tag:theconversation.com,2011:/au/topics/general-practice-820/articlesGeneral practice – The Conversation2024-03-06T17:15:01Ztag:theconversation.com,2011:article/2244272024-03-06T17:15:01Z2024-03-06T17:15:01ZGeneral practice is in crisis in the UK – and it’s failing the people who need it most<figure><img src="https://images.theconversation.com/files/579216/original/file-20240301-28-25c0vz.jpg?ixlib=rb-1.1.0&rect=14%2C22%2C4969%2C3295&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-giving-checkup-woman-exam-room-14464498">Monkey Business Images/Shutterstock</a></span></figcaption></figure><p>There is <a href="https://www.bmj.com/content/381/bmj.p966">no doubt</a> that <a href="https://www.theguardian.com/society/2022/nov/20/gps-in-england-treat-up-to-three-times-more-patients-than-safety-limit-demands">primary care</a> in the UK – the services that provide the first point of contact in the healthcare system, such as general practice – isn’t working.</p>
<p><a href="https://www.telegraph.co.uk/news/2023/11/12/gps-elusive-species-elderly-patients-phone-appointments/">Patients report</a> <a href="https://inews.co.uk/news/health/patients-struggle-gp-appointments-collapse-nhs-1742850">difficulties in making appointments</a> and seeing the same GP. <a href="https://www.rcgp.org.uk/getmedia/11f26527-5d11-47f2-a593-1a894c2fff1b/Continuity-of-care-in-modern-day-general-practice1.pdf">Continuity of care</a> is an important factor in patient outcomes, particularly for older adults with comorbidities – those living with more than one long-term condition, such as diabetes or asthma. </p>
<p><a href="https://www.telegraph.co.uk/news/2024/02/23/seeing-the-same-gp-fewer-visits-to-the-doctor/#:%7E:text=Patients%20who%20see%20the%20same,to%20return%20after%20shorter%20periods.">Research shows</a> that patients who see the same doctor have fewer hospital admissions and lower mortality rates. However, we also know that <a href="https://www.theguardian.com/society/2024/mar/04/worst-off-find-it-harder-than-well-off-to-access-nhs-care-survey-finds">people on the lowest incomes</a> have much more difficulty getting GP appointments. And when they do, they are much more likely to have a <a href="https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/what-are-healthcare-inequalities/deprivation/">much worse experience</a> than those who’re more financially comfortable. </p>
<p>Evidence shows that, in particular, older adults who live in poorer areas <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839575/">struggle to access</a> the primary care that they need. They already have poorer health outcomes, and their life expectancy is lower those living in more affluent areas – yet GP services are not providing the help they should.</p>
<p>Access to <a href="https://www.bmj.com/content/375/bmj.n2916/rr">general practice is vital</a> to maintaining good public health. It’s the entry point to the national health care system, and <a href="https://blogs.bmj.com/bmj/2021/05/14/if-general-practice-fails-the-nhs-fails/">accounts for around 90%</a> of all patient contact with the NHS. </p>
<p>But overall patient satisfaction with general practice <a href="https://www.bmj.com/content/378/bmj.o1764">seems to be in sharp decline</a>. Between 2021 and 2023, the percentage of patients <a href="https://www.kingsfund.org.uk/insight-and-analysis/reports/public-satisfaction-nhs-and-social-care-2022#key-findings">reporting a good overall experience</a> fell from <a href="https://www.england.nhs.uk/statistics/2023/07/13/gp-patient-survey-2023/">71% to 55%</a>. </p>
<p>The reasons for this apparent <a href="https://bmjopen.bmj.com/content/9/2/e026048">crisis in confidence</a> have been covered widely in the media. But reports have tended to focus on GPs rather than the patients who’re most affected. </p>
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<p>For example, it’s been widely reported that the <a href="https://www.rcgp.org.uk/getmedia/155e72a9-47b9-4fdd-a322-efc7d2c1deb4/retaining-gp-workforce-report.pdf">number of GPs</a> <a href="https://researchbriefings.files.parliament.uk/documents/CBP-9731/CBP-9731.pdf">has fallen 4%-5%</a> in recent years and <a href="https://bjgplife.com/stressed-overworked-and-dissatisfied-the-unholy-trio-of-general-practice-in-the-uk/">many doctors</a> who remain in general practice report <a href="https://www.health.org.uk/publications/reports/stressed-and-overworked">feeling stressed and over-worked</a>. It’s no wonder, then, that a significant proportion of <a href="https://www.gponline.com/half-gps-cut-working-hours-ease-workload-poll-shows/article/1811685">GPs have opted to reduce</a> their hours.</p>
<p>There <a href="https://publications.parliament.uk/pa/cm5803/cmselect/cmhealth/113/summary.html">aren’t enough</a> general practitioners <a href="https://www.theguardian.com/commentisfree/2022/jul/03/the-observer-view-on-britain-gp-shortage">to meet growing demand</a>, especially for the <a href="https://www.rcgp.org.uk/getmedia/3613990d-2da8-458a-b812-ed2cf6d600a6/RCGP-Brief_GP-Shortages-in-England.pdf">complex needs of an aging population</a>.</p>
<p>But what of the people disproportionately affected by the crisis in general practice? </p>
<h2>Older, impoverished adults disproportionately affected</h2>
<p>As life expectancy in the <a href="https://www.kingsfund.org.uk/insight-and-analysis/long-reads/whats-happening-life-expectancy-england">UK increases</a>, the <a href="https://www.england.nhs.uk/ourwork/clinical-policy/older-people/improving-care-for-older-people/">role of general practice</a> in keeping people well and living independently <a href="https://www.msdmanuals.com/home/older-people%E2%80%99s-health-issues/providing-care-to-older-people/continuity-of-care">is crucial</a>. This is particularly true in older patients with comorbidities. The often complex nature of their conditions means that these patients need regular monitoring and access to GP services. </p>
<p>In addition, older adults with comorbidities are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9385725/">often socially isolated</a>, and the human contact provided by the therapeutic relationship developed through regular appointments is <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1189-9">considered vital</a> to their wellbeing. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6853241/">Research has highlighted</a> that the <a href="https://www.health.org.uk/publications/long-reads/measuring-continuity-of-care-in-general-practice">ongoing relationship</a> between GP and patient is particularly important in this group of patients. </p>
<p>However, the <a href="https://www.qmul.ac.uk/media/news/2022/smd/seeing-the-same-gp-is-good-for-your-health-but-only-half-of-patients-are-able-to-do-so.html">continuity of care</a> traditionally provided by the family doctor has declined as primary care struggles to meet the demands placed upon it. In these situations, the influence of <a href="https://patient.info/doctor/health-and-social-class">education and social class</a> on health becomes increasingly apparent. </p>
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<p>A 2024 survey by NHS watchdog <a href="https://www.healthwatch.co.uk/what-we-do">Healthwatch</a> found that already well established links between poverty and ill health are exacerbated by barriers to obtaining healthcare. </p>
<p>The report, which surveyed a representative sample of the population – 2,018 people aged over-16 in England – found that those in poverty were twice as likely to experience problems getting to see a GP than those who identified as “very comfortable” financially. </p>
<p>Louise Ansari, Healthwatch’s chief executive, suggested that the <a href="https://www.theguardian.com/society/2024/mar/04/worst-off-find-it-harder-than-well-off-to-access-nhs-care-survey-finds">survey’s findings</a> were a warning that the NHS could be moving toward a <a href="https://www.telegraph.co.uk/news/2023/10/20/nhs-care-quality-commission-report-health-service/">“two-tier service”</a> with ease of access closely related to wealth. </p>
<p>Ansari’s concerns seem to be well-founded. In more affluent, middle class areas, the quality of general practice is often better and <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/trendsinpatienttostaffnumbersatgppracticesinengland/2022">more readily available</a>, often because practices have fewer patients. </p>
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<p>Wealthier areas tend to have <a href="https://www.ons.gov.uk/visualisations/censusworkforcequalifications/">more highly educated populations</a>, who tend to be more confident in requesting appointments and articulating their health concerns. </p>
<p>Conversely, people living in <a href="https://theconversation.com/gp-crisis-how-did-things-go-so-wrong-and-what-needs-to-change-208197">less affluent areas</a> with greater levels of deprivation may not always be aware of what they are entitled to, or how to get it. </p>
<h2>Delays in seeking help</h2>
<p>The move to remote consultations is another aspect of the barriers to access faced by those who’re most socially and financially disadvantaged.</p>
<p>While remote consultation <a href="https://bmjopen.bmj.com/content/13/5/e070923">may be appropriate</a> and perfectly satisfactory, even preferable, for many patients, there are people – often from the <a href="https://digitalpovertyalliance.org/uk-digital-poverty-evidence-review-2022/introduction-myths-and-shifts/">most deprived groups</a> – who are <a href="https://www.kingsfund.org.uk/insight-and-analysis/long-reads/exclusion-inclusion-digital-health-care#:%7E:text=Groups%20commonly%20considered%20digitally%20excluded,areas%2C%20people%20from%20low%20socio%2D">digitally excluded</a> (unable to use the internet in ways that are needed to participate fully in modern society) and do not have the resources to access virtual appointments. </p>
<p>But this <a href="https://www.gov.uk/government/news/new-plan-to-make-it-easier-for-patients-to-see-their-gp">lack of easy access</a> for all patients is at odds with public health messaging. </p>
<p>For example, <a href="https://digital.nhs.uk/ndrs/our-work/ncras-work-programme/cancer-awareness-campaigns#:%7E:text=Resources-,Introduction,to%20see%20their%20GP%20sooner">public health campaigns</a> that target older adults, emphasise the importance of early detection of cancer: “<a href="https://www.england.nhs.uk/2022/03/celebrities-join-forces-with-the-nhs-to-encourage-cancer-checks/">if something doesn’t feel quite right … get it checked out”</a>. <a href="https://pubmed.ncbi.nlm.nih.gov/35298272/">Early detection and survival rates</a> in all types of cancer are inextricably linked.</p>
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<p>However, difficulty accessing a GP appointment means that <a href="https://www.bbc.co.uk/news/health-37605573">people are more likely to put off</a> and delay seeking help with their symptoms. The number of <a href="https://www.bmj.com/company/newsroom/every-month-delayed-in-cancer-treatment-can-raise-risk-of-death-by-around-10/">late presentations for cancer</a> in particular means that long term survival rates from cancer are not as good as they should be. </p>
<p>The UK’s ageing population and the recent sharp rise in the cost of living means the number of disadvantaged older people in need of consistent, high quality GP care is rising. But their chance of getting it seems to be ever dwindling.</p><img src="https://counter.theconversation.com/content/224427/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Robin Lewis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Older adults in poorer areas would benefit more from seeing the same GP, but often find continuous primary care harder to access.Robin Lewis, Senior Lecturer in Healthcare, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172642024-01-28T19:05:20Z2024-01-28T19:05:20ZMedicare turns 40: since 1984 our health needs have changed but the system hasn’t. 3 reforms to update it<figure><img src="https://images.theconversation.com/files/571353/original/file-20240125-29-9x8icz.jpg?ixlib=rb-1.1.0&rect=0%2C57%2C7719%2C4513&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/selective-focus-photography-of-assorted-color-balloons-Hli3R6LKibo">Ali Goldstein/Unsplash</a></span></figcaption></figure><p>Forty years ago, Medicare as we know it today was born. It was the reincarnation of the Whitlam government’s Medibank, introduced in 1975 but <a href="https://www.sciencedirect.com/science/article/abs/pii/0277953684902661">dismantled</a> in stages by the Fraser Liberal government. </p>
<p>Medibank was developed in the 1960s by health economists <a href="https://grattan.edu.au/news/remebering-richard-scotton-co-founder-of-medicare/">Dick Scotton</a> and <a href="https://openresearch-repository.anu.edu.au/bitstream/1885/159512/1/Daring_to_Dream.pdf">John Deeble</a>, when disease prevalence was different and the politics of reform were diabolical. </p>
<p>But the nation has changed since 1984, and so have our health needs. Medicare is now struggling to ensure the access to health care for millions of Australians we were once promised. </p>
<p>Let’s look at how we got here – and three radical changes we need to keep the Medicare promise into the future: making it cheaper to see a GP; paying less for blood and imaging tests; and covering dental care. </p>
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<a href="https://theconversation.com/if-you-live-in-a-bulk-billing-desert-its-hard-to-see-a-doctor-for-free-heres-how-to-fix-this-204029">If you live in a bulk-billing ‘desert’ it's hard to see a doctor for free. Here's how to fix this</a>
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<h2>Free hospital care, but you might pay to see a GP</h2>
<p>One of my first jobs in the health system, in the days before Medicare and Medibank, was acting in charge of revenue collection for three public hospitals. A small subset of people could get free, albeit stigmatised, care. </p>
<p>We had bad debts, because some people couldn’t afford to pay their hospital bills and I was allowed by policy to recommend that some be written off. But for others I had to seek court authorisation to seize their wages to pay off their hospital debt. </p>
<p>Medibank changed that. Now all Australians can get public hospital care without any financial barrier.</p>
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<img alt="Doctor draws blood from patient" src="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571350/original/file-20240125-19-xmbtth.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Before Medicare and Medibank, patients often faced hospital care debts.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-woman-laying-in-a-hospital-bed-next-to-a-man-dkZQfm1LLQE">National Cancer Institute/Unsplash</a></span>
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<p>But the financial barriers to seeing a GP or a private specialist (out of hospital) have remained. Doctors continue to charge what they like, with Medicare often only covering a portion of their fees. This has left many patients facing significant out-of-pocket payments.</p>
<p>When Medicare was designed, medical care was provided mostly by solo medical practitioners working in practices they owned. It was a one-to-one professional relationship, with the patient paying the practitioner for each service. </p>
<p>Over time, general practice evolved into group practices organised as partnerships. Next, they <a href="https://onlinelibrary.wiley.com/doi/10.5694/mja2.51038">consolidated and corporatised</a>. A handful of corporates now provide all <a href="https://www.accc.gov.au/system/files/public-registers/documents/ACL%20Healius%20%20-%20Statement%20of%20Issues.pdf">private pathology</a> (which tests blood and other tissues) and <a href="https://www.jacr.org/article/S1546-1440(07)00614-X/fulltext">radiology</a> (which provides imaging services) and a large proportion of GP care. </p>
<p>Corporates have not made the same inroads into most other specialties. But since the 1980s, states have reduced public hospital outpatient services. So patients are now more reliant on private medical specialists for care referred by their GP.</p>
<h2>Much has changed, but cost of living pressures remain</h2>
<p>Health-care needs have changed. As we live longer, we live with more diseases, many of which are chronic. The care required increasingly involves many different health providers and includes non-medical specialties such as podiatry, physiotherapy and psychology. </p>
<p>When Medicare was introduced, university education was offered for only a few of these professions. But their training has evolved and so too what they can do. This is particularly the case for nursing. It has evolved from an apprenticeship model to a profession with its own specialties. A subset – nurse practitioners – have the authority to diagnose and prescribe medication.</p>
<p>Broader technology trends have also had an impact on health care, as with all other sectors. Virtual care and telehealth <a href="https://theconversation.com/what-can-you-use-a-telehealth-consult-for-and-when-should-you-physically-visit-your-gp-135046">proved their worth</a> during the early years of the COVID pandemic, just as generative AI is beginning to show its promise now.</p>
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<p>Medicare was first and foremost about efficiently removing financial barriers to access. It was introduced as part of an <a href="https://www.jstor.org/stable/20635272">agreement with the Labor movement</a> about reducing costs of living and, in particular, ensuring people could attend a doctor without having to worry about how they would pay for the visit.</p>
<p>However, <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">about 1.2 million Australians</a> deferred or missed out on seeing a GP because of cost in the 2022-23 financial year. Lower-income Australians have higher rates of missing out on care. </p>
<p>Medical fees aren’t regulated and so consumers face a lottery – not knowing whether a fee will be charged and having no control over that decision. Only about 52% of all Australians were <a href="https://www.health.gov.au/sites/default/files/2023-08/medicare-statistics-per-patient-bulk-billing-dashboard-2022-23.pdf">always bulk-billed</a> in 2022-23, down from 66% a year earlier. </p>
<p>So how can we get Medicare back on track towards its goal of universal health care for all Australians? Here are three radical reforms we should prioritise. </p>
<h2>1. Make GP care affordable for all</h2>
<p>Rebates are currently subject to political whim. The Liberal government (in office from 2013 to 2022) froze rebates, leading to increases in average out-of-pocket payments and reduced bulk-billing.</p>
<p>The first step in reducing costs as a barrier to GP care should be introduction of independent fee-setting. </p>
<p>Canadian Medicare – which was the model for Australia’s system – mostly has <a href="https://journals.sagepub.com/doi/full/10.1177/0840470421994304">no out-of-pocket payments</a>. Fees are set by negotiations, not politicians’ whims, and this is <a href="https://laws-lois.justice.gc.ca/eng/acts/C-6/page-1.html#h-151558">enshrined in legislation</a>. </p>
<p>With independent fee-setting in place, a new scheme of “participating providers” should be introduced. Under such a scheme, practices would bulk-bill everyone, and participate in agreed quality-improvement programs.</p>
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Read more:
<a href="https://theconversation.com/what-if-medicare-was-restricted-to-gps-who-bulk-billed-this-kind-of-reform-is-possible-203543">What if Medicare was restricted to GPs who bulk billed? This kind of reform is possible</a>
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<p>If fees are set independently and fairly, extra billing over and above the fee is unjustifiable. Non-participating practices would not be eligible for Medicare benefits. </p>
<p>It’s anticipated the vast majority of practices would agree to participate. In Canada, the participation rate is roughly 100%, and bulk billing in Australia is <a href="https://www.health.gov.au/resources/publications/medicare-quarterly-statistics-bulk-billing-by-primary-health-network-september-quarter-2023-24">still over 75%</a>.</p>
<p>Participating practices should also be eligible for additional grants to employ other health professionals to provide a more comprehensive range of services – such as physiotherapists and psychologists – to meet the contemporary needs of a population with increasing chronic illness. </p>
<p>If successful, these changes would mean all Australians can access a GP and other primary care services without any out-of-pocket costs.</p>
<h2>2. Deal with diagnostics</h2>
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<img alt="Blood vials" src="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571360/original/file-20240125-25-3sefgm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The cost of processing tests varies.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/green-pink-and-purple-plastic-bottles-0jE8ynV4mis">Testalize.me/Unsplash</a></span>
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<p>Despite the evolution of ownership and market structures, pathology and radiology services are still reimbursed by fees for each service (with complex rules about rebates when multiple tests are performed simultaneously). </p>
<p>But while both industries are expensive to set up and buy or lease equipment, the cost of processing an additional test or image is low and sometimes close to zero. This means Medicare pays pathology and radiology providers much more than the tests or images cost.</p>
<p>Both industries are also ripe for further technological change, with the quality of generative AI rapidly improving, and costs likely to further reduce.</p>
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<p>The uncapped fee-for-service model for pathology and radiology needs to be replaced by one in which the benefits of technological change are shared between shareholders and taxpayers, rather than all accruing to the former. </p>
<p>This could be done by replacing fee-for-service payments with a payment model used in the corporate world. Private and public providers could be <a href="https://grattan.edu.au/report/blood-money-paying-for-pathology-services/">invited to tender</a> to provide these services in certain areas, with conditions around geographic access, quality and no out-of-pocket payments for consumers. </p>
<p>The same model could also apply to other technology-intensive types of health care, such as radiotherapy for cancer.</p>
<p>These changes might be cost-neutral for government, and save consumers the $24 they currently pay out of pocket on every pathology test that is not currently bulk-billed and $122 on each non-bulk-billed diagnostic imaging test.</p>
<h2>3. Cover dental care too</h2>
<figure class="align-center ">
<img alt="Boy undergoes dental treatment" src="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571358/original/file-20240125-19-wcmr9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Dental care is largely unaffordable.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/boy-in-blue-long-sleeve-shirt-drinking-from-a-feeding-bottle-loBRFqXm1QA">Lafayett Zapata Montero/Unsplash</a></span>
</figcaption>
</figure>
<p>A major omission from Medicare from the start, and a source of continuing inequity, is oral health care. More than two million Australians <a href="https://www.abs.gov.au/statistics/health/health-services/patient-experiences/2022-23#data-downloads">missed out</a> on oral health care because of cost in 2022-23.</p>
<p>A new scheme to <a href="https://grattan.edu.au/report/filling-the-gap/">slowly expand universal protection</a> against the costs of oral health care should be phased in over the next decade. This would eventually mean all preventive and basic dental care would be available for everyone, with no out-of-pocket payments. </p>
<p>This would require a parallel expansion of the oral health workforce (dentists and <a href="https://www.dentalboard.gov.au/Registration/Oral-Health-Therapist.aspx">oral health therapists</a>) and development of new payment models based on a participating practice model rather than simply introducing another unregulated schedule of oral health fees paid via Medicare.</p>
<p>Innovation <a href="https://www.health.gov.au/sites/default/files/2023-12/nhra-mid-term-review-final-report-october-2023.pdf">needs to be built into the Australian health system</a>. However, the foundations for innovation must be based on Medicare’s founding principles of addressing financial barriers to provide universal and equitable health care to all Australians. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/expensive-dental-care-worsens-inequality-is-it-time-for-a-medicare-style-denticare-scheme-207910">Expensive dental care worsens inequality. Is it time for a Medicare-style 'Denticare' scheme?</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/217264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett, like all Australians, benefits from Medicare.</span></em></p>The health care world has changed a lot in 40 years, but Medicare hasn’t. Here are three areas for radical forms to the system that will achieve its aims of universal health care for all Australians.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139812023-11-20T19:00:17Z2023-11-20T19:00:17ZNo, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing<figure><img src="https://images.theconversation.com/files/559257/original/file-20231114-26-vqpic.jpg?ixlib=rb-1.1.0&rect=718%2C370%2C6543%2C4463&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/candid-shot-black-female-doctor-explaining-2281209513">Shutterstock</a></span></figcaption></figure><p><em>Antimicrobial resistance is <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">one of the biggest global threats</a> to health, food security and development. This month, The Conversation’s experts <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">explore how we got here and the potential solutions</a>.</em></p>
<hr>
<p>The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection. </p>
<p>Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you. </p>
<p>We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria.</p>
<p>More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-new-antibiotic-clovibactin-beat-superbugs-or-will-it-join-the-long-list-of-failed-drugs-212774">Could new antibiotic clovibactin beat superbugs? Or will it join the long list of failed drugs?</a>
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</em>
</p>
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<h2>Giving GPs the tools to say no</h2>
<p>In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs.</p>
<p>Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis. </p>
<p>In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs. </p>
<p>Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>. </p>
<p>For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes:</p>
<ul>
<li><p>using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary</p></li>
<li><p>giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed</p></li>
<li><p>giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own. </p></li>
</ul>
<p>All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders.</p>
<p>To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them.</p>
<h2>Giving doctors feedback on their prescribing</h2>
<p>National programs and interventions can help GPs use antibiotics more wisely </p>
<p>One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement. </p>
<figure class="align-center ">
<img alt="GP types on laptop" src="https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">GPs tend to act on feedback about their antibiotic prescribing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-entering-patient-notes-on-laptop-1033147024">Shutterstock</a></span>
</figcaption>
</figure>
<p>The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed. </p>
<p>However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>. </p>
<p>In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others. </p>
<p>The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
</strong>
</em>
</p>
<hr>
<h2>Clearer rules and regulations</h2>
<p>Rules and regulations are crucial in the fight against antibiotic resistance. </p>
<p>Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse. </p>
<p>However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for. </p>
<figure class="align-center ">
<img alt="Pharmacist looks at antibiotics" src="https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Simple changes can make a difference to antibiotic prescribing and dispensing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-pack-704036482">Shutterstock</a></span>
</figcaption>
</figure>
<p>Other regulations or policy targets could include: </p>
<ul>
<li><p>ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia</p></li>
<li><p>ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics </p></li>
<li><p>encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later. </p></li>
</ul>
<h2>Australia lags behind Sweden</h2>
<p>Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use. </p>
<p>Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done. </p>
<p>In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-reverse-antibiotic-resistance-in-australia-heres-how-sweden-is-doing-it-123081">We can reverse antibiotic resistance in Australia. Here's how Sweden is doing it</a>
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<p>It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control. </p>
<p>In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”. </p>
<hr>
<p><em>Read the other articles in The Conversation’s series on the dangers of antibiotic resistance <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">here</a>. Listen to the podcast <a href="https://theconversation.com/antibiotic-resistance-microbiologists-turn-to-new-technologies-in-the-hunt-for-solutions-podcast-217615">here</a>.</em></p><img src="https://counter.theconversation.com/content/213981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mina Bakhit received funding from Therapeutic Guidelines Ltd (TGL) / Royal Australian College of General Practitioners (RACGP) Foundation Research Grant. </span></em></p><p class="fine-print"><em><span>Paul Glasziou receives funding from an National Health and Medical Research Council (NHMCR) Investigator grant.</span></em></p>Developing new antibiotics is important in the fight against antibiotic resistance. But we also need to use the antibiotics we already have much more wisely – GPs play a major role in this.Mina Bakhit, Assistant Professor of Public Health, Bond UniversityPaul Glasziou, Professor of Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2126202023-09-06T20:13:15Z2023-09-06T20:13:15ZIt can be tough getting a GP appointment. Nurse practitioners could take some of the load<figure><img src="https://images.theconversation.com/files/546330/original/file-20230905-29-jl68t8.jpg?ixlib=rb-1.1.0&rect=0%2C131%2C5142%2C3291&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/KdWfhEwjcIE">Unsplash/Cezar Sampaio</a></span></figcaption></figure><p>Australians are living longer than ever. But these extra years of life come with higher rates of <a href="https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity">long-term and complex conditions</a> and greater health care needs. </p>
