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Chapter 1: Current and emerging issues

1.4 An issue in focus: Multimorbidity in general practice patients

GPs are the only medical practitioners that specialise in managing multimorbidity across the full patient spectrum, from paediatrics to aged care. This unique case load requires broad-ranging knowledge and a whole-of-person approach to providing care. We know multimorbidity is increasing, and the complexity of care required is increasing with it.

This burden of complexity is in part reflected in the increasing use of MBS item numbers for longer consultations, mental health items and items relating to more complex care. GPs are spending more time with their patients as the complexity of their health conditions increases.

Between 2010–19, billing of long (20–40 minutes) and prolonged (longer than 40 minutes) consultations increased by 104% and 125%, respectively. At the same time, use of MBS items for patients with chronic disease increased by 182% and specific mental health items increased by 202%. In comparison, consultations of under 20 minutes and short consultations increased by only 32% and 19%, respectively, over the same period (Figure 10).

Figure 10. Medicare item statistics show increased use of longer and more complex item numbers

Medicare item statistics show increased use of longer and more complex item numbers

Measure: Percentage increase in billing between January 2010 and December 2019 for Standard Consults: 3,23,36,44 CDM: 721,723,729,732 Mental Health: 2700,2701,2715,2717,2712,2713 Health Assessments:701,703,705,707,715.
Source: Services Australia Medicare Item Reports.

Nearly three in four GPs reported that more than half of their patients have multimorbidity, with 29% saying more than 75% of their patients fall into that category (Figure 11).

More GPs in rural and regional areas (79%) reported that the majority of their patients have multimorbidity than their colleagues in metropolitan areas (69%).3

Figure 11. Most GPs reported that more than half of their patients have more than one chronic condition

Most GPs reported that more than half of their patients have more than one chronic condition

Measure: GP responses to the question, ‘What proportion of your patients would you describe as having more than one chronic health condition (physical and/or mental)?’
Base: Responses to survey question, n = 1386.
Source: EY Sweeney, RACGP GP Fellow Survey, May 2021.

Almost two-thirds of GPs (63%) reported that most of their patients have physical and mental health conditions that they treat concurrently (Figure 12).

There is some variation between genders, with 70% of female GPs reporting that a majority of their patients have both physical and mental health conditions, compared to 51% of male GPs.3

This mirrors the higher proportion of female GPs reporting psychological issues as the most common reason for patient presentations (Figure 2).

Figure 12. The majority of patients have physical and mental health conditions that are treated concurrently

The majority of patients have physical and mental health conditions that are treated concurrently

Measure: GP responses to the question, ‘What proportion of your patients would you describe as having physical and mental health conditions which you treat concurrently?’
Base: Responses to survey question, n = 1386.
Source: EY Sweeney, RACGP GP Fellow Survey, May 2021.

Four out of five GPs (81%) reported having patients with mental health conditions that are mostly managed within general practice. Only one in five refer patients with mental health conditions on to another medical specialist who manages their condition/s.3 This aligns with data showing that GPs provide the majority of Medicare-subsidised mental health services in Australia (Figure 3).

  • 3. EY Sweeney. RACGP GP Fellow Survey. Melbourne: EY Sweeney, 2021.
  • 12. Academy of Medical Sciences. Multimorbidity: A priority for global health research. London: The Academy of Medical Sciences, 2018.
  • 13. Mason B, Nanton V, Epiphaniou E, et al. 'My body's falling apart.' Understanding the experiences of patients with advanced multimorbidity to improve care: Serial interviews with patients and carers. BMJ Support Palliat Care 2016;6(1):60–5.
  • 14. Damarell, RA Morgan DD, Tieman JJ. General practitioner strategies for managing patients with multimorbidity: A systematic review and thematic synthesis of qualitative research. BMC Fam Pract 2020;21(1):131. doi:10.1186/s12875-020-01197-8.
  • 15. Owen K, Hopkins T, Shortland T, et al. GP retention in the UK: A worsening crisis. Findings from a cross-sectional survey. BMJ Open 2019;9(2):e026048. doi:10.1136/bmjopen-2018-026048.
  • 16. Wright M, Versteeg R, Hall J. General practice's early response to the COVID-19 pandemic. Australian health review. Aust Health Rev 2020;44(5):733–36. doi:10.1071/AH20157.
  • 17. NPS MedicineWise. General practice insights report July 2018–June 2019. Sydney: NPS MedicineWise, 2020.