30 July 2021

Profession in state of crisis: RACGP


The RACGP has responded to a draft document that could determine the next 10 years of general practice, saying it presents a “critical opportunity” to invest in primary care.

Plagued by poor funding and critical workforce shortages, the profession now looks to the Primary Health Care 10 Year Plan for solutions to its problems.

But the draft advice from the Primary Health Reform Steering Group – which included the late Dr Harry Nespolon and then current RACGP president Dr Karen Price – is fairly light on details.

TMR has previously reported on the draft recommendations which called out the “significant weaknesses” in the current funding structures supporting general practice.

The steering group suggested some radical reforms to the funding mechanism for general practice, including enabling “integrated one health system thinking” by leveraging the National Health Reform Agreement (NHRA) Addendum 2020-2025.

The group, made up of representatives from peak medical groups, also said it would like to see a minimum percentage of all health care spending allocated to primary health care.

But the report received criticism for neglecting to outline how a move away from a fee-for-service model might be implemented.

It also had several serious omissions including how the fee-for-service model might be unsuitable in a landscape of chronic illness, and detail on how the reforms would be “driven at the coalface”.

TMR understands that more than 170 submissions were made in response to the steering group’s report which was released in June. The Department of Health did not make them available.

The RACGP was one of the few organisations who made their response to the group public, citing it as a “critical opportunity to improve the lives of all Australians through achievable and cost-effective reforms and investments in primary care”.

“Many of the recommendations put forward by the steering group are a step in the right direction,” the RACGP said in its response to the draft recommendations.

“General practice is the most efficient and cost-effective part of the health system. Despite this, general practice is in a state of crisis.”

The RACGP presented itself as a staunch advocate of  the fee-for-service model in its submission, labelling it the “core of Medicare”.

But the college also identified the need to simply the fee-for-service model to reflect the true cost of providing care to patients, including support for longer consults and the removal of rebate differentiation based on provider status.

“The skills, training, responsibility, practice costs and effort of GPs must be valued equally with those of other medical specialties,” the RACGP said.

The RACGP also presented a partially opposed view to the voluntary patient enrolment model described in the steering group’s report, which linked high-value MBS items and access to telehealth items with registration. 

While the college agreed with VPE in principle, it rejected any compulsory models of enrolment, or any scheme that replaced fee-for-service.

The college also called for additional funding to implement VPE, an electronic registration system that interacted with clinical software and a commitment that any savings generated through the program would be transparently reinvested in general practice.

“Without these measures, VPE will simply increase the administrative and bureaucratic burden in general practice,” the RACGP said.

And while the RACGP said it supported the introduction of blended payment models for general practice, including through VPE, it opposed block or capitation payments.

“Such models do not align with the flexibility often required in general practice,” the RACGP said.

The Australian Privacy Foundation also weighed in on the steering group’s draft report with a recommendation that primary care should aim to have data consent mechanisms in place that are transparent to new and existing patients.

In addition, VPE “must not tether individuals to a given practice for the purpose of Medicare, Health Insurance refunds or related services,” the APF said in its feedback, adding that informed choice must remain a cornerstone of the system.

The RACP told the steering group that it should also consider the strong links that exist between the work of GPs and that of non-GP specialists in the community.

“Physicians and paediatricians are vital to the care of many health conditions involving primary care [with] obesity, diabetes and drug and alcohol addiction just some of the examples,” the RACP said in its submission.

“Excluding specialists from these recommendations disadvantages patients, fails to address the problem of high out-of-pocket costs and risks continuing a state of disconnected health care.”

And the Australiasian College of Paramedic Practitioners – paramedics play a large role in rural primary care – was disappointed to have been entirely ignored in the draft recommendations: “Sadly, within the entire document there is not one mention of the paramedicine workforce. Once again Paramedics are the forgotten profession.”

In the coming months the steering group is expected to review all submissions before delivering its final report to government.

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