SWSLHD and Bowral's Health - 51

Government "committed" to mental health cuts

• By Gemma Collins on  3 November 2011 6Minutes

Doctors have pledged to continue their fight against cuts to mental health services as the government said today it was still “committed” to its original Budget plans.  

Following the release of the long-awaited Senate report into mental health services (link) President of the RACGP Professor Claire Jackson said it had “opened the door to ongoing constructive discussion” with the government. 

But her assurance came as Minister for Mental Health Mark Butler said the government would be considering the enquiry’s recommendations but was “committed to the measures in our budget”.

“We’ll consider the recommendations of the enquiry, just like we would with any other Senate enquiry,” a spokesperson told 6minutes.  

“However, we're committed to the measures in our budget which together deliver the single largest investment in new mental health measures in Australian history.”

The report released on Tuesday recommended that the cuts to the Better Access scheme, which will see GP mental health services slashed by nearly half, be delayed until there is an “adequately equipped” alternative program for patients.

“Overall, the final Senate report leaves much open for interpretation due to its failure to provide clear recommendations,” Professor Jackson said. 

“It is the opinion of the College that a strong case has been made to justify greater reward and recognition in relation to providing mental healthcare plans – an issue the College will continue to fiercely advocate for”.

She said she would be urging the government to take on the recommendation “to revise its scheduling for the 2011-12 Federal Budget changes to ensure continuity of care”, in order “to allow for a final consensus to be formed, agreeable to the vast majority of health professionals desiring the best mental health outcomes for their patients and communities.”

SWSLHD and Bowral's Health - 50

Senate inquiry ignores GP role in mental health: AMA

2nd Nov 2011 Byron Kaye   all articles by this author

Medical Observer

THE undermining of GP involvement in mental health care through the slashing of Better Access rebates has been ignored by a key Senate inquiry examining the impact of the government’s cuts to the program, the AMA has claimed.

The claims follow the tabling late yesterday of a report from a Senate committee investigating mental health funding – the same day the controversial changes, which include substantial cuts to GP mental health rebates, took effect.

While the long-awaited report made no specific recommendation on the MBS cuts, it questioned moves to reimburse only 10 visits to psychologists under the Better Access program. Previously, up to 18 visits could be reimbursed.

AMA president Dr Steve Hambleton said the report, including dissenting reports from the Coalition and the Greens, presented a “mishmash of views” that largely overlooked the impact on GP patients of cutting MBS rebates.

“I think GPs are entitled to be disappointed,” he told MO.

“It has missed a lot of issues. I think that the department of health really didn’t assist the committee with the evidence it provided. It seems that the department has listened to the advice of bureaucrats, not doctors.”

The government’s mental health funding overhaul was however broadly attacked from both sides of the political spectrum following the release of the Senate committee report, with the Coalition saying the government had “not fully considered” the impact on patients and the Greens calling for a postponement.

The report questioned whether the alternate Access to Allied Psychological Services (ATAPS) program – which is to receive more funding and be administered through the yet-to-be-operational Medicare Locals – could be expected to service patients previously treated under Better Access straight away.

Greens senator and committee chair Rachel Siewert wrote in the report that she was “greatly troubled” that “there will almost certainly be a substantial period where Medicare Locals and GP divisions will not be fully engaged with the ATAPS program, and consequently will not be able to deliver appropriate mental health care for consumers”.

She added in a statement today that cutting the number of psychology sessions under Better Access “is likely to, in the immediate term, exacerbate existing service gaps for people with severe and persistent mental illness.”

“The current system is not ready for the government’s proposed changes. The government should revise its scheduling for the 2011–12 federal budget changes to ensure continuity of care,” she wrote.

The AMA, along with other general practice groups under the umbrella organisation United General Practice Australia, had called for a one-year moratorium on the MBS rebate cuts for GP mental health visits. Senator Siewert’s remarks did not directly address that demand – one of the key concerns that led to the inquiry in the first place.

Liberal senators also gave no recommendation on the GP rebate cuts in the dissenting report but wrote that any MBS cut “ought to have been discussed and fully canvassed with key provider groups and stakeholders before being arbitrarily inserted into the budget purely as a cost-saving measure”.

Both the Coalition and the Greens said the inquiry aired concerns about problems attracting GPs to work for youth mental health initiative headspace, which told the inquiry its staffing problems would be made worse by the rebate cuts.

Senator Siewert wrote that since headspace was getting more funding, it could “employ GPs directly, ensuring a guaranteed funding base that provides a buffer”.

