NewsGP, the news hub of The Royal Australian College of General Practitioners (RACGP), runs a weekly poll to gauge GP perspectives on various health and medical topics. In this article, we provide a summary of poll results for last year - exploring what mattered to general practice in 2023, and the challenges that are set to continue in 2024 and beyond.
GP PERSPECTIVES ON GOVERNMENT POLICIES, LEGAL AND ADMINISTRATIVE PROCESSES, AND HEALTH AUTHORITIES:
Payroll tax still threatens GP practices
- Most GPs (78% of respondents) would need to increase costs if their tenant doctors became liable for payroll tax, and 18% would need to close the clinic. Payroll tax is an ongoing issue affecting GP businesses, and the RACGP has recently stated, in this article, that payroll tax should be at the top of the National Cabinet agenda in 2024.
- The imposition of payroll tax would change GPs fee for a standard consultation, with 56% needing to increase it by more than $20, while only 6% would have no increase.
Calls to increase Medicare Rebates continue, despite the triple bulk billing incentive
- GPs were given a choice of 5 initiatives and asked which one would benefit patients the most. 43% of GPs surveyed thought ‘increasing Medicare rebates’ would be the most beneficial. 20% chose ‘boosting the GP workforce,’ and 19% chose ‘tripling the bulk billing incentive’ as the best option.
- With the triple bulk billing incentive now in action, 72% of GP respondents still stated they would not change their billing approach.
- 81% of GP respondents thought an independent statutory authority should be responsible for setting Medicare rebates.
A high proportion of GPs have experienced a vexatious complaint
- 80% of GP respondents felt they had been subjected to a vexatious complaint. Vexatious complaints can have unintended and very real consequences for GPs. According to the National Health Ombudsman’s Annual Report 2022/23 and this GPNews article, complaints about AHPRA’s notification process have increased by 39%. For more information, read the RACGP’s Submission to the National Health Practitioner Ombudsman – Review of Ahpra’s vexatious notifications framework and keep an eye on the National Health Ombudsman’s independent Vexatious notifications framework review which hopes to analyse the effectiveness of AHPRA’s vexatious notifications framework and make recommendations for improvement. For some practical tips on how to handle feedback and complaints, see AHPRA’s Checklist For Practitioners.
- Most GPs (86% of respondents) experienced denigrating attitudes towards general practice during their medical studies.
Medicare fraud and health authority adjudication still negatively impacting GPs
- Most GPs respondents didn’t agree that government health authorities provide fair adjudication for GPs whose patients access the MBS. 54% strongly disagreed, 32% disagreed, and only 1% strongly agreed.
- 91% of GP respondents thought Media Watch should investigate last year’s Medicare rorts coverage.
GPs and administrative burdens
- 87% of GP respondents found the general practice incentive programs administratively burdensome. Under half (45%) had signed up their practice to MyMedicare, and 93% agreed that additional bulk billing red tape would make them more likely to privately bill telehealth consultations.
Most GPs
- Support tighter regulation on advertising from harmful industries, like junk food and gambling (89% of GP respondents).
- Disagree with GP prescribing restrictions for PBS-listed medicines (68% of respondents).
- Were disappointed with the government’s Strengthening Medicare Taskforce report - 64% of GP respondents felt the report lacked rebate rises, and only 4% thought the report ‘was a positive start.’ Responses to the Feb 2023 report have been published by various health bodies, including the Australian Medical Association. A good summary of reactions from stakeholders can be found in this article.
GP PERSPECTIVES ON CLINICAL PRACTICE: PATIENT CARE, MEDICINES, PRESCRIBING AND REFERRALS
The shortage of the anti-diabetic medicine, Semaglutide, has led to a worsening of patient conditions
- 64% of GP respondents had observed a worsening of their patient's condition, while 23% found their patients were stable on alternative medication. The worldwide shortage of semaglutide started affecting Australia in early 2022 when production and supply could not keep up with increased demand (especially the increase in off-label use for weight loss). This is a global issue affecting GPs' ability to prescribe the drug to their diabetic patients, and unfortunately the Therapeutic Goods Administration (TGA) has been advised access to semaglutide will continue to be limited in 2024. For more information on the Semaglutide shortage, please visit the TGA website.
