Budget a ‘good start’, but has GP dial moved?

6 minute read

Jim Chalmers had good news for patients, but the benefit for GPs remains in the yet-to-be revealed details. Tell us what you think.

The RACGP and AMA are calling last night’s federal budget a “good start” while acknowledging the “devil is in the details” – but will $5.7 billion worth of reforms really move the dial for the viability of general practice?

Take our short survey at the end of this story to have your say.

The $3.5 billion allocated over five years to triple the bulk billing incentive was hailed today as a game-changer, but it is unlikely that GPs who have stopped bulk billing exclusively will go back.

Dr Nicole Higgins, president of the RACGP said she was “happy and relieved that the government has listened to GPs and the college”.

“As a funding bundle – $3.5b for the bulk billing incentive, $5.9 million over five years for longer telehealth consultations, $445.1 million over five years for the Workforce Incentive Program, including a commitment to indexation, as well as the grants recently announced – this puts GPs front and centre,” she told TMR.

“It shows that GPs are valued. This is only one budget – it’s not going to fix everything – but it’s a good start.”

Dr Karen Price, immediate past president of the RACGP, told TMR the money meant that GPs were “supported to positively discriminate who they will bulk bill and who they will continue to bill privately”.

“This doesn’t mean free healthcare – doctors are not going to go back to bulk billing all the time – but it gives us some balance so people in more disadvantaged areas have similar access to the people in Rose Bay.

“Doctors are very circumspect, and every practice is unique. This will be a welcome shot in the arm for those practices that are struggling because most of their patients need help.”

The additional bulk billing incentive funding will mean that city-based GPs will get $20.65 when they bulk bill patients who are under 16 or who hold a Commonwealth concession card, instead of $6.60. GPs treating eligible patients in the most remote regions of Australia will receive an extra $39.65.

ACRRM president Dr Dan Halliday said the budget was “a first step on a long road to recovery”.

“Tripling the bulk-billing incentive, in and of itself, will significantly impact the ability to address the needs of the higher level of older patients in remote areas,” he told TMR.

“There are some opportunities to look at reinventing models of care, and to work with our allied health and nursing colleagues, and our pharmacy colleagues to reimagine the opportunities available to us in providing models and models of care, particularly those communities in rural and remote areas, and Aboriginal and Torres Strait Islander areas as well.

“There’s a bit of a light at the end of the tunnel. However, it needs a prolonged and sustained commitment to ensure that this initial investment is worth it, and that we do get a return on that investment.”

AMA vice-president Dr Danielle McMullen said the budget measures showed the government was starting to understand the needs of complex care in general practice.

“Longer-term reforms like the increase to the WIP, MyMedicare, longer telehealth consults, reform of chronic disease item numbers and the establishment of long Level E consults will help complex patients who need that time,” she said.

One dissenting voice came from the CEO of the National Rural Health Alliance Susanne Tegen, who said the budget was a “missed opportunity”.

“While there are some modest measures included to improve healthcare access, this is not a budget that will provide rural health improvements – which is disappointing,” said Ms Tegen.

“The Alliance notes that the budget gives overarching measures for healthcare service delivery, however many are not rural-specific.

“We welcome the government’s bulk billing incentive [increase] … this incentive should assist clinicians with some of the additional costs that the tyranny of distance and challenge of servicing remote Australia bring.

“There is also a modest extension to the single-employer trial for GP registrars, allowing them to deliver services in several community-based medical practices without losing benefits as they move between employers,” said Ms Tegen.

“However … the Alliance is disappointed that significant reform of rural health care has still not been tackled, with these modest budget measures failing to address major medical and health workforce inequities. These measures also do not allow for the innovative community-led models of multidisciplinary primary health care that are desperately needed in rural areas.”

Medicare compliance will be a big issue for debate as the details emerge from the budget hype over coming days and weeks, with a possible big stick emerging from the pile of cash carrots.

The government will pour $29.8 million over four years into “strengthening the integrity of the Medicare system” in response to recommendations from the Philip Review.

“A taskforce will be established in the Department of Health and Aged Care to identify and disrupt instances of fraud and serious non-compliance before they occur. The taskforce will also produce immediate policy and legislative amendments, including to:

  • limit the duration of backdated patient-billed claims through practices, to prevent fraudulent claims being submitted through practices;
  • permit appropriate data sharing with Services Australia to allow entities and bank accounts associated with known fraud to be blocked from receiving claims payments;
  • enable the Department of Health and Aged Care to audit providers by removing the requirement for external consultation with peak bodies to occur before issuing a notice to produce.”

Health accountant David Dahm, a regular contributor to TMR, said to “beware governments bearing gifts”.

“Clearly compliance will be getting tighter,” he said. “Yes, they’re tripling the bulk-billing incentive, but will that lead to overservicing? And will that mean you’ll be handing that money back in two years when you’re audited?

“I hope this doesn’t lead to ‘Medicare audit fear’ where doctors are too scared to take advantage of the incentives.”

In the end, most people contacted by TMR today recognise that the government has at least started on a recovery path for GPs.

“Trust needs to be rebuilt,” said Dr Price.

“We’ve been burned for 10 years or more by both sides of politics. There’s a generational wound which has challenged our professionalism. We need to have our expertise valued, and the devil is in the details.”

Dr Michael Bonning, president of AMA NSW, told TMR it was “a good night”.

“The bottom line is we have $5.7 billion that we didn’t have a month ago,” he said.

“There is a lot to still happen and this can be seen as a downpayment. But we still have an excellent health system, one of the best in the world.”

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