And more than half believe the measure will force them to spend less time with their patients.
The statistics, drawn from a survey of more than 700 GPs, were revealed by AMA president Dr Steve Hambleton during his address to the National Press Club.
“The government’s decision will affect vulnerable patients and make access to vital GP services less affordable,” Dr Hambleton said.
“It is important for the community to appreciate the signal that these cuts sent to people with a mental illness.”
Under the unpopular measure – announced as part of the 2011–12 Budget – the current MBS rebate of $163.35 for a GP mental health plan will be reduced to $85.92 for a plan drawn up in a consultation of 20–29 minutes and $125.43 for one drawn up in consultations of more than 40 minutes.
The cuts – equating to $400 million – were part of a wider government push to rein in spending on the Better Access program.
Dr Hambleton noted it was not just GPs who were upset about the cuts, pointing to the 2000 signatures the AMA had collected on its petition against the measure.
“A lot of people are not happy with the cuts. These people are voters. Their numbers are growing,” he said.
He appealed to the government to reverse the decision and not “devalue the engine room of our health system – the GPs”.
Michael
20th Jul 2011
2:06pm
Meanwhile $222M (now approaching $500m of State and Federal funds)
goes to hire untrained chaplains in schools to intervene in the lives of
kids in crisis.20th Jul 2011
2:06pm
Shame
Babyteeth
20th Jul 2011
2:21pm
I support the Psychologists, as this is their expertise, and the
Drs are cutting in on their income. GPs can be Counsellors, but not all
of you. This vital service is not owned by GPs. The AMA always
encourages militancy, defiance and protest against the Governments, and
this is why the Governments don't deal with the AMA anymore. This
funding crisis could have been avoided if the AMA protected the GPs by
making sure items were not over-used, in the first place. (Today, Steve
Hambleton gave a very average Performance at the Press Club, and didn't
answer any of Sue Dunlevy's questions). 20th Jul 2011
2:21pm
gumboot
20th Jul 2011
3:24pm
The Federal Government simply doesn't get it, does it? What sense
is there in decreasing funding for mental health when there is such a
high burden of disease out there in the community? Surely it makes more
sense to invest in the nation's number one asset: it's people! Every
person suffering from emotional ill health is failing to achieve their
full potential... we finally got some long overdue assistance to help
rectify the situation and now it is going to be subjected to cutbacks -
less than a decade after implementation. SHAME SHAME SHAME 20th Jul 2011
3:24pm
Peter
20th Jul 2011
3:43pm
Simple solution, break the nexus between MHPs and psychologist
referrals! Allow me to refer patients for psychology services under
medicare in the same way as I do to specialists and I will have claimed
my last item 2710. The MHP process is a cumbersome waste of time and
when I manage mental health issues without psychologist help I use the
content based item numbers quite happily. Getting my distressed,
disturbed patients to waste time filling out K10s and wait while I fill
out a meaningless proforma plan to give them is absurd. Minister Roxon,
leave the rebate at its present level for the few GPs who like using the
plan format. Allowing the rest of us to refer more simply means most of
us will never touch it (MHPs) again, saving you millions. Problem
solved. 20th Jul 2011
3:43pm
CBT practitioner
20th Jul 2011
4:34pm
Agree with Peter. Having GPs who manage mental health issues
themselves while using the content based item numbers is the way to go.
Refering the patients you don't want to manage or feel haven't the
expertise to manage elsewhere but being aware that referral isn't always
the best way to go. Mental health plans take up time that is better
used managing the problem not referring on. The GP is in the best
position to manage these situations. 20th Jul 2011
4:34pm
Gila-mdc
20th Jul 2011
5:28pm
“The government’s decision will affect vulnerable patients and make
access to vital GP services less affordable.” “It is important for the
community to appreciate the signal that these cuts sent to people with a
mental illness.” This outcry is about the government's decision
affecting GPs income masquerading as patients vulnerability or
affordability. GPs mental health services have only been bulk-billed, ie
it's free to the patients. The public will only appreciate the signal
IF the cuts result in the appropriate gap fee that hit its own pocket,
not the GPs pocket. 20th Jul 2011
5:28pm
Donald Rose
20th Jul 2011
5:38pm
Babyteeth states the government doesn't deal with the AMA anymore.