<p>The government wants to <a href="https://www.health.gov.au/sites/default/files/documents/2022/03/australia-s-primary-health-care-10-year-plan-2022-2032-future-focused-primary-health-care-australia-s-primary-health-care-10-year-plan-2022-2032.pdf">improve</a> Australians’ access to primary care services. These services would usually be delivered by a GP. But as part of this change, a new <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/unleashing-the-potential-for-our-health-workforce-review-appointment">review</a> is exploring how other health professionals could expand their current scope of work to meet growing needs. </p>
<p>Nurses make up <a href="https://www.aihw.gov.au/reports/workforce/health-workforce">more than 50%</a> of the health workforce and have untapped and under-used skills that would ease the skills gap in our health system. Within this group, <a href="https://www.acnp.org.au/aboutnursepractitioners">nurse practitioners</a> have advanced training and the potential to deliver more services than they’re currently allowed – without the oversight of a GP. </p>
<h2>How will access to primary care change?</h2>
<p>One of the big changes is that from October 2023, some patients will be able to register with one GP or general practice under the <a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> scheme. Those who are registered will start to have access to extra funded services like longer telehealth <a href="https://www.health.gov.au/our-work/mymedicare">appointments</a>. </p>
<p>The first patients who will get access to these benefits are people with multiple health conditions and/or additional social needs. Having one doctor who knows them, and their history, can connect them more seamlessly with all of the different health professionals and services. This saves <a href="https://pubmed.ncbi.nlm.nih.gov/31698168/">patients and carers</a> time, money and effort.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-you-register-with-a-gp-what-is-mymedicare-and-how-might-it-change-the-care-you-get-206183">Should you register with a GP? What is MyMedicare and how might it change the care you get?</a>
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<p>For MyMedicare to work, Australia will need more health professionals with the right skills available in cities, regional towns and in rural and remote locations. </p>
<p>Currently, Australia is set to have a shortfall of 10,600 GPs by <a href="https://www.ama.com.au/articles/general-practitioner-workforce-why-neglect-must-end">2032</a>. This represents a serious problem. While steps are being taken to grow the GP <a href="https://insightplus.mja.com.au/2021/17/its-more-than-the-money-getting-gps-to-go-rural/">workforce</a>, this takes time. And with a <a href="https://www.who.int/news/item/02-06-2022-global-strategy-on-human-resources-for-health--workforce-2030">worldwide</a> health workforce shortage, it will not be easy. </p>
<p>Australia will need to find other solutions. One option is to look to nurses to take on tasks for which they are suitably skilled but have historically been undertaken by doctors. </p>
<h2>How nurses can help</h2>
<p>In the United Kingdom, the United States, The Netherlands and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020757/">Canada</a>, advanced nursing – where nurses have postgraduate education and training to take on more specialised tasks and roles – has been relied on for years. </p>
<p>At the most advanced level of nursing, a nurse practitioner is a trained registered nurse who provides advanced nursing care either independently and autonomously, or with a doctor. Nurse practitioners can assess and diagnose health problems, order and interpret diagnostic tests, prescribe medicines, <a href="https://www.acnp.org.au/np-fact-sheets">refer</a> patients to other health professionals and even admit them to hospitals. </p>
<p>Nurse practitioners have been practising in Australia since 2000, starting in emergency care, with <a href="https://hwd.health.gov.au/resources/publications/factsheet-nrpr-2019.pdf">more than 1,400</a> practising in total in Australia by 2019. However, unlike other countries, Australian nurse practitioners must work in collaboration with a doctor. If they were to practise more independently, nurse practitioners could expand health-care access for thousands of Australians, including those living in rural and remote areas. </p>
<p>A recent NSW Health report presented a framework for specialised rural nurse practitioners that shows how care might be provided to focus on local community <a href="https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2022_057.pdf">needs</a>. For people living with a disability, or chronic and complex conditions, nurse practitioners can provide services in their communities, such as diagnosis, treatment plans, dialysis and make referrals to a specialist, including via telehealth. This could reduce the need for long-distance travel or a long wait time to access a GP. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1622544952738865153"}"></div></p>
<h2>Don’t we have a shortage of nurses?</h2>
<p>It is true, nurses are leaving the workforce in the thousands. One fifth of nurses in Australia intend to leave nursing in the next <a href="https://www.mckinsey.com/industries/healthcare/our-insights/should-i-stay-or-should-i-go-australias-nurse-retention-dilemma">12 months</a>. Keeping them requires better working <a href="https://researchers.mq.edu.au/en/publications/workplace-stress-and-resilience-in-the-australian-nursing-workfor">conditions</a>.</p>
<p>But it’s not just about reducing burnout, stress and workloads. Nurses want career development, the opportunity to extend their scope of practice with advanced training, and for these complex care skills to be recognised and <a href="https://www.acn.edu.au/wp-content/uploads/white-paper-optimising-advanced-practice-nursing.pdf">used</a>. </p>
<p>Access to opportunities for career development and progression is a key driver of nurse <a href="https://www.nswnma.asn.au/wp-content/uploads/2023/02/Impacts-of-COVID-19-and-workloads-on-NSW-nurses-and-midwives-mental-health-and-wellbeing_final.pdf">retention</a>. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">How do you fix general practice? More GPs won't be enough. Here's what to do</a>
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</p>
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<h2>Why haven’t nurse practitioners already solved the workforce crisis?</h2>
<p>Nurse practitioners are registered nurses who have additional postgraduate education and clinical training in their speciality area. </p>
<p>Nurse practitioners are currently required to work in collaboration with a doctor to deliver care, which limits the extent to which they can resolve the workforce gaps we face. A nurse practitioner can prescribe medications, for example, but must do so with oversight via a sign-off from a <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/midwives-nurse-pract-qanda-nursepract#4">doctor</a>. </p>
<figure class="align-left ">
<img alt="Male nurse takes a woman's blood pressure" src="https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=903&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=903&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=903&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1135&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1135&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546328/original/file-20230905-27-mvp0l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1135&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Nurse practitioners in Australia currently need a doctors’ oversight to prescribe medications.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/7uSvaBY69d0">Unsplash/CDC</a></span>
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<p>The federal government’s <a href="https://www.health.gov.au/sites/default/files/2023-05/nurse-practitioner-workforce-plan.pdf">nurse practitioner workforce plan</a> aims to remove barriers to patients accessing a nurse practitioner. The plan is looking at whether nurse practitioners should provide Medicare-funded services, create additional nurse-led care items and remove the requirement for them to collaborate with doctors in delivering care.</p>
<p>The federal government’s current proposals may therefore see nurse practitioners working completely independently, in a similar way to that overseas.</p>
<p>But despite evidence showing nurse practitioners <a href="https://www.sciencedirect.com/science/article/pii/S1555415513004108?casa_token=7ye49Vc_XLMAAAAA:hw76-d1CjqvF-jBZ-7D_y9_DOAJzeMhav979UgBq1WOxnCdI7QfKoYPcLXxj98bZ2wjHqQQ7qw">provide safe health care</a>, the proposal has been met with <a href="https://www.racgp.org.au/FSDEDEV/media/documents/RACGP/Reports%20and%20submissions/2019/RACGP-submission-MBS-Review-Nurse-Practitioners-Reference-Group.pdf">concern</a> from some doctors that increased independence may risk patient safety and lead to more fragmented care. They also argue it would be unfair for patients who can’t see a doctor and who must see a nurse practitioner instead. </p>
<h2>What should happen next?</h2>
<p>Delivering better quality primary health care in Australia ultimately means we need to make better use of our health services and align it with our changing population needs. </p>
<p>To achieve this, we will need to grow our nurse practitioner workforce and use them more effectively. Enabling nurse practitioners to use all their skills independently might also help to stem the loss of nursing workforce.</p>
<p>But expanding the scope of any profession must be done in a way that improves collaboration, team-based working and patient-centred care. Health care is safest and most effective when health professionals work together – and with patients – to make decisions about care. So it’s important for the plan to include incentives that make collaboration more likely between nurse practitioners and doctors.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/pharmacists-should-be-able-to-work-with-gps-to-prescribe-medicines-for-long-term-conditions-212359">Pharmacists should be able to work with GPs to prescribe medicines for long-term conditions</a>
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<img src="https://counter.theconversation.com/content/212620/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Reema Harrison receives funding from National Health and Medical Research Council, Medical Research Futures Fund, Cancer Institute NSW, Australian Research Council, Medibank Better Health Fund, and NSW Health. </span></em></p><p class="fine-print"><em><span>Laurel Mimmo works for a NSW Health organisation and is a member of the NSW Nurses and Midwives Association, the Health Services Union and the Australian College of Nursing. She does not currently receive funding from any organisation. </span></em></p>Nurses make up more than 50% of the health workforce and have untapped and under-used skills that could ease the skills gap in our health system.Reema Harrison, Associate Professor, Macquarie UniversityLaurel Mimmo, Honorary Post-doctoral Fellow, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2061832023-07-17T20:02:39Z2023-07-17T20:02:39ZShould you register with a GP? What is MyMedicare and how might it change the care you get?<figure><img src="https://images.theconversation.com/files/533371/original/file-20230622-8583-mxjvpt.jpg?ixlib=rb-1.1.0&rect=7%2C22%2C4977%2C3295&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/british-gp-examining-young-child-mother-98508353">Shutterstock</a></span></figcaption></figure><p><a href="https://www.health.gov.au/our-work/mymedicare">MyMedicare</a> is a new voluntary scheme that allows patients to register with their usual GP, in an attempt to improve continuity of care and health outcomes.</p>
<p>From October 1, the scheme will give registered patients access to longer telehealth consultations. Then, from next year, GP clinics with patients who are frequently admitted to hospital or are aged care residents will be able to access additional “blended” funding, which sits outside Medicare’s usual fee-for-service. </p>
<p>MyMedicare was announced in the May budget, with A$19.7 million of funding over four years, alongside a range of <a href="https://www.health.gov.au/sites/default/files/2023-05/building-a-stronger-medicare-budget-2023-24_0.pdf">other health reforms</a>, including funding for practice nurses to improve team-based care, as well as new incentives to increase bulk billing rates. </p>
<p>We’re still waiting on a lot of detail about how the scheme will function. But here’s what we know so far – and what it might mean for patients and GPs. </p>
<h2>What do we know about MyMedicare?</h2>
<p>The scheme is voluntary for GPs and patients. In addition to patients opting in, GPs will also need to sign up, and have been able to do so since the start of July. There will be a gradual roll out and it will take three years to cover all of Australia. </p>
<p>Though details are yet to be confirmed, from mid-2024 individual GPs will receive “<a href="https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/resident-career-counseling-guidance-and-tips/understanding-capitation">capitation</a>” payments for patients who have more than ten hospital admissions per year. These patients are likely to have complex needs and multiple conditions and, for various reasons, may not be able to access a GP as much as they should. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/health-budget-has-big-changes-reviving-our-worn-out-medicare-fee-for-service-system-and-boosting-bulk-billing-204527">Health budget has big changes – reviving our worn-out Medicare fee-for-service system and boosting bulk billing</a>
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<p>Though not yet confirmed, GPs are likely to <a href="https://www.ausdoc.com.au/news/the-mymedicare-enrolment-scheme-is-open-for-gp-practices-should-you-sign-up-now/">receive</a> $2,000 per patient per year, plus a $500 bonus for keeping patients out of hospital. The funding provides incentives for the GP to coordinate their care and provide the patient with access to nursing and allied health if required. It’s hoped this will stop patients going to hospital as often.</p>
<p>There will also be similar payments for providing regular visits to patients in residential aged care facilities. </p>
<h2>Will MyMedicare make a difference to patients?</h2>
<p>Let’s consider four key areas patients are concerned about: </p>
<p><strong>1) Continuity of care</strong></p>
<p>Research shows greater <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2753.2009.01235.x">continuity of care</a> – developing a relationship with and seeing the same provider or team for your care – improves patient outcomes and reduces costs to the health system. People who use MyMedicare to get a regular GP may see some of these benefits.</p>
<p>But many patients already see the same GP or visit the same practice, especially those with chronic conditions. So registration with a practice may not make much difference for this group of patients. What are the other benefits of registration? </p>
<p><strong>2) Reducing hospital admissions</strong></p>
<p>Avoiding hospitals can be beneficial – in hospitals, there are no home comforts, they are inconvenient for you and relatives, there is little privacy, and they can be costly. Patients with ten or more hospital admissions in a year have been targeted as they have more complex chronic conditions and may be from vulnerable populations. </p>
<p>Better access to a GP could prevent patients visiting the emergency department or prevent overnight hospital admissions. Research shows financial incentives for GPs to better manage chronic disease <a href="https://journals.sagepub.com/doi/full/10.1177/01410768211005109">can reduce hospital admissions</a>. </p>
<p>However, <a href="https://bmjopen.bmj.com/content/5/4/e007342?cpetoc=&int_source=trendmd&int_medium=trendmd&int_campaign=trendmd">hospital admissions could also increase</a> if the scheme identifies significant levels of previous unmet need.</p>
<p><strong>3) Reducing barriers to care</strong></p>
<p>MyMedicare does not directly address many of the <a href="https://link.springer.com/article/10.1186/1475-9276-12-18">barriers to accessing GP services</a>. If GPs are getting paid more and still getting fee for service payments, will MyMedicare patients be guaranteed to be bulk billed? This has not yet been mentioned, but could be an important part of the scheme to attract patients. </p>
<p>People with chronic disease have <a href="https://grattan.edu.au/report/not-so-universal-how-to-reduce-out-of-pocket-healthcare-payments/">two to three times higher</a> out-of-pocket costs than those who do not, and <a href="https://healthsystemsustainability.com.au/the-voice-of-australian-health-consumers/">30%</a> of patients with chronic disease would find it difficult to pay for care if they became seriously ill. </p>
<p>Unfortunately MyMedicare will not directly reduce out-of-pocket costs, which may be the real reason why people use “free” emergency department care.</p>
<p><strong>4) Making it clear and easy to sign up</strong></p>
<p>It is also unclear how the process of registration will work for patients. Will patients be offered a choice of alternative GPs? If chosen, will GPs be obliged to take them? </p>
<p>At the moment, there are no public data about out-of-pocket costs and quality of care provided by different GPs, and so it will be impossible for patients to make an informed choice. Information to inform choice on a website would be useful, as is the case for <a href="https://www.health.gov.au/resources/apps-and-tools/medical-costs-finder">specialists</a>. </p>
<p>It’s also unclear if patients who chose to register will find it harder to move GPs or continue to see other GPs if they wish to. The advantages to patients of MyMedicare need to be made clear to encourage them to register and be supported to exercise informed choice if they wish.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/if-you-live-in-a-bulk-billing-desert-its-hard-to-see-a-doctor-for-free-heres-how-to-fix-this-204029">If you live in a bulk-billing ‘desert’ it's hard to see a doctor for free. Here's how to fix this</a>
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</p>
<hr>
<h2>Will it make a difference for GPs?</h2>
<p>Patient registration can mean a more secure and predictable stream of future income for some patients and also less competition (in terms of “losing” patients to other GPs) and more continuity of care. </p>
<p>Moving away from fee for service towards a blended payment model is <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011865.pub2/full">widely recognised</a> to support higher value health care. </p>
<p>Yet GPs are wary of moving from fee for service to capitation payment. Capitation payments are fixed, so GPs take on more financial risk if they have more complex patients who are more costly to treat and manage in terms of time and effort. Whether the $2,000, plus $500 bonus, plus normal fee for service payments are sufficient to cover the costs of treating very complex patients is unclear. </p>
<p>Overall, GPs will get more money, and along with the other announcements in the budget, will receive a significant investment of resources invested in primary care. </p>
<p>Our previous <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hec.3572">research</a> has shown a 5% increase in earnings for GPs is predicted to reduce the total number of GPs by up to 1% (equivalent to around 310 GPs in 2021) at a time of significant GP shortages. If they get paid more, they would prefer to work less.</p>
<p>But this could also be offset because the increase in funding will hopefully make general practice more attractive as a career and so there will be more postgraduate doctors <a href="https://www.sciencedirect.com/science/article/pii/S0167629612000902">choosing to be a GP</a>. </p>
<p>Voluntary patient registration under MyMedicare has potential to strengthen the relationship between patients and their GP, and focuses on keeping patients out of hospital and properly cared for in residential aged care. But the devil is in the detail and we will need a proper evaluation to determine the impacts on health outcomes, costs and access to health care. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-if-medicare-was-restricted-to-gps-who-bulk-billed-this-kind-of-reform-is-possible-203543">What if Medicare was restricted to GPs who bulk billed? This kind of reform is possible</a>
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<img src="https://counter.theconversation.com/content/206183/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Scott receives funding from the Australian Research Council, Medibank Better Health Foundation, and the Independent Hospital and Aged Care Pricing Authority.</span></em></p>MyMedicare is a new voluntary scheme that allows patients to register with their usual GP. How will it work? And how might it benefit patients? Here’s what we know so far.Anthony Scott, Professor of Health Economics, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2096812023-07-13T20:06:13Z2023-07-13T20:06:13ZShould GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts<p>Australian of the Year and body positivity advocate Taryn Brumfitt has <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">called for</a> doctors to avoid discussing a patient’s weight when they seek care for unrelated matters.</p>
<p>A 15-minute consultation isn’t long enough to provide support to change behaviours, Brumfitt says, and GPs don’t have enough training and expertise to have these complex discussions. </p>
<p>“Many people in larger bodies tell us they have gone to the doctor with something like a sore knee, and come out with a ‘prescription’ for a very restrictive diet, and no ongoing support,” Brumfitt <a href="https://www.smh.com.au/healthcare/doctors-should-avoid-discussing-patient-s-weight-australian-of-the-year-says-20230707-p5dmhv.html">told the Nine newspapers</a>. </p>
<p>By raising the issue of weight, Brumfitt says, GPs also risk turning patients off seeking care for other health concerns. </p>
<p>So should GPs bring up a patient’s weight in consultations about other matters? We asked 5 experts.</p>
<h2>Three out of five said yes</h2>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=138&fit=crop&dpr=1 600w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=138&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=138&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=174&fit=crop&dpr=1 754w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=174&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/537232/original/file-20230713-25-ksqj6n.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=174&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Here are their detailed responses:</em></p>
<p><iframe id="tc-infographic-887" class="tc-infographic" height="400px" src="https://cdn.theconversation.com/infographics/887/8a1d47185e014ea9461db2c1880afe8687edaa14/site/index.html" width="100%" style="border: none" frameborder="0"></iframe></p>
<p><em>Disclosure statements: <strong>Brett Montgomery</strong> is a general practitioner. He does not have a specific interest in obesity, but like almost all GPs, he treats many patients who are overweight or obese. He is a fellow of the Royal Australian College of General Practitioners; the college’s position statement on obesity prevention and management is linked to from this article. However, Brett writes here as an individual, and not on behalf of any organisation; <strong>Emma Beckett</strong> has received funding for research or consulting from Mars Foods, NHMRC, ARC, AMP Foundation, Kellogg, and the University of Newcastle. She works for Nutrition Research Australia and member of committees/working groups related to nutrition or the Australian Academy of Science, the National Health and Medical Research Council and the Nutrition Society of Australia. Emma has lived experience of GPs bringing up her weight; <strong>Liz Sturgiss</strong> receives funding from NHMRC, RACGP Foundation, National Centre for Healthy Ageing, Victorian Health Promotion Foundation. She is an appointed committee member of the Guidelines Development Committee for the review and update of the Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia and is the co-founder of the RACGP Specific Interest Group in Poverty; <strong>Nick Fuller</strong> works for the University of Sydney and has received external funding for projects relating to the treatment of overweight and obesity. He is the author and founder of the Interval Weight Loss program; <strong>Helen Truby</strong> has received funding from the NHMRC, the MRFF, the Commonwealth Department of Health, Health and Wellbeing Qld, Clinical Therapy Research in the Specialist Health Services (KLINBEFORSK, Norway), the Andrea Joy Logan Trust, the Victorian Cancer Agency Health Services Scheme.</em> </p>
<p><em>Editor’s note: This article has been updated to include Helen Truby’s final sentence, which was erroneously cut off during layout.</em></p><img src="https://counter.theconversation.com/content/209681/count.gif" alt="The Conversation" width="1" height="1" />
Australian of the year Taryn Brumfitt has called for doctors to avoid raising the issue of weight in consultations about other matters. We asked the experts if they should – or not.Fron Jackson-Webb, Deputy Editor and Senior Health EditorLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048002023-05-02T10:58:54Z2023-05-02T10:58:54ZNew Medicare reforms won’t fix everything but they start to tackle the system’s biggest problems<figure><img src="https://images.theconversation.com/files/523712/original/file-20230502-28-w6y3xw.jpg?ixlib=rb-1.1.0&rect=40%2C200%2C3190%2C1940&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://photos.aap.com.au/">AAP/Tracey Nearmy</a></span></figcaption></figure><p>Federal Health Minister Mark Butler has long said Medicare is in the <a href="https://www.sbs.com.au/news/article/australias-gp-system-in-the-worst-shape-in-40-years-mark-butler-warns/iquhpkxx5">worst shape</a> it’s been in decades. Premiers have come to successive national cabinet meetings saying primary care is failing – and demanding reform and investment.</p>
<p>Fortunately, the policies Minister Butler <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023">outlined</a> today at the <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/minister-for-health-and-aged-care-speech-national-press-club-2-may-2023">National Press Club</a> to strengthen Medicare live up to challenge. These reforms will be funded with a total of A$2.2 billion</p>
<p>They certainly won’t fix everything. But instead of kicking the can down the road, or just addressing superficial symptoms, they start to tackle some of the biggest challenges in general practice: outmoded technology, GPs working with little support, a broken funding model, and restrictive regulations. </p>
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<em>
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Read more:
<a href="https://theconversation.com/health-and-housing-measures-announced-ahead-of-budget-and-ndis-costs-in-first-ministers-sights-204675">Health and housing measures announced ahead of budget, and NDIS costs in first ministers' sights</a>
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<h2>Diagnosing the problem</h2>
<p>There are many visible and urgent crises in health care, ranging from falling rates of bulk-billing to overwhelmed hospital emergency departments. But the minister zeroed in on the one big structural failure driving many of these problems: Medicare hasn’t kept up with the health needs of Australians. </p>
<p>Medicare was established in the 1980s. Today, Australians are living longer, often with chronic diseases. Chronic diseases – such as heart disease, diabetes, asthma, and depression – are the leading cause of illness and death. <a href="https://www.aihw.gov.au/reports/australias-health/chronic-conditions-and-multimorbidity">Almost half</a> of Australians have one chronic condition; more than half of Australians over 65 have two or more. </p>
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<img alt="Doctor takes her patient's blood pressure" src="https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523717/original/file-20230502-20-lx98hp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Almost half of Australians have a chronic health condition.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/QTH2xmoJ_p0">Unsplash/CDC</a></span>
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<p>As Minister Butler noted, Medicare has not kept up and has “started to show its age”. A system designed for quick, one-off consultations with doctors isn’t a good fit for the more complex range of ongoing care and support many patients need today. </p>
<p>To update Medicare, the minister announced three areas of reform. </p>
<h2>1. Modernising digital systems</h2>
<p>With people likely to have multiple health conditions, and to see a range of professionals across the health system, it’s more important than ever for patients and clinicians to have relevant and up-to-date health information. That helps clinicians understand their patients’ needs. It also means patients don’t have to provide the same information again and again, or have duplicated, wasteful tests. </p>
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<strong>
Read more:
<a href="https://theconversation.com/my-health-record-is-meant-to-empower-patients-but-with-little-useful-information-stored-is-it-worth-saving-199508">My Health Record is meant to empower patients – but with little useful information stored, is it worth saving?</a>
</strong>
</em>
</p>
<hr>
<p>Australia’s digital systems are outdated, hard to use and ineffective. My Health record, our main digital health tool, is only used by <a href="https://journal.achsm.org.au/index.php/achsm/article/view/311/267">a small minority</a> of specialists, private hospitals and allied health providers. According to Minister Butler, only one in ten specialists use it, and only one in five radiology test results (such as X-rays or MRIs) are uploaded. </p>
<p>Computer systems in practices and hospitals usually can’t talk to each other, and often they aren’t connected to My Health Record.</p>
<p>To start to address this, more than $950 million will be spent on digital health, including keeping the Digital Health Agency running and improving My Health record.</p>
<h2>2. Building bigger teams</h2>
<p>To respond to the growing complexity of people’s health needs, most countries are moving towards “multidisciplinary” teams in general practice. Those teams might include nurses, physiotherapists, pharmacists, psychologies and administrative roles. This approach can improve care and take pressure off GPs. </p>
<p>As with digital systems, Australia is well behind other countries. Our GPs are <a href="https://grattan.edu.au/report/a-new-medicare-strengthening-general-practice/">more likely</a> to work on their own, or with little support. That’s because the way we fund general practice is stuck in the past, mostly restricted to paying GPs for disconnected, one-off consultations. </p>
