‘Decouple’ GP-provided mental health care from psychologist-provided sessions through Better Access, say GPs. Competition is not the ethos of mental health care.
The RACGP is advocating for “decoupling” of GP-provided mental health care from care provided by psychologists and other accredited providers through the Better Access scheme.
“We’re not wanting to compete with psychologists, which is what the case is [now],” RACGP psychological medicine special interest group chair Dr Cathy Andronis told The Medical Republic.
“We want to be able to work alongside them. A competitive system is a model that’s inappropriate for mental health.”
The Better Access scheme, which began in 2006, allows GPs to refer some patients for 10 MBS-subsidised psychology appointments each year.
On Friday, the federal government released its response to the final report of an independent evaluation of the Better Access scheme, which was published in December 2022.
While psychiatrist, and the driving force behind the Better Access Scheme, Professor Ian Hickie was generally supportive of the response, general practice had a little more to say.
Speaking to TMR, Dr Andronis said GPs should not be in competition with psychologists and other mental health care providers for the limited 10 sessions allocated through the scheme.
“The Better Access [scheme] does include us,” said Dr Andronis.
“For GPs, one of its great benefits [is] the fact that we can use [Better Access] item numbers in addition to our usual time-based item numbers, and it gives us an opportunity to be validated that we’re capable of doing this work because we are using these numbers alongside psychologists and other [mental health] professionals.”
The precursor to Better Access, Better Outcomes, allowed GPs with additional training to provide longer, more complex mental health sessions, with better remuneration than normal GP consults.
But due to the limited pool of GP providers and the impediment of longer consultations, the government expanded the Better Outcome scheme to include other mental health providers, the majority of whom are psychologists.
GPs are still able to provide sessions through the, now, Better Access scheme, by undertaking the Focused Psyhcological Strategies (FPS) training course.
The course takes around 20 hours and requires ongoing CPD, but the rebates are around 20% higher than the equivalent 30/40minute GP consult, said Dr Andronis.
“[It’s] often useful for people who don’t want to go to psychiatrist, can’t afford to go to psychiatrists or would prefer to stay close to their GPs,” she said.
“It’s particularly useful for people in regional or remote areas where access to psychologists is extremely difficult or almost nonexistent.”
Other FPS-accredited providers, like social workers and occupational therapists, can also provide care through the Better Access scheme.
Dr Andronis acknowledged that cost and time were barriers to the FPS training, adding that even FPS-trained GPs often avoided using the Better Access sessions as it eats into the 10-session limit.
Meaning either GPs were being remunerated less, or patients were paying higher gap fees.
Dr Andronis said she was advocating, with the college, for the GP-provided mental health sessions to be exempt from the 10-session limit, or “decoupled” from care provided by other providers.
“A competitive system is a model that’s inappropriate for mental health.
“Mental health is about community and teams.”
Dr Andronis said she was sure GPs didn’t want to “take over” from mental health clinicians, but mental health work was “unavoidable” within general practice.
“We [want to] do it more skillfully, get paid a little bit more money to do it and feel validated for it.”
Related
RACGP poverty and health group chair Dr Tim Senior said GPs provided “ongoing [mental health] care in the absence of support from elsewhere in the health system”.
GPs, with their patients, are constantly balancing the why and the who and the when of referral for mental health services, while at the same time providing ongoing care, quite often when those referrals are knocked back
— Dr Tim – also say hello on Blue Sky & Mastodon (@timsenior) August 19, 2024
Recommendation number 11 from the Better Access evaluation, which was supported-in-principle by the government, also drew GP ire.
“Other options to increase affordability that sit within or outside the MBS should also be explored (e.g. bulk-billing incentives, loadings on specific item numbers, practice incentive payments, service incentive payments, and blended funding models),” reads recommendation 11.
Government trying on the same thing for psychologists as they are for GPs:
— QLDCountry GP (@QLDCountryGP) August 19, 2024
Payments to 'practices' rather that the actual practitioner (recommendation 11).
Oh dear.
Fundamental misunderstanding of how these groups actually function. https://t.co/xlO5SdtDJm
I'd love to know that too.
— QLDCountry GP (@QLDCountryGP) August 20, 2024
What's the logic @healthgovau? What's the evidence base for this position? @Mark_Butler_MP
Is there evidence? or is it just 'the vibe' from a handful of usual suspects? pic.twitter.com/k5Q81mksqW
