Doctors’ group calls for support for longer GP consultations, a strong PBS, and lifting of caps on subsidies that can support employment of pharmacists in general practice
With the 2019-20 Federal Budget scheduled to be delivered on 2 April 2019, the Australia Medical Association (AMA) has issued its pre-budget submission with a call for investment in primary care.
“The key to successful long-term health reform is to properly fund and invest in primary care, especially general practice,” says AMA President Dr Tony Bartone.
Dr Bartone says the AMA submission focuses on the four major pillars of the health system – public hospitals, the private health sector, the PBS, and primary care.
“The government, let by Health Minister Greg Hunt, has shown strong commitment to the Pharmaceutical Benefits Scheme (PBS) and we expect this ongoing commitment to be reflected in the Budget,” he says.
The AMA also calls for additional Medicare Benefits Schedule (MBS) funding, saying that the system “needs to be one that provides adequate patient rebates so that we don’t end up with a two-tier system – those who can afford treatment and those who can’t.”
It asks the government for increased support for longer GP consultations through the introduction of an ‘extended’ Level B MBS consultation item that recognises the extra work involved for those GPs who spend more time with their patients.
This comes after a comment in July last year from then president of the Royal Australian College of General Practitioners (RACGP) Dr Bastian Seidel that it is common for longer appointments to be refused because they are not financially viable.
“They are saying, ‘it’s 10 minutes and the patient goes out’. And people are being told ‘if you have a mental health condition you probably have to go elsewhere’,” Dr Seidel told the Sydney Morning Herald.
“[It] allows some GPs to cream the system by seeing 10 patients an hour and earning $380, while good GPs see four patients an hour and can only bill $152 an hour,” one respondent reportedly told the ongoing review into the Medicare Benefits Schedule.
In its 2019-20 pre-budget submission, the RACGP adds to the call for investment in longer consultations to support the ongoing delivery of complex care.
The AMA also asks the government to support enhanced access to GP-led team-based care for patients by lifting the caps on subsidies available through the incoming Workforce Incentive Program (WIP), “better supporting the employment of nurses, pharmacists and allied health professionals in general practice”.
From 1 July, general practices will be supported to expand their in-practice health team by engaging the services of a non-dispensing pharmacist or allied health provider to enhance the range of care provided, explains Dr Richard Kidd, Chair of the AMA Council of General Practice.
This funding, promised as part of the 2018-19 Federal Budget, is set to provide financial incentives for around 5000 general practices to take part in the program.
“To ensure that practices can grow their capacity to meet patient health care needs and delivery quality and comprehensive healthcare, the AMA wants this support extended to lifting the caps on the subsidies available under the WIP,” says Dr Kidd.
In its own pre-budget submission, the PSA recognises the inclusion of non-dispensing pharmacists to the list of eligible health professionals under the WIP will allow general practices to best decide what health professionals would be suited within the practice.
However the PSA also contends that this should be applied to the inclusion of pharmacists as Eligible Allied Health Providers under the Chronic Disease Management (CDM) items as part of the MBS.
Representatives of the Pharmacy Guild have recently stated that non-dispensing pharmacists in general practice will lead to a duplication of services that community pharmacists already provide.
“The use of the Workforce Incentive Program… will serve to exacerbate the already serious workforce shortages seen in community pharmacy small businesses in regional, rural and remote areas,” said Guild national councillor Catherine Bronger late last year.
The Pharmacy Guild has not mentioned non-dispensing pharmacists in general practice in its pre-budget submission, instead focusing on recommending that the Federal Government remove the optional $1 discount and calling for it to be replaced by a $1 reduction of PBS and RPBS co-payments for all patients.
In its submission the Guild argues that the $1 discount, which was introduced in January 2016, has “proven to be an ineffective way to provide more affordable access to PBS medicines, and has instead increased inequity and undermined the universality of the PBS while commoditising medicine usage”.
“Effectively, all the $1 discount policy has done is entrench competition where it was already strong – in localised highly urban areas where competition is already strong in relation to non-subsidised medicines below the patient co-payment, as well as for non-prescription medicines and other pharmacy products.
“Why should this be the case? How is this good policy?” says the Guild.
“Medicines are not normal products of commerce. The optional $1 co-payment discount has commoditised and devalued the importance of safe dispensing of PBS medicines.”