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2019 Federal Election GP Campaign Kit

The 2019 Federal Election campaign is underway and health is once again a major policy issue for all political parties. The AMA has developed a campaign kit of tools that our GP members can use to advocate for key issues relevant to health and the medical profession during the Federal Election.

About the AMA

Key health issues for the 2019 Federal Election

How can you be involved?

The strength of the AMA is the voice of our members. Passionate and dedicated GPs who are willing to make their voice heard can talk to their local candidates and the media, especially in marginal seats. To help with this, we have compiled a series of resources you can use throughout the Election. These include one-page handouts on key priority areas you can give to politicians, drafts of letters you can personalise, and a gap payments poster highlighting the impact of the Medicare freeze on patient rebates. 

Resources

Key priority areas:

All of the documents are collected at the bottom of the page.

Thank you for being part of the AMA GP campaign for the Federal Election. Your support and assistance in ensuring general practice is a key election issue is greatly appreciated.


Support for longer GP consultations

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Increase support for longer GP consultation through the introduction of an “extended” Level B MBS consultation item that recognises the extra work involved for those GPs who spend more time with their patients.
  • The Australian population is getting older and sicker. As the population ages, treatment and management of chronic disease is required for extended periods of a person’s life.
  • This is important for all Australians, but especially for Aboriginal and Torres Strait Islander patients, who experience multiple medical conditions and more disability at a younger age. As a result, the cost of healthcare for governments and individuals is increasing at an unsustainable rate.
  • The average patient consultation is more complex than ever, requiring extensive time and skill from a GP. GPs are increasingly finding it unsustainable to cover the costs of providing care solely through the MBS patient rebate.
  • Almost half of all Australians, and 87% of Australians over the age of 65, report having one or more chronic disease or condition. Yet, the value of the patient’s rebate decreases significantly as they spend more time with their GP, penalising patients who require longer consultations.
  • For example, for a Level B Consultation (the most commonly used item) in which the patient will be reimbursed $37.60, there are disincentives for GPs to provide longer consults. They will be reimbursed the same amount for a six-minute consultation as they will for a 19-minute consultation (the value of Medicare rebates drops from $6.27 per minute at 6 minutes to $1.88 per minute at 19 minutes).
  • Additionally, after years of the Medicare freeze, during which MBS rebates were not indexed, the reimbursement for all MBS items is inadequate.
  • It is essential that GPs are supported to provide patients with complex care when they need it. However, providing complex care takes time and the current MBS structure is not designed to adequately support this type of care.
  • Failure to support longer consultations in the general practice setting will inevitably result in increased hospital presentations and increased government costs, as GPs will be unable to continue to bear the cost of providing complex care.
  • The next Government needs to increase support for longer GP consultation through the introduction of an “extended” Level B MBS consultation item that recognises the extra work involved for those GPs who spend more time with their patients. 

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Improved access to After-hours GP services

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Improve access to after-hours GP services for patients by bringing forward the Medicare definition of after-hours in-rooms consultation items so that they commence at 6:00pm on weeknights and 12 noon on a Saturday.
  • The organisation and provision of after-hours primary health care services is an important element of the overall health care system. Access to primary health care, including after hours, is considered an important element of high-quality health care.
  • When people become ill outside normal business hours, they often need to access after-hours health care services or advice. Choice of which service to access is influenced by a range of factors such as where they live, the time of day, the accessibility of health care services and mode of delivery.
  • Primary health care is often the first port of call in meeting after-hours health care needs across the country and in so doing reducing health inequity, lowering rates of avoidable hospitalisation and improving health outcomes.
  • Access to after-hours GP services is a critical part of the health system for patients. Many families depend on these services, but they should not be seen as a substitute for a visit to a patient’s usual GP. If a patient can wait until the next day to see their usual GP, or attend their usual general practice, that is the best option.
  • The after-hours period has traditionally been defined as: being before 8.00 am and after 6.00 pm on weekdays, before 8.00 am and after 12.00 pm on Saturday and all day on Sunday and public holidays.
  • While this is the case for non-urgent after-hours attendances at a place other than consulting rooms, for non-urgent after-hours attendances in consulting rooms (Items 5000, 5020, 5040, 5060, 5200, 5203, 5207 and 5208) the after-hours period is: before 8am and after 8pm on a weekday, before 8am and after 1pm on a Saturday, and all day on Sunday and public holidays. In recent times, the Government has made a number of changes to MBS funded urgent after-hours GP services to ensure quality after-hours care is available to all Australians.
  • In line with the goal of providing quality care, the AMA is also of the view that the Medicare definition of after-hours in-rooms consultation items should be brought forward so that they commence at 6:00pm on weeknights and 12 noon on a Saturday.
  • This will encourage more practices to provide extended hours of services and will improve access to after-hours GP services and continuity of care.

