Have you seen the Report from MBS Review about GP Item Numbers?

25 February 2019

Have you seen the report from the MBS taskforce about GP and primary care consultation item numbers yet? Well if not you are not alone. The report was released just before Christmas, and will be of some interest to many of us.

Just for background, the General Practice and Primary Care Consultation Committee (or GPPCCC) was established in October 2016, as part of the MBS Taskforce- the planned three year review of the complete Medicare Benefits Schedule or MBS. The MBS outlines the rules and rebates that the Federal Government pays to health providers for treating patients. The GPPCCC has 21 members including many strong advocates for primary care (including two former RACGP Presidents).

The report makes 18 recommendations. Many of these represent changes to the current MBS, similar to the reports that other MBS Taskforce Committees have made. Recommendations include deleting item numbers for health assessments less than 30 minutes, linking Medication Management Reviews to patients with chronic disease GP Management Plans (GPMPs), increasing the rebate for home visits for patients with GPMPs and also introducing a new level E consultation item number for consults over 60 mins. The Committee has also recommended a 6 minute minimum for standard GP (Level B) consultations.

A number of other recommendations are less specific and appear about improving access to primary care services – such as increasing primary access to residential aged care facilities, greater clarity in MBS about roles of registered and enrolled nurses, increasing access to care facilitation services, and providing rebates for allied health providers who participate in case conferences.

Of most interest might be the first three recommendations, which are broader recommendations about increasing the quality of general practice care and strengthening the stewardship role of GPs within the health system. These recommendations are more long term, interlinked and likely to have the greatest impact on GPs, practices and our patients. They are:

  • Move to a patient-centred primary care model supporting GP stewardship
  • Introduce a new voluntary patient enrolment fee
  • Introduce flexible access linked to voluntary patient enrolment

1. Move to a patient-centred primary care model supporting GP stewardship

In this first recommendation, the Committee has identified a number of principles for primary care. Many of these are familiar, and align with RACGP Standards and the high quality care, such as providing comprehensive, person-centred care, equitable access and providing continuing care for our patients. Also prominent is the recognition of the GP stewardship/gatekeeping role.

The Committee has recommended a number of mechanisms to encourage the stewardship role, including supporting multi-disciplinary team-based care, encouraging better preventative health care. The central mechanism is achieved by introducing voluntary patient enrolment (discussed further below.)

2. Introduce a new voluntary patient enrolment fee

A new MBS fee for enrolling patients with a GP and patient is recommended. Patients would choose a practice and nominate a GP within the practice to be their usual GP. Attached to this recommendation is an outline of additional potential mutual obligations of patients and GPs/practices which might be provided.

3. Introduce flexible access linked to voluntary patient enrolment

Linked to enrolment is the potential for additional patient services to be provided beyond current face-to-face Medicare services. These include providing some element of non face-to-face access, (such as email or telephone access) and some after-hours care, and the nominated GP being responsible for maintaining a patient’s MyHealthRecord (if not opted out).

The Report outlines this direction and does not provide advice on what fees for enrolment might be. Funding for practices to provide additional care is also not discussed but is of central importance to understand whether providing this care is cost effective.

Further in the recommendations it is suggested that health assessment and CDM item numbers will be restricted to enrolled practices for patients who enrol.

The Committee also recommends:

  • that the Government engage with consumers (potentially through focus groups) to develop a clear outline of the patient's role in enrolment,
  • there is broad consultation with consumers and health professionals on all recommendations, noting the potentially wide-ranging impact of this specific recommendation
  • if voluntary patient enrolment is not feasible, then MBS items to support the other non-face-to-face activities should be considered.

These changes look quite fundamental to the care that we provide so it is important we understand what is contained within the Report. The Report is 146 pages, and this is only part of a brief summary. What do you think? Is this the type of general practice that you want to be operating in? Does this sound like a better model of care for our patients, and for us than the current systems?

The consultation process is currently open and the PHN is also collecting feedback Please provide feedback here by Wednesday 6 March or alternatively direct to the taskforce MBSReviews@health.gov.au.

The RACGP are also gathering feedback from GPs (which I am involved with) so if you are an RACGP member you can provide feedback to advocacy@racgp.org.au.

Full list of recommendations can be found here.

Full report found here.

Dr Michael Wright
Chair, EIS Health Board