In its section of the report, Labor repeated its claim that the Better Access changes would “achieve a better balance between the Medicare fee-based model provided through Better Access and the low- to no-cost services directly targeted to hard-to-reach groups through ATAPS”.

 
Tags: Mental health, MBS, Better Access, ATAPS, United General Practice Australia

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Rebate cuts jeopardise GP role in child mental health

26th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

CHILDREN’S mental health visits to GPs have risen dramatically under the Better Access program and cutting the rebates would leave the profession’s role in child mental health care in doubt, new research suggests.

An analysis of Bettering the Evaluation and Care of Health (BEACH) data by the research project’s own authors also suggests GP involvement in child psychology has become less prescription-focused under Better Access as the family doctor plays a more active ongoing role in the mental health care of young Australians.

The study, published in the latest Australian and New Zealand Journal of Psychiatry, claims to be the first dedicated snapshot on GP treatment of child mental health issues over four decades.

Better Access, which offers rebates for GP mental health plans, was introduced in 2006 but is being scaled back – with some rebates cut by almost half – to save $400 million from next week.

The BEACH paper indicates:

·     The proportion of GP mental health visits by patients younger than 15 jumped from 1.4% in 2000–01 to 2.6% in 2008–09

·     16.8% of child mental health visits to GPs claimed Better Access rebates, compared to 7% of GP mental health visits from patients of all ages in 2006–08

·     The rate of GPs prescribing medication to children in mental health visits fell from 28.8 per 1000 in 2000–01 to 18.3 in 2008–09

·     Child mental health visits to GPs for enuresis, insomnia and “behavioural problems” have fallen dramatically since 1971, while child GP visits for ADHD, anxiety, depression and autism rose.

BEACH director and report co-author Associate Professor Helena Britt said the study confirmed Better Access had led to a massive increase in children being treated by their GPs for mental health issues and predicted the rebate cuts would have an impact.

“With the decreased payments to GPs and the decreased number of [psychologist] visits being covered by the program, I’m sure there will be an effect on the extent to which GPs are involved in children’s psychological problems, as with adults,” she told MO.

Dr Emil Djakic, chair of AGPN – a member of United General Practice Australia (UGPA), which is fighting the rebate cuts – said changes to funding child mental health treatment “need to be done with some caution”.

He said the cuts would fund programs targeting children with more complex psychological problems but lamented “the fact that that’s been done, rather than by building on funding for primary healthcare, by a relative change of funding for the general practice side of the equation”.

Australian and New Zealand Journal of Psychiatry 2011; online 22 October, DOI:10.3109/00048674.2011.610743

 
Related:

Tags: Children, Mental Health, Better Access, BEACH, AGPN

SWSLHD and Bowral's Health - 44

We’ll fight cuts, GP groups vow

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer


GP LEADERS have vowed to keep fighting the “very dangerous policy” of cutting mental health rebates, after a survey found half of family doctors were dissatisfied with their efforts to stop it.

A survey of 150 GPs nationwide, carried out by Cegedim on behalf of MO, found an overwhelming 95% of respondents did not feel their views and experiences with mental health had been “adequately taken into account by government” in the  push for mental health reform.

But the survey also found the disquiet went further than government with 54% answering “no” when asked: “Are you satisfied with the efforts of the RACGP and AMA in their attempts to convince the government to cancel the cuts?”

The cuts to the Better Access scheme, designed to save about $400 million to fund other mental health services, look set to begin next week unchecked.

From 1 November, existing MBS rebates 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 a consultation of more than 40 minutes.

The tabling of a mental health Senate inquiry report,  sparked by the cuts, originally due in September and expected to provide advice on their impact, has been delayed. It is understood the report will be released this Friday – just three days before the cuts take effect.

RACGP president Dr Claire Jackson said GPs should be reassured by the quick and cohesive action of both bodies and the AGPN, under the United General Practice Australia banner,  to block the cuts.

“In my presidency it is the most critical issue the profession has faced, and the college was determined to work closely with the AMA and the AGPN,” Dr Jackson said.

“It was very much a team effort to try and bring all our strength to bear on overturning what we think will be a very dangerous policy initiative for the most vulnerable Australians,” she said.

AMA president Dr Steve Hambleton said dissatisfaction with his organisation’s representation came from its inability to prevent the cuts, but he would continue pushing the government to restore them.

The poll also found 31% of GPs would continue to bulk-bill mental health plans despite the cuts, while 39% said they would charge a gap and 13% said they would seek other options.

