The AMA and RACGP have questioned several of the conclusions drawn by the latest report on general practice released by the Grattan Institute.
A new Medicare: strengthening general practice argued that although Australia’s universal healthcare system has failed to keep up with changes to complex health needs, the underlying narrative that this is the result of a chronic GP shortage, a position regularly repeated by both the AMA and RACGP, is a false assumption.
The report justified the controversial conclusion based on a comparison with other OECD countries (amongst other indicators), which showed that with 1.2 GPs per 1,000 people, Australia has more GPs relative to our population than the average member nation – with more than enough doctors in training to keep up with forecast demand.
The Grattan Institute agreed that the current system is outdated and recommended eliminating the 15-minute GP visit as the central institution of primary care, proposing a ‘teamlet’ based model as the most efficient and effective structure for funding and delivery.
RACGP President Nicole Higgins said that while the report had promising elements, many of the recommendations should be approached with caution, and warned that any reform of Medicare and general practice care must have GPs and general practice teams front and centre – “so that no patients are left behind.”
“The report blithely states that Australia ‘has many GPs, with more on the way.’ This is a disappointingly simplistic take on a very complex problem that if not properly addressed will result in compromised patient care across the nation,” Dr Higgins said.
“Australians deserve and need a well-supported and high functioning primary healthcare system. While we acknowledge that investment through the current Medicare structure will not fix all the existing challenges in general practice, it will help to guarantee access for patients until significant reforms can be implemented.
“Unfortunately, the Grattan Institute’s report doesn’t properly investigate the longer-term financial viability of general practice care in Australia or consider the impact it has on patients when more GPs close their doors because they cannot afford to continue to provide care.”
Dr Higgins said that Australia needs to proceed carefully in terms of how to fund general practice.
“Certainly, the college agrees with the report’s conclusions that the Medicare Benefits Schedule is too complex, and that less micromanagement through complex MBS rules would be beneficial,” she explained.
“However, we need to be wary of diving head-first into a capitation model because evidence from overseas is mixed at best: for example, in the United Kingdom many GPs and their teams end up doing a lot more for less, at the expense of patient care, and we must avoid that.
“We have flagged these concerns before, including in our submission to the Primary Healthcare 10 Year Plan, and will continue to caution against models that do not align with the flexibility required in general practice.”
Speaking with ABC Radio on Monday, 5 December 2022, AMA Vice President, Dr Danielle McMullen argued that the current fee-for-service system was not broken but had certainly been severely neglected by successive governments and was in strong need of repair.
“And part of that repair is reforming it to make sure that we have got more flexible funding options to take best care of our patients, particularly those with chronic and complex disease,” Dr McMullen said.
“What we want to see is the best possible patient care, and that is in patient-centred, GP-led care teams… yet our current model of general practice in Australia doesn’t easily support that.
“The crux is that for any funding to come into general practice, you need to have the doctor and the patient in that room together, and that means that we cannot adequately fund our nurses or other allied health staff to help support that team.
“Any reform in a system comes with challenges, but we do know that GPs and doctors in general are well trained in team-based care – we have a bunch of doctors out there with the skills and ready to use them. Like anything, there will be some push back in other directions, but we are quite keen to see a flexible option that takes forward people who are ready to practise a bit differently.”