GPs agree with 60 day dispensing times
- 85% of GP respondents thought their patients would benefit from 60 day dispensing times. With the Albanese Government’s 60-day dispensing policy, patients living with a chronic, stable condition will be able to buy two months’ worth of medicines for the price of the current 30-day supply. The change will be implemented over 12 months, starting 1st September 2023. This policy shift has been welcomed by many professional health bodies and associations, and the Department of Health and Aged Care has released a detailed 60-day prescriptions Information kit for prescribers.
- Despite this, the poll found that over half of GP respondents (54%) thought their local pharmacy was actively discouraging the implementation of 60-day prescriptions.
- Most patients are choosing to receive 60-day prescriptions, with 72% of GP respondents agreeing that, when given the opportunity, their patients chose 60-day prescriptions.
Referrals to Psychiatrists rejected and waitlisted
- 44% of GP respondents had referrals to Psychiatrists rejected. 34% said the average wait time to see a Psychiatrist in their area was 6-12 months. The Royal Australian & New Zealand College of Psychiatrists has acknowledged Australia’s severe psychiatry workforce shortage in this article, which is backed up by ABS data on mental health.
ADHD referral requests on the rise, while GPs split on ADHD medication
- 78% of GP respondents saw a substantial increase in the number of patients requesting a referral for an ADHD diagnosis (March 2022-March 2023). With health services and waitlists already stretched, the growing demand for assessment and management of neurodiverse conditions may leave GPs feeling under-resourced to support these patients. Practitioners can view evidence-based clinical practice ADHD guidelines, which are NHMRC-approved and RACGP-endorsed, to help them upskill in managing and treating patients with ADHD.
- If properly supported with funding and training, 45% of GP respondents said they would feel comfortable initiating ADHD medication prescriptions, while 46% said they would not.
Less GPs offering COVID-19 vaccinations
- In March 2023, just over half (59%) of GP Practices were still offering COVID-19 vaccinations. 40% had stopped, and this was part of a wider trend which saw increased immunity in the community and the end of many vaccine mandates.
Over half of GPs need more training to properly help patients with eating disorders
- Only 15% of respondents felt they were well equipped to recognise and support patients with eating disorders, 26% felt not well equipped at all, and 57% needed more training in this space.
In clinical practice, most GPs
- Use a family member when an interpreter is required (40%), or a phone interpreter (41%).
- Feel comfortable discussing weight issues with their patients (73%), with 21% stating that it would depend on the context.
- Would feel confident certifying appropriate patients with diabetes for access to continuous glucose monitoring devices (71%).
- Thought the hospital discharge sheet should be reframed as a clinical handover (79% of respondents).
- Follow their own advice on the importance of having their own GP (77%).
- Thought there was room to expand GPs’ scope of practice (72% of GP respondents).
GP PERCEPTIONS OF THE FUTURE:
GP practices at risk of closing, and less positivity for next year
- When asked if their practice was at risk of closing in the next 12 months, 34% of GPs responded yes, 44% responded no, and 21% were unsure.
- 85% of GP respondents are feeling less positive about the future of general practice compared to a year ago.
- However, 44% of GP respondents thought their clinic was busier compared to 12 months ago. 27% thought their clinic was about the same, and 27% thought their clinic was less busy.
Mixed perspectives on Artificial Intelligence
- 48% of respondents felt concerned about the future of artificial intelligence in medicine, while 26% were optimistic, and 24% were unsure.
General practice in Australia will continue to face challenges into the future. These challenges exist in the funding and regulatory environment, but also in clinical practice, where access to medicines, clinical training and specialist services may be compromised by extra demand and limited resources. NewsGP’s weekly poll offers an authentic glimpse into the perspectives of GPs and is a great way to bring awareness to the important issues affecting general practice in Australia.