Tasmanian GP Dr Graeme Alexander said “general practice has been abandoned” by government at state and federal levels but dismissed the AMA and RACGP as “out of touch”.

“We certainly can’t get a political person of any flavour to show leadership and fix [the health system],” he said.
“We have no representative body.”

Tags: Mental Health; MBS; Better Access; AMA; RACGP; Steve Hambleton; Claire Jackson

Comments:

Ross
26th Oct 2011
5:48pm

As a bulk billing GP who derives a considerable part of my income from treating mental health cases my income is set to drop when the new item numbers take effect. This is in addition to rebates not keeping up with inflation. The government continue with their so called reforms to improve General Practice when in fact they are wrecking it.

 

SMS
26th Oct 2011
8:51pm

i am putting a big sign up in my waiting saying gillard and roxon big axe to mental health- so far i have alot of angry patients toward labour government- soon i will have charge a gap payment of $80 for drawing up a mental plan

27th Oct 2011
4:06pm

I very much respect Prof McGorry as a defender of youth mental health. However, in this interview, he seems to narrow the mental health budget debate to youth mental health only. That GPs work with Headspace centers would not be much help to a 32 year old with depression.
That we introduce yet more Medicare item number to differentiate between treating a 20 year old and a 25 year old is only going to give those of us at the front line of service delivery more unnecessary administration issues.
Youth mental health is important but not more important than child mental health or adult mental health. Whilst mental illnesses tend to first manifest in youth, most of the burden of disease is manifested by adults who present to their local GP practices in distress. Surely the government has to appreciate the fact that as an aging society, prevention should be focus, but so too the distribution of resources need to accommodate the current demands in mental health services.

 

Annabel
27th Oct 2011
5:26pm

Well said...Prof McGorry is terrific at championing his cause. Does it need to be at the expense of other mental health needs. Rob Peter to pay Paul. Was there no way of gaining the extra funding for Headspace and EPPIC without alienating the whole General Practice and psychologist Profession? Prof. McGorry is saying that in no other area of health care would one group be pitting itself against another for funding (I doubt this is true) and he seems to be pointing the finger at primary care providers as being the divisive faction.

 

Liz
28th Oct 2011
9:21pm

Having previously worked in Addiction and Mental Health, the Mental Health package available to GPs enabled continuing treatment of this group of patients within the GP environment. The ability to refer these patients to a psychologist also assisted their care significantly because ongoing care was often not available in the public sector. These changes to Medicare are such a retrograde step. Professor McGorry seems to think that transferring funding from GPs who mostly do a good job in supporting mental health patients of all ages, to just one group just doesn't make any sense.

SWSLHD and Bowral's Health - 40

GPs to prepare for mental health cuts

• By Gemma Collins on  21 October 2011 - 6Minutes

Many bulk-billing GP practices will have to start charging patients for Better Access services, the RACGP says.

With the final report into the Senate inquiry on mental health cuts being delayed, the College has said that the changes to the Better Access general practice mental health item numbers announced in the May budget, are likely to come into effect from November 1. 

Ina  series of likely scenarios (link) the College says it will continue to lobby the government but “practices may require revised practice systems and billings in order to continue delivering high quality patient care”.

College members have come up with a list of different practice scenarios to provide GPs with alternatives models of care for mental health services.

It has given the scenarios of a large practice in the northern suburbs of Melbourne and a small busy private practice in the western suburbs of Sydney that will both no longer be able to afford to continue bulk-billing mental health services through the Better Access program.

They will instead charge a patient co-payment for all the mental health services or refer their patient to public state-based services.

Meanwhile a medium sized private rural general practice in Queensland that employs a practice nurse with mental health skills is planning to use General Practice Management Plans (GPMP) and Team Care Arrangements (TCAs) which will involve the GP and the practice nurse who will coordinate mental health screening and assessment. 

Meanwhile a fourth scenario for a bulk-billing practice that is unable to charge a patient co-payment due to its service charter, is to use the new MBS item 2715 in combination with other appropriate MBS items.

GPs are being told to contact the RACGP Policy & Practice Support Unit for advice (advocacy@racgp.org.au)

Comments

We drew up our new fees at the beginning of October and published them at the practice for patient’s information. Mostly our Gap is $30, but the gap for <40minutes plan is higher. I only realised this week when I received a mailing from Psychologist Association the if a patient has already used 10 sessions this year, they are ineligible for any more session after November 1st.

Milton Doctor | 22 October 2011 at 20:56