<p>The <a href="https://www.health.gov.au/our-work/workforce-incentive-program/about">Workforce Incentive Program</a>, which funds general practices to hire a range of different health professionals, will be increased. For small clinics, and in areas with too little care to go around, <a href="https://www.health.gov.au/our-work/phn">Primary Health Networks</a> (regional bodies responsible for improving primary care) will fund and attract allied health professionals and nurses to work in GP clinics. </p>
<p>But the biggest change is a new way of funding care. Our outdated fee-for-service system rewards rushed consultations, is <a href="https://www.health.gov.au/sites/default/files/2023-04/independent-review-of-medicare-integrity-and-compliance_0.pdf">complex and confusing</a> for doctors, and blocks team-based care. For clinics and patients who choose to participate, a new system dubbed My Medicare will change that. </p>
<p>Patients will register with a preferred practice. The practice will then get a budget for treating them, on top of fees for each visit. Getting a patient-centred budget alongside visit fees will give care teams the flexibility to plan and deliver care in new and better ways. </p>
<p>Registering with a clinic will support strong relationships between patients and their care teams. Funding will be focused on that relationship, not on isolated visits, and will reflect the work of the whole care team, not just the GP. </p>
<h2>3. Unlocking workforce skills</h2>
<p>Along with measures to attract nurses to primary care settings, there will be a review of the barriers that stop health professionals using all their skills. </p>
<p>Australia has a thicket of inconsistent regulations and complex funding rules that result in double-handling, high costs, wasted talent and GPs having to do too much. The review is an opportunity to clear many of these barriers away, and make sure that workforce roles reflect the best evidence about how to provide safe, high-quality care.</p>
<p>Pharmacists will also <a href="https://www.health.gov.au/sites/default/files/2023-04/summary-of-strengthening-medicare-policies.pdf">do more</a>, with new funding for free vaccinations and expansions to treatment for people addicted to opioids. And there will be more training places in primary care for nurses, and efforts to attract nurses who have left the profession back into general practice. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">Should pharmacists be able to prescribe common medicines like antibiotics for UTIs? We asked 5 experts</a>
</strong>
</em>
</p>
<hr>
<h2>Evolution not revolution – and a team effort</h2>
<p>The breadth of the proposals is important – there will be little progress without improvements in all those areas. </p>
<p>At the National Press Club, Minister Butler said “remaking Medicare for the 21st century will take persistent evolution, not overnight revolution”. </p>
<p>That incremental approach is important too, including making the most complex reform, My Medicare, voluntary. These changes will be hard, so participating clinicians and patients must be convinced of the benefits, willing to change, and ready for inevitable setbacks. </p>
<figure class="align-center ">
<img alt="Nurse shows a patient a pamphlet" src="https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/523719/original/file-20230502-18-1rui3z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Medicare reform process will be incremental.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/lNkRnZPfiwY">Unsplash/CDC</a></span>
</figcaption>
</figure>
<p>The reforms won’t satisfy everyone, but this might be the biggest opportunity for primary care reform in a generation. </p>
<p>The minister remarked on the “pointy elbows and loud voices” of the various professional groups in health care that provided input through his <a href="https://www.health.gov.au/committees-and-groups/strengthening-medicare-taskforce#publications">Strengthening Medicare Taskforce</a>. This package needs the support of all the workforce groups involved in primary care, and a strong voice for patients. Hopefully they will work together to make sure these reforms succeed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/heres-why-pharmacists-are-angry-at-script-changes-and-why-the-government-is-making-them-anyway-204028">Here's why pharmacists are angry at script changes – and why the government is making them anyway</a>
</strong>
</em>
</p>
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<img src="https://counter.theconversation.com/content/204800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Breadon's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p><p class="fine-print"><em><span>Lachlan Fox's employer, Grattan Institute, has been supported in its work by government, corporates, and philanthropic gifts. A full list of supporting organisations is published at <a href="http://www.grattan.edu.au">www.grattan.edu.au</a>.</span></em></p>The new reforms tackle some of the biggest challenges in general practice: outmoded technology, GPs working with little support, a broken funding model and restrictive regulations.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteLachlan Fox, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035612023-04-18T20:01:47Z2023-04-18T20:01:47ZMedicare billing is a problem but our research found many more GPs undercharge<figure><img src="https://images.theconversation.com/files/520646/original/file-20230413-18-4oyane.jpg?ixlib=rb-1.1.0&rect=68%2C53%2C5002%2C3327&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-consultant-meeting-teenage-patient-284516786">Shutterstock</a></span></figcaption></figure><p>Australia’s Medicare billing system is overly complicated, bureaucratic and not meeting the needs of a modern health service, potentially leaking billions of dollars. But claims this loss is mostly due to fraudulent billing practices by GPs are inaccurate. </p>
<p>In October, the ABC’s 7.30 program and the Nine newspapers <a href="https://www.smh.com.au/politics/federal/medicare-is-haemorrhaging-the-rorts-and-waste-costing-taxpayers-billions-of-dollars-a-year-20221013-p5bpp9.html">raised concerns</a> about an estimated A$8 billion in Medicare waste, caused by a mixture of doctors’ errors, over-servicing and outright fraud. The examples given, however, were almost exclusively intentional fraud, mainly in general practice. This promoted health minister Mark Butler to commission an <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/independent-review-into-medicare-compliance">independent review</a>, led by Dr Pradeep Philip.</p>
<p>The <a href="https://www.health.gov.au/resources/publications/independent-review-of-medicare-integrity-and-compliance?language=en">Philip review</a>, released earlier this month, was highly critical of the current Medicare system and found non-compliance and fraud accounted for $1.5 to $3 billion of Medicare waste.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1643122020585029632"}"></div></p>
<p>Our research team <a href="https://www1.racgp.org.au/ajgp/2023/april/general-practitioner-charging-of-medicare">analysed GP activity</a> recorded during almost 90,000 patient encounters to assess how GPs were billing for the services they provided. </p>
<p>We found GPs undercharged at 11.8% of encounters and overcharged at 1.6%. This suggests GPs aren’t routinely defrauding Medicare, and in fact have saved the system equivalent to $351 million in the 2021-22 financial year. </p>
<p>However, we agree the current billing system needs to be urgently reformed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
</strong>
</em>
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<hr>
<h2>How does Medicare billing work?</h2>
<p>GPs claim a fee for service, called a rebate, which is a fixed amount ascribed on the Medicare Benefits Schedule (MBS), based on the type of service provided. </p>
<p>There are nearly 6,000 MBS item numbers. GPs can charge for one or more MBS items for a patient service. </p>
<p>Around 90% of MBS items claimed by GPs are considered standard consultation items (surgery, residential aged care facility visits, home visits and so on), that are in four levels (A, B, C and D) which increase in length. </p>
<p>The cost associated increases with each level. An example of an error would be a GP accidentally charging for a Level C consultation (requires 20 minutes or longer; $76.95 rebate) when the visit only met the criteria for a Level B (less than 20 minutes; rebate of $39.75). An example of under-billing is when a GP is entitled to claim for a Level C but charges only a Level B. </p>
<p>An example of over-servicing is a pathology test for blood glucose level being repeated for the same patient at consecutive visits, where the patient’s condition did not warrant the second test. </p>
<p>An example of fraud would be claiming for a service that had not been provided.</p>
<figure class="align-center ">
<img alt="patients wait in a GP clinic waiting room" src="https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/521169/original/file-20230417-16-dpm1yh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Rebates are based on the time spent with the patient.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woodbridge-suffolk-6-july-2021-people-2003258147">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Examining doctors’ billing in the real world</h2>
<p>The data we analysed in our peer-reviewed <a href="https://www1.racgp.org.au/ajgp/2023/april/general-practitioner-charging-of-medicare">study</a> were collected between 2013-2016 from nationally representative samples of GPs during 89,765 real-time encounters with their patients. The GPs recorded the start and finish time for each visit. </p>
<p>The Philip review did not try to quantify the amount of underbilling. </p>
<p>We decided to examine the billing data following the 7.30 Report/Nine news investigation, but the participants could not have been influenced by these reports as the data we used were collected prior to the ABC/Nine publications.</p>
<h2>Why would doctors undercharge?</h2>
<p>We theorised GPs were likely undercharging Medicare for two reasons:</p>
<p>1) while time is the predominant measure, GPs are likely to still consider content and complexity when billing standard Medicare items, rather than just billing according to the time spent with the patient</p>
<p>2) fear of triggering a professional services review (PSR) of their billing.</p>
<p>A professional services review can be triggered for a variety of reasons, for example, a GP has a higher proportion of longer consultations than might be expected. A professional services review involves an audit of the GP’s billing. It can potentially lead to a decision that can prevent the GP from being able to bill Medicare.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/6-reasons-why-its-so-hard-to-see-a-gp-199284">6 reasons why it's so hard to see a GP</a>
</strong>
</em>
</p>
<hr>
<p>Last week, <a href="https://www.healthed.com.au/">HealthED</a>, a health education company, included three post-webinar questions on this topic in an online survey of 1,852 GPs from across Australia. Answering these questions was not compulsory.</p>
<p>The results showed most (83.3%) GPs consider the length and complexity of the consultation when billing Level C and D items, even though increased complexity is no longer required (since 2011).</p>
<p>More than half (60.3%) intentionally under-billed Medicare in the previous week. </p>
<p>The most common reasons for under-billing were:</p>
<ul>
<li><p>they did not feel that the content of the consultation justified a higher MBS item (41.9%)</p></li>
<li><p>fear of triggering a professional services review alert (33.5%)</p></li>
<li><p>confusion around Medicare schedule criteria (30.8%).</p></li>
</ul>
<p>These responses correlate with the findings from our nationally representative sample, which suggests GPs predominantly act with integrity, but also based on fear and confusion.</p>
<h2>Time to reform Medicare billing</h2>
<p>A simplification of the current very complex Medicare billing system would resolve a lot of waste through unintended errors. Reducing low value and unnecessary care is not a simple task as these are difficult to define, and often rely on situational judgement. When systems are no longer fit for purpose, they should be reviewed and revised, as the Philip review has recommended.</p>
<p>There are bad actors in every profession and those who “game” Medicare should be called out. However, the claims of widespread fraud have not been supported by our work or the Philip review.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-so-many-gps-leaving-the-profession-how-can-i-find-a-new-one-190666">With so many GPs leaving the profession, how can I find a new one?</a>
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</p>
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<img src="https://counter.theconversation.com/content/203561/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New research suggests GPs aren’t routinely defrauding Medicare, and in fact have saved the system hundreds of millions of dollars by under-billing.Christopher Harrison, Senior Lecturer, Sydney School of Public Health, University of SydneyJoan Henderson, Senior Research Fellow (Hon), University of Sydney. Editor, Health Information Management Journal (HIMJ), University of SydneyMelissa Kang, Associate Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1993032023-02-09T19:11:35Z2023-02-09T19:11:35ZNeed a bulk-billing GP? Why throwing more money at Medicare isn’t the answer<figure><img src="https://images.theconversation.com/files/509059/original/file-20230208-19-3507v7.jpg?ixlib=rb-1.1.0&rect=1%2C2%2C997%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/female-doctor-consultant-having-meeting-patient-1993144466">Shutterstock</a></span></figcaption></figure><p>Last financial year, the Australian government <a href="https://budget.gov.au/2022-23-october/content/bp1/download/bp1_2022-23.pdf">spent</a> almost A$29 billion on Medicare. Most was spent on primary care – a patient’s usual first contact with the health system when sick or injured, such as GP, allied health and diagnostic services. Every year, this spending increases.</p>
<p>Yet, many patients are paying more to see their GP, some <a href="https://theconversation.com/rising-out-of-pocket-health-costs-are-a-worry-but-the-major-parties-have-barely-mentioned-it-181595">cannot afford care</a> and emergency departments are <a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">overcrowded with patients</a> who could be treated by a GP.</p>
<p>Last week, the Strengthening Medicare Taskforce released its much-anticipated <a href="https://www.health.gov.au/resources/publications/strengthening-medicare-taskforce-report?language=en">report</a> on how to improve the primary health-care system. The report provided broad-brush recommendations mostly focused on delivering patient-centred care, supported by better health data and information technology.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1622358000051658753"}"></div></p>
<h2>Medicare is set for an overhaul</h2>
<p>An important subtext of the report is to overhaul Medicare, Australia’s national public health insurance scheme. Medicare pays a proportion of costs for every Australian that receives subsidised primary care services.</p>
<p>There has not been a major reform to Medicare since its introduction in 1984. If successful, reforming Medicare will be the greatest change to primary care in decades. </p>
<p>It will help governments usher in long sought-after integrated care pathways – with patients cared for by a team of health professionals that better meet their needs, especially those with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117605/">chronic conditions</a>.</p>
<p>But let’s not celebrate just yet. Major funding reform is not a given. Health Minister Mark Butler concedes there’s a long road ahead, telling <a href="https://www.health.gov.au/ministers/the-hon-mark-butler-mp/media/radio-interview-with-minister-butler-and-sabra-lane-abc-am-9-february-2023?language=en">the ABC</a> this week that we’re not going to fix Medicare in one budget.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medicare-reform-is-off-to-a-promising-start-now-comes-the-hard-part-197914">Medicare reform is off to a promising start. Now comes the hard part</a>
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</em>
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<hr>
<h2>A battle looms ahead</h2>
<p>A potential battle between health providers and the Australian government looms on the horizon.</p>
<p>That’s because the most ferocious national health-care debates are often about how GPs should get paid. Medicare needs to pay providers based on patient health outcomes. Some providers, like GPs, may be worse off financially if they perform poorly.</p>
<p>That will be a hard pill to swallow. Pressure from strong lobby groups that represent primary care providers may water down reform. That runs the risk of worsening patient outcomes compared to what could be achieved.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Street signage of bulk-billing medical centre on high street" src="https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509062/original/file-20230208-19-pysvye.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A bulk-billing GP has become harder to find. So we need widespread reform to improve access to quality, value-for-money care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/melbourne-vicaustraliaoct-9th-2019-sign-bulk-1743252638">Shuang Li/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/patient-advocate-or-doctors-union-how-the-ama-flexes-its-political-muscle-60444">Patient advocate or doctors' union? How the AMA flexes its political muscle</a>
</strong>
</em>
</p>
<hr>
<h2>How did we get here?</h2>
<p>Successive governments over the past 30 years have tried to tighten the reins on runaway Medicare spending. Most attempts have failed.</p>
<p>The Hawke government introduced a <a href="https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/FlagPost/2014/April/GP_co-payment_lessons_from_past">$2.50 co-payment</a> in 1991, which GPs could charge to non-concessional patients when they received bulk-billed services. In 1992, Keating abolished this when he became prime minister. The Abbott government tried to introduce a $7 co-payment in 2014, but <a href="https://www.abc.net.au/news/2015-03-03/timeline-dumped-medicare-co-payment-key-events/6275260">dumped the budget announcement</a> against fierce community opposition in 2015.</p>
<p>The Abbott government did manage to freeze the annual increase in Medicare Benefits Schedule fees (fees doctors are paid to perform certain subsidised services) between 2015 and 2020. This led to fierce opposition from primary care providers.</p>
<p>The Australian Medical Association (AMA) <a href="https://ama.com.au/sites/default/files/documents/Handout%20for%20politicians_MBSIndexation%20Freeze.pdf">suggested</a> this would force GPs to increase co-payments and reduce bulk billing to maintain their business returns. </p>
<p>While co-payments <a href="https://www.aihw.gov.au/reports/health-welfare-expenditure/health-expenditure-australia-2020-21/contents/summary">have increased</a>, annual bulk billing rates have only declined in the past year.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=370&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=370&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=370&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=465&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=465&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508789/original/file-20230208-23-wqbzej.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=465&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bulk-billing rates have only declined in the past year.</span>
<span class="attribution"><a class="source" href="https://www.pc.gov.au/ongoing/report-on-government-services/2023/health/primary-and-community-health">Productivity Commission</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523">Explainer: what is Medicare and how does it work?</a>
</strong>
</em>
</p>
<hr>
<h2>How should we fund primary care?</h2>
<p>It’s clear Medicare is no longer “fit for purpose”. Some patients <a href="https://www.aihw.gov.au/getmedia/f6dfa5f0-1249-4b1e-974a-047795d08223/aihw-mhc-hpf-35-patients-out-of-pocket-spending-Aug-2018.pdf.aspx?inline=true">avoid care</a> because they cannot afford it. Patients with higher incomes, and patients living in more affluent areas, often pay more if not bulk billed, but can access primary care easier.</p>
<p><a href="https://www.ama.com.au/media/medicare-report-encouraging-significantly-more-investment-needed-save-general-practice">Increasing Medicare rebates</a>, as the AMA proposes will not fix those problems. </p>
<p>A financial incentive for providers to deliver care of little value to patients <a href="https://www.mja.com.au/journal/2012/197/2/caretrack-assessing-appropriateness-health-care-delivery-australia">will remain</a>. Providers will still be paid regardless of the health outcomes they achieve, and care misaligned with best practice will continue to be funded.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-gps-just-keep-their-heads-above-water-other-doctors-businesses-are-more-profitable-than-law-firms-192163">Some GPs just keep their heads above water. Other doctors' businesses are more profitable than law firms</a>
</strong>
</em>
</p>
<hr>
<h2>We need a radical rethink</h2>
<p>A complete rethink of Medicare is required to support the vision presented in the Strengthening Medicare Taskforce report. The Australian government must start now, as the health-care system adjusts to a post-pandemic world.</p>
<p>Reforming Medicare cannot happen in isolation. It must sit within a cohesive national vision and a <a href="https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-49-roadmap-towards-scalable-value">ten-year plan for health-care funding reform</a>.</p>
<p>Medicare reform should be accompanied by public hospital funding, private health insurance and co-payment reform – the three other major funding sources for health care – to ensure Medicare does not remain siloed while governments seek to integrate care.</p>
<p>An independent national health payment authority should be developed and tasked with designing and coordinating the implementation of funding reform. This would work closely with state and federal governments, primary health networks and local health networks. </p>
<p>It would also clarify who is responsible for which elements of funding reform and reduce the potential for duplicating efforts across states.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1621331889540808704"}"></div></p>
<h2>We need to do things differently</h2>
<p>Australia could benefit from <a href="https://ahha.asn.au/publication/health-policy-issue-briefs/deeble-issues-brief-no-49-roadmap-towards-scalable-value">payment models</a> being explored internationally. These include funding a pathway of multiple, integrated health providers – let’s say a GP working with a physio and nurse practitioner – to provide cheaper care that improves outcomes.</p>
<p>In such “value-based” payment models, there’s an incentive to improve health outcomes and reduce costs. Providers share the cost savings compared to what it would have cost using the current Medicare Benefits Schedule.</p>
<p>If we’re to reform Medicare towards paying for value, then we’ll need much more data on patient health outcomes, other factors that impact health outcomes but are outside the control of providers (such as socioeconomic factors), and data on the cost of delivering care. </p>
<p>That requires reforming the way data is collected and shared, and investment in better information technology infrastructure. </p>
<p>The government will need to work closely with providers to ensure they are equipped to manage the transition towards value-based payment models. It will also need to help providers connect and work together to coordinate different types of care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-the-training-to-diagnose-test-prescribe-and-discharge-nurse-practitioners-could-help-rescue-rural-health-199287">With the training to diagnose, test, prescribe and discharge, nurse practitioners could help rescue rural health</a>
</strong>
</em>
</p>
<hr>
<p><em>Update: the article has been updated to more accurately reflect government expenditure on Medicare.</em></p><img src="https://counter.theconversation.com/content/199303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henry Cutler does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Medicare needs an overhaul to improve patients’ access to quality care. And we have a unique opportunity to shake up how health care is provided.Henry Cutler, Professor and Director, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992842023-02-09T06:21:56Z2023-02-09T06:21:56Z6 reasons why it’s so hard to see a GP<figure><img src="https://images.theconversation.com/files/509075/original/file-20230209-27-pnpjpj.jpg?ixlib=rb-1.1.0&rect=8%2C179%2C5982%2C3808&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.abc.net.au/news/2021-07-12/remote-nt-gp-shortage-but-new-menzies-research-offers-solutions/100282786">Shutterstock</a></span></figcaption></figure><p>The recently released Strengthening Medicare Taskforce <a href="https://www.health.gov.au/resources/publications/strengthening-medicare-taskforce-report?language=en">report</a> found more people are <a href="https://www.abc.net.au/news/2023-02-02/australians-delaying-health-care-because-of-cost/101916104">delaying care</a> or attending emergency departments because they can’t get in to see a GP.</p>
<p>And it’s likely to get worse. General practice is shrinking rapidly, with estimates Australia will be <a href="https://www2.deloitte.com/content/dam/Deloitte/au/Documents/Economics/deloitte-au-cornerstone-health-gp-workforce-06052022.pdf">11,500 GPs short</a> by 2032. This is one-third of the current GP workforce. </p>
<p>So why is it harder to access and afford GP care? Here are six key reasons why.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medicare-reform-is-off-to-a-promising-start-now-comes-the-hard-part-197914">Medicare reform is off to a promising start. Now comes the hard part</a>
</strong>
</em>
</p>
<hr>
<h2>1) Patients are older and sicker</h2>
<p>The population is ageing, and more people with multiple <a href="https://www.aihw.gov.au/reports-data/health-conditions-disability-deaths/chronic-disease/overview">chronic diseases</a> – such as cancer, diabetes and heart disease – are living longer in the community. Rates of mental illness are <a href="https://www.aihw.gov.au/reports/mental-health-services/mental-health">also rising</a>. </p>
<p>This not only increases GPs’ <a href="https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00520-9">clinical workload</a>, it also shifts a greater load of <a href="https://www.healthed.com.au/clinical_articles/most-gps-do-3-hours-of-unpaid-work-a-week/">care coordination</a> onto the GP. This decreases the number of patients a GP can see. </p>
<p>GPs have also been under increasing pressure from <a href="https://www1.racgp.org.au/newsgp/professional/female-gps-more-likely-to-spend-time-on-non-billab">administrative</a> and <a href="https://www1.racgp.org.au/newsgp/professional/nudge-letters-in-spotlight-amid-gp-push-back-on-co">compliance</a> activities for Medicare, as well as paperwork for the aged care, disability, social security, health and workplace sectors. </p>
<figure class="align-center ">
<img alt="GP talks to older patient" src="https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509057/original/file-20230208-29-dbogbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients have increasingly complex health issues, which take up more time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-patient-having-consultation-nurse-office-317588417">Shutterstock</a></span>
</figcaption>
</figure>
<h2>2) General practice is no longer financially viable</h2>
<p>GP clinics are less financially viable than they used to be. One <a href="https://www.racgp.org.au/general-practice-health-of-the-nation-2022#:%7E:text=The%202022%20General%20Practice%3A%20Health,the%20provision%20of%20patient%20care">survey</a> of doctors found 48% of respondents said their practices were no longer financially sustainable. As a result, many are closing. </p>
<p>The Medicare rebate has <a href="https://www1.racgp.org.au/newsgp/professional/should-bulk-billing-rates-be-used-as-a-measure-of">increased much more slowly than inflation</a> and was <a href="https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169">frozen</a> from 2014 to 2020. </p>
<p>While this was a <a href="https://www.ama.com.au/sites/default/files/2022-11/AMA%27s-plan-to-Modernise-Medicare-Why-Medicare-indexation-matters.pdf">huge saving</a> for the government, a low rebate meant the gap between the cost of care and the rebate had to be passed on to GPs and their patients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169">What is the Medicare rebate freeze and what does it mean for you?</a>
</strong>
</em>
</p>
<hr>
<p>A GP’s fee has to cover the costs of the whole practice. There are <a href="https://www1.racgp.org.au/newsgp/professional/miserly-mbs-indexation-criticised">growing operating costs</a> for insurance, rent, wages, information technology and consumables like gowns, gloves and single-use clinical equipment. When a GP bulk bills, their businesses <a href="https://theconversation.com/gps-are-abandoning-bulk-billing-what-does-this-mean-for-affordable-family-medical-care-182666">absorb the gap</a> between the cost of care and the Medicare rebate. The rebate is now so low (for example, the <a href="http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=2713">rebate</a> for a 45 minute consultation for mental health is A$76), and costs are high, few GPs are able to afford to bulk bill patients. This means people on low incomes have trouble affording the care they need. </p>
<p><a href="https://insightplus.mja.com.au/2022/37/the-harsh-realities-of-working-as-a-female-gp/">Women doctors</a> in particular feel these cost pressures. Medicare rebates are lower per minute for <a href="https://www.smh.com.au/politics/federal/gps-warn-of-higher-fees-without-increased-medicare-rebates-for-long-consults-20220112-p59nqg.html">long consultations</a> and female GPs see more patients with <a href="https://www.smh.com.au/lifestyle/health-and-wellness/we-re-paid-less-to-do-so-much-more-one-female-doctor-speaks-out-20190709-p525lj.html">mental ill-health and complex chronic disease</a> requiring longer appointment times. This leaves women <a href="https://data.gov.au/data/dataset/taxation-statistics-2019-20/resource/0ea4e23c-4462-4fe2-a4b7-339d129c5ede?inner_span=True">GPs earning at least 20% less</a> than their male colleagues. </p>
<figure class="align-center ">
<img alt="Doctor talks on the phone" src="https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509050/original/file-20230208-29-dkrz4k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women doctors spend more time with patients and earn less.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/doctor-talking-on-the-cellphone-5207089/">Pexels Karolina Grabowska</a></span>
</figcaption>
</figure>
