“Equity of health outcomes was at the centre of our discussions,” declare members of the Strengthening Medicare Taskforce in their 11-page report released today.
Time will tell whether the implementation of these recommendations exacerbates or reduces health inequities.
The report’s recommendations are grouped under four broad aims, as per below.
Beneath this summary is a rolling post of reaction from stakeholders, including the Consumers Health Forum of Australia, the Australian College of Rural and Remote Medicine, the Australian Practice Nurses Association, the Australian Nursing and Midwifery Federation, Allied Health Professions Australia, Royal Australasian College of Physicians, Australian Medical Association, Australasian College for Emergency Medicine, Australian Healthcare & Hospitals Association, cohealth, the Doctors Reform Society, the Royal Australian College of General Practitioners, the Society of Hospital Pharmacists, The Australasian College of Paramedicine, and Optometry Australia.
In his statement, Health Minister Mark Butler said the Government’s 750 million commitment to the Strengthening Medicare Fund, “will be the start of a major revamp of the primary care system”.
Report recommendations
1. Increasing access to primary care
• Support general practice in management of complex chronic disease through blended funding models integrated
with fee-for-service, with funding for longer consultations and incentives that better promote quality bundles of care
for people who need it most.
• Support better continuity of care, a strengthened relationship between the patient and their care team, and more
integrated, person-centred care through introduction of voluntary patient registration. This needs to be supported
with a clear and simple value proposition for both the consumer and their general practice or other primary care
provider. Participation for patients and practices needs to be simple, streamlined and efficient.
• Develop new funding models that are locally relevant for sustainable rural and remote practice in collaboration
with people, providers and communities. Ensure new funding models do not disadvantage people who live in
communities with little or no access to regular GP care, and whose care is led by other healthcare providers.
• Grow and invest in Aboriginal Community Controlled Health Organisations (ACCHOs) to commission primary care
services for their communities, building on their expertise and networks in local community need.
• Strengthen funding to support more affordable care, ensuring Australians on low incomes can access primary
care at no or low cost.
• Improve access to primary care in the after hours period and reduce pressure on emergency departments by
increasing the availability of primary care services for urgent care needs
2. Encouraging multidisciplinary team-based care
Fast-track work to improve the supply and distribution of GPs, rural generalists, nurses, nurse practitioners
and midwives, pharmacists, allied health, Aboriginal and Torres Strait Islander health workers and other primary
care professionals.
• Work with states and territories to review barriers and incentives for all professionals to work to their full scope
of practice.
• Increase investment in the Workforce Incentive Program to support multidisciplinary teams in general practice,
improving responsiveness to local need, increasing accountability and empowering each team member to
work to their full of scope of practice.
• Support local health system integration and person-centred care through Primary Health Networks (PHNs)
working with Local Hospital Networks, local practices, ACCHOs, pharmacies and other partners to facilitate
integration of specialist and hospital services with primary care, and integrate primary care with mental health,
aged care, community and disability services.
• Increase commissioning of allied health and nursing services by PHNs to supplement general practice teams in
under served and financially disadvantaged communities.
3. Modernising primary care
• Modernise My Health Record to significantly increase the health information available to individuals and their health
care professionals, including by requiring ‘sharing by default’ for private and public practitioners and services, and
make it easier for people and their health care teams to use at the point of care.
• Better connect health data across all parts of the health system, underpinned by robust national governance and
legislative frameworks, regulation of clinical software and improved technology.
• Invest in better health data for research and evaluation of models of care and to support health system planning.
This includes ensuring patients can give informed consent and withdraw it, and ensuring sensitive health
information is protected from breach or misuse.
• Provide an uplift in primary care IT infrastructure, and education and support to primary care practices including
comparative feedback on their practice, so that they can maximise the benefits of data and digital reforms,
mitigate risks and undertake continuous quality improvement.
• Make it easier for all Australians to access, manage, understand and share their own health information and find
the right care to keep them healthy for longer through strengthened digital health literacy and navigation.
4. Supporting change management and cultural change
• Put consumers and communities at the centre of primary care policy design and delivery. Allow for flexibility in
models of care to deliver on local needs and incentivise innovation to deliver better health outcomes.
• Learn from both international and local best practice, and invest in research that evaluates and identifies models
of high value primary care excellence.
• Work with providers to help them effectively manage change and transition to new ways of working, including
through a strengthened role for PHNs to support the adoption of successful, locally designed models of care.
• Support the continued development of practice management as a profession, including through an initial training
program to help practices transition to new ways of working.
• Implement a staged approach to reform, supported by an evaluation framework to monitor progress and measure
the impact of reforms.
