GPs warn of worse access and more waste under Scope of Practice recommendations

The Royal Australian College of GPs (RACGP) has urged the Federal Government to exercise caution in its assessment of the recommendations of the Scope of Practice Review report, warning some recommendations will make seeing a GP harder for more patients.

The College said some of the report’s recommendations may sound good on the surface but will result in a costlier health system, more delays to care, and higher out-of-pocket costs for patients.

The RACGP is particularly concerned about the proposal to open direct referral pathways to more health professionals.

RACGP President Dr Nicole Higgins said: “This is a report, not a plan, but its recommendations will raid Medicare and set us up for a two-tiered health system where those who can afford to see a GP will, and those who can’t, don’t.”

“Direct referral to a specialist for something a GP can do won’t make our health system more efficient or cheaper for patients.

“This isn’t gatekeeping, it’s coordination of a patient’s care by a GP who knows them, their context, and their history, and who can make the link between the medical implications of different types of care and results and a patient’s health and needs. Dropping that coordination will lead to a free for all, without a GP’s oversight to ensure care is necessary and in a patient’s interest, and not doctors and other health professionals duplicating each other’s work.

“There’s also a risk of more inappropriate referrals as patients are sent to non-GP specialists in greater numbers, including specialisations already facing workforce shortages. That will increase out-of-pocket costs for patients already struggling with cost-of-living pressures, and delay their care as they wait to see specialists already in short supply.

“GPs can and should be part of the solution. Allowing GPs to provide more services and prescribe more medicines will reduce patient costs and wait times. This could include allowing GPs to provide more acne treatments, diagnosis and management of ADHD, iron infusions, and medicines with dementia, reducing the need to refer to other specialists.

“There is no substitute for the quality care you get from a GP who knows you, and your history. Every year, more than 22 million Australians choose to see a GP for their essential healthcare.

“These Australians deserve affordable and accessible GP care. GPs have the highest qualifications in primary care, over 10 years training – and our training matters.”

The RACGP however gave conditional support to the recommendation of a body to provide evidence-based advice on workforce innovation – provided it is politically independent – and gave cautious support to the recommendation for funding and the introduction of a new blended payment to enable access to multidisciplinary health care.

She said: “If it’s implemented well, a blended payment model that continues to support fee for service would give general practices more flexibility to employ or engage different health professionals in a multidisciplinary care team. Fee for service is important because it gives practices the flexibility to meet their patient’s need and local context. For patients, that means more services under one roof, so you can receive a referral from a GP and see a psychologist, physio, or pharmacist who works down the hall and who has a more complete knowledge of your health issue.

“And the proposal for a truly politically independent mechanism for health workforce innovation could help to create more patient-focused initiatives like this. Reforms must be evidence-based, not political, as we’ve seen with the haphazard and at best inconsistent rollout of pharmacy prescribing models, without evaluation of their health outcomes. An independent body should help to ensure future reforms are, first and foremost, in the interest of patients.”

But Dr Higgins also warned the Government to consider issues patients have experienced where politicians sought to substitute non-medically trained health workers for GPs.

“We’ve seen the human cost of politically driven health policy in the UK, where austerity has been used to excuse lower quality care,” she said.

“Rather than investing in general practice, they substituted less qualified health professionals without medical training for GPs – it was disastrous. There was not just lower quality care, but real harm, including misdiagnosis that ended with a patient’s death.

“We mustn’t make the same mistake. Australia has a world-class health system, but it hasn’t been funded properly for decades. While the Albanese Government tripled bulk billing incentives for pensioners, children and healthcare card holders, previous governments stripped general practice of funding and froze Medicare. As a result, our health system is struggling, and patients’ Medicare rebates don’t come close to the real costs of care.

“The solution is not raiding Medicare to create a two-tier health system, where only the wealthy can afford the care needed to stay healthy. Yet, that’s what this review recommends.

“Funding gets results. We can't fix our health system without it. We need meaningful investment in patients’ Medicare subsidies, and the RACGP has long been calling for an increase in rebates for 20-minute and longer consults.”

~ENDS

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