The RACGP is backing calls for greater scrutiny of proposed NDIS reforms, with GP leaders warning that support is being withdrawn before replacement services are ready.
Disability reforms risk leaving vulnerable children and families without adequate support, with concerns that changes to the National Disability Insurance Scheme could outpace the rollout of alternative services, GPs warn.
Appearing before a Senate committee inquiry into proposed NDIS reforms this week, Royal Australian College of General Practitioners chair of Specific Interests Child and Young Person’s Health, Dr Tim Jones said many families were already losing access to supports while replacement programs remain under development.
“We are already hearing of families being removed from the NDIS every day when it has become the only support that they can access, and so it is a deep fear for our members that currently people with disability have been receiving support, that support is now being withdrawn, and this seems to be moving faster than any one of us can predict,” he told the inquiry.
He said the bill was an opportunity to remove the silos between various insurance schemes.
“GPs have an extensive history of stewards of public funding via Medicare, and general practice is the natural home for co-ordination of support needs,” he said in his opening statement.
“The RACGP also recommends that all needs assessors have a health background, at a minimum. Ideally, these roles would be performed by members of a GP-led, multidisciplinary care team, such as practice nurses or other valued allied health professionals.
“Finally, while not directly relevant to the bill, but to consider better co-ordination between funding pools, there is an ongoing issue when GPs complete NDIS paperwork and applications.
“Medicare rebates are only available if the patient is present, meaning patients face potential fees when applying for the NDIS. We are keen to explore options to address this, including care coordination payments through the My Medicare scheme.”
The inquiry heard evidence from medical colleges representing GPs, paediatricians, rehabilitation physicians and psychiatrists, with multiple witnesses calling for more time to examine the proposed legislation and clarify how key elements of the reforms will operate in practice.
Dr Jones supported recommendations for a longer consultation process, arguing that significant questions remain unanswered around assessment tools, workforce capability and access pathways.
One of the RACGP’s central concerns is the growing reliance on functional capacity assessments and automated decision-making processes within the NDIS.
“We see human beings who are struggling, and they need those supports to be available to them in a way that is transparent, and they need a process that they understand for how to access those supports now and into the future,” Dr Jones said.
“Our fear as a college around relying on computer-aided decision-making and AI-assisted decision-making is that it has none of that, it has none of those elements of human qualities, it has none of those elements of transparency to it, and we fear what that would mean for people who are already vulnerable when they’re coming to the NDIS for care and support.”
Dr Jones warned that people with disability needed access to “human connection as part of their process of accessing NDIS supports” and cautioned against repeating mistakes associated with automated government decision-making systems.
“The concern in our mind, and I think it was shared by my colleague here, is that there isn’t enough information about that decision-making process to enable confidence that people will have transparency and continuity of care,” he said.
The RACGP also advocated for a stronger role for GPs within the NDIS, arguing that general practice was uniquely positioned to provide longitudinal evidence about a patient’s disability and support needs.
“Specialist GPs are intrinsically involved in disability care. There is no substitute for the quality of care provided by a GP who knows the patient and their history,” Dr Jones said.
“The NDIS is at a critical juncture with higher-than-expected participant numbers and fraud undermining the scheme.
“GPs stand ready to assist with getting the scheme back on track. However, the bill currently before Parliament misses an opportunity to acknowledge general practice for the care it provides.
“Embedding the role of specialist GPs in legislation would recognise their status as care coordinators, providing extensive, comprehensive, and coordinated supporting evidence as part of NDIS applications.”
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Dr Jones said a “fractured approach across health service systems” had led to uncoordinated efforts, gaps in responsibility, and a lack of collaboration between general practice and the disability sector.
He said there must be scope for GP involvement in the new framework planning.
“GPs are treating health professionals for NDIS purposes, but this is not properly understood by NDIS staff, and anecdotal evidence suggests that their clinical input can be dismissed,” he told the hearing.
“GPs are already responsible gatekeepers to all other parts of the health system, ensuring appropriate utilisation of resources. Formalising this role within the NDIS will maximise outcomes, rein in costs, and build in an additional fraud prevention control.
“There is an opportunity with this bill for GPs to inform revised NDIS eligibility criteria and the definition of functional capacity. GPs can advise when a person has exhausted all other treatment options and share valued insights into their patient’s care.”
He told the committee that GPs are already responsible for coordinating care across multiple parts of the health system and should be formally recognised within NDIS assessment and planning processes.
Dr Jones also raised concerns that evidence provided by treating GPs is being given less weight in NDIS decision-making.
“We feel really passionately that reform towards functional need is so important to get right,” he said.
Drawing on his experience in child development, Dr Jones said disability assessments must account for the changing circumstances that could dramatically affect a child’s development.
“If I am seeing a three-year-old who is already struggling with multiple differences in their development, let’s say their parents separate, or there’s a natural disaster [that] sweeps through their town, that is going to have an immediate and significant consequence on the developmental trajectory of that child,” he said.
“If we do not intervene at that point to provide extra support, just for a time, that child misses a developmental window that was entirely related to the circumstances in which they found themselves.”
Dr Jones said reforms should allow support to increase or decrease according to a person’s needs, rather than forcing people into an “in or out” model of care.
“We feel really passionately that reform towards functional need is so important to get right, and one of the factors we would really love to see is that we have the ability to access a truly stepped care model of care, where people can step up to high levels of support when it is needed, step down to low levels when it is needed, and that we have that ability to say to the support system for that person, we can help you access what you need when you need it,” he said.
“Needless to say, the impact that would make on our hospital sector and on our mental health sector as well is staggering, because that’s just people getting what they need when they need it.
“If people don’t get that, they end up in hospital, or they end up in our mental health system, or both.”
Dr Jones said one of the things that must be critical in these tools and evidence-based assessments was that they translated to the “real world”.
“They have to be usable across broad swathes of our population,” he said.
“We know that, coming back to the question on letters of support [for NDIS funding], the people we were most writing letters support for were the people who had no voice, either due to their circumstances, their cultural background, or their disability.
“They had no way of navigating the system, and that inequity of access to endless is something that we have seen sadly, and we’re passionate about correcting.
“One of the things that we need to make sure is that those tools themselves do not embed those same biases over access.”
The Senate committee is expected to report on the proposed reforms later this month.
