Allied health groups are urging the federal government to consider new Medicare funding models to let patients see nurses, physiotherapists or counsellors as their first point of call, saying overcrowded GPs with long waiting lists cannot remain as the sole entry point for the medical system.
Labor’s strengthening medicare taskforce, to report within weeks, is expected to recommend major changes to health funding and expanding rebates to more services. Several taskforce members outside general practice, including the Allied Health Professionals Australia national chair, Antony Nicholas, said a shortage of GPs means people need more access points to receive care.
“General practice has served Australia well with quality care but over the last decade it’s been a gradual decline … clearly we need something different,” he said.
“We have a primary healthcare system hinged on GPs being the gatekeeper to care, and if that’s already challenging and only going to get worse, then there have to be other alternatives.”
As Labor promises the “biggest revamp” to Medicare in history, with a $750m commitment to fund taskforce recommendations, professional groups are jockeying for their slice of the pie. Nicholas said there was complexity in the argument because while organisations such as the Australian Medical Association and Royal Australian College of General Practitioners advocated boosting Medicare rebates for GP appointments to encourage more bulk-billing doctors, others backed different options to accept patients.
“There’s no one silver bullet,” he said. “We might need three or four different models, maybe not just one model will solve it for everybody.”
The health minister, Mark Butler, said the government would retain a focus on fee-for-service care, but put more cash into “block” funding for patients with complex conditions who require teams of specialists. This aims to better resource staff to coordinate treatments and develop care plans.
Nicholas said allied health groups wanted more funding through Primary Health Networks, which would then fund allied health. He suggested skirting GP shortages by allowing other professionals to become the “coordinator” of a person’s care plan.
“It’s obviously important the GP is involved, but in some models, it’s another person’s job to be the coordinator if you need to see a dietician, podiatrist or physiotherapist,” Nicholas said. “That’s different to the GP diagnostician being in control of your healthcare.
“Many practice nurses are giving people this advice now, there’s just no billing model for it. People might spend more time with the nurse than the doctor already.”
He said Australians were currently “reliant” on GPs to begin care, “but they shouldn’t have to be”.
Others in allied health believe Australia’s medical system is approaching a “tipping point” where a shortage of GPs may necessitate larger changes to health structures.
“No single health practitioner or discipline can manage the complex care of so many people in the community,” said Karen Booth, who is the president of the Australian Primary Health Care Nurses Association and a member of the Medicare taskforce.
“All these other health professionals are contributing to patient care, but it’s not funded adequately so they can share the load,” she said.
Booth was critical of nurses not being better resourced to see patients. She suggested nurses be funded to treat patients with chronic conditions requiring regular non-acute appointments to free up GPs to treat patients with more urgent needs.
“The funding model funds doctor services rather than the activity of the patient,” she said. “We need to change our thinking.”
The president of the Australian Physiotherapy Association, Scott Willis, agreed. He is advocating for more Medicare funding to allow people to directly attend a physiotherapist or other health service as their initial visit.
“In this era, all conditions don’t need to be controlled by a GP,” Willis said. “A lot do, but there are areas of care other health professionals can help in assisting [to] reduce the burden.
“One in six presentations to a GP are for musculoskeletal concern. If you take that out of the equation, and it’s a physiotherapist taking that role, you alleviate the burden of GPs and help patients.”
He criticised “legislative barriers” that meant patients couldn’t get a Medicare-backed specialist’s visit in the first instance.
“Patients can see a physiotherapist if they pay for it in the private sector, and that works very well, but it can also work under Medicare for someone needing acute care for back pain or a knee injury,” Willis said. “A physiotherapist could be a first contact practitioner if funded by Medicare, to see if they need to have a scan or MRI.
“I agree with the minister that we can’t keep pumping more money into the same system and expect it to serve the community the way we want.”
Willis said more block funding would lead to better patient outcomes for complex needs, by encouraging professionals to develop coordinated care plans and communicate better between services.
Booth said the move from purely fee-for-service would benefit patients.
“The current funding mechanism means a practice only gets paid when a patient turns up to see the doctor,” she said. “It doesn’t fund thinking ahead, big picture.”