AMA response to report on GP after-hours services
The AMA has provided its comments on the MBS Review Taskforce’s preliminary report, Urgent After-Hours Primary Care Services funded through the MBS (‘the report’).
In its submission, the AMA acknowledges that access to after-hours GP services is a critical part of the health system, while recognising that poor models of after-hours GP care have the potential to fragment patient care, result in poorer outcomes for patients and incur additional costs to the health system.
In considering reform in this area, the AMA has emphasised that it is critical that services providing after-hours GP care, particularly those that operate exclusively in the after-hours period, adopt a collaborative model that complements the care provided by a patient’s usual GP or through their regular general practice.
The AMA is pleased to see that the Taskforce has recognised within its report previous concerns raised by the AMA, particularly the fact that direct marketing and the promotion of after-hours home visits as being free and easy to access has driven much of the growth we have seen in the use of urgent MBS items, as opposed to genuine patient need.
Overall, the AMA submission agrees with the principles that underpin the report, and the logic behind its recommendations. However, the submission highlights concern that some of the recommendations will potentially undermine the viability of genuine medical deputising services (MDSs) and significantly impact on access to care for patients.
While agreeing that there is scope for some MBS savings through the better targeting of funding for urgent after-hours GP services, the AMA submission says the extent of the likely financial impact of the Taskforce’s approach is significant and this is not recognised or well addressed in its report.
The submission recommends more work is required to explore different funding arrangements for genuine MDSs, including a revised MBS item number structure for MDS doctors or, as suggested by the 2014 Jackson Review of After-Hours Services, the adoption of a blended funding model. In offering to work further with the Taskforce and the Government, the AMA recommends that this work should be guided by the following principles:
- Services remain highly accessible to patients, but based on clinical need, not convenience;
- Arrangements complement the services provided by a patient’s usual GP or through their regular general practice;
- The value of services being provided to patients is appropriately recognised;
- Services are of an appropriate quality, including the infrastructure required for triaging, supervision, training as well as communication with a patient’s regular GP;
- Unpredictable and uneven service demand is recognised; and
- MDSs have access to and utilise an appropriately skilled workforce.
While the Taskforce has been limited by its terms of reference to a review of existing MBS item numbers, the AMA believes that this only represents one component of the necessary reform to after-hours arrangements. While some of the concerns expressed to the AMA by members can be addressed to an extent by potential changes to MDS funding arrangements, the AMA emphasises that a broader package of reforms is required to ensure high quality and appropriately targeted services. These will need to address issues such as:
- MDS workforce skills, training and supervision;
- MDS accreditation arrangements;
- Patient triage processes;
- Direct to consumer advertising; and
- The necessary link between an MDS and a patient’s usual GP or regular general practice.
While the AMA submission expresses reservations about the extent of the impact of some of the report’s recommendations, as highlighted earlier, it does agree that MBS savings can be found and justified. In this regard, the AMA response highlights the significant funding pressures on general practice, including the lasting impact of the MBS freeze, and the critical need for any savings to be re-invested to support general practice.