A ‘win’ for health consumers
Statement by Consumers Health Forum of Australia
Consumers Health Forum has welcomed the commitment of the Strengthening Medicare Taskforce to put consumers and communities at the centre of primary care policy design and delivery.
CHF CEO Dr Elizabeth Deveny was the only independent member of the Taskforce representing consumers and advocated strongly for them to play an active role in any changes.
“Whatever reforms the government decides to introduce, it is essential that health consumers are involved in the design and implementation of any new policy or service,” she said.
“Consumers will be the litmus test of whether these proposed changes deliver better healthcare – everyday Australians will ultimately be the judge of how the reforms work in the ‘real world’.”
Dr Deveny also applauded the reforms that aim to provide wraparound care for those who need it most.
“Although I’m sure many sectors of our community were looking for a ‘quick fix’ increase in the Medicare rebate for doctors, the Taskforce recommendations are aimed at long-term reform,” Dr Deveny said.
CHF has called on Minister for Health and Aged Care Mark Butler to consider all funding options.
“Increasing access to bulk-billing GPs and reducing general healthcare costs is the number one issue for Australian health consumers,” Dr Deveny said.
She also said Minister Butler must back consumer-led activities with funding in the 2023 Federal Budget.
“We must ensure that health consumers are supported to actively contribute their expertise and lived experience to any committee or policy forum, providing education or training as needed,” she said.
Regarding the Taskforce’s other recommendations, CHF also supported:
- increasing access to primary care through blended funding models and ensuring Australians on low incomes can better access primary care at no or low cost
- providing wraparound care to people with chronic and complex health issues with voluntary patient registration
- addressing rural and remote health inequities and investing in First Nations’ health
- modernising My Health Record and making it easier for all Australians to manage their own health information by strengthening health literacy and navigation.
Read previous article at Croakey: Timely advice to governments (and the media): a 10-point action plan for health reform
Next steps are crucial
Statement by Australian College of Rural and Remote Medicine
The Australian College of Rural and Remote Medicine (ACRRM) welcomes the release of the Strengthening Medicare Taskforce Report today, saying it will allow for reform and improve healthcare access for rural, remote, and Aboriginal and Torres Strait Islander communities.
ACRRM has been involved in Taskforce deliberations and provided experience and expertise to strongly advocate for rural and remote General Practitioners (GPs) and Rural Generalists (RGs).
College President Dr Dan Halliday says that the College supports the intent of the report and its recommendations.
“Like all such reports, the devil will be in the detail,” Dr Halliday says.
“We will be looking at how the federal, state and territory governments respond to the recommendation.
“The next steps of the reform process are crucial, including delivering more detail regarding priority of reforms, funding details and implementation timelines.
“It is vital they adopt a united approach and continue to consult with the College and other key stakeholders, including GPs, Rural Generalists, and rural and remote consumers.”
Dr Halliday says GPs and RGs are the cornerstone of quality primary care and have a pivotal role as leaders and coordinators of primary care teams and are gatekeepers to other medical specialties.
“We also recognise that in rural and especially remote communities, GPs and RGs may not be the regular, on-the-ground team member, and that we need to allow flexibility in the system to ensure viability of services when they are not available.
“People living in rural and remote locations should never have to accept a lesser standard than their urban counterparts.
“There should be a minimum acceptable standard for healthcare services in rural and remote Australia, consistent with the principle of equitable access to services regardless of location.
“To achieve this, rural and remote communities, starting with the most vulnerable, should be consulted on the specific solutions they require to maintain service viability.”
In particular, the College will be seeking greater detail on:
- The role of the Rural Generalist/specialist GP in the coordination of multidisciplinary, team-based care
- How the primary care sector will be consulted and supported to implement the significant reforms that are required to ensure that Australia’s Medicare system is fit-for-purpose
- How general practices and primary care facilities more broadly, will be incentivised and funded to deliver high quality, continuity of care that meets patient needs and keeps people out of hospital and emergency departments; and provide effective prevention and treatment for chronic disease
- How voluntary patient registration will be implemented, particularly within the rural and remote context, and
- The expanded role of Primary Health Networks, and the implications for rural and remote GPs and RGs, practices and healthcare facilities and communities.
It’s now time for action. Nurses are ready for change
Statement by Australian Primary Health Care Nurses Association (APNA)
APNA welcomes Federal Health Minister Mark Butler’s thoughtful and considered approach to change in Australian health care.
Primary health care nurses can make a huge difference to patients seeking health care, with about 96,000 primary health care nurses working outside of a hospital setting in Australia. This is around one in eight of Australia’s 642,000 registered health professionals.