Based on what? The AMA is regularly voted the most effective lobby group
in Australia and represents more doctors than any other group. As it
puts patient's interest as its priority no government would be game to
ignore it. 20th Jul 2011
5:38pm
Fedup
20th Jul 2011
6:38pm
Not that anyone cares but as of November 1st, I will cease taking
on new patients with mental health problems. It is not a financial
decision - it is about MY quality of life. I have devoted an enormous
amount of time over the last 10 years, assisting individuals, families
& carers cope with mental illness in an area where the public mental
health system is grossly inadequate. However I do not want to become
another GP suicide statistic. So tough love it is. 20th Jul 2011
6:38pm
sergie
20th Jul 2011
6:51pm
For the fee charged, since the patient knows best what his symptoms
are, let him complete the mental health plan in the waiting room -
perhaps guided by a written series of questions given to him or by a
brief preliminary explanation of what you need to know - leaving it to
him then to record his symptoms, associated morbidities, medications
that he is taking, etc, and what he is seeking from the psychologist.
THEN, without erstwhile interruption to your other consultations, bring
him back into the consulting room, peruse the plan, have him elaborate
upon what you perceive to be his major concerns, solicit from him other
details (e.g.) ideations, hallucinations, obsessions, relationship
issues and so on that he may not have included, and refer him to his or
your preferred psychologist.20th Jul 2011
6:51pm
Not an ideal compromise, perhaps, but in this kind of situation, is it terribly wrong or unfair to ask of the patient to do some of this time-consuming bureaucratically-imposed paperwork - for that is what this is - in his very own interests? In other words, to sub-contract to do the basic groundwork, and then charge the mooted reduced fee for the time spent with him?
In short, reduced payment, reduced time. But as long as the requirements of the plan are met, can any of those long-table pen-pushers seated in brain-storming search of more encumbrances upon doctors complain?
Sergie.
Wron
20th Jul 2011
7:06pm
Peter has it in a nutshell. The only reason I can see for ever
doing MHPs is to overcome the bureaucratic obstacle to referral to a
psychologist. The real drama comes when the patients march off with
their bulk-billed MHP, to discover that the can't afford the gap fee
charged by the psychologist. It's a cock-eyed system. 20th Jul 2011
7:06pm
CountryPsych
21st Jul 2011
11:54am
I would have to agree with Peter. The amount of useful information
contained within a MHP is laughable. When they sit in our waiting room
they fill in a DASS, so the K10 done in the MHP doesn't add much. 21st Jul 2011
11:54am
Much better just to get a summary of the clients presentation from the GP in a referral letter, much the same as they would supply to any other specialist.
Furthermore, clients are often leave the GP with the impression that they are going to receive more free service once they get to our offices. But it's just not possible to run a practice on $81.60 per 50 min session, so it often comes as a shock that they will be charged a gap. But I can go broke sitting at home...
grandpa
21st Jul 2011
3:21pm
Sorry folks. My patient's welfare is more important to me than the
reduced fee for completing a MHP - I may only compete one MHP per week
so my income will not alter by much. What does concern me about the
Government's changes is the reduction in consultations which a clinical
psychologist is able to perform. This also affects my patient's welfare.
21st Jul 2011
3:21pm
Noreye
21st Jul 2011
5:34pm
Assessing mental illness is the realm of the Postgraduate trained
Clinical Psychologist or Psychiatrist. Let GP's refer their patients to
Clin Psychs using the same process they use to refer their patients to
Psychiatrists. Thus, freeing up their time to do the work that GP's do
best, General Practice. I also agree with 'grandpa', a reduction in the
number of sessions for psycholgical services is detrimental to the
psychological welfare of many patients. 21st Jul 2011
5:34pm
Dino
21st Jul 2011
8:36pm
If this goes ahead, one would have little reason to partake in Mental Health Plan preparation.21st Jul 2011
8:36pm
The predictable follow on is that psychologists receive less referrals. So, really, the Government is saying it made a mistake in creating them. How tres predictable.
