13 April 2022

RACGP: More support needed for Tasmanian regional and rural general practice care

The Royal Australian College of General Practitioners (RACGP) is calling for government action in Tasmania to give general practice care in regional centres and rural areas a shot in the arm and institute reforms that will improve patient health outcomes.

It comes following the release of the Community Affairs References Committee’s interim report into the provision of general practitioner and related primary health services to outer metropolitan, rural, and regional Australians. The committee recommended the federal Government investigates substantially increasing Medicare rebates for all levels of general practice consultations, as well as other general practice funding options. Recent reports of ramping and hospital delays in Tasmania highlight the importance of having an adequately funded primary care system to help relieve pressure on the state’s hospitals.

RACGP President Adj. Professor Karen Price, who has today concluded a three-day listening tour of Tasmania, said that all patients deserve access to high-quality general practice care.

“This tour of Tasmania has reinforced how vital general practices are to communities right across the state,” she said.

“I have met with GPs, general practice teams and patients in communities including Hobart, Bridgewater, Latrobe, Burnie, Wynyard, Devonport, Ulverstone and Launceston and I have heard the same thing again and again – general practice care is in a precarious position.

“Governments must deliver greater support for general practice; otherwise, patient care will be compromised, and long-term health outcomes will be at risk. A strong primary care system is particularly important in Tasmania, given that the state unfortunately does have higher rates of smoking and chronic health conditions including asthma and heart disease.”

Adj. Professor Price said that action at the federal level was needed to help Tasmania’s primary care system.

“I urge the federal Government to step up and provide a helping hand for Tasmanian general practice care so that no patient is left behind,” she said.

“Just a few months ago, the RACGP released its Election Statement urging the Government to adopt a series of timely reforms to improve patient health outcomes. The Government must put general practice on a more sustainable, long-term financial footing. If this doesn’t occur, practices will be forced to charge patients more or close shop – a scenario in which no one wins, particularly those living in regional and rural communities. If bulk billing rates fall, some patients will delay or avoid consultations and end up with a far more serious health condition requiring treatment in a hospital.

“We are calling for a 10% increase to Medicare rebates for Level C and Level D GP consultations as well as introducing a new Medicare item for longer consultations lasting more than 60 minutes. This will allow us to take the time needed to care for patients with complex needs, such as those with mental health concerns.

“Greater investment in high quality general practice care will not only enhance patient outcomes and lower mortality rates and hospital admissions, but also reduce the use of more expensive health services including hospital care. In places like Launceston, patients are presenting to emergency departments for health concerns that should really have been managed at first instance by a GP and this only worsens problems like ‘ramping’ which we have seen across the state.

“Keep in mind that the cost of a non-admitted emergency room presentation is estimated at more than $500 compared to a standard GP consultation at just over $39. Therefore, by enhancing general practice accessibility the entire health system is put on a more sustainable footing.

“The RACGP also believes it is crucial to permanently reinstitute Medicare rebates for longer telephone telehealth consultations. This is something that is particularly beneficial for those patients who do not have the skills or access to the technology required for video consults, including people in rural and remote communities, Aboriginal and Torres Strait Islander people, and older patients.”

The RACGP President said that the Tasmanian Government also had a vital role to play.

“To help address workforce issues, a major problem in many rural and regional areas, I encourage the Tasmanian Government to introduce a state-level package to lure more GPs to regional and rural communities,” she said.

“This could include a grant encouraging them to train in certain locations where there are GP shortages. A helping hand can make all the difference, we know from past experienced that programs such as Avenues to Rural, and the RACGP’s Practice to Practice allow GPs to experience rural and remote general practice and develop new skills with a strong mentor.

“If greater funding for these types of initiatives was made available, it would provide a vital pathway for more GPs to work outside of major cities. It’s essential to adopt a whole-of-community approach to settle GPs into these communities. Measures could include, for example, assistance finding somewhere to live, childcare services, schools and partner employment, and funding for relocation. All these steps would add that extra incentive that could make all the difference in a GP opting for a career path in regional or rural Tasmania.”

RACGP Tasmania Chair Dr Tim Jackson said that the federal Government could institute a host of other measures to boost general practice care in regional and rural areas.

“The maldistribution of GPs in Tasmania is a major concern with many communities missing out,” he said.

“Every patient, no matter their postcode, deserves access to high-quality general practice care; however, Tasmania is at risk of running out of GPs. The pandemic has meant a reduced intake of international medical graduate doctors and 15% of the state’s GPs are 60 and over. However, this problem hasn’t occurred overnight, there has simply not been enough investment in the general practice workforce for many years, and this has led to many communities in Tasmania, particularly outside of major cities, facing major shortages.

“There are many steps the Government can take. Australia’s medical intern program is almost exclusively hospital-based with few interns experiencing a spell in general practice. We need to boost experience in practices during medical school and those vital prevocational years, because only when interns get the opportunity to work alongside GPs and general practice teams will they see what an appealing career being a GP can prove to be.

“We also need more investment in programs that increase exposure to rural general practice, including the John Flynn Prevocational Doctor Program. In addition, medical schools should increase time spent training in rural areas, and it would be useful to review the teaching Practice Incentive Payment to make sure it supports practices hosting medical students and junior hospital doctors.

“Something else that must be urgently addressed is the lack of maternity and paternity leave for GP registrars. Those who remain in the hospital system do have access to paid parental leave, but young GPs miss out and this is a huge disincentive for young doctors in training to choose the general practice career path.”

RACGP Deputy Chair and Launceston-based GP Dr Toby Gardner agreed with Adj. Professor Price that the Tasmanian Government had a key part to play.

“General practice mostly falls within federal jurisdiction; however, we can and should continue to work in partnership with the Tasmanian Government to boost general practice care,” he said.

“We received grant funding from the state Government last year for our Urgent Care Centre to open on weekends and hopefully that will become recurrent funding. In addition, the Tasmanian Government covers the $150 out of pocket cost for all concession card holders presenting after-hours.  This is the perfect example of the sort of investment at a state level that can make a real difference for general practice care.”

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