<h2>3) GPs, like other health workers, are becoming unwell</h2>
<p>The rate of <a href="https://www.abc.net.au/news/2021-09-25/doctor-burnout-crisis-looming-warns-psychologist/100449906">physical and mental illness among GPs</a> <a href="https://www.publish.csiro.au/py/fulltext/PY21308">is rising</a>. The causes are complex, and include the <a href="https://www.smh.com.au/national/i-m-totally-utterly-done-the-insider-take-on-our-growing-gp-crisis-20220628-p5axab.html">stress</a> of increasing workloads, <a href="https://www1.racgp.org.au/newsgp/professional/we-need-to-be-kind-to-ourselves-vicarious-trauma-a">vicarious trauma</a> (the cumulative effects of exposure to traumatic events and stories), <a href="https://www.mja.com.au/journal/2016/205/2/estimating-non-billable-time-australian-general-practice">administrative overload</a> and financial worries. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1555696592212090880"}"></div></p>
<p>The suicide rate for female doctors is <a href="https://www.mja.com.au/journal/2018/reducing-risk-suicide-medical-profession">more than twice the national average</a>, and rates of depression <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.13717">are high</a>. It can be difficult for doctors to access care, particularly if they work in rural practice.</p>
<p>Abuse and violence is also more common, with one survey finding at least <a href="https://www.racgp.org.au/getmedia/6d67fbc5-6257-4b14-b6b2-639d13264e55/Health-of-the-Nation-2017-report.pdf.aspx">80% of GPs saw or experienced</a> a form of violence at their place of work. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-so-many-gps-leaving-the-profession-how-can-i-find-a-new-one-190666">With so many GPs leaving the profession, how can I find a new one?</a>
</strong>
</em>
</p>
<hr>
<p>However, it is the <a href="https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/">moral distress</a> of knowing how to help patients, but being unable to do so, that often damages their health the most. </p>
<figure class="align-center ">
<img alt="Older doctor treats older patient" src="https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509060/original/file-20230208-25-28t6qk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Illness among GPs is rising.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-patient-having-medical-exam-doctor-317585774">Shutterstock</a></span>
</figcaption>
</figure>
<h2>4) Fewer junior doctors are choosing general practice</h2>
<p>Around 40% of junior doctors <a href="https://www.smh.com.au/politics/federal/why-has-my-doctor-stopped-bulk-billing-the-medicare-overhaul-explained-20230130-p5cgj1.html">used to choose general practice as a career</a>. It is now <a href="https://www.racgp.org.au/health-of-the-nation/chapter-5-the-future-of-the-gp-workforce/5-1-interest-in-entering-general-practice-training">15%</a>.</p>
<p>Junior doctors now carry more than <a href="https://insightplus.mja.com.au/2022/1/exorbitant-fees-deter-graduates-from-specialising-as-gps/">A$100,000 in HECS debts</a>, so it is understandable they may <a href="https://www.abc.net.au/news/2022-08-31/gp-shortage-to-worsen-as-junior-doctors-turn-to-specialty-fields/101386674">choose other specialties</a> with similar lengths of training that will earn them <a href="https://data.gov.au/data/dataset/taxation-statistics-2019-20/resource/0ea4e23c-4462-4fe2-a4b7-339d129c5ede?inner_span=True">double or triple the yearly income</a>. </p>
<p>However, we suspect one of the key reasons <a href="https://insightplus.mja.com.au/2019/14/a-students-eye-view-of-the-training-crisis/">junior doctors avoid general practice</a> is the <a href="https://medicalrepublic.com.au/med-school-gp-bashing-has-workforce-consequences/75680">denigration of GPs</a>. GPs are portrayed as <a href="https://www1.racgp.org.au/newsgp/gp-opinion/gps-are-not-self-serving-we-are-desperate">greedy</a>, <a href="https://www1.racgp.org.au/newsgp/professional/gps-forced-to-defend-commitment-to-hippocratic-oat">unethical</a> and <a href="https://medicalrepublic.com.au/down-with-generalist-gatekeepers/74863">incompetent</a>.</p>
<p>We cannot attract young doctors to a profession that is constantly under <a href="https://insightplus.mja.com.au/2022/41/are-doctors-really-parasites-healthcare-system/">public and political attack</a>. Education Minister <a href="https://ministers.education.gov.au/clare/national-teacher-workforce-plan">Jason Clare</a> recognised this in teaching, saying “It’s also about respect. […] We need to stop bagging teachers and start giving them a wrap.” We need this <a href="https://patconaghan.com.au/local-mid-north-coast-gps-deserve-our-thanks-and-appreciation/">for GPs too</a>. </p>
<h2>5) Rural GPs are leaving</h2>
<p>It has always been challenging to attract GPs to country practice. Rural practice often involves a wider scope of practice, personal isolation and <a href="https://centralnews.com.au/2022/10/14/gps-bear-brunt-as-rural-australia-falls-behind-on-healthcare/">increased workloads</a> with less professional support. </p>
<p>Rural GPs often work long hours and have on call responsibilities. Jobs, schools and services for <a href="https://insightplus.mja.com.au/2017/44/families-come-first-for-gps-thinking-about-rural-practice/">GP families</a> can be difficult to access. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-burnt-out-health-workforce-impacts-patient-care-180021">A burnt-out health workforce impacts patient care</a>
</strong>
</em>
</p>
<hr>
<p>Despite a growing number of <a href="https://www.health.gov.au/our-work/national-rural-generalist-pathway">programs for educating and training rural doctors</a>, the uneven distribution of GPs may be <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0011/3809963/ANZ-Health-Sector-Report-2021.pdf">worsening</a>. </p>
<h2>6) Fewer overseas-trained doctors are arriving</h2>
<p>There is a <a href="https://apps.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/index.html">global shortage of all health-care workers</a>, which is expected to worsen. Supply of international medical graduates may drop as their options for work in other countries increases. Border closures during COVID have also reduced supply. </p>
<figure class="align-center ">
<img alt="Two young international medical graduates talk" src="https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/509061/original/file-20230208-25-xkb01v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There is a global supply of doctors.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/paris-france-november-22-2022-doctor-2230732303">Shutterstock</a></span>
</figcaption>
</figure>
<p>International medical graduates make up more than <a href="https://www.racgp.org.au/health-of-the-nation/chapter-2-general-practice-access/2-2-gp-workforce">50% of the rural workforce</a>. However recent <a href="https://www.health.gov.au/topics/rural-health-workforce/classifications/dpa">changes</a> mean these doctors can now work in urban locations, rather than the more isolated practices in rural areas. This may worsen <a href="https://www.ausdoc.com.au/news/another-workforce-crisis-govts-img-rule-changes-slammed/">GP shortages in rural communities</a>.</p>
<p>International medical graduates have to <a href="https://www.acrrm.org.au/docs/default-source/all-files/43251-pathways-to-becoming-registered-brochure-f-web.pdf?sfvrsn=e6e69beb_4">fund their own training and assessment</a>. This starts with becoming <a href="https://www.amc.org.au/specialist/">registered as a doctor</a> in Australia and then involves <a href="https://www.racgp.org.au/education/imgs">training as a GP</a>. The training is <a href="https://medicalrepublic.com.au/red-tape-strangling-img-rural-supply/82701">long, arduous and expensive</a>, and doctors often need <a href="https://www.theguardian.com/australia-news/2022/jul/24/international-doctors-unable-to-work-in-australia-due-to-broken-system-experts-say">additional support</a>. There is also an ethical question of recruiting health-care workers from countries that <a href="https://www.smh.com.au/healthcare/the-global-race-to-lure-healthcare-workers-down-under-20220505-p5aiza.html">need their services more</a>. </p>
<p>While the Strengthening Medicare Taskforce supports GP care, it doesn’t identify the specific changes required to improve accessibility and affordability and requires significant structural change. </p>
<p>It will be months before the recommendations of the report can be translated into policy, and it may be years before radical changes can be implemented. Without addressing the GP shortage in the meantime, there may be a much smaller workforce to strengthen. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">Emergency departments are clogged and patients are waiting for hours or giving up. What's going on?</a>
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<img src="https://counter.theconversation.com/content/199284/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Stone is a Fellow of the Royal Australian College of General Practitioners and the Australian College of Rural and Remote Medicine</span></em></p><p class="fine-print"><em><span>Jennifer May is a GP and Director of the University of Newcastle Dept of Rural Health which is in receipt of Commonwealth funding under the Rural Health Multidisciplinary Funding Training Programme.She is the co chair of the Medical Workforce Advisory Reform Committee
</span></em></p>More Australians are delaying care or going to emergency departments because they can’t see a GP. Here are six reasons why.Louise Stone, General practitioner; Associate Professor, ANU Medical School, Australian National UniversityJennifer May, Betty Fyffe Chair of Rural Health Director of University of Newcastle Dept of Rural Health, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992872023-02-06T03:59:28Z2023-02-06T03:59:28ZWith the training to diagnose, test, prescribe and discharge, nurse practitioners could help rescue rural health<figure><img src="https://images.theconversation.com/files/508244/original/file-20230206-31-xycpwx.jpg?ixlib=rb-1.1.0&rect=53%2C35%2C5892%2C3961&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/coronavirus-pandemic-confident-modern-medical-doctor-1823878736">Shutterstock</a></span></figcaption></figure><p>It can be tough to access front-line health care outside the cities and suburbs. For the seven million Australians living in rural communities there are significant <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">challenges</a> in accessing health care due to serious workforce shortages, geographic isolation and socioeconomic disadvantage. This <a href="https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health">results</a> in rural people having poorer quality of life, and long-term poor health outcomes.</p>
<p>Primary health care is the entry point into the health system. It includes care delivered in community settings such as general practice, health centres and allied health practices. It can be delivered via telehealth where face-to-face services are unavailable. </p>
<p>But there is a <a href="https://www.abc.net.au/news/2022-09-22/wa-regional-towns-endure-ongoing-doctor-gp-shortage/101454544">critical shortage</a> of general practitioners (GPs) in rural areas. The Royal Australian College of General Practitioners (RACGP) <a href="https://www.racgp.org.au/general-practice-health-of-the-nation-2022">paints a grim picture</a> of an ageing GP workforce, a declining interest in general practice as a career choice and unequal distribution of GPs between urban and rural areas. </p>
<p>Experts are searching for ways to “<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">fix the GP crisis</a>”, but we can look at the broader picture and ask: “How else might we address the primary health care needs of rural communities?” Highly trained nurses in rural areas could be part of that response – if we support them properly.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/medicare-reform-is-off-to-a-promising-start-now-comes-the-hard-part-197914">Medicare reform is off to a promising start. Now comes the hard part</a>
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</em>
</p>
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<h2>What makes a nurse practitioner?</h2>
<p>There are more than <a href="https://www.acnp.org.au/client_images/2312067.pdf">2,250 nurse practitioners</a> currently trained, qualified and registered to provide services in Australia. Nurse practitioners are the most senior and experienced clinical nurses in the health care workforce. </p>
<p><a href="https://www.acnp.org.au/client_images/2312068.pdf">Nurse practitioners</a> complete a master’s degree and have a minimum of eight years of consolidated clinical practice and expertise. </p>
<p>But nurse practitioners can’t access Medicare rebates or the Pharmaceutical Benefits Scheme unless they enter into a <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/midwives-nurse-pract-collaborative-arrangements#:%7E:text=A%20collaborative%20arrangement%20is%20an,a%20specified%20medical%20practitioner%3B%20and">collaborative arrangement</a> with a GP. </p>
<p>Under this arrangement, GPs effectively “supervise” the work of nurse practitioners. This fails to recognise nurse practitioners’ high levels of clinical expertise and skills, which should allow them autonomy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-physio-will-see-you-now-why-health-workers-need-to-broaden-their-roles-to-fix-the-workforce-crisis-188984">The physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis</a>
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<h2>What nurse practitioners can do</h2>
<p>In Australia, nurse practitioners are not working to their full capacity or “<a href="https://www.acnp.org.au/client_images/2159748.pdf">scope of practice</a>” according to the <a href="https://www.acnp.org.au/index.cfm?module=news&pagemode=indiv&page_id=1834299">Australian College of Nurse Practitioners</a>. This scope gives them the legal authority to practice independently and autonomously, unlike registered nurses. </p>
<p>They can assess and diagnose health problems, order and interpret diagnostic tests, create and monitor treatment plans, prescribe medicines and refer patients to other health professionals. Nurse practitioners are qualified to admit and discharge patients from health services, including hospitals.</p>
<p>At the public health level, nurse practitioners can collaborate with other clinicians and health experts to improve health care access, prevent disease and promote health strategies, improving outcomes for specific patient groups or communities. </p>
<p>The federal government’s Strengthening Medicare Taskforce lists nurse practitioners as primary carers and <a href="https://www.health.gov.au/sites/default/files/2023-02/strengthening-medicare-taskforce-report_0.pdf">puts</a> general practice “at the heart of primary care provision”. But the <a href="https://www.racgp.org.au/advocacy/position-statements/view-all-position-statements/health-systems-and-environmental/nurse-practitioners-in-primary-healthcare">RACGP</a> and <a href="https://www.ama.com.au/articles/ama-nurse-practitioners-2022">Australian Medical Association (AMA)</a> say nurse practitioner care should be GP-led. They contend any change to this arrangement would lead to inferior care, a disruption in continuity of care, fragmentation of the health system, and increased care complexity, inefficiency and cost. We have looked closely at these arguments and found they are not supported by evidence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="sign in rural location to local amenities including health centre" src="https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508243/original/file-20230206-19-spvthz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There is a shortage of rural GPs in Australia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/williams-western-australia-8-30-2021-2039141012">Shutterstock</a></span>
</figcaption>
</figure>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">How do you fix general practice? More GPs won't be enough. Here's what to do</a>
</strong>
</em>
</p>
<hr>
<h2>What works overseas</h2>
<p>Nurse practitioners have been working as lead practitioners internationally for many years, which means there is a <a href="https://doi.org/https://doi.org/10.1016/j.ijnsa.2021.100034">body of evidence</a> looking at patient <a href="https://doi.org/10.1002/14651858.CD001271.pub3">outcomes and satisfaction</a>. </p>
<p>Experts found nurse practitioners provide equivalent and, in some cases, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001271.pub3">superior patient outcomes</a> compared to doctors across a range of primary, secondary and specialist care settings and for a broad range of patient conditions. </p>
<p>Nurse practitioners were <a href="https://doi.org/https://doi.org/10.1016/j.ijnsa.2021.100034">more likely</a> to follow recommended evidence-based guidelines for best practice care and patients were more <a href="https://doi.org/https://doi.org/10.1016/j.ijnsa.2021.100034">satisfied with the care</a> they received, reporting communication regarding patient illness was better compared to GP care. </p>
<p>Employing nurse practitioners also resulted in <a href="https://doi.org/https://doi.org/10.1016/j.ijnsa.2021.100034">reduced waiting times and costs</a>.</p>
<p>Finally, these studies found while patient consultations were slightly longer for nurse practitioners and the number of return visits slightly higher compared to doctors, there was <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001271.pub3">no difference</a> in the number of prescriptions or diagnostic tests issued, attendance at Emergency Departments, hospital referrals or hospital admissions. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1617673580833013760"}"></div></p>
<h2>Clearing the way</h2>
<p>GP practices are <a href="https://www.abc.net.au/news/2022-09-01/brighton-doctors-clinic-closes-doors/101390526">closing</a> in <a href="https://www.theguardian.com/australia-news/2022/aug/31/rural-victorian-town-left-without-bulk-billing-doctor-after-clinic-closes-doors">rural communities</a> all over Australia, leaving people without access to vital, cost-effective primary health care services. Yet the majority of nurse practitioners are ready and willing to work in rural areas, with <a href="https://hwd.health.gov.au/resources/publications/factsheet-nrpr-2019.pdf">2019 workforce distribution data</a> clearly showing many nurse practitioners already work in rural, remote and very remote communities.</p>
<p>A new way of working is required, one that includes nurse practitioners working both independently and in collaboration with health care teams in rural communities.</p>
<p>International evidence shows allowing nurse practitioners to lead patient care and work with greater flexibility and freedom will not fragment the primary health care system, it will enhance it.</p><img src="https://counter.theconversation.com/content/199287/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Leesa Hooker receives funding from the Victorian Government Department of Justice and Community Safety and the Department of Jobs, Skills, Industry and Regions. She is a member of the Australian Nursing and Midwifery Federation and the Australian College of Nursing. </span></em></p><p class="fine-print"><em><span>Fiona Burgemeister and Jane Mills do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Instead of asking how to fix the rural GP shortage, we should look at the bigger picture and ask how nurse practitioners could work to their full capacity.Jane Mills, Professor and Dean La Trobe Rural Health School, La Trobe UniversityFiona Burgemeister, Research Officer, La Trobe Rural Health School, La Trobe UniversityLeesa Hooker, Associate Dean Research and Industry Engagement, La Trobe Rural Health School, La Trobe University, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1969662023-01-27T11:59:40Z2023-01-27T11:59:40ZEarwax removal no longer available at GP surgeries – leaving many struggling to hear<figure><img src="https://images.theconversation.com/files/506314/original/file-20230125-24-dh3ts5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6497%2C4325&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-shot-frustrated-young-caucasian-female-1950619960">Anatoliy Karlyuk/Shutterstock</a></span></figcaption></figure><p>Each year, more than <a href="https://doi.org/10.1093/qjmed/hch082">2 million people in the UK</a> have troublesome earwax that needs to be removed. However, more people are finding that this service is no longer being provided at their GP surgery. In fact, 66% of people seeking these services have been told that earwax removal is <a href="https://rnid.org.uk/wp-content/uploads/2022/11/Ear-Wax-Report-FINAL.pdf">no longer available on the NHS</a>.</p>
<p><a href="https://questions-statements.parliament.uk/written-questions/detail/2020-09-15/90063">Questions have been raised in parliament</a> about why people are being referred to earwax clinics in hospitals. This results in long waiting times and is not the best use of specialist services. </p>
<p>Many people are resorting to using private services on the high street that cost around £50 to £100. But the Royal National Institute for Deaf People (RNID), a charity, reports that more than a quarter of people they surveyed <a href="https://rnid.org.uk/wp-content/uploads/2022/11/Ear-Wax-Report-FINAL.pdf">cannot afford to pay</a> to have their earwax removed privately. This especially applies to people requiring recurrent earwax removal, such as those who wear hearing aids and earbud earphones – which tend to cause impacted earwax.</p>
<p>Our bodies produce earwax to clean, protect and keep our ears healthy. Movement of the jaw, as well as the skin that lines the ear canal, causes the wax to move to the entrance of the ear where it then flakes off or is carried away when we wash. Sometimes this doesn’t work and the earwax becomes impacted. Impacted earwax that blocks the ear canal is a major reason for GP consultations.</p>
<p>The National Institute for Health and Care Excellence (Nice) is clear that NHS earwax removal <a href="https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax">services should be provided in the community</a> where demand is greatest. Why is this recommendation for community earwax removal services falling on deaf ears? </p>
<p>A recommendation from Nice is not a mandate, and GPs are under no obligation to offer an earwax removal service. There are several reasons this service is often no longer offered in primary care, some of which are based on misunderstandings.</p>
<p>First, manual water-filled syringes for flushing out earwax can cause high pressure of water and might damage the patient’s ears – not something a GP wants to be responsible for doing. (Alternative cheap, low-pressure water irrigation devices are now widely available.) </p>
<p>Second, there is a mistaken belief among some GPs that earwax can be self-managed using wax-softening ear drops on their own. However, there is <a href="https://www.nice.org.uk/guidance/ng98">no good quality evidence</a> that softened earwax dissolves and magically disappears into the ether.</p>
<h2>Effects of impacted earwax</h2>
<p>The <a href="https://bjgp.org/content/73/727/90">most common symptom</a> caused by impacted earwax is hearing difficulty. This is often accompanied by discomfort and noises in the ears. <a href="https://healthwatchoxfordshire.co.uk/summarised-reports/getting-treatment-for-earwax-and-hearing-problems-in-oxfordshire/">Healthwatch Oxfordshire</a>, a charity, revealed that adults with earwax required between one and four NHS visits before attending a dewaxing clinic and that the time from first experiencing symptoms to final resolution was three to 30 weeks. </p>
<p>Try simulating the effect of impacted wax by walking around with your fingers firmly plugging both of your ears for a few days. You’ll soon realise that what at first sounds trivial is no laughing matter.</p>
<p>Hearing difficulty means you can’t communicate with ease or listen to the TV. It also reduces your ability to detect and monitor sounds in the environment, such as an approaching car. Hearing difficulty can lead to <a href="https://www.nice.org.uk/guidance/ng98">social isolation and depression</a>. More than <a href="https://doi.org/10.3399/bjgp23X732009">nine out of ten people</a> report that impacted earwax was at least moderately bothersome to them, and 60% said it is very or extremely bothersome.</p>
<p><a href="https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax">Nice recommends</a> that impacted earwax is removed by irrigating the ear with the newer, safer low-pressure water irrigation devices, or microsuction to hoover it up. When questioned, most people <a href="https://doi.org/10.3399/bjgp23X732009">do not have a preference</a>, although some report that water irrigation is messy and others that microsuction causes discomfort and is noisy.</p>
<p>Removal of earwax in health centres using microsuction results in levels of <a href="https://doi.org/10.3399/bjgpopen19X101649">patient satisfaction</a> that are at least as good as those provided in a hospital.</p>
<p>Before removal, pre-treatment drops or sprays are used to soften the earwax. These are applied daily for up to five days before removal. There is a vast array of pre-treatment earwax softening products, but <a href="https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax">none are better than any other</a>. As a result, most people use olive oil, which can be administered as drops or as a spray.</p>
<p>There are a variety of self-administered, earwax management products on the market but the evidence for these is limited and <a href="https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax">none are currently recommended by Nice</a>. An example is the use of Hopi ear candles or cones. To use these, you lie with your head on one side and place the lit candle in the upward-facing ear. </p>
<p>These are reported to work by softening the wax and then sucking it out of the ear canal and up the cone like a chimney. There is <a href="https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599816671491">no evidence</a> to support this claim. These candles and cones cost money and are ineffective.</p>
<figure class="align-center ">
<img alt="The author, Kevin Munro, trying Hopi ear candles." src="https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/506534/original/file-20230126-22936-u4nv53.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The author, Kevin Munro, tries Hopi ear candles.</span>
<span class="attribution"><span class="source">Kevin Munro</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>How it could be done</h2>
<p>If individual GP surgeries lack the expertise or funding to provide earwax removal services, an alternative is for groups of practices to collaborate as a network. The portable nature of modern wax removal equipment is ideal in such settings and for use in home visits. This approach could be especially valuable for vulnerable people, such as those in care homes where <a href="https://doi.org/10.1016/j.jamda.2022.07.011">44% of residents with dementia also have impacted earwax</a>.</p>
<p>In the meantime, the withdrawal of NHS earwax removal services is having a <a href="https://rnid.org.uk/wp-content/uploads/2022/11/Ear-Wax-Report-FINAL.pdf">far-reaching impact</a>, with people experiencing bothersome and distressing symptoms, sometimes leading to poor mental health.</p><img src="https://counter.theconversation.com/content/196966/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kevin Munro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Impacted earwax that blocks the ear canal is a major reason for GP consultations.Kevin Munro, Ewing Professor of Audiology, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1906662022-12-12T23:35:11Z2022-12-12T23:35:11ZWith so many GPs leaving the profession, how can I find a new one?<figure><img src="https://images.theconversation.com/files/499451/original/file-20221207-24-bxleyf.jpg?ixlib=rb-1.1.0&rect=46%2C18%2C6155%2C3484&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/african-male-pediatrician-hold-stethoscope-600w-1463202677.jpg">Shutterstock</a></span></figcaption></figure><p>Perhaps you have been happily attending the same GP for many years. They know your medical history better than anyone. Then all of a sudden they retire, or the practice closes, or it gets taken over by a bigger company and everything at the practice changes. Or maybe you’ve just had an unexpected visit to hospital and they ask who your GP is on discharge, then you realise you’re in need of one. </p>
<p>More than 80% of Australians <a href="https://pubmed.ncbi.nlm.nih.gov/29779298/">visit a GP</a> each year and those with chronic medical conditions will attend multiple times within the same period. It’s important to have a good GP who can coordinate your care. So how do you find a new one to develop a trusted relationship with? </p>
<p>As practising GPs ourselves, we are often asked: “Do you know a good GP?” This can be a somewhat difficult question to answer, as each person’s perception of “good” is highly subjective, dependent on many factors.</p>
<p>Studies of peoples’ preferences have varied results. One study found the <a href="https://pubmed.ncbi.nlm.nih.gov/21334160/">listening ability</a> of the GP to be important. Other studies found patients put more value in <a href="https://pubmed.ncbi.nlm.nih.gov/18332402/">clinical competency</a>, a <a href="https://bjgp.org/content/70/698/e676">trusting relationship or continuity of care</a>. </p>
<p>So a better question is: what GP will be a good fit for me?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/gps-are-abandoning-bulk-billing-what-does-this-mean-for-affordable-family-medical-care-182666">GPs are abandoning bulk billing. What does this mean for affordable family medical care?</a>
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</em>
</p>
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<h2>What factors are important to you? 6 aspects to consider</h2>
<p>Here are some tips to help speed up your search for your new GP. Remember though, it may take a few visits to develop a trusting relationship and know if the fit is right for you. </p>
<h2>1. Your health needs</h2>
<p>If you are young and healthy, a GP offering a convenient service and who is easy to book in quickly with may suffice. For those living with chronic complex conditions or disabilities who need to visit often, a consistent and thorough doctor is recommended. </p>
<h2>2. Cost</h2>
<p>Bulk-billing doctors are becoming rarer given the rising cost of services, salaries, equipment and utilities. To stay afloat, these doctors are having to see more patients in less time. </p>
<p>This could result in a poorer understanding of you as an individual and your health values and goals. Again, this might not be a problem for simple consults. But if you get a serious disease down the track, you might wish you’d had a regular GP all along, because they would know you and your history. </p>
<p>If you’re able to wear some extra cost but wondering how much to pay, consider the Australian Medical Association recommendation as your guide – a standard 15-minute <a href="https://www.ausdoc.com.au/news/rebate-gap-blows-out-47-standard-gp-consult/#:%7E:text=In%20its%20latest%20list%20of,currently%20sits%20at%20just%20%2439.10.">consult cost</a> is $86 with a $39 rebate from Medicare. </p>
