How Medicare reforms will change going to a doctor

General practice is in crisis with bulk billing in decline. But changes might be too late. This is what the Medicare changes mean for your next GP visit.

A major review of Medicare that calls for patients to enrol with a single GP practice that will become a one-stop shop providing services from nurses, physiotherapists and others might be too late to save primary care.

Health Minister Mark Butler released the government’s Strengthening Medicare Taskforce report on Friday. It calls for Medicare to fund a new long consultation for people with complex mental health, domestic violence and other complex health care needs.

The report stated after hours care must be overhauled to reduce pressure on emergency departments, by increasing the availability of primary care services for urgent needs.

Bulk billing is in decline, patients are paying up to $100 to see a GP and just 14 per cent of medical graduates are training to work in primary care.

Bricks and mortar GPs are having their business stolen by online providers like InstantScripts which use telehealth and online consults to provide electronic scripts.

Three states have allowed trials of pharmacy prescribing, further eroding the income of cash strapped GPs.

As inflation was surging past 7 per cent last July, the Medicare rebate to see a GP increased by just 1.6 per cent (65 cents).

The gap fees charged by a GP now average $42, which is more than the $39.75 Medicare rebate. This has not kept pace with inflation for almost 40 years.

The new report is right to argue that Medicare’s fee for service system is not up to the task of dealing with an ageing population with complex chronic illnesses.

Billions of dollars more must be spent employing nurses, mental health nurses, physiotherapists, dietitians and others in one-stop GP superclinics designed to keep people out of hospital.

Yes we have long needed better-after hours care, so people with broken or sprained limbs are not clogging up hospital emergency departments.

It’s true we need a better My Health Record that is actually used by hospitals and the medical profession so we don’t waste money on having the same medical tests twice.

The problem is the government has so far allocated just $250 million extra per year for these reforms, which won’t even cover a $2 increase in the Medicare rebate.

The Australian Medical Association (AMA) has calculated below inflation indexation and a six year freeze on indexing the Medicare rebate for GPs has stripped $8 billion out of primary care.

No details on how the reforms will be funded or how they will work. Picture: NCA NewsWire / Brenton Edwards

However, neither the report nor the Health Minister outlined how the reforms called for would be funded, nor did they provide any detail on how the changes would work.

Doctors have been calling for an immediate increase in the Medicare rebate to save bulk billing and help GP practices stay afloat.

Frustratingly, AMA President Dr Steve Robson couldn’t say how much he wants the rebate to rise, or how much extra the government needed to spend to save the system.

Mr Butler did not rule out increasing the Medicare rebate on Friday but he said he didn’t necessarily want to keep funding an outdated health system.

The report contains sensible recommendations that multiple inquiries have said should be implemented for over a decade.

In essence it’s what should have been in Mr Butler’s incoming brief when he took over as health Minister last May.

Instead we’ve wasted eight months on yet another inquiry and will have to wait another three months to get any detail on how the changes will work.

We have to stop continually describing the problem; it’s time to come up with detailed solutions.

“I think unless there is significant financial input this year, we’re on the way out for general practice because I guarantee when we see medical students graduate next year, we’re going to have a single figure percentage wanting to do it,” Dr Robson said.

The Royal Australian College of General Practitioners is also calling for immediate action.

“We need serious investment and long-term reform to secure the future of general practice care, but we also need to stem the bleeding in the sector with short-term action right now,” RACGP president Dr Nicole Higgins said.

YOUR MEDICARE QUESTIONS ANSWERED

Why does Medicare need reforming?

It’s 40 years since Medicare was introduced to help people cover the cost of seeing a GP or a specialist, and get treatment in public and private hospitals. In that time Medicare rebates have not kept pace with inflation and bulk billing; the system which sees the patient get care at no cost is in decline. Medical advances have totally changed the types of treatment people receive and our ageing population means more people have chronic complex illnesses that need constant wrap around care.

What is patient enrolment?

The Strengthening Medicare Taskforce wants patients to enrol with a single GP practice and get all their care at the one clinic. Eventually, people with chronic illnesses might get an annual allocation of funding to cover regular check ups and care for conditions like asthma and diabetes instead of paying a fee every time they go to the clinic.

How will nurses and other health professionals have a greater role in care?

Under the proposed changes a GP would get government funding to employ more primary care nurses, mental health nurses, physiotherapists, dietitians and diabetes educators who would provide more intensive patient care. Instead of having to always see your GP, sometimes a nurse might check the patient’s blood pressure or blood sugar, stitch their wounds, or provide mental health care, and the system would fund that consultation. At present a clinic is only paid if the doctor is involved in the care.

Will chemists be able to prescribe medicines?

Three states – Queensland, NSW and Victoria – are trialling a system where chemists can prescribe medications for certain conditions like urinary tract infections and contraceptives. The idea is that this will relieve pressure on overstretched GP clinics. Doctors argue chemists are not trained in diagnosis and have a conflict of interest when they prescribe because they make money from selling medicine. Already in the Queensland trials some patients who thought they had a urinary tract infection and received antibiotics from a chemist turned out to have cancer.

How will after hours care change?

The Morrison Government did not provide funding in the Budget for after hours medical care after June 30. The Albanese Government has promised to set up 50 urgent care clinics before the end of the year. These will help with minor but acute injuries like broken bones and strained ankles and wounds that require stitches, relieving pressure on hospital emergency departments.

Why does the digital My Health Record need changing?

More than 23 million Australians have a digital My Health Record but general practitioners hardly use the system and fewer than one in four specialists are connected to it. Hospitals are also not using it. Doctors complain it is clunky and say it is hard to find test results and information in the record. It needs major work and could save the health system money if it was fit for purpose by reducing repeat blood tests and scans.

Originally published as How Medicare reforms will change going to a doctor