Primary care missing from vote-buying budget

8 minute read

GP and other medical groups may look to a new government to implement much-needed reforms.

Healthcare groups, while welcoming some items, have generally expressed disappointment with last night’s federal budget.

Some saw the government’s final budget before the election as simply maintaining the status quo while others went further, arguing it represented a lost opportunity to begin reforming a healthcare system already battered by the pandemic and to attract graduates to the most cost-efficient part of the sector: primary care. 

Funding for long GP appointments, both in person and via telehealth, to support complex care was absent. The funding and implementation of the Primary Health Care 10-year Plan was another key omission, while the colleges and the RDAA were disappointed not to see portability of employment entitlements for GP registrars – one of the key items on their pre-budget wish list.

This budget is effectively the Morrison government’s election pitch, with Treasurer Josh Frydenberg seeking to reassure voters through cost-of-living relief in the face of soaring petrol prices.

The AMA quickly branded the health measures as a “business-as-usual budget” that neglected non-covid health needs. Claims of record spending on health in tonight’s federal budget mask a failure to tackle stress in the health system, the association said, although continued spending on the response to the covid pandemic was welcomed.

“Pleased as we are to see tonight’s budget finally acknowledge the 10-year plan for primary care, we can see no plan for how its implementation will be funded,” Dr Khorshid said in a budget-night statement.

“This budget was the last chance for the government to show it is serious about primary care reform by delivering the extra funding needed to improve patient access to high-quality general practice. While the Health portfolio has been spared funding cuts, the government’s focus on cost of living has overlooked quality of life, particularly for the thousands of Australians languishing on hospital waiting lists.” 

RACGP Karen Price said in a statement that GPs were still under enormous pressure with the covid vaccine rollout, and soon to have the flu vaccine workload added.

“We are helping patients who have delayed or avoided care during the pandemic, including those with mental health issues amidst a looming mental health crisis in Australia,” Dr Price said.

“Tonight’s budget simply did not live up to expectations on the 10-year plan.

“This is very frustrating given the time, resources, and effort we and many other health groups have put in over several years. The federal government has failed to provide much-needed funding to support vulnerable patient groups, including those with chronic and complex disease, and deliver on what is needed to ensure a strong future for primary healthcare in Australia.”

The budget also failed to include funding to implement long-overdue reforms related to voluntary patient enrolment aimed at providing more support for patients who need it most, the college said.

But, speaking to journalists after the budget speech, Health Minister Greg Hunt said the 10-year primary care plan “has been released and is live”.

And in a significant change, he said that access to MBS-funded telehealth would no longer depend on enrolment at a practice.

“The heart of the plan is that we were able to bring forward by a decade our intention to deliver universal and permanent telehealth,” he said.

“As part of the 10-year plan, we are putting in place voluntary patient enrolment or registration. We will now work with medical groups over the course of the next six months to bring that to a co-design that’s acceptable to everybody. We’re not going to have any dependency on enrolment to access telehealth, which is an important change.”

As part of its package to strengthen primary care, the government said it would provide $230.7m over five years, from 2021-22 to 2025-26 – including $205.6m in 2022-23 – to improve access to primary health care services. This would include $23.8m over four years from 2022-23 to support improvements to general practice accreditation and linkages to My Health Record.

It would also provide additional funding to accredited practices for their provision of temporary telehealth services during the pandemic.

Part of this sum was slated to enable communities affected by natural disasters to access continued healthcare services via telehealth.

The government also said it would set aside $56.0m in 2022-23 to support PHNs in commissioning after-hours services and to address broader drivers of after-hours demand. Four million dollars would be allocated for 2021-22 to support approved medical deputising services to redesign business models and integrate after-hours call out and patient information systems.

$7.5 million in 2022-23 would be used to support the MBS Continuous Review to ensure the MBS remains clinically appropriate, the government said.

To help patients with serious and rare diseases make contact with health services and treatment, $200,000 would be allocated in 2022-23 to extending the Patient Pathways Program pilot.

The budget’s rural healthcare package – one of the most eagerly awaited components – includes $224.4m over 4 years from 2022-23 to improve access to health services and support doctors delivering primary care in rural and remote Australia.

$99.3 million over that period would fund an increase in the number of medical students studying in rural and remote locations; $36.2 million is allocated to fund two new university departments of rural health in the southwest and Goldfields regions of Western Australia to support rural medical training; and $33.3m over four years from 2022-23 will go to the Royal Flying Doctor Service in support of emergency aeromedical services.

As part of the aged-care package, $32.8m over four years from 2022-23 (and $2.8 million per year ongoing) is allocated to provide additional clinical placements for students in the care and support sectors and to expand the rural health multidisciplinary training program to five new aged-care demonstration sites.

The RDAA – which had been hoping for the introduction of a single-employer model for rural generalist trainees – said it would be looking for more from an incoming government, regardless of its political colours.

“We have again only seen an entrée of measures for the rural medical sector in this budget, but there is a glimmer of hope that the main course may be in the oven,” RDAA president Dr Megan Belot said in a statement.

 “We now need to see the government deliver on real investment for the rural medical sector – and the Labor Party to show us what it can offer – as we go to the election.”

Australia needed 400 full-time equivalent rural training places for junior doctors if there were to be an impact on the rural doctor workforce shortage, Dr Belot said, noting that this could provide as many as 1,600 junior doctors with a quality rural placement experience.

“The government needs to recognise that only funding medical school places will not deliver doctors to rural Australia – medical school is only the start of a doctor’s training journey,” she said.

The budget’s preventive health measures, including those included in the National Preventive Health Strategy 2021-2030, cover a wide range of areas. However, they do not include the service incentive payments to support provision of a grouping of preventive care services for people aged over 65, those with mental health conditions and those living with a disability. These payments were proposed by the RACGP in its pre-budget submission.

The government has, however, proposed providing $170.2m over five years from 2021-22 (and $4.9m per year ongoing) for preventive health initiatives. Funding includes $40.7m over three years from 2022-23 to address the reduction in testing and screening services due to the covid pandemic by increasing the availability of testing and screening services related to bowel, breast and cervical cancer.

The RACGP welcomed $16.4m to establish new endometriosis and pelvic pain clinics in general practice, ensuring there is frontline, primary care support available to improve early diagnosis, treatment, and care, as well as $5.1m to develop an endometriosis management plan to support patients in primary care.

The government will provide $163.3m over four years from 2022-23 for a package of initiatives to improve women’s health and further support the implementation of the National Women’s Health Strategy 2020-2030. It also includes $300,000 over two years from 2022-23 to assess and promote all MBS and PBS items for diagnosis and treatment of endometriosis.

The RACGP’s Dr Price warned of the consequences of underinvesting in healthcare, especially in primary care.

“This budget will do nothing to attract medical students to the specialty of general practice and this means that the sustainability of the most cost-efficient and effective part of the health system remains at high risk,” she said.

“A failure of investment in primary care puts every other part of the health system in jeopardy. We can’t afford to run out of GPs.”

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