Roso
22nd Jul 2011
3:23pm
This is just another example of greedy GPs whose care factor is
dependent on how much the government pays them. There are bulk billing
GPs and bulk billing Psychologists that are doing a fantastic job
helping their patients to regain mental health wellness and they will
continue to do so even with the changes. Greedy GPs just dont get
it........ change is imminent, it is being driven by the failure of GPs
to adequately meet the needs of their patients! There are many health
disciplines in Primary Care and the community want to access them
without having to listen to their GPs carry on about politics during the
patient consultation that are paid for by the patients and the federal
government. Multidisciplinary primary health care practitioners are here
to stay and provide quality, evidenced based practice for the
community. 22nd Jul 2011
3:23pm
22nd Jul 2011
3:58pm
KarynPsych
22nd Jul 2011
8:08pm
For those lamenting out of pocket costs to patients, the national
review showed the average out-of-pocket fee to see a psychologist to be
$33 and over 80% bulk billed the strugglers. The Federal govt offers a
lame consolation in cutting out primary health mental health care, 50
consultations with a psychiatrist when few offer psychological
strategies, average fee is over $80 gap payment and they charge a heck
of a lot more than the psychology items to Medicare also. Good luck
asking most psychiatrists to bulk bill or spend longer than 15 or 30
minutes with a patient. These are facts that nobody seem to want to
mention when people lament the psychologists adding a small sum to their
hour consultation to cover costs. Take away open access of mental
health in people's own communities and see how many patients suffer. 22nd Jul 2011
8:08pm
inkblot
25th Jul 2011
12:36am
A client-driven campaign about the cuts to psychological services
has led to the formation of a website: www.betteraccess.net 25th Jul 2011
12:36am
Meech
26th Jul 2011
8:58am
The Better Access process has in the past been very useful in the
procurement of psychotherapeutic services to mental health patients,
especially in areas where there is a lack of availability of
Psychiatrists. I would like to emphasize that Psychiatrists practice
psychotherapy, and are not purely diagnosticians who prescribe following
a purely biological treatment pathway. Many Psychiatrists bulk-bill or
provide scheduled fees with a significantly reduced gap payment
according to patient's financial circumstances. Clinical Psychologists
are extremely available due to numbers entering private practice
following the introduction of Better Access. This availability of
psychotherapy has been invaluable to our patients, especially when there
is a lack of Psychiatrist availability. Common criticisms, however,
have been the significant gap fee that some Psychologists charge for
their services, and the lack of communication regarding psychotherapy
provided, and progress during psychotherapy. The consequence of reduced
referrals due to reductions in the MHP item will ultimately be to the
detriment of the patient, with mental health illness sufferers bearing
the brunt of this. Babyteeth is being overtly provocative in presuming
that only psychologists are capable of providing psychotherapy, and it
would be more appropriate for this person to declare their agenda as a
government mouthpiece. Clinical psychologists should be the only
psychologists that should receive referrals under the Better Access
system. GPs are the central clinicians providing all aspects of general
health care including mental health.GPs are capable of providing certain
forms of psychotherapy, but many choose not to due to the lack of cost
efficacy and the time commitment in busy practices (thus depriving other
patients of their assistance and care). Psychiatrists also provide
psychotherapy, but the lack of availability of such Psychiatrists has
meant that GPs have another alternative in clinical psychologists, when
purely psychotherapy is being considered as a treatment pathway choice. A
patient driven MHP document could be problematic in that many mental
health patients do not have insight into the nature or severity of their
symptoms and signs, or the potential interventions. This is why this is
best driven by the GP who has the skills to elicit and formulate the
same. Let us hope that the government sees the light in the folly of
their supposed cost cutting exercise. 26th Jul 2011
8:58am