“We welcome the recognition that nurses working to their full skill set can help drive significant improvement in the health of Australia,” APNA President Karen Booth said.
“This is the second Government Taskforce in as many years that has delivered a report recommending how primary healthcare in Australia needs to change.”
“It is now time to deliver the change that is needed, and APNA looks forward to working closely with the Minister and all stakeholders to deliver a healthier Australia,” Ms Booth said.
Implement “historic reforms”
Statement by Australian Nursing and Midwifery Federation (ANMF)
The ANMF is calling on the Albanese Government to use the Federal Budget to implement historic reforms of Medicare, including funding nurses and midwives to work to their full scope of practice, to ensure optimal health outcomes for the whole community.
The Final Report from the Strengthening Medicare Taskforce was released today after being submitted to Federal Cabinet, with key recommendations for additional funding to allow frontline nurses, midwives and allied health professionals to deliver care in primary health settings, as part of a new model of multi-disciplined care for patients.
ANMF Federal Secretary Annie Butler, who sits on the Taskforce, said it was crucial the Albanese Government and State and Territory leaders work together and ‘not waste this historic opportunity for reform’ by ensuring that nurses and midwives are at the centre of patient care in the community. This will ensure affordable, accessible care for all Australians – when and where they need it.
“Highly-qualified healthcare professionals, such as nurses, midwives, nurse practitioners (NPs) and other health professionals, who up until now, have been unable to fully work to their full capacity, expertise and skill must be central to the reform of Australia’s universal healthcare system,” Ms Butler said.
“Nurses, NPs and midwives provide quality care in every setting in Australia including in rural and remote settings, where often, there are no GP’s. It’s just common-sense to allow them to work to their full scope of practice in these settings.
“With appropriate stand-alone ‘block funding’ for nurses working in general practice, people would be able to see a registered nurse for a whole range of health care and chronic disease management checks, would care, immunisations, sick certificates and health promotion and prevention, which would certainly reduce the number of people having to go to hospital for these everyday care episodes.
“We’re calling on the Government to back the Taskforce’s report and allow nurses to do what they’re trained and qualified to do for the benefit of the whole community, particularly in rural and regional areas, and other areas of disadvantage, where workforce shortages are having an even greater impact on access to care.
“After 40-years, Medicare just isn’t working as it should and must be changed to meet the growing demands of our fast-ageing population. The Taskforce’s recommendation for blended funding models, which will allow full wrap-around care for all communities are very welcome.”
Ms Butler thanked Taskforce Chair, Minister for Health and Aged Care, Mark Butler and fellow Members of the Taskforce for their input into the Final Report.
Concerns and cautions
Statement by Allied Health Professions Australia
Allied Health Professions Australia welcomes the release of the Strengthening Medicare Taskforce Report today and supports the commitment of the Albanese Government to reform the primary care system, of which allied health is key.
Recognising the value of multidisciplinary primary care is long overdue. AHPA Chair and Taskforce member Antony Nicholas said “We encourage reforms that strengthen multidisciplinary team care and support funding mechanisms that allow allied health professionals to work to their full scope. However we caution that reform without an implementation roadmap and a commitment to engaging with the allied health sector will ultimately result in more of the same.”
AHPA is particularly concerned with the recommendation to increase investment in the Workforce Incentive Program (WIP). AHPA CEO Bronwyn Morris-Donovan says “There is no evidence that the employment of allied health professionals under the WIP has improved access to multidisciplinary care.”
“The allied health sector has opposed the WIP since its inception – it undermines the entire employment model of private allied health. The Government is taking a general practice incentive payment and calling it a win for multidisciplinary team care. It is a not a win for consumers or allied health. It shows there is still no real understanding of how to build a system that genuinely puts consumers at the centre.”
While AHPA strongly supports greater investment into PHNs to strengthen their capacity to commission allied health services, it should not be seen as a mechanism to ‘supplement general practice teams.’ We must move on from the notion that general practice is the only setting where primary care takes place.
There are thousands of allied health professionals working in the community in small private practices. The idea that bundling services under one roof is the antidote to fragmented care is fanciful. Coordinated care requires all parts of the primary health care system to work as a team, supported by appropriate resources, including connected digital technologies.
Although we welcome recommendations to modernise the My Health Record (MHR), allied health must be given access to, and considered in the development of all digital development. Morris-Donovan said “We must not forget that allied health professionals cannot contribute critical health information into the MHR, or choose suitable clinical information systems (CIS) that are interoperable with MHR.
“If Minister Butler is serious about improving continuity, quality and safety in health care, then bringing allied health into the digital ecosystem must urgently be addressed.
