General practice is in ‘a state of crisis’ that could further deteriorate, the RACGP has warned.
In a written submission responding to the Department of Health’s (DoH) draft Primary Health Care 10 Year Plan, the college states that high-quality care offered by GPs is at risk if substantial investment and reform do not take place.
Calling general practice ‘the most efficient and cost-effective’ aspect of the health system, the college says that the urgency of the situation has been exacerbated by COVID-19.
‘Rising rates of chronic disease, an ageing population, the COVID-19 pandemic, delayed preventive care due to the pandemic and a looming mental health crisis are putting increasing pressure on the system,’ the submission reads.
‘This is resulting in poorer outcomes and long hospital wait times. Unless there is significant investment and reform, the system will fail.’
Among the most pressing issues highlighted by the college are the stagnation in Medicare funding and critical gaps in workforce supply.
Some of the RACGP solutions outlined to the Primary Health Reform Steering Group in July had been adopted in the draft plan, the college says, but others have not been included.
The submission urged changes in the plan to address the remaining gaps. Some of the specific measures advocated by the college include:
- the introduction of a Medicare Benefits Schedule (MBS) item for Level E consultations over 60 minutes
- the installation of a ‘permanent and equitable telehealth scheme’. This would include making longer telephone consultations permanent, which would facilitate access to care for groups such as Aboriginal and Torres Strait Islander people, elderly people, as well as people with a disability and rural populations
- more support to allow GPs to adapt to new digital systems
- investment to support GPs spending more time with their patients, including higher rebates for Level C and D standard consultations, which would help improve access to care for people at risk of poorer outcomes
- ensuring a fit-for-purpose model of Voluntary Patient Enrolment (VPE) that supports high-quality care, with increased funding for quality general practice care not supported by Medicare
- introducing more measures to help GP recruitment, including boosting the attractiveness of general practice as a career, as well as providing greater support for rural GPs
- making GPs the ‘key stakeholders’ in joint planning and commissioning, as well as developing mechanisms to involve local general practices in service design and delivery.
The issue of GP shortages in rural areas is a particularly key point.
‘The decline in general practice funding via Medicare, through both the Medicare rebate freeze and the ongoing failure to appropriately index MBS patient rebates, has impacted the viability of rural general practices and the attractiveness of general practice more broadly,’ the submission reads.
Among the aspects of the plan welcomed by the college is the incorporation of additional funding for mental health and aged care, as well as the commitment to Close the Gap
and support for Aboriginal Community Controlled Health Organisations (ACCHOs).
The submission says the process that is now underway offers a chance to improve healthcare outcomes, both in primary care and more broadly.
With the pandemic providing examples of new collaborations between general practice and state government health authorities
, the college suggests the 10-year plan should seek to build on those partnerships.
‘The RACGP supports a new funding mechanism which promotes innovative models of GPs and hospitals working together to reduce emergency presentations and preventable hospital readmissions,’ the submission reads.
However, the college consistently underlines the need for investment to support GPs, warning of rising costs to the system more broadly if that does not happen.
‘Evidence both nationally and internationally shows that a well-supported general practice sector will result in efficiencies for primary and secondary care, and the broader healthcare system,’ the submission reads.
‘Failure to invest adequately in general practice will result in continued increases in overall healthcare costs.
‘While the Primary Health Care 10-Year Plan presents a significant opportunity for reform, it must be targeted towards supporting general practices to deliver high-quality, comprehensive care.’