General Practice in the spotlight

A report from the Grattan Institute released this week reiterated the AMA’s calls for Medicare reforms.

Entitled, “A new Medicare, Strengthening general practice”, a new report from the Grattan Institute sparked a wide discussion in the community about the challenges facing general practice, as already highlighted through the AMA’s own advocacy work on General Practice in the AMA’s Plan to Modernise Medicare.

The AMA agreed with Grattan that the Medicare funding model is broken, but as Vice President Dr Danielle McMullen told the Sydney Morning Herald, while fee-for-service is likely to remain the bedrock of our health care system, it needs to be supplemented.

In a round of media interviews, Dr McMullen spoke to a number of the report’s strengths, including support for GP led multidisciplinary care to meet patients’ needs, flexible funding models and the need for a review of current MBS items for standard consultation to reward and quality care and allow GPs to spend the time with their patients that they need. The AMA however strongly differed from Grattan over GP workforce numbers, with a recent AMA report projecting a shortfall of over 10,600 GPs by 2031.

Grattan proposes a range of solutions to fix the funding model for general practice and the AMA will be discussing these with members. Dr McMullen directly addressed AMA GP membership this week to discuss Voluntary Patient Enrolment (VPE) clarifying what it is, and what it is not.

VPE is a key component of the Commonwealth Government’s 10-year primary care reform plan which the AMA was instrumental in developing, and will continue to back.

A final VPE model has not yet been determined, and Dr McMullen stressed VPE is not capitation.

Capitation refers to a payment arrangement for healthcare service providers in which the provider (such as a doctor or group of doctors) receives a set payment per period of time for every patient attributed to them, regardless of the number of times the patient seeks care.

The AMA view is that VPE is just that: enrolment. It is not in itself a funding mechanism, although having patients enrolled may attract funding. The AMA will argue that any funding which arises from services provided to enrolled patients at a particular clinic must be in addition to the Medicare fee-for-service funding.

Discussion on VPE and other issues facing general practice continue with the Department of Health and Aged Care through the Strengthening Medicare Taskforce, but the AMA’s immovable position is that any reform of general practice, including any VPE model, needs to strengthen the position of general practice. The AMA will not support a model that does not deliver additional investment into general practice.

AMA President Professor Steve Robson also wrote to bring AMA members up to date with the advocacy work undertaken on behalf of GP members in recent months, encapsulated in the AMA’s seven-point plan to address the critical issues facing general practice.

In addition to the advocacy work outlined above, the AMA report Why Medicare Indexation matters analysed just one Medicare item — the Level B consultation item — to reveal how successive governments have saved $8.6 billion due to poor indexation since 1993.

The AMA’s report The general practice workforce: why the neglect must end, released in November this year,  showed the degree to which demand for GP services had grown, while at the same time too few GPs were added to the workforce. The AMA’s projections estimate a shortfall of 10,600 full time GPs by 2031-32 unless strategies are put in place to attract and retain the GP workforce.

Modernising Medicare will continue to be a key focus for the AMA during 2023.