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Introduction of specific MBS rebates for GP telehealth consultations

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Introduce specific MBS rebates for GP telehealth consultations provided by a patient’s usual GP for:
    • After-hours services;
    • Patients with a GP Management Plan; and
    • Patients in residential aged care facilities.
  • Telehealth has the potential to considerably enhance access to general practitioner services for specific patients’ groups and deliver productivity gains in general practice.
  • At present, Medicare will only support GP consultations that are provided face to face, with the exception of recently announced limited funding to support rural GPs in remotely providing mental health support to patients in drought-affected areas.
  • In contrast, Medicare has allowed patients receiving care from an Aboriginal health service or living in rural areas or a residential aged care facility to access care provided by non-GP medical specialists via telehealth since 2013.
  • The Australian government must improve access to care by supporting patients to participate in telehealth services with their regular GP.
  • Enabling patients to connect with their preferred GP in a way that fits their lifestyle will foster stronger GP-patient relationships and enhance opportunities for continuity of care.
  • Telehealth could considerably enhance access to general practitioner services for: Indigenous populations in remote Australia; residents of aged care facilities; and for rural, remote and outer metropolitan patients who have difficulty attending general practices because of mobility problems or because of distance.
  • The AMA has highlighted problems with ongoing access to medical care for residents of aged care facilities for many years.
  • The Federal Government’s telehealth initiative provides incentives for aged care providers to set up video conferencing facilities. It is extremely inefficient for these facilities to be used only for referred specialist consultations.
  • Medicare rebates for GP video consultations with residents of aged care facilities would improve the efficiency of providing follow-up care by GPs, and ensure full use is made of existing Government-funded video consultation facilities in aged care centres.
  • Similarly, there are rural, remote and outer metropolitan patients who have difficulty attending general practices because of mobility problems or because of distance.

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Wound Care

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Support patients with hard-to-heal wounds by funding the costs of dressings for patients who:
    • Have a diabetic foot ulcer or diabetic leg ulcer; or
    • Have a venous or arterial leg ulcer; or
    • Are 65 years of age and over.
  • It is estimated that more than 400,000 Australians are suffering from a chronic wound, including venous leg and diabetic foot ulcers, which can take months or even years to resolve.
  • This can involve multiple visits to GPs and practices to have dressings changed, and to discuss nutrition, exercise, and other ways the patient can look after their wound themselves to help the healing process between appointments.
  • Many of these patients are older Australians. Many are on limited or reduced incomes, due to their stage of life or their reduced capacity to work due to their condition.
  • Where possible, their GP will bulk bill patients for their care. But GPs and practices are increasingly unable to absorb the cost of providing the bandages and dressings that their patients need each visit, which can cost between $4 and $50 per patient.
  • Under Medicare restrictions, GPs cannot bulk bill a patient for a consultation and charge the patient the cost of the bandage.
  • This means that they have to decide between bulk billing the patient and absorbing the cost of the bandage themselves or charging the patient for both the consultation and the dressing.
  • General practices, after years of frozen and inadequate rebates for the cost of care, are just not in a position to subsidise this cost any longer.
  • In many cases, patients buy their bandages or dressings at market rates from a pharmacy, just so the GP treating the wound can bulk bill them for the consultation without falling foul of legislative restrictions.
  • Chronic wounds are debilitating for patients, causing a myriad of complications including constant pain, social isolation, and depression or anxiety, and the cost of bandages and dressings is prohibitive for many people.
  • As such, there is an imperative for the Government to support best practice care.
  • A precedent already exists, with GPs allowed to charge for a vaccine when bulk billing a professional attendance item.
  • KPMG, in an evaluation of the use of compression bandages for patients suffering venous leg ulcers, estimated back in 2003 that $166 million a year could be saved with their use.

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Lifting the caps on subsidies for the Workforce Incentive Program