“As it stands, the Strengthening Medicare Taskforce digital recommendations offer no reassurance that allied health will be prioritised.”
Additionally, while AHPA is supportive of recommendations to ‘fast-track’ the supply and distribution of the health workforce, we caution how this can be achieved. “There is no consistent collection and integration of allied health workforce data. This means the Government cannot confirm vital information about allied health professionals and their roles, resulting in fragmented, inconsistent approaches to workforce and service planning,” says AHPA Chair Antony Nicholas.
“The impact of this is poor access to essential allied health services, especially for people in rural and remote areas and people with chronic conditions.”
Changes in funding and infrastructure to Australia’s health systems that allow for consumer-centered primary care and equity of access to all Australians needs to happen now.
Allied Health Professions Australia is committed to working with the Australian Government to deliver the Taskforce recommendations. The impact of these recommendations is far-reaching for the health of all Australians. A clear implementation plan is the next step to reform.
Patients need more access to specialist care
Royal Australasian College of Physicians
The Royal Australasian College of Physicians welcomes the report of the Strengthening Medicare Taskforce, but patients need more access to specialist care than is foreshadowed by the report. Specialist care of physicians and paediatricians plays an essential role in delivering high quality healthcare for patients, especially the increasing number with chronic diseases.
One of the recommendations of the report is to “support local health system integration and person-centred care through Primary Health Networks (PHNs) working with Local Hospital Networks, local practices, ACCHOs, pharmacies and other partners to facilitate integration of specialist and hospital services with primary care, and integrate primary care with mental health, aged care, community and disability service.” The RACP supports this recommendation but knows more need to be done.
RACP President Dr Jacqueline Small says “The RACP welcomes new thinking and innovative approaches to health system reform, but these reforms will be both ineffective and costly if they do not include specialists, and will impact negatively on patients.
“Every day, physicians and paediatricians play a critical role in delivering quality community care to patients with chronic or complex illnesses. We do so in collaboration with General Practitioners, allied health professionals and other support staff.
“Including medical specialists in integrated and team-based models of care will deliver better outcomes for patients, provide support and capability development for GPs and other health professionals, and address problems with accessing specialist medical care.
“Supporting medical specialists to work more closely with GP practices is one model that could improve patient satisfaction and health outcomes, reduce fragmentation of care and reduce hospitalisations from chronic and complex conditions.
“We already have examples of effective team-based care models in action. The Strengthening Care for Children Project has shown promising outcomes from integrating paediatric and GP care, while the Geriatrician in the Practice Program in rural NSW has provided regional patients with easier and better coordinated access to geriatric care managed through their regular GP clinics.
“Our own Model of Chronic Care Management sets out a path to make multidisciplinary team care more accessible and patient-centred, while avoiding unnecessary hospital visits to people with intermediate level of chronic conditions. We’re eager to share our model with all stakeholders and encourage all sectors of the healthcare profession to engage with it,” Dr Small said.
“It’s a better way of working, but there need to be changes in the way the system operates to make team-based care more widely available.
“The RACP wants to work with the Minister for Health, Mark Butler MP, to deliver the optimum healthcare system that works for all Australians – a system that doesn’t leave patients waiting, but delivers the quality level of care they need when they need it.
The RACP is calling on the Federal Government to:
- Involve medical specialists in primary care reform, and implement the RACP Model of Chronic Care Management to integrate and streamline patient-centred GP, medical specialist and allied care for patients with chronic comorbid conditions and disabilities
- Involve medical specialists (physicians and paediatricians) in the design and operation of Urgent Care Clinics to expand their outreach into community-based care services
- Integrate medical specialists into innovative blended funding models to be implemented as part of the announced reforms, including
- provide funding support for GPs to seek advice from medical specialists in difficult cases
- break down the place of service delivery (public hospital versus private practice) funding barrier for patients with chronic conditions to ensure GPs and physicians can work collaboratively from the same care plan
- Include medical specialists in the voluntary patient registration scheme to support team-based routine care for chronic patients
- appropriately index Medicare rebates so they are sustainably aligned with inflation.
More investment needed to save general practice
Statement by the Australian Medical Association
The federal government’s Strengthening Medicare Taskforce report outlines broad reform directions that are generally welcome, but time is ticking for a primary care system in desperate need of action and more investment.
Australian Medical Association President Professor Steve Robson said the report included a welcome focus on proposals identified in the AMA’s Modernise Medicare campaign including improving funding for the Workforce Incentive Program, support for after-hours GP services and the introduction of voluntary patient enrolment to strengthen the relationship between a patient and their GP.
“This is a timely acknowledgement of the key role of general practitioners and moves us towards the medical home model that will better support patients with more coordinated care — delivering a more sustainable health system in the long term,” Professor Robson said.
