matterson said.

Structuring the fund this way would also mean minimal administrative and cost burden on general practices, she said.

“This investment would help kickstart a fund that can and will attract other philanthropic/corporate investors who want to contribute to improving access and equity across Australia’s primary healthcare system and be part of investing so future doctors can become GPs,” Dr Matterson said.

“It is also a step towards realising true public/private donor arrangements in our sector, with many wanting to contribute to ensure communities have access to future GPs.”

The only other item on the organisation’s 2024 budget wishlist is $2m for the Future GP Peer Initiative, which would promote positive connections between medical students and working GPs.

ACRRM

Hot off the back of its successful training year, ACRRM’s pre-budget submission asked the government to double its funded rural generalist places.

This would bring its total yearly intake to 500 registrars.

The college makes a strong argument: it overfilled its allotted Australian General Practice Training program places by 10% and its Rural Generalist Training Scheme places by 90% this year, making it the second year in a row that it was oversubscribed for rural generalist places.

Rural generalism is also on track to become a fully fledged specialty within the next 12 months.

“This [recognition] could significantly add to the attractiveness of a rural generalist career and appropriately recognise and remunerate the rural generalist training and skill set,” ACRRM president Dr Dan Halliday said.

ACRRM’s other three budget asks were to introduce rural generalist-specific Medicare item numbers, more remuneration for GP supervisors and extending the training pipeline to promote rural medicine to high school students.

Funding this last idea would cost significantly more than GPRA’s pitch to connect medical students with GPs, coming in at $7.5m over three years.

It also suggested a scholarship scheme to support rural students commencing a medical degree, which would cost $17.25m over three years and support 200 students per year.

Rural Doctors Association of Australia

The Rural Doctors Association of Australia, which represents both GP and non-GP specialists, also zeroed in on the need to strengthen the training pipeline through increasing medical student exposure to rural healthcare.

Funding an additional 150 places on the John Flynn Prevocational Program, it argued, will “significantly enhance” the recruitment opportunities for rural GPs and rural generalists.

With each place costing around $200,000, the total would add up to $30m per annum – more than the ACRRM and GPRA suggestions combined.

Like ACRRM, the RDAA also advocated for increased payments for rural GP supervisors, pegging the estimated additional investment required at $50m.

“Under the current fee for service model … the system relies on supervisors to work unpaid for many hours throughout a GP registrars’ training time,” the RDAA submission said.  

“This is unacceptable.

“Consultants working in the hospital system would all resign if the time they spent supervising their registrars was unpaid.”

The RDAA also recommended expanding the eligibility criteria for certain MBS items to recognise rural generalists with additional skills training in certain areas.

This could include, for example, opening up psychiatrist items to rural generalists with advanced mental health training, the organisation said.

National Rural Health Alliance

The National Rural Health Alliance’s pre-budget submission recommended funding that broadly addressed the “market failure” of Australia’s rural health system.  

It outlined three key proposals – establishing primary care Rural Integrated Multidisciplinary Health Services, funding inter-site governance support and committing to a National Rural Health Strategy.

The integrated multidisciplinary health service proposed by the alliance is similar in design to an Aboriginal Community Controlled Health Organisation, in that each one would be a non-profit organisation funded by the government to employ a mix of healthcare professionals.

“[These clinics] do not rely on health practitioners committing to establish their own practice, with the attendant responsibilities of operating a financially viable, standalone business (managing staff, administration and compliance), in what are generally thin markets,” the NRHA said.

“This employment model makes it easier for health practitioners to take up a rural position, knowing they can focus on their professional practice without the stress of establishing, purchasing or running a practice in a thin or failed market.”

Setting up each clinic would cost an estimated $3.3m, and the NRHA said seven sites were “shovel ready” to test the model.

Pharmaceutical Society of Australia

Peak pharmacy body the Pharmaceutical Society of Australia called for the budget to fund top-of-scope activities for pharmacists, including expanding the National Immunisation Program and supporting pharmacist-led consultation services.

Its proposed approach to consultation services is to fund four types of community pharmacy consultation services: screening and risk assessments, common ailments, medicine administration and discharge medicine services.

The PSA defined common ailments as including urinary tract infections, vulvovaginitis, constipation, gastroenteritis and migraine.

The screening and risk assessment consultation type would include point of care tests and screening questionnaires for conditions like diabetes and mental illness.

Results would be shared with the patient’s regular health team.

It’s not clear whether these consult services would take place in a community pharmacy setting or within a general practice team context, but the submission does mention the pharmacy-based urinary tract infection trials as a “successful” model.

The PSA did not provide any estimate of cost.

It’s also possible that the society’s asks will be fulfilled before the calendar rolls over to March, with the eighth Community Pharmacy Agreement set to be signed and sealed by the end of February.

Honourable mentions

Mental Health Australia urged the government to put the mental health sector “on the agenda” by developing and funding a multi-year reform roadmap, as well as addressing the Better Access scheme’s shortcomings.

“As the independent evaluation of Better Access recommended, the program ‘should be supplemented by other multidisciplinary models that not only provide more intensive, longer-term clinical care but also offer holistic support for dealing with life’s complexities,’” Mental Health Australia said.

Major political donor Medicines Australia asked to continue its “collaborative and effective partnership” with the government to ensure the PBS “continues to meet the needs of patients”.

Palliative Care Australia had three big asks for the 2024 budget: an interim home care program for people under 65 with a life-limiting illness, improving access to after-hours palliative care and maintaining funding for the Comprehensive Palliative Care in Aged Care measure, which is set to end in June.

The Association of Australian Medical Research Institutes said its number one concern was that government grants only cover a portion of total research costs, and requested a larger investment in Medical Research Future Fund grants.