Funding the GP-led healthcare teams of the future | AMA (WA)


General practitioner giving consultation

Funding the GP-led healthcare teams of the future

Thursday November 9, 2023

Dr Simon Torvaldsen, AMA (WA) Vice President & Chair, General Practice Group

I have written previously about the structural deficiencies in our Medicare Benefits Schedule (MBS) disincentivising quality care in general practice. This needs to be addressed, if we are to solve the problems of general practice and enable the full potential of primary care.

However, that is only one side of the problem. The other is addressing how this care can be delivered efficiently.

Currently, we have a system that requires GPs to deliver almost all the care. In fact, the so-called ‘upgrade’ of our practice Workforce Incentives Program (WIP) in the 2023 Budget delivered a pathetic 4 per cent increase to the maximum payment. And the maximum that any metro practice is funded to deliver is about 1.3 full-time practice nurses – regardless of whether they have 5, 10 or more full-time equivalent GPs.

What is the answer?

The solution to effective primary care is not outsourcing it to pharmacists writing prescriptions to anyone ticking the right checkboxes. Or fragmenting the care to multiple private nursing and NGO allied-health providers.

The answer is integrated, GP-led team care within the existing, well-established general practice infrastructure.

Not only is this cost effective – leveraging existing centres of primary care excellence – but will also deliver better care. Our general practices are the ‘hospitals of the future’ where most of the healthcare can, and should be, delivered. But hospitals are not staffed by doctors alone. Nor do the staff all work in different buildings and communicate only by mail.

Just as hospitals deliver effective care using a team of healthcare professionals, so will general practice. It is not only inefficient to make GPs perform every task for their patients, but their nursing, pharmacy and allied health colleagues have skills and knowledge in their respective fields that complement a GP’s skillset. Using this extended team will actually deliver better care, provide more cost-effective outcomes, keep more patients away from hospital, and make GPs’ lives easier and less stressful.

The current funding for little more than a single practice nurse within general practice is an outdated, short-sighted and siloed funding approach.

This has to change, if we are to empower general practice to fulfil its potential and do what needs to be done – to manage the increasing burden of complex and chronic care, and to minimise the number of patients ending up in our very expensive and overburdened tertiary care system.

I have advocated very strongly that MBS reform needs to go hand in hand with proper funding to enable GP-led team care within Australian general practice. Pharmacists writing prescriptions based on a symptom checklist is not going to keep anyone out of hospital, or provide any long-term health benefit.

What needs to be done?

I believe the current WIP program is good in principle. But it needs a total restructure and major funding boost to make it work effectively and fulfil the promises above. And a five-GP cap is ridiculous. Why do the patients of a 10-GP practice deserve half the nursing services compared to those attending a five-GP practice?

I believe Federal Health Minister Mark Butler does recognise the power of these arguments, which have been put to him very forcefully. However, funding needs to be delivered to make any meaningful change. The current tinkering around the edges will achieve nothing. A significant commitment is required. Otherwise, we are left with a health system that requires at
least 10,000 more GPs, increasing GP shortages, and ever-increasing attendances at public hospitals.

My belief is that Government has a clear choice. Either properly fund an integrated, team-based, high-quality primary care system within general practice, or pay many times that amount for fragmented, substandard care.

Changes to bulk-billing incentives and minor other benefits are welcome, but they are just a small start. What your AMA is focused on, is clearly delivering this message to Government and ensuring they respond in a meaningful way that will bring real results for you and your patients.