It was a year of payroll tax, Medicare investments, reviews galore and more payroll tax. Here’s what's to come in 2024.
With 2023 drawing to a close, The Medical Republic sat down with leaders from three of the biggest doctor organisations to chat about the highs and lows of the year that was.
Top of the highlights lists for ACRRM president Dr Dan Halliday was the transition back to college-led GP and rural generalist training in February.
“Admittedly, there have been a few teething issues through the course of the year, things we needed to learn as we expanded our network and our communities of practice into the different states and territories,” he told TMR.
“But I feel that we’ve been able to deal with those as we needed to.”
In all, he said, the process has been “smoother” than expected – thanks, in part, to ACRRM and the RACGP creating a joint venture to manage aspects of the transition.
“Having been involved the transition of GP training since the start, albeit with another organisation, it’s been so satisfying to see the results … and to be able to have GP training return home to college,” said RACGP president Dr Nicole Higgins, who previously chaired GP Supervisors Australia.
Arguably the biggest news of the year came in May, when Health Minister Mark Butler announced new funding for Medicare.
“To be there [in parliament house] when they announced what is effectively the biggest investment in general practice for last 10 years was very humbling,” Dr Higgins told TMR.
While the tripled bulk billing incentive for certain time-based consults soaked up most of the attention, there were also promising developments in other areas.
“One bit that people may have missed was the commitment to a wound consumables scheme,” AMA vice president Dr Danielle McMullen said.
“We know that GPs really struggle with trying to provide care for people with chronic wounds, because of the cost of dressings and the difficulty for patients to access those.”
Dr McMullen told TMR that the association had been working to get a wound consumables scheme up and running for years.
The May budget, she said, was a strong sign that the government is interested in fixing primary care.
“We recognise the tripling of the bulk billing incentive, while it’s not going to fix general practice, is an injection of funding to buy some time to get the ball rolling on longer-term reform measures,” said Dr McMullen.
This year, GP practices across the east coast have been hit with retrospective payroll tax bills reaching into the hundreds of thousands.
While some states are yet to budge, others have agreed to amnesty periods and working alongside the AMA and RACGP to come up with workable solutions.
“It’s still a work in progress, obviously, but it certainly reached the agenda at all state and territory levels,” Dr McMullen said.
“And I think people are increasingly recognising the impact it’s having on the sustainability of general practice.”
With no national solution on the cards, payroll tax issues will likely be rolling right through into 2024. And the ATO, as TMR has been predicting for months, may yet prove a bigger threat to practices and GPs.
Practice costs have risen so much this year that the AMA had to adjust the way it calculated its recommended fees list.
It did so after a second round of government-led indexation, which saw item numbers on the MBS go up by about half a percentage point.
Rural generalist recognition
It’s a multi-year process, but rural generalism got one step closer to official specialtyhood in the second half of this year.
The most recent consultation push wound up earlier this week, and an outcome is expected by June.
“That will be signed off and hopefully put into the required frameworks by the end of [the financial year],” Dr Halliday said.
Rural generalist recognition will send a positive message about the value of the practice and profession, Dr Halliday said.
There’s still a chance that it could be opposed, but that seems extremely unlikely at this stage.
If 2023 has been all about reviews and reports, 2024 will hopefully be about action.
“We’re seeing reviews into scope of practice, into the PIPs and WIPs, into after-hours care,” Dr McMullen said.
“We’ve had reviews into employment reform for GP registrars and planning for MyMedicare.
“2024, I think, is going to be another really busy year in general practice advocacy.”
Getting these reforms over the line next year will be particularly critical, given that many of the contracts that govern primary care – PHNs, training organisations, etc – are up for review in 2025.
“The opportunities for general practice are that we will be able to have an increased scope of practice,” Dr Higgins said.
“[If we] had that recognised, I’d expect increased funding to come with that.
“The challenge is that of changing the narrative away from GPs in crisis to general practice as a solution.”
Dr Higgins also foreshadowed an incoming announcement on a GP registrar portability of entitlements scheme early in the new year.
She also hinted at changes to the way the RACGP operates.
“It’s going to be a year where we focus on our core values, which is education and training and standards, while continuing to advocate for the profession,” she said.
“I’m looking forward to working with our interim CEO, who understands membership organisations and medical colleges.”