RACGP’s seven-point plan for general practice and the NDIS

The RACGP has reiterated a call for more GP involvement in National Disability Insurance Scheme (NDIS) planning, a move it says will improve patient outcomes and make the system more efficient and accountable.
 
In a submission to the ongoing independent NDIS Review, the suggestion is one of seven ‘overarching principles’ outlined by the college to support GPs in disability care and management.
 
The correspondence from RACGP President Dr Nicole Higgins to the Review’s Co-Chairs – disability reformer and economist Professor Bruce Bonyhady and former senior public servant Lisa Paul – also notes the ‘unique perspective’ of GPs on the operation of the NDIS.
 
‘By providing evidence of disability and functional impact, essential care coordination, facilitation of appeals processes and support of patient health literacy, we play an important role in assisting patient access and navigation of the scheme,’ the submission states.
 
It includes a recommendation that GPs have the chance to view and discuss draft NDIS plans with patients, as well as provide feedback to planners if given permission.
 
‘GPs often have in-depth knowledge of supports that have been unhelpful for their patient in the past or where current contraindications exist,’ Dr Higgins wrote.
 
Another principle draws attention to the financial challenges for GPs involved in NDIS planning.
 
‘MBS rebates are not available for paperwork completed in the patient’s absence,’ the submission states. It concludes that GPs should be ‘appropriately remunerated to support the healthcare needs of patients with disability and help them apply for the NDIS’.
 
For Associate Professor Robert Davis, Chair of RACGP Specific Interests Disability, the issue is exacerbated by what he describes as ‘a silo’ between the respective bureaucracies overseeing health and the NDIS.
 
‘We’re caught in that no-man’s land between health and disability at times,’ he told newsGP.
 
‘Medicare comes through health, so getting Medicare to recognise the valuable contribution of general practitioners towards the support of patients with disability is a problem.’
 
In the correspondence to the NDIS review, the college advocates greater uptake of GP Management Plans and Team Care Arrangements by NDIS participants ‘to enable GPs to plan and coordinate care for those with complex conditions who require ongoing care from a multidisciplinary team’.
 
Improving collaboration and culturally safe services for Aboriginal and Torres Strait Islander people are other areas covered by the college, as well as improving access in more remote locations and giving clearer information on NDIS processes.
 
An independent mechanism should be introduced to allow for a ‘collaborative’ review of cases, according to the submission.
 
‘Treating medical and other health professionals should have input into this process,’ Dr Higgins wrote.
 
The RACGP President also suggests a fraud reporting mechanism should be brought in ‘to promote better oversight and scrutiny of service providers’.
 
NDIS theft has been identified as a major concern for the scheme, along with its spiralling costs – one estimate suggests NDIS will cost almost $60 billion annually by 2030.
 
The college has previously observed general practice is not embedded enough in the NDIS process, which was legislated in 2013 and went nationwide in 2020.
 
The current review was announced by Federal Minister for the National Disability Insurance Scheme Bill Shorten in October last year.
 
He acknowledged that the system has ‘become problematic’ for too many people, saying that it has often developed ‘into a source of stress and anxiety’.
 
‘We want it to do what it’s meant to do: to provide choice and control for people with disability,’ Minister Shorten said on launching the review.
 
A final report is due by October, with the RACGP saying it is ready to contribute further when the recommendations are published.
 
While Associate Professor Davis believes the review’s existence is positive, he is reserving judgement on its likely impact.
 
‘We’ve had reviews, but what action is going to be taken?’ he said. ‘That’s the question.’
 
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