<h2>3. Accessibility and practice size</h2>
<p>Consider the distance you need to travel and the opening hours you may need, including weekend availability. </p>
<p>Bigger practices are more likely to be able to get you in to see a doctor, if not your doctor, and often have longer opening hours. Having more than one preferred GP within the same practice can provide more flexibility and they will each be able to access your medical records and results. You may want to enquire also about disability access and telehealth options.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-businesses-are-offering-online-medical-certificates-and-telehealth-prescriptions-what-are-the-pros-and-cons-194154">More businesses are offering online medical certificates and telehealth prescriptions. What are the pros and cons?</a>
</strong>
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</p>
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<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="doctor's waiting room" src="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499457/original/file-20221207-14-45b636.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You may be able to see a doctor more quickly at a larger practice.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-couple-face-masks-sitting-600w-1828070570.jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>4. Reviews</h2>
<p>Online recommendations can be tricky to interpret. Only <a href="https://www.center4research.org/believe-online-reviews-doctors/">6–8% of people</a> post online reviews for doctors. And there are plenty of people out there who have inappropriate requests or expectations of GPs, which may be their basis for a negative review. Also, someone who has been happily seeing their GP for decades is less likely to post a rating than a one-off visitor. </p>
<p>Be sure to consider what reasons were given for a negative review – was it because of actions taken, an attitude, or a personality clash? – and how those reasons align with your preferences. In saying that, community Facebook groups are often a hotspot for discussions about local GPs and recurrent positive recommendations can and should be held in higher regard. </p>
<h2>5. New doctors</h2>
<p>There are many young GPs starting off in the profession or new to the area. Many will be fantastically caring and competent. But these doctors are not going to come with recommendations yet. </p>
<p>These GPs often have plenty of appointment slots, and the most recent up-to-date training. Being an early adopter of their services could be to your benefit. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-you-fix-general-practice-more-gps-wont-be-enough-heres-what-to-do-195447">How do you fix general practice? More GPs won't be enough. Here's what to do</a>
</strong>
</em>
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<hr>
<h2>6. Sub-specialists</h2>
<p>Many GPs have special interests and advanced skills, such as skin cancer care, musculoskeletal medicine, women’s health or mental health. </p>
<p>They may have done postgraduate training, usually listed on the practice website along with their special interests. They are likely to have a shorter waiting time and lower costs than specialists – so consider these doctors if your needs match their expertise. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1541592411776090113"}"></div></p>
<h2>Other things to check</h2>
<p>About 80% of practices go through a <a href="https://www.semphn.org.au/general-practice-accreditation">practice accreditation process</a>, which proves attainment of standards set by the Royal Australian College of General Practitioners. Such practices will advertise this status on their website and at the entrance to the clinic.</p>
<p>You can also ask about a doctor’s qualifications and about the standard consultation length. This may range from 10 to 20 minutes. Don’t be afraid to ask these questions when calling a practice about your first visit.</p>
<p>The final and arguably most important test is how you connect when you meet them in person. Finding a GP can be like finding your favourite cardigan. You don’t know it’s your favourite until it has been worn in. </p>
<p>Similarly you don’t know that your GP is great until you’ve journeyed with them through some potentially challenging times of your life. We encourage you to use the above tips to find a suitable GP, then give them some time to get to know you and grow a therapeutic relationship. </p>
<p>With continuity of care, trust will grow, as will knowledge about you and your values. This will ultimately improve your overall health care experience. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
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</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>‘See your GP’ is standard advice. But what if you don’t have one? Or yours is shutting up shop? Here’s how to find a new GP who suits you.David King, Senior Lecturer in General Practice, The University of QueenslandRhys Cameron, Senior lecturer, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1954472022-12-04T19:01:29Z2022-12-04T19:01:29ZHow do you fix general practice? More GPs won’t be enough. Here’s what to do<figure><img src="https://images.theconversation.com/files/498406/original/file-20221201-26-16ycmp.jpg?ixlib=rb-1.1.0&rect=0%2C785%2C4060%2C3774&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/doctor-writing-on-a-notebook-while-talking-on-the-phone-5207088/">Karolina Grabowska/Pexels</a></span></figcaption></figure><p>Australians are getting older, sicker, and harder to treat. This isn’t news to GPs, who say they are <a href="https://www1.racgp.org.au/newsgp/professional/ministers-told-overwhelmed-gps-need-help">overwhelmed with demand</a> and frustrated with a rigid system that <a href="https://www1.racgp.org.au/newsgp/gp-opinion/people-do-not-understand-general-practice-and-that">doesn’t support them</a>. </p>
<p>To improve general practice, the Albanese government has set aside almost a billion dollars and convened a <a href="https://www.health.gov.au/committees-and-groups/strengthening-medicare-taskforce">Strengthening Medicare Taskforce</a> to advise how to spend it. <a href="https://www.racgp.org.au/advocacy/reports-and-submissions/2022-reports-and-submissions/gp-crisis-summit-white-paper">Many people argue</a> recruiting more GPs is the best path forward. </p>
<p>But as a <a href="https://grattan.edu.au/report/a-new-medicare-strengthening-general-practice">new Grattan Institute report shows</a>, Australia has plenty of GPs – although they’re not always in the right areas. What we lack are supporting clinicians to help GPs respond to a growing tide of chronic disease. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-gps-just-keep-their-heads-above-water-other-doctors-businesses-are-more-profitable-than-law-firms-192163">Some GPs just keep their heads above water. Other doctors' businesses are more profitable than law firms</a>
</strong>
</em>
</p>
<hr>
<h2>General practice is becoming more complex</h2>
<p>One reason many GPs feel overwhelmed is because their patients are getting sicker. More patients have <a href="https://www.sydney.edu.au/content/dam/corporate/documents/faculty-of-medicine-and-health/research/research-collaborations-networks-and-groups/41-2006-07-to-2015-16.pdf">multiple conditions</a> that need to be managed by their GP, and the proportion with more than one chronic condition has been estimated at <a href="https://pubmed.ncbi.nlm.nih.gov/27027989/">nearly half</a>.</p>
<p>Managing these patients is more complex and takes more time, but Medicare does not reward GPs for longer consultations. Average consultation length has been stuck at between 14 and 15 minutes since 2002, despite the increasing complexity of patients’ needs. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497871/original/file-20221129-22-4qs0rs.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Patients’ needs are becoming more complex.</span>
<span class="attribution"><span class="source">BEACH survey results, Britt et al. (2010) and Britt et al. (2015)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Australia has many GPs</h2>
<p>To help general practices meet this demand, <a href="https://www.racgp.org.au/advocacy/reports-and-submissions/2022-reports-and-submissions/gp-crisis-summit-white-paper">peak bodies have called for</a> more GPs, and to attract them to the specialty through higher pay. </p>
<p>It’s true that many places in Australia, particularly some rural areas, <a href="https://www.sciencedirect.com/science/article/pii/S0277953621003774">don’t have enough GPs</a>. And the pandemic has led to a surge in demand everywhere, with wait times spiking after years of steady decline. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497840/original/file-20221129-18-z9z333.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Wait times have spiked.</span>
<span class="attribution"><span class="source">ABS patient experiences survey (2022)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>But at a national level, almost all the indicators suggest GP supply is stronger than ever. As our report shows, Australia has more GPs per person than ever before, more GPs than most wealthy countries, and record numbers of GPs in training. </p>
<h2>GPs need more support</h2>
<p>While the supply of GPs has grown, more GPs alone can’t manage the rising tide of chronic disease, or the growing pressure on many general practices. Instead, we need to make general practice a team sport. </p>
<figure class="align-left ">
<img alt="Nurse looks into the distance" src="https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498407/original/file-20221201-12-1tn5v7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nurses don’t get to use all their skills.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/CEFYNiM9xLk">Luke Jones/Unsplash</a></span>
</figcaption>
</figure>
<p>Team-based care is increasingly used in general practice overseas. But compared with similar countries, Australian GPs have little support. </p>
<p>About three-quarters of clinical staff in Australian general practice are GPs, with nurses making up almost all the remaining quarter. And those nurses don’t get to help as much as they want, with three-quarters saying they face barriers to using all their skills. </p>
<p>Other countries have different types of workers that Australia lacks. Germany has about <a href="https://bmcprimcare.biomedcentral.com/articles/10.1186/1471-2296-14-110">400,000 medical assistants</a>, providing administrative and clinical support in general practice, while Australia has only about 100. England has about <a href="https://digital.nhs.uk/data-and-information/publications/statistical/general-and-personal-medical-services/30-september-2022">one supporting clinician for every GP</a>, three times as many as Australia. In the United States, nurse practitioners and physician assistants deliver <a href="https://pubmed.ncbi.nlm.nih.gov/21851446/">about 11%</a> of all medical services outside hospitals. In Australia they would deliver less than 0.1%.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/general-practices-are-struggling-here-are-5-lessons-from-overseas-to-reform-the-funding-system-188902">General practices are struggling. Here are 5 lessons from overseas to reform the funding system</a>
</strong>
</em>
</p>
<hr>
<h2>Team care is good for everyone</h2>
<p>Evidence overwhelmingly confirms these and many other clinicians can share parts of a GP’s load with the same safety and quality of care. Studies suggest well-implemented team care can improve <a href="https://pubmed.ncbi.nlm.nih.gov/22042511/">quality of care</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/22042511/">patient safety</a> and <a href="https://www.tandfonline.com/doi/full/10.3109/13561820.2015.1051616?scroll=top&needAccess=true">health outcomes</a>, as well as reducing demand on hospitals.</p>
<p>It also makes GPs’ jobs more manageable, impactful and satisfying. By sharing simpler care with other team members, GPs can spend more time working with more complex patients. </p>
<p>It also creates time for other types of work: planning, improving care, maintaining oversight of the team’s care, and consulting with other specialists. While a GP’s clinical work will be more complex, they will also have more time to do other vital aspects of their role.</p>
<p>Emerging trials in many states (such as the pharmacist-prescribing trials in <a href="https://www.abc.net.au/news/2022-10-12/queensland-gov-plan-for-controversial-pharmacy-program-revealed/101529066">Queensland</a>, <a href="https://www.theguardian.com/australia-news/2022/nov/13/pharmacists-to-get-prescription-powers-in-nsw-game-changer-trial-that-gps-call-madness">New South Wales</a> and <a href="https://www.aap.com.au/news/andrews-scores-narrow-vic-poll-debate-win/">Victoria</a>) have also made it clear task-sharing is happening – with GPs, or without them. </p>
<p>Unlike these trials, our recommendations focus on bringing new workforces into general practice, not taking care out.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-pharmacists-be-able-to-prescribe-common-medicines-like-antibiotics-for-utis-we-asked-5-experts-195277">Should pharmacists be able to prescribe common medicines like antibiotics for UTIs? We asked 5 experts</a>
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</em>
</p>
<hr>
<h2>What needs to change?</h2>
<p>GPs might think this sounds like a fantasy that would never work for them. That’s because for most clinics, it will only be possible if there are fundamental changes to how the system is run. </p>
<p>The first barrier is funding. General practices <a href="https://doi.org/10.1093/fampra/cmx095">lose revenue</a> if they have anyone other than a GP deliver care. Medicare does not fund practice pharmacists, physiotherapists, practice nurses, nurse practitioners or Indigenous health workers to work to their full skill level. </p>
<p>Other workforces, such as physician assistants, community paramedics and medical assistants, are not funded to provide care at all. </p>
<figure class="align-right ">
<img alt="Medic puts gloves on" src="https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/498408/original/file-20221201-24-fuusx4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Funding is a key barrier to using other health workers’ skills.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/7hjh_X3xsDA">Magdiel Lagos/Unsplash</a></span>
</figcaption>
</figure>
<p>General practices should be able to opt into a new funding model which, as well as paying GPs for each appointment, gives them a budget for ongoing care of each patient. This would enable GPs to expand their team, and give them funding even when another team member is providing care. Most wealthy countries use this kind of funding model. </p>
<p>The second barrier is regulation. An independent commission should advise government on how different roles should be regulated, to make sure workers can safely use all their skills.</p>
<p>Finally, taking away barriers isn’t enough. As <a href="https://www.england.nhs.uk/gp/expanding-our-workforce/">other countries</a> have found, change needs financial support. </p>
<p>The federal government should use Strengthening Medicare funding to roll out 1,000 new nurses, physiotherapists, mental health clinicians, pharmacists and other allied health workers in the highest-need communities, to work in general practices alongside GPs, providing fee-free care. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-physio-will-see-you-now-why-health-workers-need-to-broaden-their-roles-to-fix-the-workforce-crisis-188984">The physio will see you now. Why health workers need to broaden their roles to fix the workforce crisis</a>
</strong>
</em>
</p>
<hr>
<p>The shift to team-based general practice won’t be easy. It will require changes in how practices are designed and operate, and enough funding, time and training for teams to work well together. This should be recognised with more funding and sustained expert support. </p>
<p>Although it will be hard, the payoff will be worth it. GPs will be free to choose a model with more support and more sustainable workloads. Government will be able to reduce the biggest gaps in access and outcomes. And patients will have more time with their general practice team, quicker access when they need it, and better care.</p><img src="https://counter.theconversation.com/content/195447/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new Grattan report recommends making general practice a team sport, using the skills of other clinicians and health-care workers.Peter Breadon, Program Director, Health and Aged Care, Grattan InstituteDanielle Romanes, Visiting Fellow, Grattan InstituteLachlan Fox, Associate, Grattan InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1941542022-11-28T00:56:26Z2022-11-28T00:56:26ZMore businesses are offering online medical certificates and telehealth prescriptions. What are the pros and cons?<figure><img src="https://images.theconversation.com/files/495294/original/file-20221115-22-kets3u.jpg?ixlib=rb-1.1.0&rect=36%2C45%2C5970%2C3944&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-male-doctor-telehealth-concept-600w-1456779692.jpg">Shutterstock</a></span></figcaption></figure><p>Telehealth has played an <a href="https://journals.sagepub.com/doi/10.1177/1357633X20916567">important role during the pandemic</a>. Telephone and online consultations have enabled social distancing and kept patients and clinicians safe from transmissible infections. </p>
<p>Since the start of COVID in March 2020, there have been <a href="https://coh.centre.uq.edu.au/telehealth-and-coronavirus-medicare-benefits-schedule-mbs-activity-australia">122 million telehealth consultations</a> funded through Medicare. About 90% of these services were provided by general practitioners (GPs), with <a href="https://www.publish.csiro.au/AH/AH20183">nine out of ten</a> of these consults done as a telephone call. </p>
<p>Online services for prescriptions and medical certificates have become available to consumers at the click of a button. Given the <a href="https://www.abc.net.au/news/2022-10-06/gps-turning-away-from-medicine-as-pressures-mount/101505626">shortage of GPs</a>, difficulties getting timely appointments, and clinic restrictions if patients have COVID-like symptoms, consumers seem to be welcoming these services. Patients can consult a GP by telephone or video call, and then receive an electronically dispatched medical certificate or prescription (if clinically appropriate). </p>
<p>These services are either paid for partially, or totally by the consumer, with <a href="https://www.health.gov.au/health-alerts/covid-19/coronavirus-covid-19-advice-for-the-health-and-disability-sector/providing-health-care-remotely-during-the-covid-19-pandemic">limited Medicare rebates available</a>. They are fast, convenient and readily available. But what do consumers need to know about their pros and cons? </p>
<h2>On the plus side…</h2>
<p><strong>Convenience</strong> </p>
<p>Offering services online means ease of access and convenience. We have seen this in the banking, retail and travel industries. Who wants to wait three days for a GP appointment, spend two hours in traffic and one hour in the waiting room, for a short consultation? </p>
<p><strong>Access to care</strong> </p>
<p>When providing health services, we have to think of our whole population (see points below on equity). These instant services offer greater convenience and benefits for those who find it hard to access transport, are time-poor, or who find it difficult to leave the house (such as parents of little kids or people with other physical disabilities or mental health concerns). </p>
<p><strong>Reduced wait times</strong> </p>
<p>If it isn’t possible to get an appointment with your regular GP and you need a medical certificate for work, these services may be a good fit. They also enable acute conditions to be managed in a timely manner, for instance by getting a script for tablets to stop vomiting. </p>
<p><strong>Reducing congestion in hospitals and medical centres</strong> </p>
<p>These services also <a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">reduce pressure</a> on primary care services and hospitals. If someone can be supported by an online service instead of visiting an emergency department or urgent care centre, then the bricks-and-mortar hospitals, clinics and medical centres remain available for people with more serious health needs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="woman comfort child while on phone" src="https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/495296/original/file-20221115-17-vj95us.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You might get a quicker telehealth appointment, but complex conditions might require an in-person consult.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/8376257/pexels-photo-8376257.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">Emergency departments are clogged and patients are waiting for hours or giving up. What's going on?</a>
</strong>
</em>
</p>
<hr>
<h2>But there are also downsides</h2>
<p><strong>Continuity of care</strong> </p>
<p>The downside is you may risk losing continuity of care, as you are not necessarily going to be seeing your own GP online. If you have complex health needs or chronic conditions, it is better you have a primary care provider who knows your history and can manage your health condition holistically. </p>
<p><strong>Access to a complete health history</strong> </p>
<p>Australia doesn’t yet have a single complete and integrated information system for sharing all personal health information. So when you access these services, it is often your responsibility to share health information with the provider and also inform your GP about your online appointment. </p>
<p>However, communication systems are improving slowly, and a summary may be shared electronically with your nominated GP after your consultation. For patients who have opted in to <a href="https://www.myhealthrecord.gov.au/for-you-your-family">My Health Record</a>, some of this communication will happen automatically. </p>
<p><strong>Complex conditions</strong> </p>
<p>There are limits to the types of services that can be provided online or by phone. You may need an in-person appointment, especially if a physical assessment is required, or the concerns are more complex than anticipated. GPs adhere to <a href="https://www.racgp.org.au/running-a-practice/practice-standards">guidelines and practice standards</a> irrespective of how services are delivered. For instance, provision of e-scripts and medical certificates require documentation and screening measures to ensure appropriate care is provided.</p>
<p><strong>Medications</strong> </p>
<p>Online or telehealth services aren’t suited for starting new medications that require monitoring or might have side effects. </p>
<p>New medications for chronic conditions should ideally be started by someone who you can see you again to check they are working and manage potential side effects or reactions. Additionally, there are medications (such as strong pain relief) these services won’t prescribe, and consumers need to see an GP in person to obtain. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/gps-are-abandoning-bulk-billing-what-does-this-mean-for-affordable-family-medical-care-182666">GPs are abandoning bulk billing. What does this mean for affordable family medical care?</a>
</strong>
</em>
</p>
<hr>
<h2>Medical certificates aren’t just for your boss</h2>
<p>Local pharmacists can write medical certificates for single days and assist with advice and medications for minor health issues. However, they cannot write prescriptions.</p>
<p>The aim of a medical certificate is to satisfy an employer. But getting a medical certificate may also be an opportunity to have symptoms checked and make sure there is nothing seriously wrong. </p>
<p>Online services make accessing a medical certificate for the flu or gastro much more convenient. However, if people are having ongoing health issues that require regular time away from work, they should be seeing a regular GP to help manage their condition. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-after-hours-and-i-need-to-see-a-doctor-what-are-my-options-190144">It’s after-hours and I need to see a doctor. What are my options?</a>
</strong>
</em>
</p>
<hr>
<h2>Online doesn’t mean equal access</h2>
<p>There is the risk of inequity of access for these services, especially for consumers who don’t know how to access them, can’t afford to pay, or do not have access to the necessary technology (including reliable internet).</p>
<p>A <a href="https://journals.sagepub.com/doi/full/10.1177/1357633X221107995">recent paper</a> suggested ways to tackle this digital divide. These included improving digital health literacy, workforce training, co-designing new models of care with clinicians and patients, change management, advocacy for culturally appropriate services, and sustainable funding.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="person holding blister pack of yellow capsules" src="https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/496647/original/file-20221122-23-c1u58b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Strong painkillers won’t be prescribed online.</span>
<span class="attribution"><a class="source" href="https://images.pexels.com/photos/3873191/pexels-photo-3873191.jpeg?auto=compress&cs=tinysrgb&w=1260&h=750&dpr=2">Pexels/Polina Tankilevitch</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Other points to remember</h2>
<p>Finally, consumers need assurance that health services are provided by suitably qualified health professionals. This is usually achieved with confirmation of health provider credentials prior to, or at the start of, the consultation. </p>
<p>Consumers can also look up their provider through the <a href="https://www.ahpra.gov.au/registration/registers-of-practitioners.aspx">Australian Health Practitioner Regulation Agency (Ahpra)</a> where all clinicians are registered. </p>
<p>Consumers should also look for an Australian service to ensure it adheres to Australia’s quality standards and clinician registration criteria. This is also important because of the Australian standards around personal data collection and storage. Consumers should read information provided by services about their data policies. </p>
<p>As with all health care, it is about finding the right balance and ensuring services align with clinical indications. </p>
<p>Telehealth is not about replacing in-person appointments. Telehealth should be used in conjunction with face-to-face advice, to <a href="https://doi.org/10.3399/bjgpo.2021.0182">maintain high-quality care</a> that best suits the needs and wishes of the consumer.</p><img src="https://counter.theconversation.com/content/194154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Online and phone consultations might ease pressure on local clinics and mean you can access paperwork when visiting a GP isn’t possible. But there are downsides to be aware of too.Centaine Snoswell, Research Fellow Health Economics, The University of QueenslandAnthony Smith, Professor of Telehealth; and Director of the Centre for Online Health, The University of QueenslandKeshia De Guzman, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1901442022-11-08T04:32:49Z2022-11-08T04:32:49ZIt’s after-hours and I need to see a doctor. What are my options?<figure><img src="https://images.theconversation.com/files/492919/original/file-20221102-26769-rn9s3s.jpg?ixlib=rb-1.1.0&rect=0%2C361%2C5506%2C3371&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/35bnMbid2rQ">Shane/Unsplash</a></span></figcaption></figure><p>There are times when medical care can’t wait until 9am or first thing Monday. Perhaps your COVID has worsened and you’re becoming short of breath. Or your baby has a fever that’s worrying you. Or your elderly parent’s pain can’t be relieved with over-the-counter medications.</p>
<p>When last asked in 2020, <a href="https://chf.org.au/ahpafterhoursprimarycare">two-thirds of Australians</a> had accessed after-hours health services in the previous five years. But how do you access health care on weekends and after 5pm in 2022? </p>
<p>Many GP Super Clinics continue to operate beyond business hours, accept walk-ins and provide access to onsite pharmacy services. You can find their locations <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/pacd-gpsuperclinics-locations">here</a>, though opening hours and costs vary between clinics.</p>
<p>Search engines such as <a href="https://www.hotdoc.com.au/find/doctor/australia">HotDoc</a> and <a href="https://www.healthdirect.gov.au/australian-health-services">Healthdirect</a> can help you find local health services such as GPs, COVID testing clinics, emergency departments, and allied health services. You can filter search results by “open now”, bulk-billing and accessibility requirements such as building access ramps. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/emergency-departments-are-clogged-and-patients-are-waiting-for-hours-or-giving-up-whats-going-on-184242">Emergency departments are clogged and patients are waiting for hours or giving up. What's going on?</a>
</strong>
</em>
</p>
<hr>
<p>The COVID pandemic accelerated investment in virtual care for non-life-threatening emergencies, which can be less stressful for patients and families than attending an emergency department. </p>
<p>Here are some options for in-person and virtual after-hours care.</p>
<h2>Nurse helplines</h2>
<p>If you’re not sure whether you need medical care, or if you need basic information or advice, a useful starting point is to call a <a href="https://www.healthdirect.gov.au/nurse-on-call">free nursing helpline</a> such as <a href="https://www.health.vic.gov.au/primary-care/nurse-on-call">Nurse-on-Call</a> in Victoria, <a href="https://www.qld.gov.au/health/contacts/advice/13health">13HEALTH</a> in Queensland, or <a href="https://www.healthdirect.gov.au/nurse-on-call">Healthdirect</a> in other states.</p>
<p>In some cases, nurses may offer a <a href="https://about.healthdirect.gov.au/after-hours-gp-helpline">call-back from a GP</a> using phone or video consultation. </p>
<figure class="align-center ">
<img alt="Doctor talks on phone" src="https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492920/original/file-20221102-26775-8kxbwh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In some cases, the nurse may offer a call back from a GP.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/doctor-talking-on-the-cellphone-5207089/">Pexels/Karolina Grabowska</a></span>
</figcaption>
</figure>
<h2>Getting a doctor to visit you at home</h2>
<p>The <a href="https://homedoctor.com.au">National Home Doctor service</a>, which can be booked using telephone (13 74 25) or its mobile app, provides bulk-billed doctor home visits. </p>
<p>Telehealth consultations can also be booked through this service, though they may incur a fee.</p>
<h2>Video consultation with a GP</h2>
<p>A range of companies offer GP telehealth consultation after hours, for a fee. It doesn’t have to be an emergency, and can be used for things like last-minute repeat prescriptions.</p>
