News

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Why fixing ‘two-tiered’ NDIS is a priority

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A system already plagued with red tape and access issues, the National Disability Insurance Scheme (NDIS) needs to operate more efficiently in rural, regional and remote areas, according to the RACGP.
 
In its latest submission to the inquiry into NDIS participant experience, the college is urging the Federal Government to better invest in the delivery of the scheme across these communities, saying everyone deserves access to essential care.
 
‘No person with a disability, irrespective of where they live, should miss out on the care and support they need,’ RACGP President Dr Nicole Higgins said.
 
‘The NDIS is a game changer full of opportunities, but people with a disability in the bush are being left behind.
 
‘We have the solutions to significantly improve the NDIS outside of major cities.’
 
The RACGP Rural submission outlined several key recommendations aimed at addressing the disadvantages people with a disability in these areas face, including:

• bolstering the rural and remote healthcare workforce to allow for interdisciplinary teams to provide person-centred, wrap-around support to people living with a disability
• end changes to payroll tax to ensure that rural and remote practices can continue servicing their communities
• support innovations in rural general practice, including flexible pathways for additional training, such as Rural Generalist pathways
• funding to support additional college-led training programs to create rural-specific training and CPD courses for GPs managing disability and NDIS pathways
• review the recruitment process of the NDIS workforce and implement mandatory minimum checks and training requirements for working with vulnerable cohorts.

It comes amid ongoing calls from the college for a system overhaul, with Dr Higgins reiterating the frustrations many GPs face in navigating NDIS patient care with Medicare, as well as being inadequately compensated for what is often a time-consuming and complex process.
 
‘The Medicare rebate system makes our job helping patients looking to access the NDIS near impossible, and that must change,’ she said.
 
‘A GP’s time is sorely limited, and we aren’t remunerated for the time spent writing lengthy reports to support NDIS applications when patients aren’t present.’
 
This is particularly challenging outside metropolitan areas, she emphasised, given rural and remote GPs work within a varied scope due to limited local health services.
 
‘[These GPs] play such a versatile role meeting the diverse needs of their community … so for them, there is an even higher administrative and financial burden,’ Dr Higgins said.
 
The RACGP is calling for GPs to be adequately recognised for the work they do in coordinating multidisciplinary care teams, saying they are currently not supported to liaise with NDIS service providers and should be spending more time helping patients and less time on paperwork.
 
‘The Government must reform Medicare or explore alternative solutions to help GPs help patients on the NDIS, something that is especially important in the bush,’ Dr Higgins said.
 
‘This includes providing adequate remuneration for GPs so that we’re paid for time spent preparing reports and other paperwork.
 
‘We also recommend expanding the list of disability-related health supports funded by the NDIS to include some general practice supports not covered by Medicare.’
 
General practice is the most accessed health service for people on the NDIS, with 91.1% of participants using GP services.
 
The college said most health issues impacting rural and remote communities have access and equity at their core, with member feedback highlighting the difficulty in providing patients with the ‘necessary specialists to gather evidence and reports’ to apply for NDIS funding.
 
Even when funding was granted, members found this did not necessarily translate into health outcomes, due to the limited availability of trained support workers and a lack of variety of care interventions.
 
Ongoing rural and remote workforce shortages have also resulted in people with a disability missing out on the necessary funding and support.
 
RACGP Vice President and Rural Chair, Associate Professor Michael Clements, said the NDIS needs urgent Government repair to ‘plug holes in NDIS service provision’ in the bush.
 
‘Right now, we have a two-tiered NDIS – one for people in major cities, another for people living everywhere else,’ he said.
 
‘Rural GPs tell me about concerns regarding the quality of supports in rural and remote communities due to limited resources and an often under-skilled workforce. This is not to criticise workers doing their best in a challenging situation, it’s a system-wide issue.
 
‘These same GPs also warn about a lack of transparency in understanding what services have been provided to patients by their support teams.’
 
He said the Government must enhance the NDIS workforce in the bush as a priority, including introducing minimum checks and training requirements, recruitment of advocacy-specific workers who understand the needs of rural communities, and annual reporting to be implemented for each NDIS participant to keep GPs in the loop.
 
‘Let’s also make the NDIS as inclusive as possible,’ Associate Professor Clements said.
 
‘GPs have spoken to me about the need for further investment in culturally informed and appropriate care for Aboriginal and Torres Strait Islander people accessing the NDIS, and concerted efforts made to recruit Aboriginal and Torres Strait Islander people to become NDIS support workers.
 
‘The NDIS is changing the lives of people across Australia, and I don’t want anyone, regardless of where they live, to be left behind.
 
‘Let’s make this scheme even better and make sure that patients in the bush are always front of mind.’
 
The RACGP President echoes these calls.
 
‘The entire rural and remote health system must be operating efficiently to get patients proper NDIS care and support – right now, that just isn’t happening,’ Dr Higgins said.
 
‘Patients in the bush tell me about long wait times and having to travel gruelling distances, at their own expense … one rural GP tells me about patients stuck on waitlists for two years just to seek appropriate evidence to submit their NDIS paperwork.
 
‘Imagine the toll this is taking on patients just trying to get the right kind of support to make their lives that much easier.’
 
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access to care disability National Disability Insurance Scheme NDIS RACGP Rural rural and remote

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