“The report is high level vision document with little detail, and potentially sets primary care on a pathway to long term reform. However, patients can’t wait that long and need more immediate support.
“While the report and last year’s $750 million investment are welcome, we know that patients are increasingly struggling to access care and facing growing out of pocket costs.
“While this is due to the failure of successive governments to deliver the support general practice has been crying out for, the reality is that it is playing out on the current government’s watch, and the government needs to take urgent action to turn this trend around.
“We need to see a health budget delivered in May, with the kind of funding that will make a real difference to the system and the health of all Australians.
“The kind of issues we are seeing across the system, including in primary care aren’t going to be fixed with this investment. We must see a far greater investment that will address current problems and establish a sound platform for long term reform to ensure Australians can access affordable care when they need it.”
Professor Robson said immediate action could be taken to index Medicare appropriately.
“This is a problem created by successive governments and it can’t be ignored anymore. Additional funding to appropriately index the Medical Benefits Schedule (MBS) must be a priority, and we need to rebalance the MBS consultation items so patients can spend the time they need with their GP.”
Professor Robson said while more action is needed urgently, the report’s focus on strengthening the relationship between patients and their GP was encouraging.
“As our population ages and the number of patients with chronic conditions increases, we need to see well-coordinated models of care where GPs work with other health professionals to deliver care.
“A patient should be able to enrol with their GP of choice. A medical home model, where patients can choose to enrol with the GP, will also provide data that demonstrates the importance of an ongoing GP-patient relationship.”
Courage needed
Statement by the Australasian College for Emergency Medicine
The Australasian College for Emergency Medicine (ACEM; the College) acknowledges the release of the Strengthening Medicare Taskforce report and is hopeful it will contribute to the urgently needed, meaningful and widespread reform required to help improve Australia’s struggling healthcare system.
The report provides an overarching direction, and it is now time to hit ‘accelerate’ on bringing all stakeholders to the table, to develop the detail and implement reforms.
GPs are the specialist experts in primary medical care, and emergency doctors acknowledge their leadership on these issues. Well-functioning primary healthcare services that are accessible, affordable and well-integrated into the rest of the healthcare system are crucial to ensuring all Australians have access to the care they need when and where they need it, regardless of where they live.
ACEM commends the Australian Government, and all involved in the development of the report, for progressing this complex and challenging work to better support access to primary healthcare.
The College emphasises the importance of ensuring any implementation contributes to improved linkages between primary healthcare and emergency departments, as well as broader improvements across the hospital and healthcare system. The recognition of the need for strategies to improve collaboration and build links between healthcare sectors and services to be more patient-centred are welcome.
The College is also hopeful proposed improvements to My Health Record will contribute to better data sharing between primary care, emergency departments and hospitals, and result in better, more streamlined experiences for patients and clinicians.
Progressing reform is a massive undertaking, and the proof of success or otherwise of the Strengthening Medicare exercise will become evident as recommendations and measures are developed and rolled out.
ACEM emphasises the vital importance of maintaining focus on the healthcare system as a whole, and ensuring emergency physicians and other emergency department clinicians – who serve a critical role at the intersection between primary care and hospital-based services – are at the table, with their views heard and reflected as this work progresses.
“Australia’s healthcare system has been under sustained and mounting pressure for many years, and is now at breaking point,” said ACEM President, Dr Clare Skinner.
“The entire health system is long overdue for reform, and we are hopeful that the broad principles and recommendations outlined in this report will lead to the reimagining that is so desperately needed to improve health outcomes for all Australians.
“We need to see courage from all governments and decision makers to tackle longstanding issues and deliver the healthcare system that communities need and deserve. ACEM is ready and eager to work collaboratively with all governments, our colleagues across healthcare, patients, carers and communities to achieve the necessary reforms.”
A vision for Medicare but not a quick fix
Statement by Australian Healthcare & Hospitals Association (AHHA)
AHHA welcomes the release of the Strengthening Medicare Taskforce Report, while recognising it will be the details that matter.
‘Our members and stakeholders across the health system have long been calling for a commitment to reorient the system towards one that is person-centred, outcomes-focused and value-based,’ said AHHA Chief Executive Kylie Woolcock.
‘This report identifies those critical enablers that will align diverse stakeholders around a shared vision.’
‘We welcome the Government’s commitment to a staged approach that will build multidisciplinary models of care around the needs of individuals and communities with complex and chronic conditions; that will introduce changes to funding models that incentivise improved health outcomes, not just more activity; and that embeds evaluation and learning so we can scale what works for the system, and the people and workforce that it serves. AHHA acknowledges that this is not a quick fix.’
