Australian Doctor 10th May issue 2024 | Page 5

NEWS 5
ausdoc . com . au 10 MAY 2024

NEWS 5

Big idea will ‘ blow out the budget ’

Antony Scholefield and Heather Saxena

NURSES and pharmacists accessing GP-level Medicare rebates and “ cashing out ” GP incen-
RACGP president Dr Nicole Higgins fears patients will be subject to unnecessary tests and treatments .
tive programs to pay for multidisciplinary
care are among the
suggestions from the Federal Government
’ s Scope of Practice Review .
Last month saw the release of its
120-page issues paper , which also
suggests MBS funding for allied
health referrals direct to specialists ,
bypassing GPs in the process .
Chief reviewer Professor Mark
Cormack had promised the paper
would canvass policy options for
discussion , and many have turned
out to be radical , with a direct
impact on GP care .
One of the biggest and clearest
suggestions is for equal government
funding for different health professions
doing similar tasks .
“ A priority example of existing
practice is vaccination ( delivered by various professions — including medical , nursing and pharmacy
Professor Mark Cormack .
— and paid at different rates ),” the
paper says .
“ Others include procedural
items , such as catheterisation ,
cannulation , cervical screening
and wound care .”
This would mean either
AAP
opening up existing Medicare
items to more professions or
their practice scope .
health profession can diagnose ,
organisations ” to support a “ flexible
adding more dollars to existing
In the short term , it said , pro-
prescribe and clinically manage
mix of health services to meet the
payments to nurses , nurse prac-
fessional associations and peak
— the review suggested outsourc-
local health needs of their enrolled
titioners and pharmacists , the
bodies would be “ tasked with iden-
ing to an independent body , either
population ”.
review paper says .
tifying and agreeing a shortlist of
one within AHPRA or separate to
It is unclear who — Medicare ,
RACGP president Dr Nicole Hig-
referral pathways ”.
AHPRA .
the Federal Government , Primary
gins warned it would “ blow out the health budget ”.
“ We will end up with an MBS that is out of control ,” she said .
“ Having open access to the MBS and PBS , our health system cannot cope with the cost .
“ GPs are trained around the clinical reasoning for ordering tests and prescribing medications ; the skill of general practice is knowing when not to order a test or medicine .
deemed appropriate by decision-makers ,” the review said .
“ GPs are expected to be less burdened by low-value episodes of care where the consumer seeking a referral has already been instructed to do so by a relevant health professional .”
It acknowledged that a “ proliferation of referrals ” could clog
But it outlined a scenario where a consumer experiencing pain associated with an acute musculoskeletal injury visits their physiotherapist for assessment .
“ The physiotherapist is enabled to refer the patient for diagnostic imaging and to an orthopaedic surgeon for their opinion on treatment options .
“ This streamlined referral pathway includes digital notification
‘ Our health system cannot cope with the cost of having open access to the MBS and PBS .’
Health Networks — would oversee this .
But the funding streams that the review has suggested assimilating include the following :
• Workforce Incentive Program
• Practice Incentive Payments
• Chronic disease management MBS items
• MyMedicare benefits and incentives
• Primary Health Network commis-
“ That saves the health system money .”
Another key recommendation was letting non-doctors refer to
waiting lists , overwhelm non-GP specialists and lead to a “ sharp increase ” in MBS costs , “ impacting overall system sustainability ”.
of the consumer ’ s home GP , where available , but reduces the requirement to visit the GP to obtain referrals .
In another illustration of its ambitions , Professor Cormack ’ s review also suggested “ cashing out ”
sioning funds
• MBS special aged care items
• Medication review items .
It suggested that an organisation
allied health or specialists under Medicare , although Professor Cor-
But it argued a “ staged approach ” could protect against
“ The result is a more efficient process and an improved consumer
dozens of GP payments to pay for multidisciplinary care teams “ work-
comparable to the PBAC , the Medical Services Advisory Committee
mack urged a cautious approach by
this .
experience resulting from fewer
ing to their full scope ” through a
or the MBS Review Taskforce could
starting small .
The report said , under the
unnecessary GP visits and quicker
wide , blended funding stream .
also advise governments and other
“ Additional referral pathways
expansion , non-doctors would be
access to required treatment .”
It suggested that funding go
regulators “ on how the scopes of
may subsequently be considered for
free to order MBS-funded tests and
In terms of what is maybe the
to general practices , practice
practice for health professionals can
incorporation into the act and MBS as
imaging , providing they work to
key issue — who decides what each
groups and “ primary care provider
continue to meet community need ”.

GPs unburdened of low-value care ? I ’ m angry , not grateful

WHY is it that everyone is always prepared to tell me what I think ?
This report states that GPs are expected to be less burdened by low-value episodes of care when “ the consumer seeking a referral has already been instructed to do so by a relevant health professional ”. I am not “ burdened ” by these consultations because , weirdly enough , healthcare is a service , not the purchasing of a product .
I think about the referrals I make : those consultations actually matter .
If they do not , why bother using referrals at all ? Why not use the US model and let the patient ( who knows their own body ) go straight to the specialist with no referral at all .
I am not grateful for being “ unburdened ”.
On behalf of my patients , I am infuriated that large and powerful unions have managed to lobby for the shiny things they want instead of honestly serving the real needs of patients . Dr Louise Stone , Canberra GP . See Guest Editorial , page 14