<p>Search engines <a href="https://www.hotdoc.com.au/find/doctor/australia">HotDoc</a> and <a href="https://www.healthdirect.gov.au/australian-health-services">Healthdirect</a> can direct you to these services through the “accepts telehealth” or “telehealth capable” options.</p>
<h2>Virtual emergency departments</h2>
<p>Virtual emergency departments in <a href="https://www.vved.org.au">Victoria</a>, <a href="https://metronorth.health.qld.gov.au/hospitals-services/virtual-ed">Queensland</a> and <a href="https://www.wacountry.health.wa.gov.au/Our-services/Command-Centre">Western Australia</a> allow people in these states to virtually connect with emergency doctors and nurse practitioners for treatment and advice on non-life-threatening emergencies. </p>
<p>In Victoria, the establishment of the <a href="https://www.vved.org.au/">virtual ED program</a> has <a href="https://www.prnewswire.com/news-releases/northern-health-using-the-clinicians-digital-health-platform-to-expand-their-victorian-virtual-emergency-department-statewide-301557186.html">decreased wait times</a>, with an easy-to-use platform, triage and waiting room. After the consultation, instructions can be emailed, or e-scripts sent to your local pharmacy. This service is currently covered by Medicare with no out-of-pocket costs, though that may change in the future.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/video-and-phone-consultations-only-scratch-the-surface-of-what-telehealth-has-to-offer-146580">Video and phone consultations only scratch the surface of what telehealth has to offer</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.myemergencydr.com">My Emergency Doctor</a> is a private service with a hotline and web-based consultations with expert emergency doctors, for patients across Australia. Typically consultations cost A$250-$280, however people living in <a href="https://www.myemergencydr.com/patients/patients-within-primary-health-networks/">certain Primary Health Networks</a> can receive free after-hours telehealth consultations through this platform. </p>
<h2>Children’s health services</h2>
<p>In South Australia, free paediatric emergency services are available through the Women’s and Children’s Hospital’s <a href="https://www.wch.sa.gov.au/patients-visitors/emergencies/virtual-urgent-care">Child and Adolescent Virtual Urgent Care Service</a>, though similar services aren’t available across the country. </p>
<p>However, on-demand services such as <a href="https://www.kidsdoconcall.com.au">KidsDocOnCall</a> and <a href="https://www.cubcare.com.au">Cub Care</a> provide telehealth paediatric services after-hours to people in all states and territories, for a fee. </p>
<figure class="align-center ">
<img alt="Small baby's hand" src="https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492924/original/file-20221102-12-2rqzk2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Paediatric telehealth is available after-hours for a fee.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/N-VEeMnm7gE">Baby Abbas/Unsplash</a></span>
</figcaption>
</figure>
<h2>Pharmacies</h2>
<p>If you need to see a pharmacist or buy medicine after-hours, the <a href="https://www.findapharmacy.com.au">Pharmacy Guild of Australia</a> and <a href="https://nationalnurse.com.au/late-night-pharmacies">National Home Nurse</a> pharmacy finders might be helpful. </p>
<p>In Victoria, <a href="https://www.chemistwarehouse.com.au/supercare-24-hour-chemist">Supercare Pharmacies</a> are also open 24/7, with nurses available from 6pm to 10pm.</p>
<p>Under the Pharmaceutical Benefits Scheme Continued Dispensing Arrangements, approved pharmacists may supply <a href="https://www.pbs.gov.au/info/general/continued-dispensing">eligible medicines</a> to a person in time of immediate need, when the prescribing doctor can not be contacted, once in a 12-month period.</p>
<h2>Medical chests in remote areas</h2>
<p>The Royal Flying Doctor service runs a <a href="https://www.flyingdoctor.org.au/sant/what-we-do/medical-chest-sant/">Medical Chest program</a>, to provide emergency and non-emergency, pharmaceutical and non-pharmaceutical treatments for people in remote areas, such as antibiotics, pain relief and first-aid. </p>
<p>Medical chests are provided for communities which are located more than 80 kilometres from professional medical services and maintained by a designated local medical chest custodian. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/our-study-found-after-hours-gps-actually-do-reduce-visits-to-emergency-rooms-79108">Our study found after-hours GPs actually do reduce visits to emergency rooms</a>
</strong>
</em>
</p>
<hr>
<h2>Mental health support</h2>
<p>Some mental health supports are available after-hours. Free options include:</p>
<ul>
<li><a href="https://healthability.org.au/services/after-hours-mental-health-nursing-service/">HealthAbility</a></li>
<li><a href="https://www.beyondblue.org.au/get-support/talk-to-a-counsellor">Beyond Blue</a></li>
<li><a href="https://www.suicidecallbackservice.org.au">Suicide Call Back Service</a></li>
<li><a href="https://www.lifeline.org.au">Lifeline</a> (13 11 14)</li>
<li><a href="https://kidshelpline.com.au">Kids Helpline</a>.</li>
</ul>
<p>You can also access paid psychologist services via platforms such as <a href="https://virtualpsychologist.com.au">Virtual Psychologist</a> and <a href="https://www.mymirror.com.au">MyMirror</a>. </p>
<figure class="align-center ">
<img alt="Woman waits in hospital waiting room" src="https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492927/original/file-20221102-26784-d2poox.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hospital emergency departments can be hectic places.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-sitting-hospital-ward-hallway-waiting-1085218841">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Indigenous health and wellbeing</h2>
<p><a href="https://www.vahs.org.au/yarning-safenstrong/">Yarning SafeNStrong</a> is a free, confidential, culturally suitable counselling service for Aboriginal and Torres Strait Islander people. This service offers support with social and emotional wellbeing, financial wellbeing, medical support including COVID testing, drug and alcohol counselling and rehabilitation services. </p>
<p>Other Indigenous health services include <a href="https://www.13yarn.org.au/contact-us-13yarn">13YARN</a>, <a href="https://supportact.org.au/get-help/first-nations-support-2/">Support Act</a>, and <a href="https://www.dardimunwurro.com.au/brother-to-brother/">Brother to Brother</a>. </p>
<h2>For people with communication needs</h2>
<p>Access to after-hours care is often dependent on people’s ability to communicate over a phone. </p>
<p>The <a href="https://www.infrastructure.gov.au/media-communications-arts/phone/services-people-disability/accesshub/national-relay-service">National Relay Service</a> can assist hearing- or speech-impaired people with changing voice to text or English to AUSLAN. </p>
<p>Non-English speaking people can access interpreter assistance for telehealth via the <a href="https://www.tisnational.gov.au">National Translating and Interpreting Service</a>. This service is typically free of charge, covers 150 languages, and can be accessed after-hours. </p>
<h2>Life-threatening emergencies</h2>
<p>Of course, none of the options above should replace the Triple Zero (000) service for life-threatening emergencies <a href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/calling-an-ambulance">such as</a> difficulty breathing, unconsciousness and severe bleeding. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/looking-online-for-info-on-your-childs-health-here-are-some-tips-97701">Looking online for info on your child's health? Here are some tips</a>
</strong>
</em>
</p>
<hr>
<p>This handy infographic shows some of your options for after-hours care. Click on the hand icon on top right to activate interactive elements. Then press the + button to learn more:</p>
<div style="width: 100%;"><div style="position: relative; padding-bottom: 56.25%; padding-top: 0; height: 0;">
<iframe title="" frameborder="0" width="100%" height="675" style="position: absolute; top: 0; left: 0; width: 100%; height: 100%;" src="https://view.genial.ly/633e428a5edcf7001226ef91" type="text/html" allowscriptaccess="always" allowfullscreen="true" scrolling="yes" allownetworking="all"></iframe>
</div> </div>
<hr>
<p><em>We would like to acknowledge the following people for their input to this article: Dr Loren Sher (Director of Victorian Virtual ED at the Northern Hospital), A/Prof Michael Ben-Meir (Director of Emergency Department, Austin Health), Ms Karen Bryant (Senior Aboriginal Liaison Officer, Northern Health) and Dr Kim Hansen (Director of Emergency, St Andrew’s War Memorial Hospital).</em></p><img src="https://counter.theconversation.com/content/190144/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Sometimes you just can’t wait to see a doctor. With the addition of more virtual services during COVID, these days you have more options.Mahima Kalla, Digital Health Transformation Research Fellow, The University of MelbourneFeby Savira, Alfred Deakin Postdoctoral Research Fellow, Deakin UniversityKara Burns, Digital Health Program Manager at the Centre for Digital Transformation of Health, The University of MelbourneSathana Dushyanthen, Academic Specialist & Lecturer in Cancer Sciences & Digital Health, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1927782022-10-24T07:48:26Z2022-10-24T07:48:26ZSocial prescribing needs more evidence to support its benefits before widespread rollout – new study<figure><img src="https://images.theconversation.com/files/490668/original/file-20221019-12-a6qlpt.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5104%2C3403&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medium-shot-senior-woman-grey-hair-1859323645">Juice Verve/Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.bmj.com/content/364/bmj.l1285">one in five GP visits</a> are for non-medical problems, such as loneliness or financial difficulty. However, these non-medical problems are known to have a big impact on patients’ health and wellbeing. GPs are aware of this and want to take a more holistic approach to care, but often are not sure how to do it. This has led to the development of “social prescribing”, where GPs “prescribe” social activities or support for people with the help of a link worker. </p>
<p>The link worker is someone who knows a community well, is an excellent listener and is skilled in supporting people to make changes. They meet with people referred for social prescribing, talk about what matters to them and make a personal plan – the “social prescription”. </p>
<p>This might include joining community groups, support to return to work or education, accessing mental health supports or lifestyle changes, like doing more exercise. The link worker then helps people to join groups or just keeps in touch and encourages people to do the things on their prescription. The length and type of link worker support are tailored to the needs of each person. </p>
<p>These social prescribing (also called “community support”) programmes are being rolled out in many countries, including <a href="https://www.england.nhs.uk/personalisedcare/social-prescribing/">the UK</a>, <a href="https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/mental-health-and-wellbeing/social-prescribing/?gclid=CjwKCAjwwL6aBhBlEiwADycBIBT2MLqaG7FE5axw6dLzxCHKKLo0hOnvZvdVV0h-c-1sCFcUcCtWoBoCovMQAvD_BwE&gclsrc=aw.ds">Ireland</a>, <a href="https://www1.racgp.org.au/newsgp/clinical/most-health-professionals-already-undertaking-soci">Australia</a> and <a href="https://time.com/6187850/social-prescriptions-improve-health/">the US</a>. Policymakers hope that social prescribing can not only deliver improved health and wellbeing, but can reduce health inequalities and save money by diverting people to more appropriate care in the community. My colleagues and I set out to see what evidence there was for this and found mixed results – although we acknowledge that proving the effectiveness of these types of programmes is difficult. Our results are <a href="https://bmjopen.bmj.com/content/12/10/e062951">published in BMJ Open</a>.</p>
<p>We searched all the medical studies, websites and reports from social prescribing projects. We were looking for studies that compared a group of people who met a social prescribing link worker to a group that didn’t, (known as controlled trials – a high standard of clinical trial) and synthesised the evidence in a “systematic review”. </p>
<p>We summarised all the studies, in particular, to see if they had measured quality of life or mental health, and if they had included people from disadvantaged areas or with several health conditions, as often social prescribing programmes focus on these groups. </p>
<p>We found eight studies in total. Three were published in the US and five were published in the UK. </p>
<p>The length of time people could meet the link worker varied. Most of the studies were quite short (less than six months) and people only met the link worker a couple of times. Because there was so much variation in the studies, it was hard to find consistent evidence that link workers made a difference to patients’ quality of life, mental health, social contacts, physical activity or primary healthcare use. </p>
<p>Three US and one Scottish study included people from disadvantaged areas, who also had more than one health condition. Two of the US studies had longer and more intensive programmes where the link workers met people weekly for six months and worked closely within the healthcare system. These two studies found that people reported higher quality care and there were also cost savings because of fewer days in hospital. </p>
<p>The third US study found a reduction in emergency department attendance, but an increase in primary care visits. The Scottish study found that people who met the link worker three or more times had improvements in quality of life, mental health and exercise. </p>
<figure class="align-center ">
<img alt="GP talking to an older patient." src="https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/490674/original/file-20221019-12-3832z9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in five GP visits are for non-medical matters, such as loneliness or debt problems.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-female-doctor-senior-male-patient-280364663">Monkey Business Images/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Partial picture</h2>
<p>Overall, evaluating social-prescribing link workers in this way would appear to show limited benefits, but this only gives a partial picture. Social prescribing is designed to be different depending on the needs of the person and the resources in the local area, so determining if it works or doesn’t work on a larger scale is difficult. This evaluation approach is also very health-focused and social prescribing is likely to have wider benefits for communities and society.</p>
<p>What our findings do suggest is that longer, more intense support from link workers working closely with healthcare providers probably benefits people with complex needs, such as those who live in disadvantaged areas and with several health conditions. </p>
<p>At the moment, there are very few link workers per head of population. In Ireland, for example, a national social prescribing system is being introduced that will have <a href="https://www.hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/mental-health-and-wellbeing/hse-social-prescribing-framework.pdf">one link worker for every 50,000 people</a>. To see changes in health inequalities and cost savings, our review suggests that there needs to be a focus on intense support for a smaller number of people or an expansion of the availability of link workers. Either way, it is important to keep learning about how social prescribing works best so the potential benefits can be realised.</p><img src="https://counter.theconversation.com/content/192778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bridget Kiely received funding from the Health Research Board Ireland to carry out this research.</span></em></p><p class="fine-print"><em><span>Susan Smith receives funding from the Health Research Board of Ireland and this work was supported through Grant reference HRB CDA-2018-003. </span></em></p>A new review finds an absence of evidence for social prescribing.Bridget Kiely, Clinical Research Fellow, RCSI University of Medicine and Health SciencesSusan Smith, Professor of General Practice, Trinity College DublinLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1921632022-10-11T19:03:56Z2022-10-11T19:03:56ZSome GPs just keep their heads above water. Other doctors’ businesses are more profitable than law firms<figure><img src="https://images.theconversation.com/files/488898/original/file-20221010-57880-2zni7j.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1920%2C1077&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/black-and-white-photo-of-window-with-message-9295975/">Sonny Sixteen/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Almost all GPs and most non-GP specialist doctors (such as cardiologists, gynaecologists and dermatologists) run private businesses to provide medical care in Australia. Business decisions can influence the costs of medical care, the care patients receive, and access to medical care in different geographic areas. </p>
<p>But until now, we’ve had no national data on the costs or profitability of running a private medical practice.</p>
<p>Our ANZ-Melbourne Institute Health Sector <a href="https://www.anz.com.au/content/dam/anzcomau/documents/pdf/ANZ-Melbourne-Institute-Health-Sector-Report.pdf?adobe_mc=MCMID%3D44747976514731566262638549714644871422%7CMCORGID%3D67A216D751E567B20A490D4C%2540AdobeOrg%7CTS%3D1665566472">Report</a>, out today, uses data from the Australian Bureau of Statistics on all medical businesses in Australia.</p>
<p>We examined trends in growth, costs and profitability, and how the financial health of doctors’ businesses has been affected during the COVID pandemic.</p>
<p>Among our findings, we show how medical businesses, in particular for non-GP specialists, remain very profitable compared to other businesses, including law, accountancy and finance.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-much-seeing-private-specialists-often-costs-more-than-you-bargained-for-53445">How much?! Seeing private specialists often costs more than you bargained for</a>
</strong>
</em>
</p>
<hr>
<h2>Why should we care about medical businesses?</h2>
<p>Many people seeking health care do not think about the costs involved, or the profitability of, running a private medical practice.</p>
<p>But the sudden <a href="https://www.abc.net.au/news/2022-08-11/tristar-medical-clinic-closures-to-leave-some-towns-without-a-gp/101322264">closure</a> of GP practices for financial reasons reduces access to health care for communities. For others, a focus on seeking profits means out-of-pocket costs can rise. </p>
<p>There are also more widespread <a href="https://www1.racgp.org.au/newsgp/professional/drop-in-national-bulk-billing-rate-signals-increas">reports</a> of reduced access to bulk billing (where there are no out-of-pocket costs).</p>
<p>So how doctors run their private businesses is very much in the public interest.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-worker-burnout-and-compassion-fatigue-put-patients-at-risk-how-can-we-help-them-help-us-191429">Health worker burnout and 'compassion fatigue' put patients at risk. How can we help them help us?</a>
</strong>
</em>
</p>
<hr>
<h2>The growth of private practice</h2>
<p>It was not too long ago that GPs and non-GP specialists worked largely on their own. But the benefits of working with others has led to a growth in private group medical practice. </p>
<p>GPs were the first doctors to do this. Now almost 90% of GPs report working in a group practice. But other specialists are rapidly catching up, where almost 70% now work in a private group practice. </p>
<p>The total number of doctors in a solo private practice has fallen by 0.5% between 2013 and 2020, while the number in group private practices has increased by 28.9%.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Patient talking to doctor receptionist or health staff behind desk" src="https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488942/original/file-20221010-26-39u7f5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Groups practices can keep costs down by sharing the costs of premises, administration and support staff.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/a-receptionist-smiling-at-a-person-4269203/">Cedric Fauntleroy/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Group practices can be good in keeping costs down by sharing the costs of premises, administration, nurses, and medical equipment. Working together can improve the quality of care and access to health care, as patients can easily see another GP in the practice if their preferred one is too busy. In a group practice, doctors can also more easily share knowledge. </p>
<p>But if businesses get too big, this could mean less choice for patients looking for a local doctor, and less competition. This could further increase out-of-pocket costs as there is less competitive pressure to keep fees low.</p>
<p>While more non-GP specialists are working in group private practice, they are also on average spending less time there. In 2020 they spent about three hours per week less in private practice compared to 2013.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/last-year-half-a-million-australians-couldnt-afford-to-fill-a-script-heres-how-to-rein-in-rising-health-costs-178301">Last year, half a million Australians couldn't afford to fill a script. Here's how to rein in rising health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Rising profits and costs</h2>
<p>We show profits rose by an average of 2.4% a year for GP businesses and 5.3% a year for non-GP specialists businesses between 2005-6 and 2020-21. </p>
<p>Costs for GPs rose by an average 2.7% a year over the same time period. Turnover from total fees charged grew by 2.9%.</p>
<p>For non-GP specialists costs rose by an average 2% a year over the same time period, while turnover grew by 3.5%.</p>
<p>Overall the growth in costs for GP businesses was higher than for other specialists, and the growth in turnover was lower. This gap between costs and turnover has grown over time. </p>
<p>Non-GP specialists’ businesses made 50% more profit than GP businesses in 2020-21 ($216,468 and $144,485), compared to 14% more in 2005-6 ($120,452 and $105,924).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-need-more-than-a-website-to-stop-australians-paying-exorbitant-out-of-pocket-health-costs-108740">We need more than a website to stop Australians paying exorbitant out-of-pocket health costs</a>
</strong>
</em>
</p>
<hr>
<h2>Impact of COVID</h2>
<p>Medicare coverage of telehealth meant GPs avoided losing income from the fall in face-to-face visits because of COVID. So revenue from fees continued to increase, though at a lower rate than before 2020. </p>
<p>Medical practices could also claim JobKeeper payments to maintain employment of practice staff. This financial support meant the number of GP and non-GP specialist businesses winding up or going bust actually fell during 2019-20. In fact, the total number of medical businesses continued to grow throughout the pandemic. </p>
<p>Profits initially fell during COVID by 1.9% for GPs and by 4.5% for non-GP specialists between 2018-19 and 2019-20. </p>
<p>But profits bounced back the following year because of the pent-up demand during the pandemic. People who were avoiding health care because of COVID or who had their elective surgeries cancelled, came back and still needed care.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two surgeons operating" src="https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/488943/original/file-20221010-11-5addt1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People who once had their elective surgeries cancelled can now go ahead.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/surgeons-performing-surgery-2324837/">Павел Сорокин/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
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</figure>
<p>This was especially the case for non-GP specialists, where profits grew by 10.8% between 2019-20 and 2020-21 compared to 2.2% for GPs. </p>
<p>However, medical businesses, especially GPs, experienced sudden increases in costs as they adapted to COVID settings. For GP businesses, costs increased by over 8% during the pandemic (4.1% between 2018-19 and 2019-20, and by 4% between 2019-20 and 2020-21.</p>
<p>It is expected demand will remain high for private medical care provided by GPs and non-GP specialists as people who delayed care and treatment during the pandemic return to seek care. </p>
<p>In fact, medical businesses, especially non-GP specialists, remain very profitable compared to other businesses such as law, accountancy, finance, construction and agriculture. In 2021, the median gross profit per business (turnover minus costs before tax) was $216,468 for non-GP specialists, $120,452 for GPs, and $124,431 for legal businesses.</p>
<h2>Implications for patients</h2>
<p>Achieving good access to high-quality medical care requires medical businesses to be located in areas of need and where out-of-pocket costs are kept to a minimum for low-income populations.</p>
<p>The growth in private group medical practice can mean medical businesses are run more efficiently, with continuing cost pressures leading to the formation of larger medical groups, especially for non-GP specialists. </p>
<p>In most cases maintaining profitability of private medical businesses is necessary to ensure their survival and maintain access to medical care, as long as out-of-pocket costs don’t increase at the same time.</p><img src="https://counter.theconversation.com/content/192163/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Scott receives funding from the Australia and New Zealand Banking Group for the annual report series 'ANZ-Melbourne Institute Health Sector Reports'. Professor Scott conducts the data analysis and writes the report. </span></em></p>The cost and profits involved in running a medical practice is everyone’s business. It can influence the type of health care you receive.Anthony Scott, Professor of Health Economics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1827642022-05-22T05:58:51Z2022-05-22T05:58:51ZLabor has a huge health agenda ahead of it. What policies should we expect?<p>Labor’s win in Saturday’s election heralds real change in health policy. Although Labor had a small-target strategy, with limited big spending commitments, its victory represents a value shift to a party committed to equity and Medicare, and, potentially, a style shift to a hands-on, equity-oriented health minister.</p>
<p>Labor’s shadow health minister, <a href="https://www.aph.gov.au/Senators_and_Members/Parliamentarian?MPID=HWK">Mark Butler</a>, is expected to be the new health minister, subject to a reshuffle caused by two Labor shadow ministers losing their seats. </p>
<p>Butler is very different from his predecessor. He was Australia’s first minister for mental health and ageing in the Gillard government. He also held the equity-focused ministries of housing, homelessness, and social inclusion. He has written a <a href="https://www.mup.com.au/books/advanced-australia-paperback-softback">book about ageing in Australia</a>, published by Melbourne University Press.</p>
<p>The new minister faces two urgent policy priorities: primary care and COVID.</p>
<h2>Fixing primary care</h2>
<p>Outgoing health minister Greg Hunt released an <a href="https://www.health.gov.au/resources/publications/australias-primary-health-care-10-year-plan-2022-2032">unfunded strategy paper</a> on budget night. It aimed to improve primary care – a person’s first point of contact with the health system, usually their GP or practice nurses. The paper had languished on his desk for months and was the result of years of <a href="https://consultations.health.gov.au/primary-care-mental-health-division/draft-primary-health-care-10-year-plan/">consultation and consensus-building</a>.</p>
<p>One of the largest and most important Labor commitments during the campaign was almost A$1 billion over four years for <a href="https://theconversation.com/labors-health-package-wont-strengthen-medicare-unless-it-includes-these-3-things-183093">primary care reform</a>, about A$250 million in a full year. </p>
<p>The funding commitment is cast broadly, promising to improve patient access to GP-led multidisciplinary team care, including nursing and allied health and after-hours care; greater patient affordability; and better management of complex and chronic conditions. </p>
<p>Presumably, a key way this will be effected will be through <a href="https://www.mja.com.au/journal/2021/214/9/introducing-general-practice-enrolment-australia-devil-detail">voluntary patient enrolment</a>. A patient would enrol with a practice, and the practice would get an annual payment for that enrolment. This was promised for people over 70 in the 2019–20 budget but not delivered.</p>
<p>This new policy is a welcome start for reform in primary care and signals the importance that a Labor government attaches to the sector. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Middle aged man speaking" src="https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/464396/original/file-20220520-15-n2s5da.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Mark Butler was minister for mental health and ageing in the Gillard government.</span>
<span class="attribution"><a class="source" href="https://photos-cdn.aap.com.au/Image/20220514001658867799?path=/aap_dev12/device/imagearc/2022/05-14/0a/0b/22/aapimage-7kzfhcv3ys51mot3f1bfw_layout.jpg">AAP Image/Lukas Coch</a></span>
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<p>The <a href="https://www.alp.org.au/policies/strengthening-medicare-taskforce">Strengthening Medicare Fund</a> was only sketched out in broad terms before the election, and provides insight into the new ministerial style. The details of the policy will be thrashed out in a taskforce which will include key stakeholders. Most importantly, the taskforce will be chaired by the minister – no hiding behind consultants; he or she will hold the hose.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/labors-health-package-wont-strengthen-medicare-unless-it-includes-these-3-things-183093">Labor's health package won't 'strengthen' Medicare unless it includes these 3 things</a>
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<hr>
<h2>Reducing COVID deaths</h2>
<p>Another crucial early challenge for the minister will be addressing the <a href="https://www.theguardian.com/australia-news/2022/may/18/labor-to-consider-new-national-covid-strategy-to-reduce-deaths">continuing COVID pandemic</a>. </p>
<p>COVID deaths continue: three times as many people have died this year than in the previous two. The coalition delegitimised any form of action, including mask wearing and vaccine mandates, as part of its undermining of state public health measures, especially action by Labor states. </p>
