‘The horse has bolted’ on pharmacist prescribing, one panellist claimed in a session unpacking the Strengthening Medicare Taskforce report.
RACGP president Dr Nicole Higgins remained adamant that increasing the Medicare rebate is the best path to Medicare reform in an address to the National Press Club today, reiterating a call for the states to back off on payroll tax if they want to achieve lasting change.
Dr Higgins was joined by Dr Kerrie Aust, president-elect of the AMA’s ACT branch, and Professor Stephen Duckett, former head of the health program at the Grattan Institute, at a session pulled together in the wake of last week’s release of the Strengthening Medicare Taskforce report.
“Currently, the biggest threat to any federal Medicare reform is actually state payroll tax,” Dr Higgins said. “We have the state premiers on the one hand saying let’s fix Medicare, but on the other hand we have payroll tax.
“We already pay payroll tax, including on our GPs in training. What this will do is force GPs to uncouple from Medicare, and that is already happening, and to pass that cost on to patients. This will hit our most vulnerable and bulk billing will be killed off overnight.”
Professor Duckett, who has received a lot of criticism from GPs about his resistance to simply raising rebates, repeated his call for rebates to be set by an independent panel rather than subject to a government’s whims.
He told the Press Club that “lazy Budget savings by freezing should go”.
“The government should commit to fair indexation of general practice rebate through an independent rebate tribunal, including any necessary rebasing,” Professor Duckett said. “This will give the profession some surety for the future and would be a sign of good faith.
“Simply increasing rebates may not end up with increased bulk billing rates and does not progress the structural form necessary for contemporary primary care.”
Professor Duckett also said the decline in bulk billing has inevitably meant both the public and governments have adopted or are considering alternatives to traditional primary care, such as independent pharmacist prescribing.
“In my view, that is unfortunate, as I prefer an integrated primary care system,” he said. “Telehealth disrupters have also been an innovative response – again, unfortunately, in my view – but the horse has bolted on both changes. But they both fill a niche being vacated by general medical practice and they will grow.”
Dr Higgins said collaboration with non-GP healthcare professionals was crucial but was being hampered by the lack of technology that would facilitate interoperability and it was important to balance access with continuity of care.
“Once we start fragmenting care, we know that we get more complications, more duplications of services, ordering more pathology,” she said. “It actually is a false economy because we don’t have the electronic systems in place at the moment, with data-sharing, to be able to make sure that we can work across that seamlessly.”
Dr Aust said GPs should be able to work within multidisciplinary teams, one of the key recommendations of the taskforce.
“At a recent ACT Health GP forum, I was asked, ‘which patients don’t you want to manage?’ The answer is I want all of them because keeping my patients within our sphere of practice with good quality multidisciplinary GP-led team management actually creates better health outcomes for our patients.
“But we really need to get behind primary care and fund it properly. That is why I find it very, very confusing when we say, we can’t keep adding more funding to existing structures, because I am not sure where this ‘more and more funding’ concept actually comes from.”
Professor Duckett responded that the taskforce was about “emphasising integrated multidisciplinary teams and blended payments”.
“My Twitter feed is full of comments from GPs railing against both directions,” he said. “Of course, Twitter is not a random sample of the GP world nor its leadership so it is unclear whether the profession will embrace change or not.
“So far, my Twitter feed has almost no comments from consumers or other health professionals, so it’s hard to determine broader public opinion other than to get bulk billing rates back up.”
