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Australia has an excellent primary health care system, the key to which is the provision of comprehensive, continuous, and coordinated patient-centred care by general practitioners.

General practice is the backbone of the Australian health care system, with more than 113 million services provided by GPs each year under Medicare arrangements. It’s a fact that high-quality general practice care in the community keeps people out of hospitals. We also know that a strong general practice-led primary care system improves equity of access for patients to health care services and that Australia’s GP-led model of primary health care services delivers affordable high-quality health care outcomes.

The Australian community places a high value on care provided by GPs, with research commissioned by the AMA showing that 88 per cent of patients have their own family GP.  The same research shows that patients trust their family GP and they want to be able to spend more time with that doctor when they or family members are ill or seeking advice about their health.

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The evidence clearly shows that there is a positive impact on the quality of care provided, and there are better health care outcomes, when GPs can spend more time with their patients. A system that is designed to better support GPs would provide much-needed relief from the pressures of red tape and workforce shortages, help improve the management of chronic and complex disease, and give GPs more opportunity to talk to patients about their preventative care needs.

Patients also benefit through the involvement of other health professionals in their care as part of well-coordinated, GP-led primary care teams. This improves access to care, including allied health services.  While there have been some reforms to improve access to practice nurse and GP-referred allied health services, the reality is that much more could be done to help patients.

Current Medicare arrangements also fail to recognise the important advances in technology that could help improve the care provided to patients through general practice. MRI is a well-established and valuable technology and the current Government’s own review found that Point-of-Care Testing (PoCT) in general practice is just as effective as more traditional pathology testing arrangements.

Patients want their GP to have access to the best possible diagnostic tools to help manage their care needs. This can provide more timely access to care and support improved management of patient care needs.

At the same time, individual patients should be encouraged to take responsibility for their own health, based on the advice they receive from their GP.

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There is clear recognition of the central role played by GPs in high-quality patient care. The role of general practice will be critical to the next Government’s hopes of reducing avoidable hospital admissions and ensuring that precious health dollars are spent wisely.

The goal for the next Government must be to improve patient access to GP services. The next Government must ensure that GPs are better supported in their role and relieved from the current burden of red tape. Patients must receive a Medicare rebate that reflects the value of the care provided by GPs.

Some estimates indicate that GPs must spend up to nine hours a week complying with red tape obligations. For every hour that a GP is tied up doing Government paperwork, about four patients cannot get to see that doctor.

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The role of general practice as the cornerstone of a good primary care system must be strengthened, not substituted.  GPs are under enormous pressure. The next Government must:

• Support patients’ right to choose their GP;
• Support patients’ right to see their GP as often as they need to;
• Support the central role of GPs in delivering health care and advice to patients and their families;
• Provide support that will enable patients to spend more time with their GP when they need to;
• Cut red tape to minimise the paperwork and processes that reduce the time that GPs can spend caring for patients.

MBS reform and simplification and indexation

The current Government’s simplification of the MBS, which commenced on 1 May 2010, has not delivered the red tape reductions that GPs had been promised. While the number of items has been cut, the structure of items and associated red tape requirements do not support modern day general practice. At the same time, the real value of patient rebates continues to be eroded because MBS indexation has not kept pace with the increasing costs of running medical practices.

The next Government must urgently order a comprehensive review of the MBS to modernise the GP consultation items, cut red tape, and ensure that patient rebates for services provided by all medical practitioners reflect the value of the service provided.

Slash red tape

General practice is drowning in red tape.

In addition to delivering the MBS reforms and simplification required (as outlined above), the next Government must implement the previous recommendations of the Productivity Commission and other reviews to reduce red tape in areas such as authority prescriptions, practice incentive program requirements, provider number arrangements, chronic disease item numbers, and other Government programs.

GP infrastructure funding

Existing general practices need an immediate injection of funds for vital infrastructure such as teaching rooms and extra facilities that support the provision of multidisciplinary care in general practice. The current Government announced $355 million for infrastructure funding in the 2010-11 Federal Budget, only about one-third of which is allocated to infrastructure grants to expand existing practices.

Rather than establish another 23 GP Super Clinics, the next Government must make these funds available so that more existing GP practices can expand their facilities and deliver benefits to more local communities.

Practice nurses

Practice nurses have been one of the success stories in improving access to GP services, with more than 8500 now employed in practices across the country. The current Government has said it will provide additional funding to increase practice nurse numbers. While we support this objective, feedback from GPs indicates that there is widespread concern about the design of the proposed new arrangements.

The next Government must rethink the proposed practice nurse subsidy arrangements and negotiate with the profession to ensure effective implementation that does not disadvantage GPs or practices.

Primary health care organisations – Medicare Locals/Divisions of General Practice

It is important that patients, under the guidance of their GP, can access appropriate services that support their health care needs.

The current Government has announced that it intends to replace the existing Divisions of General Practice with Medicare Locals to coordinate local primary health care services. The Opposition has announced that it will retain the Divisions of General Practice that provide specific support to local GPs.

The next Government must ensure that any arrangements to support local general practices and provide coordination for primary care services complement the work of GPs and work effectively with any governance arrangements that are introduced for hospitals.

The next Government must also ensure that bodies that provide coordination for primary care and assist general practice do not become ‘managed care’ organisations and do not increase the red tape load on general practice.

To be effective, they must have strong GP leadership, a local focus, and minimal bureaucracy. The services they support must be designed at the local level around the clinical needs of patients and be based on the advice of local GPs and be accountable to them.

GP-referred MRI

Modelling undertaken for the AMA has demonstrated that GP-referred MRI can save money and improve the timeliness of access to care.

The next Government must implement GP-referred MRI, based on best practice clinical protocols to govern its use.

The next Government must also commission the AMA, the Royal Australian College of General Practitioners and the Royal Australian and New Zealand College of Radiologists to agree on appropriate guidance to promote the safe and cost effective implementation of GP-referred MRI.

Point-of-Care Testing (PoCT) in general practice

PoCT has been shown to yield significant benefits in the treatment of chronic and complex disease by providing timelier test results that enable GPs to better manage the care of their patients.

The next Government must fund PoCT in general practice through the introduction of relevant MBS rebates.

* For a full pdf version of the Key Health Issues for the 2010 Federal Election click here