<p>The prevalence of third dose vaccinations, necessary for adequate protection from Omicron, sits at about two-thirds of the over-16 population, much lower in the under-16s, meaning that many in the population are not protected.</p>
<p>Public hospitals are bursting at the seams, with staff overwhelmed. This needs urgent attention, and the Coalition strategy of ignoring it and saying it was someone else’s problem, must be dumped. Labor <a href="https://www.theguardian.com/australia-news/2022/may/18/labor-to-consider-new-national-covid-strategy-to-reduce-deaths">vowed to</a> “step up the national strategy” late in the election campaign.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/reducing-covid-transmission-by-20-could-save-2-000-australian-lives-this-year-183426">Reducing COVID transmission by 20% could save 2,000 Australian lives this year</a>
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</em>
</p>
<hr>
<h2>Aged care support</h2>
<p>Hopefully Labor’s shadow aged care minister, <a href="https://www.aph.gov.au/Senators_and_Members/Parliamentarian?MPID=140590">Clare O’Neil</a>, will continue in this role post-election. She proved more than a match for her hapless opponent, Richard Colbeck.</p>
<p>Labor made big <a href="https://www.alp.org.au/policies/aged-care">commitments in aged care</a>, creating a significant point of difference with the Coalition, despite the Coalition’s investments in the <a href="https://theconversation.com/budget-package-doesnt-guarantee-aged-care-residents-will-get-better-care-160611">2021–22 budget</a>. </p>
<p>In addition to the Coalition commitments, Labor promised 24/7 registered nurse coverage in residential aged care facilities, and to support a wage rise for aged care workers. The latter is particularly important because without a wages uplift, the staff shortages in the sector will continue.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/labors-plans-for-aged-care-are-targeted-but-fall-short-of-whats-needed-180497">Labor's plans for aged care are targeted but fall short of what's needed</a>
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<hr>
<h2>A new approach</h2>
<p>Labor won’t engage in climate denialism or use climate policy as a political wedge. </p>
<p>Recognising and addressing climate change is an <a href="https://grattan.edu.au/report/climate-change-and-health-preparing-for-the-next-disaster/">important issue for the health sector</a> and, of course, the community more broadly as the teal surge and the Greens’ wins demonstrated. </p>
<p>Labor has committed to establishing a <a href="https://www.alp.org.au/policies/australian-cdc">centre for prevention and disease control</a>, which should provide a framework for addressing social and economic determinants of health.</p>
<p>Potentially as important in terms of policy style are Labor’s public service policies. The “<a href="https://www.degruyter.com/document/doi/10.3138/9781442668034/pdf">consultocracy</a>” which thrived under the Liberals will be <a href="https://www.afr.com/politics/federal/labor-cuts-to-consultants-could-restore-public-sector-expertise-20220428-p5agvx">shown the door</a>, replaced by public servants doing the job the public service has always been available to do.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/first-nations-people-in-the-nt-receive-just-16-of-the-medicare-funding-of-an-average-australian-183210">First Nations people in the NT receive just 16% of the Medicare funding of an average Australian</a>
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<p>Obviously, a new Labor government will not be able to be meet all the community’s pent-up aspirations in a single term. </p>
<p>Nevertheless, it is disappointing Labor did not commit to phasing in universal dental care – the crucial <a href="https://grattan.edu.au/news/filling-the-gap-a-universal-dental-care-scheme-for-australia/">missing piece</a> of Australia’s universal health coverage.</p>
<p>Butler and his colleagues have a huge agenda on their plates. Starting with primary care is a good first focus, as without those foundations in place, the whole system cannot work well.</p><img src="https://counter.theconversation.com/content/182764/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephen Duckett does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Primary care and COVID will be the top two challenges for new government. But the likely ministers have strong credentials.Stephen Duckett, Honorary Enterprise Professor, School of Population and Global Health, and Department of General Practice, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1826662022-05-18T04:51:51Z2022-05-18T04:51:51ZGPs are abandoning bulk billing. What does this mean for affordable family medical care?<figure><img src="https://images.theconversation.com/files/463830/original/file-20220518-25-puyo6.jpg?ixlib=rb-1.1.0&rect=33%2C25%2C5573%2C3707&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/calculator-stethoscope-on-financial-statement-600w-244903105.jpg">Shutterstock</a></span></figcaption></figure><p>GPs have been <a href="https://www1.racgp.org.au/newsgp/professional/drop-in-national-bulk-billing-rate-signals-increas">sounding the alarm</a> over rising costs of providing care – compounded by the pandemic and more complex demands. Many have said they are abandoning <a href="https://www.servicesaustralia.gov.au/bulk-billing?context=60092">bulk billing</a>, the Medicare scheme that pays doctors a flat rate for providing consultations. </p>
<p>GPs earn <a href="https://advancemed.com.au/blog/highest-paid-doctors-in-australia/">considerably less</a> than other medical specialists, sometimes two or three times less annually. If GPs maintain high rates of bulk billing and the Medicare repayment rate doesn’t cover their costs, practices become unsustainable. </p>
<p>Health-care quality can also decline, as GPs try to see more patients in a day to clock more bulk-billing fees. But opting out of bulk billing, as our specialist colleagues have done, could mean some patients lose access to care.</p>
<p>Meanwhile, more than 13% of voters who responded to The Conversation’s #SetTheAgenda <a href="https://theconversation.com/climate-change-the-environment-and-the-cost-of-living-top-the-settheagenda-poll-181933">poll</a> were worried about health. Cost-of-living pressures were also on their list of concerns before the election.</p>
<p>The Australian Medical Association (AMA) has long supported GPs moving away from bulk billing so they don’t have to depend on government to set their incomes. This time around, many GPs will heed the call, and leave patients with a larger gap fee to pay. Here’s why.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523">Explainer: what is Medicare and how does it work?</a>
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</em>
</p>
<hr>
<h2>The rising cost of health care</h2>
<p>General medical practices are essentially small, private businesses, which are free to set their own fees and working conditions. <a href="https://theconversation.com/explainer-what-is-medicare-and-how-does-it-work-22523">Medicare</a> is a government insurance scheme to help patients access private GPs.</p>
<p>Medicare Benefits Schedule (MBS) fees are raised each year in accordance with the government’s <a href="https://www.abs.gov.au/statistics/economy/price-indexes-and-inflation/wage-price-index-australia">Wage Price Index</a>. This approach has <a href="https://ama.com.au/sites/default/files/documents/160604_Indexation_of_MBS_Rebates_FINAL.pdf">long been criticised</a> for failing to keep pace with inflation in the health sector.</p>
<p>Compounding this lag, rebates were <a href="https://theconversation.com/what-is-the-medicare-rebate-freeze-and-what-does-it-mean-for-you-114169">frozen</a> in 2013 as a cost-cutting measure for attendance items until July 2018.</p>
<p>Total spending on health in 2021–22 is <a href="https://archive.budget.gov.au/2021-22/bp1/download/bp1_2021-22.pdf">estimated</a> to be A$98.3 billion, representing 16.7% of the federal government’s total expenditure. Around <a href="https://www1.racgp.org.au/ajgp/2021/september/general-practice-and-primary-healthcare-health-exp">6.5% of total health expenditure</a> is allocated to delivering GP services. </p>
<p>The <a href="https://www.ausdoc.com.au/news/rebate-gap-blows-out-47-standard-gp-consult">gap</a> between the AMA-recommended fee (around $86) and the Medicare rebate for a standard GP consult ($39.10) has grown by $13.50 over a decade to around $47. Average patient out-of-pocket costs for services directly provided by GPs have <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/Medicare%20Statistics-1">increased</a> by 50% over the last decade.</p>
<p>Some 88.4% of GP services were bulk-billed in the <a href="https://www1.racgp.org.au/newsgp/professional/drop-in-national-bulk-billing-rate-signals-increas">final quarter of 2021</a>, an increase of 0.3% on the previous year, according to the Department of Health. But much of this increase can be explained by mandated bulk-billed telehealth consultations under COVID rules, which replaced in-person consultations during lockdowns. The percentage of bulk-billed consultations was also down on the previous quarter.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1517311190938308608"}"></div></p>
<h2>Health care consumer confidence</h2>
<p>So, health care costs in Australia are <a href="https://theconversation.com/inflation-hits-5-1-how-long-until-mortgage-rates-climb-181832">rising faster</a> than cost of living pressures and wages growth. And there is ample evidence out-of-pocket costs <a href="https://www1.racgp.org.au/newsgp/professional/the-concern-of-rising-out-of-pocket-health-costs">create barriers</a> to people getting health care – especially for many who need it most: rural populations, young families, those with disabilities and chronic conditions. </p>
<p>Earlier this year, a large <a href="https://healthsystemsustainability.com.au/the-voice-of-australian-health-consumers/">survey</a> found 30% of people with chronic conditions were not confident they could afford health care if they became seriously ill; 14% of people with chronic conditions said they could not afford healthcare or medicine now.</p>
<p>Rising out-of-pocket costs for health care is an important issue the major parties have not yet substantially addressed during the election campaign. The Labor party has finally <a href="https://www.abc.net.au/news/2022-05-14/labor-promises-almost-1-billion-for-medicare-and-gps/101066662">come to the table</a> with a funding promise to better support GPs and primary care, which the AMA has applauded as a good start.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="wallet with medicare card and bills" src="https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=475&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=475&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463834/original/file-20220518-11-sydn3n.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=475&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some 14% of people with chronic health conditions say they can’t afford medical care.</span>
<span class="attribution"><span class="source">Editor supplied</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<strong>
Read more:
<a href="https://theconversation.com/how-do-the-major-parties-rate-on-medicare-we-asked-5-experts-182230">How do the major parties rate on Medicare? We asked 5 experts</a>
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<h2>GPs feeling the strain</h2>
<p>General practices have worked hard to adapt to funding squeezes by creating efficiencies of scale (boosting practice size); adopting new technology, and seeing more patients with shorter consultation times. But around <a href="https://www.racgp.org.au/health-of-the-nation/chapter-2-general-practice-access/2-2-gp-workforce">half are concerned</a> about the long-term viability of their practices.</p>
<p>Anecdotally, younger GPs say they are thinking about leaving face-to-face general practice, finding the <a href="https://www.ausdoc.com.au/opinion/election-looms-heres-how-i-think-we-can-save-general-practice?brandTid=18126">demands and expectations unsustainable</a>. Even sadder is their perception the specialty has been devalued and deskilled.</p>
<p>Due to the lower income and status of general practice, medical students have a limited interest in pursuing it as a career and registrar training places <a href="https://www.abc.net.au/news/2022-04-29/regional-towns-face-doctor-shortage/101022348">go unfilled</a>.</p>
<p>So, the GP workforce gets older. Some 50% of GPs are now over 50. Around 80% of GPs think <a href="https://www.racgp.org.au/health-of-the-nation/health-of-the-nation">better pay</a> would attract more graduates to the specialty.</p>
<p>The pandemic has <a href="https://insightplus.mja.com.au/2022/3/the-other-long-covid-impacts-on-health-systems-and-clinicians/">compounded the strain</a> on our health workforce, with GP clinics shouldering significant responsibility for testing, vaccinating and caring for COVID patients. Staff and supply shortages and inadequate funding models have put substantial stress onto an already busy and demanding career. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1526449586772275200"}"></div></p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/with-surgery-waitlists-in-crisis-and-a-workforce-close-to-collapse-why-havent-we-had-more-campaign-promises-about-health-182327">With surgery waitlists in crisis and a workforce close to collapse, why haven’t we had more campaign promises about health?</a>
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<h2>No quick fixes</h2>
<p>It’s understandable that many GPs are opting out of bulk-billing. But there are no simple solutions for delivering high quality health care to everyone.</p>
<p>Adopting new funding models, including more blended payments – moving away from fee-for-service and incorporating “pay for performance” <a href="https://www.oecd.org/els/health-systems/Better-ways-to-pay-for-health-care-FOCUS.pdf">funding</a> – could ease the strains on general practices.</p>
<p>Our health system is due for some courageous reforms. GPs have long advocated for better telehealth, reducing the current funding bias towards procedural medicine, and more consultation tiers, to improve quality of care. A strong Medicare system is important to provide a safety net, ensuring equitable access for all Australians.</p><img src="https://counter.theconversation.com/content/182666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David King does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>GPs say they can’t survive on bulk-billing. But abandoning it altogether might leave vulnerable patients out in the cold.David King, Senior Lecturer in General Practice, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1830932022-05-17T03:55:43Z2022-05-17T03:55:43ZLabor’s health package won’t ‘strengthen’ Medicare unless it includes these 3 things<p>“Strengthening Medicare” is one of Labor’s key election platforms. On Saturday, one week from the election, the opposition finally <a href="https://anthonyalbanese.com.au/media-centre/labor-will-strengthen-medicare-butler-health">outlined its commitment</a> to prop up the ailing primary care system, with a A$970m funding package.</p>
<p>The promise of additional funding for primary care is welcome. More money is badly needed, but Labor’s plans have no detail on how this will improve health outcomes and equity of access.</p>
<p>In order to ignite the structural health care reform we so desperately need, Labor needs to focus on three key areas: GP numbers, free access to GPs and better access to specialists.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-the-major-parties-rate-on-medicare-we-asked-5-experts-182230">How do the major parties rate on Medicare? We asked 5 experts</a>
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</em>
</p>
<hr>
<h2>Remind me, what is primary care?</h2>
<p>Primary care is a person’s first point of contact with the health system. This is usually in general practice, with GPs and practice nurses, and also includes some care provided in community health centres and Aboriginal community-controlled health services. </p>
<p>The current Liberal government published its <a href="https://www.health.gov.au/resources/publications/australias-primary-health-care-10-year-plan-2022-2032">Primary Care ten year plan</a> in 2022 after a <a href="https://consultations.health.gov.au/primary-care-mental-health-division/draft-primary-health-care-10-year-plan/">consultation</a> period starting in 2019. It included technological improvements to boost quality, voluntary patient registration for the elderly (to sign up with a GP clinic which will support their long-term, chronic diseases), and support for integrated care, allowing people to move more easily from hospital to primary care, and other parts of the health system. </p>
<p>But as the Australian Medical Association (AMA) has highlighted throughout the campaign, this plan remains unfunded. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1503529644284575746"}"></div></p>
<h2>What does Labor’s plan include?</h2>
<p><a href="https://anthonyalbanese.com.au/media-centre/labor-will-strengthen-medicare-butler-health">Labor’s plan</a> promises new funding of A$950 million. The centrepiece is a new, so-called Strengthening Medicare Fund of A$750 million that aims to improve access to GPs – though it doesn’t say how. There is little detail on how this fund will be used.</p>
<p>The “how” will be decided by a so-called Strengthening Medicare Taskforce, chaired by the new health minister, plus many of the same people who designed the Liberals’ plan. It’s therefore unclear how different this would end up being from the Coalition’s plan. </p>
<p>Labor’s plan also includes A$25,000 or A$50,000 grants to improve practice infrastructure including IT, “upskilling” staff, and new equipment including infection control. </p>
<p>Direct subsidies to support the costs of running a practice is important, though by itself does not guarantee more patients can find a bulk billing GP. Nor does it guarantee the <a href="https://theconversation.com/rising-out-of-pocket-health-costs-are-a-worry-but-the-major-parties-have-barely-mentioned-it-181595">rising health care costs</a> will slow down.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1520149339439517696"}"></div></p>
<h2>Three problems that need to be fixed</h2>
<p>The taskforce will take time to deliberate. But here are some ideas to begin with. </p>
<p><strong>1) Address the GP shortage</strong></p>
<p>There remains a chronic shortage of GPs, with many GP training places <a href="https://www.aph.gov.au/DocumentStore.ashx?id=379fba97-8d67-4831-9f1c-cc3a8c6a4eb7&subId=716543">remaining unfilled</a> and with a much <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0011/3809963/ANZ-Health-Sector-Report-2021.pdf">higher growth</a> in the number of specialists compared to GPs.</p>
<p><a href="https://minerva-access.unimelb.edu.au/items/4495ceea-9018-50ea-b9c1-6ee09791a1b6">Our research</a> has shown three things can persuade junior doctors to choose general practice as a career: money, more procedural work (such as helping deliver babies or removing skin lesions) and more opportunities for research and academic work. </p>
<p>There are no policies in any parties’ plans that address these. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/poor-and-elderly-australians-let-down-by-ailing-primary-health-system-100586">Poor and elderly Australians let down by ailing primary health system</a>
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<p>More money needs to be used carefully and needs to reduce the large <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0011/3809963/ANZ-Health-Sector-Report-2021.pdf">gap between GPs’ and specialists’ incomes</a> if more junior doctors are to be attracted to this specialty. </p>
<p><a href="https://minerva-access.unimelb.edu.au/items/bc6d10b3-938b-56c0-bc11-21524d1233c3">Procedural work for GPs</a> exists in rural areas but is more tricky in cities, but many city GPs have specific special interests in undertaking procedures that should be better supported. </p>
<p>Primary care research and basic data collection remains a <a href="https://www.mdpi.com/1660-4601/19/4/1912">gaping hole</a> in need of additional funding. </p>
<p><strong>2) Increase free access to GPs</strong></p>
<p>The key issue for many patients is accessing free GP services, with many people <a href="https://healthsystemsustainability.com.au/the-voice-of-australian-health-consumers/">avoiding GP visits</a> because they have to pay. </p>
<p>Again, nothing in either party’s plan will directly reduce out-of-pocket costs. </p>
<p>The solution requires new, innovative funding models for primary care, especially in low socioeconomic and rural areas. This could include federal government funding to expand community health centres, which are run by states.</p>
<p>There has never been a specific policy focus in Medicare for low socioeconomic areas. </p>
<figure class="align-center ">
<img alt="Main in a respirator waits for this GP appointment." src="https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/463483/original/file-20220517-27-3pzy04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cost is a major issue for some people.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/prague-czechia-patient-kn95-respirator-waiting-1933933733">Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>3) Improve access to specialists</strong></p>
<p>Labor’s plans are about strengthening Medicare, yet the largest part of spending on Medicare services is for services provided by specialists. Of the <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/32CC6EB4BCC0BB1CCA257BF0001FEB92/$File/Annual%20Medicare%20Statistics%20-%20State%20-%202009-10%20onwards.xlsx">total spending on Medicare benefits</a> of A$27.5 billion in 2020-21, 32% (A$8.8 billion) was spent on GPs, while 54% (A$14.2 billion) was spent on other specialists. </p>
<p>However, the Labor and Coalition plans completely ignore the continuing problems of <a href="https://melbourneinstitute.unimelb.edu.au/__data/assets/pdf_file/0016/2800141/ANZ-MI-Health-Sector-Report-Specialists-2018.pdf">access to specialists</a>. </p>
<p>Rich people have <a href="https://www.sciencedirect.com/science/article/abs/pii/S0168851020302244">better access</a> to specialists, including for <a href="https://www.sciencedirect.com/science/article/pii/S0277953618302041">child health services</a>. You either wait up to a year for a public hospital appointment or pay sometimes exorbitant out-of-pocket costs. This contributes to significant inequalities in health.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/with-surgery-waitlists-in-crisis-and-a-workforce-close-to-collapse-why-havent-we-had-more-campaign-promises-about-health-182327">With surgery waitlists in crisis and a workforce close to collapse, why haven’t we had more campaign promises about health?</a>
</strong>
</em>
</p>
<hr>
<h2>What next for Medicare?</h2>
<p>It’s easy to point out what’s wrong with the Australian health system, and much harder to think of solutions, especially where significant structural change is actively discouraged by some in the sector. </p>
<p>We need primary care that is guaranteed to be free and accessible for a significant part of the population in the bottom half of the income distribution. </p>
<p>More money is good only if it can address these issues to properly strengthen Medicare and primary care.</p><img src="https://counter.theconversation.com/content/183093/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Scott receives some funding from the Medibank Beter Health Foundation.</span></em></p>Labor’s election pledge for Medicare includes some additional funding, but to strengthen the system, it needs to improve people’s access to doctors.Anthony Scott, Professor of Health Economics, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1817092022-05-02T02:58:24Z2022-05-02T02:58:24ZPeople attending GPs aren’t getting all the preventive health care they need. Here’s what could help<figure><img src="https://images.theconversation.com/files/459035/original/file-20220421-20-pnbx4h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6605%2C4386&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>When you go to your usual GP, you probably sit down, tell her your health-care needs or problems, and she advises and discusses with you how you can address them. </p>
<p>But there’s one important aspect missing in many visits to the GP: what you can do to prevent ill health in the future. </p>
<p>Preventive care includes advice, such as to stop smoking or about forthcoming perimenopause; physical examination such as measuring blood pressure, waist circumference or eyesight; tests for high cholesterol or screening mammography (breast X-ray); and treatments such as vaccinations.</p>
<p>We’ve been <a href="https://doi.org/10.1071/PY21204">researching</a> ways GPs and people attending them can be better reminded of relevant preventive health care, and have developed a solution that might help.</p>
<h2>What are patients missing?</h2>
<p>Just to give a few examples, only about half or fewer eligible Australians currently participate in the national programs to <a href="https://www.aihw.gov.au/reports/cancer-screening/national-cancer-screening-programs-participation/contents/summary">screen</a> for cancer of the bowel, breast or cervix.</p>
<p>Osteoporosis is a condition in which bones become weak and can break easily. It is a major health program that is common in older people, with osteoporotic fractures reducing quality and length of life. Despite this, only about <a href="https://healthybonesaustralia.org.au/hcps/initiatives-reports/">10% of people at higher risk</a> for osteoporosis are screened for it by their GP. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="xray image of hips and pelvis" src="https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=487&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=487&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=487&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=612&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=612&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460689/original/file-20220502-56362-czfgz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=612&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Osteoporosis can lead to fractures and reduce quality and length of life, but few people are screened for it.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/pelvis-xray-human-skeleton-image-600w-1120195781.jpg">Shutterstock</a></span>
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<p>Invasive pneumococcal infection is serious and sometimes fatal. Our research has found 30% of people under the age of 65 years have chronic health conditions that put them at higher risk of pneumococcal infection, but <a href="https://pubmed.ncbi.nlm.nih.gov/35078659/">only 24% of them</a> report having received pneumococcal vaccine.</p>
<h2>Why isn’t all recommended preventive care routinely offered?</h2>
<p><a href="https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/guidelines-for-preventive-activities-in-general-pr/preamble/introduction">National guidelines</a> for prevention advise how often different activities should be performed for people of different ages and sexes, making the date on which each relevant preventive activity is due for each person predictable. In view of this, why don’t most people know which preventive activities are recommended for them and when each is due next to be performed? There are a few reasons for this.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/focus-on-prevention-to-control-the-growing-health-budget-13665">Focus on prevention to control the growing health budget</a>
</strong>
</em>
</p>
<hr>
<p>One reason is that the guidelines for the prevention, early detection or care of some conditions are complex. </p>
<p>Second, which preventive measures are recommended changes as people age and as their personal and family health history changes.</p>
<p>Preventive care is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314474/">more likely to be offered</a> in longer consultations, but the Medicare Benefits Schedule provides lower subsidies per minute for longer consultations than for shorter ones. This increases patients’ out-of-pocket costs for longer consultations and discourages patients from seeking, and GPs from offering, longer consultations.</p>
<p>Currently, there is no one place each person can view a list of all of the preventive health measures recommended for them, when each of them was done, and when they are next due. </p>
<h2>Our research developed a solution</h2>
<p>Most of the electronic clinical record systems used by Australian GPs automatically generate onscreen reminders to GPs about preventive activities. Those reminders cover only a limited range of preventive activities, are not very informative, and GPs can ignore them repeatedly without any accountability. </p>
<p>Most importantly, the reminders are not communicated automatically to the patient. To address this, we are studying the effects of <a href="https://www.publish.csiro.au/py/pdf/PYv27n4abs">automatically sending SMS messages to patients</a> about preventive activities that are due to be performed.</p>
<p>The messages are sent after the person has made an appointment to see their GP. They tell the person what care is due and advise the person to discuss this in their forthcoming consultation. These reminders empower their recipients and enable them to receive the recommended care with a minimum of additional time, effort or cost.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=293&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=293&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=293&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=368&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=368&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460454/original/file-20220429-18-cqrtly.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=368&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An example of the text message sent to patients.</span>
<span class="attribution"><span class="source">Author Provided</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Our earlier <a href="https://www.annfammed.org/content/15/3/276">studies</a> of providing information and reminders on paper before consultations found people welcomed receiving this information and acted on them. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-physical-activity-in-australian-schools-can-help-prevent-depression-in-young-people-107889">How physical activity in Australian schools can help prevent depression in young people</a>
</strong>
</em>
</p>
<hr>
<p>GPs’ clinical software systems should be improved to allow and encourage each person to view a comprehensive display of their preventive care updates. Currently, the freely available <a href="http://www.doctorscontrolpanel.com.au/">Doctors Control Panel</a> onscreen reminder software for GPs (used in our research program) comes closest to providing a comprehensive listing of preventive activities recommended for each person, and when they were, or are, due to be performed.</p>
<h2>What can you do now?</h2>