AHHA looks forward to working with Minister Butler, our members and stakeholders in achieving this vision.
A roadmap upon which community health can deliver
cohealth
Victorian community health service, cohealth, has applauded the focus on multi-disciplinary, team-based care in the final report of the Strengthening Medicare Taskforce, and
says that many of the recommendations in the report reflect precisely the model that community health delivers in Victoria.
“We don’t need to reinvent the wheel because right here in Victoria we have a model which works very well and is scalable,” said Acting Chief Executive, Christopher Turner.
“Community health services keep people with complex health issues out of hospitals and acute care settings by offering multidisciplinary, team-based health and social services – which includes GPs integrated with allied health and nurse practitioners – close to where people live,” said Mr Turner.
“We remove barriers by taking care to where people are, rather than waiting for them to navigate the system to find us.”
cohealth says that place-based, integrated care that addresses the spectrum of social, physical and mental health needs must be core to the primary health reform, and that the Federal Government should draw on the expertise of the Victorian community health system.
“The Strengthening Medicare Taskforce has recognised the need to transition away from a system of private practice GPs delivering episodic care in isolation and instead shifting to viewing GPs as part of a team who are responding to the holistic health needs of the community,” said Mr Turner.
Mr Turner commended the report’s recommendation to provide targeted primary health care to under served and financially disadvantaged communities.
“For people from refugee backgrounds, living in poverty due to systemic inequality or who are homeless, it’s about more than finding a bulk billing clinic, it’s about knowing how to find services that are sensitive to their needs, accessible, trauma-informed and culturally safe,” said Mr Turner.
“People who experience disadvantage or have complex health conditions have the greatest health needs, yet face significant barriers to receiving care, so community health responds with targeted programs and services that remove those barriers,” he said.
cohealth says it shares other organisations’ concerns that the report does not recommend any immediate actions to improve access to GPs.
“The transition to multidisciplinary, team based care is not an overnight process, and it’s worrying that the report doesn’t outline any immediate actions to resolve the crisis in general practice,” said Mr Turner.
Cautious welcome
Royal Australian College of GPs (RACGP)
The RACGP has cautiously welcomed many measures contained in the Strengthening Medicare Taskforce Report but warned that even greater reform is required to secure the future of general practice care.
The Medicare Taskforce was commissioned by the Federal Minister for Health and Aged Care, the Hon Mark Butler MP, to determine how best to spend the $250 million a year Strengthening Medicare fund that the Albanese Government took to the 2022 federal election. Specific recommendations in the report welcomed by the RACGP include:
- funding for longer consultations to reflect the fact that chronic and complex care requires more time than is funded for in a standard consultation, which the RACGP has been advocating for over many years
- increasing investment to support multidisciplinary teams in general practice that are responsive to local needs, as long as patients are accessing centrally coordinated care via their general practice
- “blended funding models” integrated with fee-for-service, including incentives to promote better care for people who need it most
- introducing a streamlined and straightforward voluntary patient registration scheme, which enables patients to sign up to a practice that receives extra funding to co-ordinate care. This is particularly valuable for older patients and those with multiple chronic conditions that need to be carefully managed
- better use of data and digital technology to share critical patient information and support superior patient healthcare
- investing in Aboriginal Community Controlled Health Organisations to commission primary care services building on their expertise and exploring new funding models that are locally relevant for rural and remote practice
- investing in primary care research.
The report also broadly recommends strengthened funding to support more affordable care as well as improving access to primary care in the after-hours period and reducing pressure on emergency departments. However, despite repeated RACGP calls for greater investment in general practice care, it is silent on measures such as boosting Medicare rebates and increasing incentives for bulk-billing. The RACGP is encouraged that Minister Butler has not ruled out increases to Medicare rebates in today’s press conference following the release of the report.
RACGP President Dr Nicole Higgins said the report held many promising elements, but that more action was needed to secure the future viability of general practice care.
“The RACGP is pleased to have participated in the taskforce and we are committed to working alongside government to implement reform,” she said.
“It is very positive that health reform is, as the Prime Minister said today, a first priority issue for 2023 and to see the states and territories come to the table with the federal Government to discuss these vital issues. We welcome many aspects of the report but there is a high level of ambiguity, and the devil will be in the detail on many of the recommendations.
“The promise of reform without proper investment to back it up is hollow. Medicare is almost 40 years old, and we need change; however, today’s recommendations will not of themselves go far enough in securing the future of general practice care. The report features several measures to improve our healthcare system and there is some mention of strengthening funding to support affordable care. We are looking forward to working with the federal Government to achieve meaningful new investment in general practice care. This will provide a much-needed boost for GPs and practice teams who are performing such a critical role in serving their communities and it will help attract new future doctors into general practice.
