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Budget bludgeon for battling GPs

While health came out of the Federal Budget relatively unscathed when compared to the slash and burn experienced by other sectors, there were some casualties – with GPs near the top of the list. First, let’s acknowledge the positives from the Budget – which, by necessity, was a Budget for tough financial times. And you have to look more broadly than just the Health portfolio.

20 May 2012

While health came out of the Federal Budget relatively unscathed when compared to the slash and burn experienced by other sectors, there were some casualties – with GPs near the top of the list.

First, let’s acknowledge the positives from the Budget – which, by necessity, was a Budget for tough financial times. And you have to look more broadly than just the Health portfolio.

There was the aged care package, some new Indigenous health funding, upgraded bowel cancer screening, new dental services, rural health infrastructure, and a commitment to the National Disability Insurance Scheme (NDIS).

We support all these initiatives. They will deliver good health outcomes to the community.

But when funding was found for one area of the health system, other areas of the health system felt the squeeze. Once again it is GPs who have been left footing the bill.

The Budget cuts to Practice Incentive Payments (PIP) to GPs – totalling $83.5 million over four years (that is $83.5 million being ripped out of general practice) - will have a significant negative impact on the health system.

They will penalise GPs for not meeting new higher targets for cervical cancer screening and specialised diabetes care, and they remove incentives for immunisation.

Australia is a world leader in childhood immunisation rates but this decision could undermine that reputation and undo a lot of hard work by parents, GPs and other health professionals who promote the importance of immunisation in the community and in schools.

The decision to discontinue the GP Immunisation Incentives Scheme kicks another leg out from the tripod that supports this good work.

Similarly, there was no consultation on the increase in targets for the PIP Cervical Screening Incentive and the PIP Diabetes Incentive either.  This may put the brakes on successful prevention and care programs that are helping thousands of people.

These cuts are a big hit to the viability of general practice and its responsibility to deliver quality patient care.

This Budget follows the cuts made in recent Budgets to joint injection rebates and mental health rebates, the loss of Medicare practice nurse rebates and the earlier cuts to the GP Immunisation Incentives Scheme, and the imminent loss of the after hours PIP.

These measures, along with changes to the e-health PIP, could potentially undermine successful preventive health programs that are providing health benefits to many Australians.

These cuts go against the Government’s stated objectives of championing preventive health and being a world leader in electronic health.

They also place an even greater burden on the engine room of the Australian health system – hardworking GPs under pressure in suburbs and towns across the country – by making their practices less viable.

To make things worse, the Government introduced a requirement that general practices must choose to participate in the Personally Controlled Electronic Health Record (PCEHR) system if they are to continue receiving e-health PIP funding.

This is not a requirement - it is a threat.  And it comes on top of the Government’s failure to provide any new funding for the new clinical service that GPs are being asked to provide in helping patients prepare a shared health summary as part of the PCEHR.

This represents a substantial roadblock to the effective implementation of the PCEHR and threatens Australia’s efforts to be a world leader in e-health.

We need to remember that the PCEHR is an opt-in system, so the Government is going to make funding to a general practice contingent on the decision of a third party over whom they have no control.

GPs are the public face of the health system. GPs are trusted and respected by their patients and their communities.  They are the lifeblood of the system.

Sadly, the valuable service provided by GPs appears undervalued and under-appreciated by the Government. GPs are being asked to do more – much more – for less.

Australia’s general practice workforce is understandably becoming demoralised. 

GPs are propping up the health system by offering significant discounts to their patients when they bulk bill. Already, many GPs have concluded that, in order to maintain their provision of a quality service, widespread bulk billing may no longer be possible.


Published: 20 May 2012