<p>At least annually, you should ask your usual GP about which preventive activities are recommended for you, when each was last performed with what result or finding, and when each is due to be performed next. </p>
<p>If you plan to do this when you are going to see your usual GP for some other reason, ask for a long appointment so your GP can find and give you this information.</p><img src="https://counter.theconversation.com/content/181709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research has received grants from the RACGP Foundation and Pfizer's Independent Grants. Oliver Frank has advised the owner of the Doctors Control Panel software on usability, he did not receive payment or any other benefit for this advisory.</span></em></p>Many eligible Australians are not partaking in care to protect their health. Why?Oliver Frank, Senior Research Fellow, Discipline of General Practice, and Specialist General Practitioner, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1744582022-01-07T04:48:20Z2022-01-07T04:48:20ZI’ve tested positive to COVID. What should I do now?<figure><img src="https://images.theconversation.com/files/439762/original/file-20220106-25-wsffne.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5815%2C3873&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>For two years, COVID has dominated our world. In Australia, we’ve tested every sniffle, undergone extensive lockdowns, and double-vaccinated <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/numbers-statistics">more than 90%</a> of adults to combat this lethal virus.</p>
<p>So, it’s understandable our first reaction when we test positive to COVID ourselves is to panic.</p>
<p>However, a positive test doesn’t mean you will necessarily end up in hospital.</p>
<p>As a GP, here’s my advice on what you should do.</p>
<h2>When you test positive</h2>
<p>If you test positive on a rapid antigen test at home, you’re <a href="https://www.abc.net.au/news/2022-01-05/scott-morrison-rat-tests-national-cabinet/100739940">no longer required to get a PCR test</a>.</p>
<p>If you have symptoms and cannot get either a PCR or a rapid antigen test, you should assume you have COVID and self-isolate until you can get tested.</p>
<h2>Who should you tell?</h2>
<p>Tell a support person – someone who will be able to check on you every day, either in person (taking appropriate precautions) or by phone.</p>
<p>Also notify your work and cancel any other commitments you have coming up for the following week.</p>
<p>Contact tracing is completely overwhelmed in most states and territories, so make sure to notify your <a href="https://www.coronavirus.tas.gov.au/keeping-yourself-safe/contact-tracing/types-of-contacts">close contacts</a> yourself.</p>
<p>Currently, this is <a href="https://www1.racgp.org.au/newsgp/clinical/new-national-definition-of-covid-close-contact">defined as</a> a person who has spent four hours or more with you in a household or “household-like” setting while you’re infectious, which includes the two days before you got symptoms. Realistically, someone can catch it from you in much less than four hours, so notifying anyone you spent time with (even if less than four hours), would make medical sense.</p>
<p>In <a href="https://www.abc.net.au/news/2022-01-06/changes-to-victoria-covid-testing-rules-rat-pcr/100741694">some states</a> you are asked to notify the public health unit that you’ve tested positive. But at the time of writing there’s no national approach to self-reporting.</p>
<h2>Only inform your doctor if you have certain conditions</h2>
<p>Don’t automatically notify your GP. In many cases, if you’re young, fit and healthy there’s no benefit to you.</p>
<p>The current <a href="https://covid19evidence.net.au/wp-content/uploads/FLOWCHART-1-PATHWAYS-TO-CARE-V1.1.pdf">national recommendations</a> for treating COVID suggest adults with mild illness and no other risk factors may manage their symptoms at home.</p>
<p>With tens of thousands of people being diagnosed daily – and GPs rolling out booster vaccines, vaccines for children, and continuing our usual work – we don’t have capacity to review every person in Australia who’s a positive test each day. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1478990040629841921"}"></div></p>
<p>However, certain people testing positive should arrange a telehealth consultation with a GP regardless of how well they feel on receiving the news.</p>
<p>This includes people who are over 65, pregnant, immunocompromised, or are both unvaccinated/partially vaccinated and have certain diseases like diabetes, obesity, kidney, heart, liver or lung disease.</p>
<p>As people in this group are at higher risk of deteriorating, they may be able to <a href="https://monashhealth.org/patients-visitors/coronavirus/satellite-clinic/?fbclid=IwAR3PQEDv5yKhVvgVHrtfMLgUEerQSEZ9Nq1yMifJiB6cWt1F_Xv7kCg8edA">access medications</a> such as antiviral therapy to reduce that risk. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-still-not-too-late-to-fix-the-rapid-antigen-testing-debacle-why-the-national-cabinet-decision-is-wrong-and-must-be-reversed-174391">It's still not too late to fix the rapid antigen testing debacle. Why the national cabinet decision is wrong and must be reversed</a>
</strong>
</em>
</p>
<hr>
<h2>Treating ourselves at home</h2>
<p>Most of us will be treating ourselves at home.</p>
<p>This will <a href="https://www.health.nsw.gov.au/Infectious/factsheets/Pages/managing-covid-at-home.aspx">usually apply to people</a> who are under 65, aren’t pregnant, have had at least two doses of a COVID vaccine, and don’t suffer from any chronic conditions.</p>
<p>Here are some things to consider:</p>
<ul>
<li><p>make sure your home is as safe as possible for others who live there. It’s <a href="https://www.smh.com.au/national/how-we-lived-with-a-covid-positive-person-and-avoided-infection-20211226-p59k8v.html">not inevitable</a> everyone at home will catch it from you, especially if you keep it <a href="https://ozsage.org/media_releases/10-steps-to-reduce-sars-cov-2-transmission-risk-at-home/">well ventilated</a></p></li>
<li><p>as you’re not allowed to leave the house at all (except for <a href="https://www.healthdirect.gov.au/coronavirus-covid-19-self-isolation-faqs">urgent medical care</a>), ensure you have ways of getting food and medication, such as via home delivery services</p></li>
<li><p>rest, keep up your fluids, and treat pain and fever symptoms with over-the-counter medications if needed, like paracetamol and ibuprofen </p></li>
<li><p>nausea, vomiting and diarrhoea aren’t uncommon. If you experience any of these, eat small meals more often, stick to “white coloured” foods (pasta, rice, potato, white bread), and drink enough for your urine to look pale</p></li>
<li><p>continue your usual medications. It’s very important you don’t stop taking these, unless your GP specifically advises otherwise </p></li>
<li><p>if you have access to an oxygen monitor, use it <a href="https://reliefweb.int/sites/reliefweb.int/files/resources/oximeter-poster_rev3.pdf">three times a day</a> or if you feel your breathlessness is worsening. If your levels are 92% or lower, you need urgent review. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055753/">Don’t rely</a> on a smart watch for oxygen monitoring.</p></li>
</ul>
<p>Here are some further helpful guides to <a href="https://www.racgp.org.au/clinical-resources/covid-19-resources/patient-resources/managing-mild-covid-19-at-home">managing COVID</a> <a href="https://www.gps-can.com.au/covid19-blog/a-guide-self-isolation">at home</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-tips-for-ventilation-to-reduce-covid-risk-at-home-and-work-151758">5 tips for ventilation to reduce COVID risk at home and work</a>
</strong>
</em>
</p>
<hr>
<h2>When to get medical help</h2>
<p>The national Healthdirect website <a href="https://www.healthdirect.gov.au/managing-covid-19/monitoring-covid-19-symptoms#contact-gp">suggests</a> asking yourself these questions morning, afternoon and night:</p>
<ul>
<li><p>can I get my own food? </p></li>
<li><p>can I drink? </p></li>
<li><p>can I go to the toilet normally?</p></li>
<li><p>can I take my regular medication? </p></li>
</ul>
<p>If you answer “no” to any of these questions, call your GP for a telehealth assessment.</p>
<figure class="align-center ">
<img alt="Person sick at home holding chest" src="https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=316&fit=crop&dpr=1 600w, https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=316&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=316&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=398&fit=crop&dpr=1 754w, https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=398&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/439767/original/file-20220107-25-40vv6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=398&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">It’s important to speak to your GP if your condition deteriorates.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Some parts of Australia have systems where <a href="https://www.healthdirect.gov.au/managing-covid-19/monitoring-covid-19-symptoms#monitored">home monitoring</a> takes place under a management plan devised by a health-care provider. Your GP will help you access this if appropriate. </p>
<p>You may also like to complete a <a href="https://www.gps-can.com.au/covid19-blog/i-have-covid-the-infection-now-what?fbclid=IwAR0wt05dZlV1AGHlY5dGEcf4dp_nDYqQA-IVEkwzKyGqJurT9dtzqTBgmD0">daily symptom checklist</a>.</p>
<h2>When to go to hospital</h2>
<p>Bypass your GP, go to straight to hospital, or call 000 if you develop any of the following:</p>
<ul>
<li><p>breathlessness, so you’re unable to speak in sentences, for example you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8527530/">cannot count to 20 in a single breath</a></p></li>
<li><p>fainting, unusually sleepy (difficult to rouse) or lethargic, or become unconscious at any point</p></li>
<li><p>skin turning blue or pale, or becoming clammy and cold</p></li>
<li><p>pain or pressure in the chest</p></li>
<li><p>confusion</p></li>
<li><p>passing no urine or a lot less urine than usual</p></li>
<li><p>coughing up blood.</p></li>
</ul>
<h2>When will you be safe to stop isolation?</h2>
<p>Current guidelines on this are complicated, vary from state to state, and change frequently.</p>
<p>For starters however, you can expect at least seven days of isolation.</p>
<p>Rules around safely stopping isolation centre on protecting both yourself and others. Therefore, as a general rule, you may stop isolating once you’re no longer infectious (evidenced by a negative PCR or rapid antigen test), your symptoms have passed (mild/occasional coughing is OK as this can last weeks) and you feel well enough to return to your normal life. </p>
<p>It’s best to check local requirements before stopping your isolation.</p>
<p>Finally, if you’re reading this before having tested positive, now is a great time to <a href="https://www.qld.gov.au/__data/assets/pdf_file/0016/230605/covid-ready-kit.pdf">do some planning and put preparations in place</a>, just in case you do.</p><img src="https://counter.theconversation.com/content/174458/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with the RACGP </span></em></p>Whether you’ve tested positive on a PCR or a rapid antigen test, here are a GP’s tips of how to manage your condition.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1605322021-07-02T03:09:51Z2021-07-02T03:09:51ZBe kind: GP receptionists are taking the heat with every policy update during COVID, vaccines included<figure><img src="https://images.theconversation.com/files/400672/original/file-20210514-13-15pp9gi.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C997%2C529&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/receptionist-woman-office-reception-wearing-face-1726918939">from www.shutterstock.com</a></span></figcaption></figure><p>Phones are ringing off the hook at <a href="https://www.ausdoc.com.au/news/chaos-reigns-gps-swamped-demand-astrazeneca-vax-under40s">GP clinics</a> <a href="https://www.annfammed.org/content/covid-19-collection-global-primary-care-during-covid-19">with people</a> desperate to know when and how they can be vaccinated against COVID-19. </p>
<p>Every time there is a change in recommendations or advice, medical receptions field calls from concerned people trying to book in to talk to a GP or to cancel bookings. This is on top of supporting patients and juggling the extra workload required to perform COVID-19 triage, screening and telehealth.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1409459128603275264"}"></div></p>
<p>GPs and practice nurses are considered <a href="https://www1.racgp.org.au/ajgp/coronavirus/australias-primary-care-covid19-response">central and front line</a> in Australia’s primary care COVID-19 response. However, GP receptionists are one step in front. </p>
<p>Their role has changed considerably during the pandemic, taking on functions and learning new skills no-one planned for. We must not forget them and the stressful work they do.</p>
<h2>All in a day’s work</h2>
<p>Medical receptionists are an integral part of <a href="https://www.racgp.org.au/download/Documents/Standards/RACGP-Standards-for-general-practices-5th-edition.pdf">general practice teams</a> and GP clinics would be challenged to exist without them. Doctors, nurses and other staff rely on medical receptionists to create a friendly, welcoming and well-organised front-of-clinic for patients. </p>
<p>Some people assume medical receptionists “just” answer phone calls, notify doctors when patients have arrived and make follow-up appointments. But this not only understates their true impact and influence on our health system, it does not acknowledge the challenges and pressures of their work.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-younger-australians-decide-about-the-astrazeneca-vaccine-a-gp-explains-163733">How can younger Australians decide about the AstraZeneca vaccine? A GP explains</a>
</strong>
</em>
</p>
<hr>
<p>Long before the pandemic, medical receptionists were <a href="https://www.semanticscholar.org/paper/Medical-receptionists-in-general-practice%3A-Who-a-Patterson-Mar/4b51152b3a994796f1c9dd8ceaa772e254ef5e6c">increasingly undertaking clinical duties</a>, performing tasks involving direct patient assessment, monitoring and therapy. </p>
<p>Medical receptionists were typically in this situation because of a lack of <a href="https://www.uow.edu.au/media/2020/research-finds-primary-health-care-nurses-losing-work-during-pandemic.php">financial support for practice nurses</a>. But, given receptionists are not trained health professionals and are continuously handling confidential information about patients, there’s the risk they may be held <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwjFmb62ocPxAhXESH0KHWKvDyMQFjAKegQIGRAD&url=https%3A%2F%2Fespace.library.uq.edu.au%2Fview%2FUQ%3A8923%2FRisk1.pdf&usg=AOvVaw07fkvpK9ipdDfyH6ig8Wve">legally liable</a> for making a mistake. </p>
<h2>Then came the pandemic</h2>
<p>The role of medical receptionists has profoundly changed due to the pandemic, though they have not being included in pandemic planning. </p>
<p>The Royal Australian College of General Practitioners has said <a href="https://www.racgp.org.au/health-of-the-nation/chapter-2-general-practice-access/2-2-gp-workforce">many receptionists</a> have been providing health and safety advice to patients and the wider community.</p>
<p>They are routinely asking patients questions about their travel history and symptoms, and monitoring body temperature to assess the risk of a patient being infected with COVID-19, despite not being trained to make clinical decisions.</p>
<p>They are increasingly performing <a href="https://www1.racgp.org.au/newsgp/clinical/should-suspected-coronavirus-patients-present-to-g">basic triage</a> over the phone and at the front desk, essentially assessing “how sick” a patient is and how timely their care needs to be.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1377021338011901955"}"></div></p>
<p>Particularly during the pandemic, it is usually their decision whether a patient is granted a face-to-face appointment, seen in their car, placed in an isolation room for their consultation, or asked to go to the hospital instead. </p>
<p>Medical receptionists are also relied on for <a href="https://www1.racgp.org.au/newsgp/racgp/racgp-recognises-the-unheralded-heroes-of-covid-19">technical support</a> for telehealth and to train clinicians and patients to use it. </p>
<p>Deciding if a patient is suitable for telehealth alone requires a basic understanding of what the doctor might need. We wouldn’t expect any medically untrained person to make these decisions, yet we expect our receptionists to.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/view-from-the-hill-scott-morrisons-astrazeneca-hand-grenade-turns-into-cluster-bomb-163680">View from The Hill: Scott Morrison's AstraZeneca 'hand grenade' turns into cluster bomb</a>
</strong>
</em>
</p>
<hr>
<h2>No wonder it’s stressful</h2>
<p>Medical receptionists are rightly concerned about <a href="https://www.racgp.org.au/health-of-the-nation/chapter-2-general-practice-access/2-2-gp-workforce">contracting COVID-19</a> as they are so close to unwell patients in the waiting room.</p>
<p>Threats of violence from frightened patients are also <a href="https://www1.racgp.org.au/newsgp/professional/violence-towards-gps-and-staff-a-growing-problem-n">now a reality</a>. And when a patient has not been booked in correctly, or worse, when a patient enters a consultation room showing COVID-19 symptoms, they cop dissatisfaction from clinicians and patients alike.</p>
<figure class="align-center ">
<img alt="Woman looking stressed or scared wearing a mask" src="https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/409409/original/file-20210702-19-1q80ezo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Working as a medical receptionist in a pandemic can take its toll.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/receptionist-woman-wearing-covid-ffp2-face-1925465327">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The <a href="https://medicalrepublic.com.au/emotional-rescue-patients/7049">emotional demand</a> on medical receptionists is also very high. Supporting clinical teams and their personal feelings and expressions is now part of the job, as well as advocating for, and empathising with patients.</p>
<p>They do all this for an average <a href="https://www.payscale.com/research/AU/Job=Medical_Receptionist/Hourly_Rate">A$23.96 an hour</a>, much less than administrative or secretary work outside the health-care sector. </p>
<h2>Training and support are critical</h2>
<p>There is no required qualification to become a medical receptionist. However, courses such as a Certificate III in Business Administration or Certificate IV in Health Administration are <a href="https://www.seek.com.au/career-advice/role/medical-receptionist">recommended</a>. Truthfully, no training exists to equip medical receptionists for the additional pressures of the coronavirus pandemic. </p>
<p>Informal tips are circulating about how practice owners can <a href="https://www.wolterskluwer.com/en/expert-insights/9-ways-to-fight-burnout-in-overworked-medical-staff">support staff to avoid burnout</a>, and also how medical receptionists can <a href="https://www.avant.org.au/news/the-subtle-art-of-good-triage-for-medical-receptionists/">enhance their clinical and triage work</a>. </p>
<p>Unfortunately, current tips and training do not address the fundamental problem of medical receptionists not being recognised, trained or paid accordingly for their growing clinical, management and administrative work. </p>
<h2>Get vaccinated, be kind</h2>
<p>GP clinics still play a vital role in getting Australians vaccinated and helping us emerge from the pandemic. That’s on top of their existing role.</p>
<p>Receptionists are at the front line of this pandemic, changing what they do at a moment’s notice to keep the rest of their teams and community safe. Their many hardships are well overdue for our respect and recognition.</p>
<hr>
<p><em>Tracey Johnson, CEO of Inala Primary Care, a large GP clinic and charity in Queensland, contributed to this article.</em></p><img src="https://counter.theconversation.com/content/160532/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball receives funding from the National Health and Medical Research Council, RACGP Foundation, VicHealth and Queensland Health. Lauren is an Executive Committee member of the Australasian Association of Academic Primary Care and on the Editorial Advisory Committee of the Australian Journal of General Practice. </span></em></p><p class="fine-print"><em><span>David is an Executive Committee member of the Australasian Association of Academic Primary Care.</span></em></p><p class="fine-print"><em><span>Katelyn Barnes is an Executive Committee member of the Australasian Association of Academic Primary Care.</span></em></p>Medical receptionists have taken on new roles during the pandemic, which no-one planned for. We must not forget them and the stressful work they do.Lauren Ball, Associate Professor/ Principal Research Fellow, Griffith UniversityDavid Chua, Primary heath care research fellow, Griffith UniversityKatelyn Barnes, Postdoctoral Research Fellow, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1603572021-05-16T19:55:36Z2021-05-16T19:55:36ZI’m over 50 and can now get my COVID vaccine. Can I talk to the GP first? Do I need a painkiller? What else do I need to know?<figure><img src="https://images.theconversation.com/files/400439/original/file-20210513-15-1d1vv8f.jpg?ixlib=rb-1.1.0&rect=1%2C4%2C997%2C661&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-smiling-young-caucasian-woman-nurse-1769848013">from www.shutterstock.com</a></span></figcaption></figure><p>People aged 50 and over <a href="https://www.health.gov.au/initiatives-and-programs/covid-19-vaccines/getting-vaccinated-for-covid-19/when-will-i-get-a-covid-19-vaccine">are now officially eligible</a> to receive the AstraZeneca COVID-19 vaccine from selected GPs. </p>
<p>Although some practices have had permission to <a href="https://www1.racgp.org.au/newsgp/clinical/gps-with-astrazeneca-stockpile-turn-attention-to-v">provide the vaccine early</a> if they had excess stock, this marks a major step forward in Australia’s vaccination program.</p>
<p>People over 50 now have a choice of where to get vaccinated: their own GP (if taking part in the vaccination rollout), another GP practice (if their own GP is not), or respiratory clinics and mass vaccination hubs in some states.</p>
<p>Here are some practical things to think about when booking an appointment.</p>
<h2>Can I speak to the GP first?</h2>
<p>As a GP, I have been recommending patients access a vaccine from wherever is the most convenient for them. This may be from a mass vaccination hub or respiratory clinic, and not actually from a GP. However, some patients are hesitant and/or still have questions. If so, they do need to speak to a GP before they book for a vaccine. </p>
<p>The time to raise questions is not when you have turned up for your injection; most facilities allocate around 3-5 minutes for the doctor or nurse to spend with each patient. This does not allow time for prolonged discussion. </p>
<p>Instead, in the days before your vaccine, discuss concerns with your regular GP (if you have one). They know you and your medical history so are better placed to tailor advice to your individual situation. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/im-over-50-and-can-now-get-my-covid-vaccine-is-the-astrazeneca-vaccine-safe-does-it-work-what-else-do-i-need-to-know-159814">I'm over 50 and can now get my COVID vaccine. Is the AstraZeneca vaccine safe? Does it work? What else do I need to know?</a>
</strong>
</em>
</p>
<hr>
<p>If your GP is not one of the practices administering the vaccine, or if you don’t have a regular GP, you may want to book an appointment with a GP at the practice where you plan to get it, with the sole purpose of discussing your concerns.</p>
<p>Even if you book your vaccine through a GP clinic, it may not be a GP administering the vaccine. It may be a practice nurse, who is experienced at giving a range of vaccines and will have taken <a href="https://www.health.gov.au/covid-19-vaccination-training-program">the same mandatory training</a> as a GP in administering COVID-19 vaccines.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-asthma-diabetes-or-another-illness-can-i-get-my-covid-vaccine-yet-160602">I have asthma, diabetes or another illness — can I get my COVID vaccine yet?</a>
</strong>
</em>
</p>
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<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1235&fit=crop&dpr=1 600w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1235&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1235&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/396995/original/file-20210426-15-1wlylft.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><span class="source">Department of Health/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<h2>What’s the best time to have my vaccine?</h2>
<p>The best time to get vaccinated against COVID-19 is as soon as possible, once you have had all your questions answered. However, there are a few things you may need to consider.</p>
<p><strong>If you feel unwell</strong></p>
<p>If you feel very unwell on the day, especially if you have a high fever (over 38°C), you need to postpone your vaccine. This is partly because your immune system may not respond optimally to the vaccine, and partly so symptoms after the vaccine <a href="https://www.immunize.org/askexperts/contraindications-precautions.asp">aren’t confused with symptoms</a> from an underlying illness.</p>
<p><strong>If you want the flu vaccine too</strong></p>
<p>It’s best to leave <a href="https://www.health.gov.au/resources/publications/covid-19-vaccination-atagi-advice-on-influenza-and-covid-19-vaccines">at least 14 days</a> between your influenza and COVID-19 vaccines. It’s likely safe to have them both together, however this is <a href="https://www.uhbw.nhs.uk/assets/1/comflucov_faqs.pdf">still being tested</a>. Also, if you happen to get a reaction to one of them, you will know which one you have reacted to.</p>
<p><strong>If it’s time for your mammogram</strong></p>
<p>As the vaccine can cause a temporary swelling of the lymph nodes in the armpit, women are <a href="https://theconversation.com/covid-vaccine-may-lead-to-a-harmless-lump-in-your-armpit-so-women-advised-to-delay-mammograms-for-6-weeks-159529">advised</a> to either have a mammogram first, or delay it until six weeks after vaccination. This advice is particularly relevant as we start to vaccinate women 50 and over, the key target group for Australia’s <a href="https://www.health.gov.au/initiatives-and-programs/breastscreen-australia-program">breast cancer screening</a> program.</p>
<p><strong>If you can, book before a scheduled day off</strong></p>
<p>About <a href="https://www.ausvaxsafety.org.au/safety-data/covid-19-vaccines">20% of people report missing work</a>, study or routine duties for a short period after their first AstraZeneca vaccine. So have your vaccine the day before a scheduled day off work if possible.</p>
<h2>Should I take a painkiller directly before or after my vaccine?</h2>
<p>Unless you take common painkillers such as paracetamol, ibuprofen or aspirin to regularly to treat an underlying illness, do not take medications that control pain and/or fevers before your vaccine. </p>
<p>You may use them after the shot but only if you need to treat symptoms that are worrying you. Overall it is best to avoid taking them at all as they may curb your immune response.</p>
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<a href="https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person taking painkillers with glass of water" src="https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400448/original/file-20210513-15-78opp5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Taking common over-the-counter painkillers can curb your immune response.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-girl-holding-pill-glass-water-718784776">from www.shutterstock.com</a></span>
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<p>Both paracetamol and ibuprofen can <a href="https://journals.lww.com/ebp/Citation/2021/03000/Does_premedication_with_ibuprofen_affect_the.19.aspx">reduce the immune response to other vaccines</a>, particularly in children, although we’re not certain how much this affects their overall immunity to that disease.</p>
<p>One <a href="http://s0.uploads.ru/IHedb.pdf">study</a> showed taking aspirin, paracetamol or ibuprofen resulted in suppression of part of our immune response to viruses. And another study, this time in <a href="https://jvi.asm.org/content/95/7/e00014-21">mice</a>, revealed anti-inflammatory medications can impair production of some immune molecules after COVID-19 infection. </p>
<p>While none of this is strong evidence against taking these medications around a COVID-19 vaccine, the take-home message is not to take them if you don’t need to.</p>
<h2>What about exercise before and after the vaccine?</h2>
<p>Being physically fit can help you <a href="https://bjsm.bmj.com/content/45/12/987">fight off upper respiratory tract infections</a>. However does that translate to exercise also helping your immune response to vaccines? In other words, if you exercise before or after a vaccination will it work better? </p>
<p>There is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159113005023?via%3Dihub">evidence</a> exercise can help improve the response to some vaccines, particularly the <a href="https://www.sciencedirect.com/science/article/abs/pii/S0889159119306518">influenza</a> ones, but this does <a href="https://cmr.asm.org/content/32/2/e00084-18">not apply to all vaccines</a>. </p>
<p>While the jury is still out on whether your COVID-19 vaccine will work better if you exercise around the time of having it, here is my suggestion: don’t exercise more than you usually do in the days before or after your shot. </p>
<p>Muscle pain and fatigue are two of the commonest side-effects from the COVID-19 vaccine, and are also normal responses to increasing your exercise. Avoid complicating the picture by maintaining your usual fitness regimen, and give yourself some leeway in the days after the vaccination where you may be feeling the side-effects from it.</p>
<p>The US Centers for Disease Control <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/expect/after.html">recommends</a> using or exercising your arm after the shot to help reduce pain and discomfort (although not to help the vaccine work better).</p>
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<p><em>Use the government’s <a href="https://www.health.gov.au/resources/apps-and-tools/covid-19-vaccine-eligibility-checker">vaccine eligibility checker</a> to see if you’re next in line for the COVID-19 vaccine, and where you can get vaccinated.</em></p><img src="https://counter.theconversation.com/content/160357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Natasha Yates is affiliated with RACGP. </span></em></p>Australians over 50 can get their AstraZeneca vaccine from a GP clinic from today. Here’s what you need to know when you book yourself in.Natasha Yates, Assistant Professor, General Practice, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.