“GPs and practice teams have experienced many years of neglect and underfunding that has left general practice care in urgent need of an investment boost. Medicare rebates have not kept pace with the costs of providing high-quality care and the Medicare rebate freeze ripped billions from the sector. General practice is the answer to relieving pressure on the entire healthcare system, including our over-burdened hospitals, and improving the health and wellbeing of people in communities everywhere.
“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. As I said, we look forward to working constructively with the Government, because there is too much at stake to get this wrong.”
The RACGP President doubled down on calls for any reforms to reinforce the role of GPs as the stewards of patient care.
“The report states that responsibility for providing care should be shared across primary care teams and that high quality primary care depends on harnessing the skills of a diverse health workforce including nurses, nurse practitioners and pharmacists,” she said.
“The devil is in the detail here. If the current model is broken and GPs – the specialists in coordinating complex care, with well over 10-years training in diagnostics, treatment, and quality care – are no longer at the centre of care management, patient care will be compromised. We need GPs working hand in glove with allied health professionals, pharmacists, and practice nurses, and they should be supported within general practice, with GPs as the stewards of patient care.
“I’m also slightly concerned that the report identifies a ‘strengthened role for PHNs’ to drive organisational and cultural change. Again, general practice needs to be at the centre of any changes and if you ask many GPs, they will tell you that adding another layer of bureaucracy by further empowering and funding PHNs is not the best solution.”
Dr Higgins said that many of the college’s recommendations to the Government featured in the report, something that bodes well for the future of general practice care.
“Voluntary patient enrolment could well be beneficial for many patients and the college awaits further detail on the proposed model,” she said.
“In the United Kingdom, the capitation approach has seen many GPs doing a lot more for less, at the expense of patient care, and that must be avoided at all costs. We have previously warned in our submission to the Primary Healthcare 10 Year Plan that any voluntary patient enrolment model must be fit-for-purpose for the Australian health system and align with the flexibility required in general practice care.
“Digital modernisation also holds great promise, and we are keen to work with government to make sure we get this right, including privacy and security concerns. As the report makes clear, it’s no use having vital patient health information locked away in different information systems and not shared easily – no one wins in that scenario.”
The RACGP will continue to fight for long-term reform that ensures the future of GP care for all Australians. The college also calls for short term solutions to stem the bleeding, including:
- improving access to care by tripling bulk billing incentives, increasing Medicare rebates for longer, complex consultations by 20%, funding enhanced primary care services for people over 65, with mental health conditions and disability, and funding patients to see their GP after an unplanned hospital visit.
- boosting the GP workforce by fast-tracking entry for international doctors, re-instating the subsidy for their training, supporting junior doctors to intern in general practice, and introducing payroll tax exemption for independent tenant GPs to prevent more practices closing.
Long-term reforms based on the RACGP Vision to build the role of GPs as the stewards of patient care in multidisciplinary teams, with serious investment to improve the health of Australians and reduce spending on expensive hospital care.
Transformation needed
The Society of Hospital Pharmacists of Australia (SHPA)
The SHPA has welcomed the release of the Strengthening Medicare Taskforce Report, while urging the Australian Government to expand the Medicare Benefits Scheme (MBS) to broaden the positive impact of medicines review services as part of collaborative pharmacist care from hospital to the home.
The implementation of recommendations in the report, which was released on Friday, will be supported by $750m in primary care funding allocated at the last Federal Budget.
SHPA Chief Executive Kristin Michaels says the investment is a unique opportunity to leverage hospital expertise in expanding pharmacists’ scope of practice and impact to all settings of care, including primary care settings.
‘Hospital pharmacists have been collaborating in multidisciplinary team-based care models for decades, pushing the boundaries of practice to support safe, effective and efficient pharmacist care.
‘Partnered Pharmacist Medication Charting was first piloted in Australian hospitals in 2015, and is now a feature in most states and territories, as hospital pharmacists continue to demonstrate the benefits of team-based, collaborative pharmacist prescribing and medicine charting with medical colleagues.
‘Hospital pharmacists are also taking the lead in prescribing decisions, monitoring and adjusting dosages and medicines according to patient outcomes, which takes further pressure off our medical and nursing workforces.
‘These innovations need to shape the future of pharmacy, in all settings, in two ways; firstly, by informing emerging pharmacist roles that will propagate team-based, patient-centred care across the country, such as GP Pharmacists and onsite Aged Care Pharmacists.