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Support enhanced access to GP-led team-based care for patients by lifting the caps on subsidies available through the incoming Workforce Incentive Program, better supporting the employment of nurses, pharmacist, and allied health professionals in general practice.
  • An effective way to deliver quality care is through GP-led multidisciplinary care teams. Planned multidisciplinary team-based care has been demonstrated to improve outcomes in patients with chronic disease in primary care.
  • With a growing move towards GP-led multidisciplinary team care, allied health practices, which are typically small or solo operations, are increasingly co-locating with medical practices. Likewise, the growing burden of chronic disease and an ageing population, along with a recognition of the benefits of care planning, means general practices are bringing “in-house” allied health providers who can contribute to the patient’s health care management.
  • To support GP-led team-based care, from 1 Janurary 2020, the new Workforce Incentive Program will streamline existing GP, nursing and allied health incentive programs, replacing the General Practice Rural Incentive Program (GPRIP) and the Practice Nurse Incentive Program (PNIP).
  • Under this new program subsidy support will be extended to assist general practices to employ other health professionals, including non-dispensing pharmacists.
  • According to the Government, around 5,000 practices and more than 7,000 medical practitioners will be eligible for incentive payments under the Workforce Incentive Program:
    • Under the Practice Stream, eligible practices can receive incentive payments up to $125,000 a year. A rural loading will also be applied to practices located in MM3-7.
    • Under the Doctor Stream, eligible doctors located in MM3-7 can receive a maximum annual payment of up to $60,000.
  • Payments under the current incentives, however, are not indexed. This means the incentive payments do not keep pace with inflation and thus become less effective as an incentive over time.
  • The costs of running a medical practice are inextricably linked to the cost of wages and the Consumer Price Index (CPI). With wages increasing around 2% per annum and CPI increasing on average by 1% over the last 10 years, the non-indexation of incentive payments overtime significantly decreases their value and effectiveness.
  • Capping the funding that a practice is eligible for inhibits the capacity of practices to evolve and expand the range of health care services they can provide to meet their patients’ health care needs.
  • If the value of the incentives provided by the Government are not maintained in real terms then year on year the Government is effectively disinvesting, in this case, in both general practice and rural health. Caps on incentive payments are also affected by this yearly devaluation and restrict the capacity of practices to grow and enhance the practices’ health care team.
  • The next Government needs support enhanced access to GP-led team-based care for patients by lifting the caps on subsidies available through the incoming Workforce Incentive Program, better supporting the employment of nurses, pharmacist, and allied health professionals in general practice.

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Improve conditions for GP Registrars

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • publicly commit to an immediate review of the employment model for the GP training program.
  • Since 2015 we have seen a 20 per cent fall in the number of applications for GP training and a 6 per cent drop in the number of first year GP training posts filled. This is despite Australia graduating around double the number of medical students it did ten years ago.
  • An undersupply of general practitioners could lead to a situation where patients are forced to attend hospital emergency departments for primary health care. Already, rural and remote communities struggle to employ and retain GPs.
  • GP registrars earn significantly less than their hospital-based counterparts when they first commence work in a general practice. Some may earn up to $500 per week less.
  • The current employment model for GP registrars also means that their leave entitlements are much less generous, and unlike the public sector, this leave is not portable as they move around to meet their training requirements.
  • GP trainees who have children are also particularly vulnerable, with no access to paid parental leave other than the Government’s own scheme in contrast to public sector trainees.
  • The National Rural Generalist Pathway Taskforce recommended the establishment of a ‘single employer’ model for rural generalist GP trainees so that they were not disadvantaged in comparison to their hospital-based colleagues and recruitment to the pathway is encouraged. This has not been proposed for GP trainees outside the pathway.

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GP Mental Health Program

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • The AMA calls on the major parties to commit to fund a dedicated general practice based mental health program that allows GPs to provide coordinated care and case management and deliver improved health outcomes in patients.
  • Patients now see their GP for mental health more than any other health issue, and this trend is increasing. Despite this minimal funding has been directed to general practice to allow GPs to provide mental health services.
  • According to Medicare data, 2.4 million Australians (9.8% of Australians) received Medicare-subsidised mental health-specific services in 2016–17. This is an increase from 5.7% in 2008–09.
  • Most OECD countries spend between 12% and 16% of their health budget on mental health services, while Australia only spends less than 8%.
  • More access to mental health assessment facilities for public patients is also required. This should include more and better resourced mobile outreach teams operating extended hours for high risk patients.

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Long-term measures

Handout for politicians

Letter to the editor

Talking points:

The AMA calls on the major parties to:

  • Commit to working with the profession to design and implement a more robust long-term funding model for general practice, which builds on existing fee-for-service arrangements and enables patients to access improved care in the community.
  • The key to successful long-term health reform is to properly fund and invest in primary care, especially general practice. 
  • While the immediate measures highlighted above will provide much-needed support for general practice in the short term, a long-term funding plan is required to transform general practice into high performing patient-centred medical homes.
  • This transformation is necessary to ensure general practice can rise to the challenge of delivering quality care – which is patient-centred and cost effective, and which will reduce patients’ need for more complex, high-cost health care to patients, particularly to those with chronic disease or at risk of chronic disease.
  • In this context, the next Government needs to commit to working with the profession to design and implement a more robust long-term funding model for general practice, which builds on existing fee-for-service arrangements and enables patients to access improved care in the community.

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For more information please contact Nick Elmitt (nelmitt@ama.com.au) on (02) 6270 5400.  

 

All Campaign Kit documents