A white paper based on last month’s Canberra meeting calls for bulk-billing incentives to be tripled, MBS indexation and more.
The RACGP has reiterated its call for an increase in MBS rebates of at least 20%, in a white paper based on the college’s October “crisis summit”, while also outlining measures recommended by summit attendees and designed to rescue general practice.
The summit discussed three key areas: funding and the fragmentation of care; how to attract new blood to general practice and to retain existing members; and the role of GPs in collecting, analysing and using data.
Not all of the white paper – released just ahead of the college’s GP22 conference and AGM in Melbourne – represents RACGP-endorsed policy, but some recommendations clearly united summit attendees.
“Off the back of this summit, the RACGP is calling for an immediate increase in Medicare patient rebates of at least 20%, and an increase to the bulk-billing incentive by three times,” outgoing RACGP president Adjunct Professor Karen Price said.
“We are also calling for appropriate and ongoing indexation for MBS items, so that it is in line with the real-world costs of providing high-quality care in communities across the country.”
Some summit attendees called for the extended Medicare safety net threshold to be lowered from $717.90 to $500.
Standard GP consultation items should be adjusted to reweight time tiers, reduce the time intervals (for example, five-minute increments) and ensure longer consultations are appropriately valued. The cap on incentive payments should be removed and the payments should be properly indexed.
Attendees also recommended introducing VPE as a gateway to ongoing telehealth, care continuity and primary care reform funding, with equitable allocation to both practice and practitioner.
In the medium term, they recommended introducing an independent general practice pricing authority to evaluate and set pricing for GP activities on which MBS patient rebates and other payments would be based, and with regular indexation of rebates.
To improve funding in the long term, summit attendees recommended salaried models of care for underserved communities and areas of market failure, with ongoing evaluation and benchmarking.
The second key topic was the need to make general practice a more attractive career choice, both for doctors in training and those already in the profession.
“Early and sustained exposure to general practice, alongside greater support and training for general practice leaders across all spectrums of medicine, including clinical, academia and education, will help to achieve this,” the white paper said.
RACGP chair Christine Nixon made a nod to this point at last night’s college AGM, noting that with the transition to a college-led model next year, “Australian GP training is returning to its rightful home”.
Professor Price told the AGM that the profession would benefit if the Australian Medical Students’ Association was given regular observer status at RACGP Board meetings.
As a starting point, members of the Canberra summit called for GP trainees’ base salary to be made equivalent to hospital-based positions. Red tape should be cut back to streamline and simplify the Medicare system and make Medicare’s approach to compliance less punitive and more educational and preventive.
Reliable and cost-effective locum schemes could be introduced, including support for GPs to upskill, while GP workforce support should be designated a top priority by PHNs, attendees said.
In the intermediate term, medical schools should introduce programs to increase exposure to general practice in prevocational training years.
GP in training entitlements and employment conditions should be reviewed to ensure salary and leave entitlement parity with hospital-based counterparts to improve the attractiveness of general practice as a career. This should include consideration of a single-employer model to address disparity in remuneration and employment conditions, summit attendees said.
IMGs should also be able to benefit, said some attendees, flagging that an integrated strategy for IMGs could be introduced that incorporates more incentives and support, reducing red tape and administrative barriers.
In the longer term, attendees called for infrastructure according to local needs, supporting the training and retention of existing GPs. GP networks could provide support to individuals, including both cultural and lifestyle support, mentoring and leadership, while flexible employment structures should be introduced for underserved communities and areas of market failure.
The third key topic was the collection and use of data. In the medium term, the summit heard, government should adopt a national approach to data governance, transparency and security structures that would promote trust. The long-term goal should be the ability to link data nationally across sectors including health, justice, social services and education.
The college said it would use the discussions and recommendations put forward at the summit to “inform future RACGP policy and advocacy activities”.
Also today, the AMA launched a report called The general practitioner workforce: why the neglect must end on the anticipated workforce shortfall of 10,000 GPs by 2031-32.
Some findings include:
- Between 2009 and 2019 demand for GP services increased by 4.7 per cent annually (a total growth of 58 per cent), equivalent to the workload of 10,200 full-time GPs. In the past five years, 2016–2021 the workforce added an equivalent of only 4200 full time GPs, which suggests that GPs have worked under increased pressure to keep up with the demand and are now at breaking point.
- Demand for GP services is driven by population growth (1.6 per cent), ageing (0.2 per cent), more frequent visits by patients to their GPs (1.7 per cent growth) and spending more time with the GP at each consult (1.2 per cent growth).
- A West Australian study found that for every full-time GP, Australia needs to train two extra GPs to cover the changing patterns of the workforce.
- Almost half of Australians have at least one chronic condition, and one in five has multiple chronic conditions.
- Continuity of care with the same GP reduces ED presentations. An Australian study showed regular GP care reduces high repeat-use hospitalisations by up to 11 per cent.
General Practice Crisis Summit White Paper
The general practitioner workforce: why the neglect must end