‘Secondly, hospital-led expertise, experience and education can equip more pharmacists to address increasing medicines complexity. Australians entering and leaving hospital are regularly taking an average of nine medicines, so pharmacists must assist with medicines management and deprescribing in collaborative agreement with GPs.’
Ms Michaels says realising the full potential of expanded pharmacist scope is key to reforming and transforming Australia’s healthcare systems for greater sustainability and improved patient outcomes.
‘The immediate and current pressure on our models of care is felt in every part of the system. Too many Australians continue to end up in hospital, when better integration and access to healthcare services could enable more care in the community.
‘We are glad to see the Strengthening Medicare Taskforce Report enshrining healthcare professionals working in a co-ordinated, person-centred manner to their full scope of practice as part of its vision.
‘In our pre-Budget submission, SHPA advocated for pharmacists to be further embedded into general practices and for the addition of clinical pharmacy services onto the Medicare Benefits Schedule to support collaborative medication management services for patients in primary care.
‘These evidence-backed reforms will reduce demand on GPs and ensure recently discharged patients who are at risk of re-admission can access post-discharge care in a timely manner, closer to home.’
The Strengthening Medicare Taskforce Report also recommended local health system integration and person-centred care should be supported through through Primary Health Networks (PHNs) working with Local Hospital Networks, local practices, ACCHOs and pharmacies.
‘We look forward to transformation and funding that will meaningfully connect the disparate parts of our healthcare system together to ensure patients no longer face extended GP wait times, or fall through the cracks entirely.
‘Many hospitals have initiated their own post-discharge pharmacist outreach services due to the gaps in Australian primary care, and even then, communication to primary care pharmacists and GPs regarding these care episodes is lacking due to the differences in systems used by Australian clinicians and consumers.
‘On this front, we also look forward to the modernising and updating of My Health Record to become a real-time, fully-integrated digital health system, as flagged by Minister Butler earlier today.
‘Australians rightly expect a health system that places them at the centre and SHPA is ready to help make it happen.’
Include the expertise of paramedics
Ryan Lovett, Chair, Australasian College of Paramedicine
The Australasian College of Paramedicine is again calling on the Commonwealth Government to include paramedics on their Medicare Taskforce. Today’s report makes a number of recommendations, a large number of which entirely speak to paramedic’s scope of practice and realm of expertise.
Paramedics are the only healthcare profession spanning both primary and tertiary care, they are on the front line every day, after hours, on weekends and on public holidays and are the only profession that provide an emergency and community care safety net in cities, regional areas and remote Australia. Through COVID, paramedics proved their innate ability to provide holistic, yet integrated care, both independently and as part of multi-disciplinary teams.
Paramedics are a profession with genuine desire and insight to promote inclusive, person-centred, community-based care tailored to support all Australians.
Support for a new vision for Medicare
Statement by Optometry Australia
Optometry Australia has welcomed the new Strengthening Medicare Taskforce Report and Minister for Health, Mark Butler’s recent public commitments to ensuring best use of Australia’s skilled health workforce.
The peak body for optometrists is committed to working with governments and stakeholders to explore how the contribution of optometry can be maximised to improve the health outcomes of all Australians.
Interim CEO of Optometry Australia, Skye Cappuccio, said, “The recommendations in the report broadly align with our vision to support optometrists practising to their fullest scope and to enhance local integration of specialists and hospitals with primary care.”
“Optometry is a vital component of the healthcare system. As outlined in our Working Together for Better Eye Care policy platform, central to addressing Australia’s looming eye health crisis is supporting optometrists to practise to their full scope to enhance patient access and increase the efficiency of Australia’s eye health system.”
“Any change needs to be implemented alongside appropriate indexation of Medicare funding to enable a system that sustainably serves the needs of the community.”
The report highlights the importance of new locally relevant funding models for rural and remote communities and highlights the significance of enabling multidisciplinary team care and enhancing digital access and sharing of patient health information.
Optometry Australia supports these key initiatives and believes that by working together, optometrists and other health practitioners can provide a more comprehensive and integrated approach to patient care.
“Optometry has a crucial role to play in improving access to care for all Australians, and we welcome approaches that focus on making the best use of our skilled workforce” added Ms Cappuccio.
“However, a key issue that remains unaddressed, is the inadequacy of Medicare rebates for optometric care. The gap between the rebate and the cost of providing quality primary eye care continues to grow. This disincentivises the provision of more complex care within the community setting.”
Optometry Australia has welcomed opportunities to provide input to the Taskforce, and will continue to advocate to broaden the clinical scope of optometrists and ensure they can practice to their fullness of scope.
See Croakey’s archive of articles on the Strengthening Medicare Taskforce report
