As it did last year, the association’s pre-budget submission calls for a revamped seven-tier time-based rebate structure to replace the current five-tier item set.
If the health system is a house, then general practice is the foundation.
Unfortunately for the occupants, that foundation is cracked – so says AMA president Dr Danielle McMullen, who addressed the National Press Club on Wednesday.
“Over time, those cracks can become structural,” she said.
“If not fixed properly, then what? If patched up with a bit of plaster and paint and a ‘she’ll be right’ attitude, at what point does the house fall?”
The big-ticket item on the AMA’s federal budget submission for 2026, also released on Wednesday, is a restructuring of the GP time-based MBS item set.
More specifically, it wants the current consultation item structure – level A, B, C, D and E – to be replaced with seven tiers.
Instead of a level B covering all appointments between six and 19 minutes in length, the proposed ‘level two’ item would cover consults between six and 16 minutes in length and be worth $46.15.
A ‘level three’ item would cover consults between 16 and 25 minutes in length and be worth $80.10, and so on.
The proposed ‘level seven’ item would cover all consults longer than 60 minutes and be worth $267.05; under the current structure, this would be an item 123 level E consult rebated at $202.65.
By the AMA’s estimate, this would cost a total of $4.88 billion over four years.
Eagle-eyed readers will note that this is not the first time the AMA has proposed this exact restructuring. The seven-tier system was a key tenet of its Modernising Medicare campaign last year, which ran in the lead-up to the federal election.
“General practice is being asked to do more and more with a funding structure that belongs to another era,” Dr McMullen said at the press club today.
“Australians are getting older and our population is living with more chronic conditions. That means the care we are providing to everyday Australians is more complex, takes longer and is more dependent on strong coordination.
“And yet, Medicare still largely rewards short consultations and penalises the time it takes to provide that more comprehensive care.”
While the recent investments in bulk billing were welcomed, she said, they did not address the inequity baked into Medicare.
Another of the GP-facing items included in the AMA’s pre-budget submission this year was removing the Workforce Incentive Program cap to allow general practices to recruit more nurses and allied health staff.
This, the AMA estimated, would cost around $425.5 million over four years, assuming that practice uptake increased from the current 4000 Standardised Whole Patient Equivalent limit to 7000.
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The third and final policy proposal for general practice focused on after-hours care.
“By defining ‘after‑hours’ too narrowly and creating financial barriers for practices to open beyond 8pm, patients are pushed into more expensive and less appropriate care settings, driving preventable complications and fragmenting care when timely access is most needed,” the AMA submission read.
“The AMA recommends aligning the definition of after-hours care with that used for Approved Medical Deputising Services (AMDS): weekdays after 6pm, Saturdays after 12pm, and all day on Sundays and public holidays.
“This alignment would enable more patients to access care from their usual GP or practice team who understands the patient’s history, medications, and preferences.
“This is where preventable complications are most often avoided and continuity of care delivers the greatest value, reducing unnecessary hospital presentations, thereby improving patient safety.”
This proposal also came in the cheapest, at a comparatively modest $410.7 million over four years.
The submission also touched on mandating a minimum payout for private health insurers, a tax on sugar-sweetened beverages and expanding the specialist training program to address the training bottleneck.
In her National Press Club address, Dr McMullen also spoke to the dangers of fragmented care.
“The many front doors being opened in communities are not helpful if they are not connected to a GP,” she said.
“It seems access is the only goal in health policy lately. But to show the risks of access above all else, I’ll share a story, with permission, about a patient of mine, although I won’t use her real name.”
Dr McMullen’s patient, ‘Jane’, was a part-time worker in her mid-50s with asthma.
Feeling short of breath, she attended an urgent care centre and was advised to increase use of her asthma puffer.
A week later, she presented at a satellite hospital with worsening symptoms. Again, Jane was told to use her puffer and discharged.
It was a week after this that she presented to Dr McMullen’s clinic.
“She looked awful,” Dr McMullen said.
“She could barely breathe. Her oxygen levels were low. I listened to her chest – it wasn’t asthma.
“It was something I hadn’t heard in about 10 years. But thanks to my broad clinical training, I knew what I was hearing – or rather what I wasn’t hearing.
“I couldn’t hear any air moving in and out of her left lung.”
After sending Jane off for an urgent same-day x-ray and CT scans, Dr McMullen had to break the news to Jane that she had widespread cancer.
“Telling someone they have a severe, life limiting illness is awful,” the AMA president said.
“But it’s also a privilege.
“My role as a GP is to walk with people through these darkest moments and help them navigate the systems as they find their way through it.
“Thankfully, against all odds, Jane is doing well – but she was keen for me to share her story about the gaps in the system, the ways in which patients can fall through them and the power of having a usual GP.”
