SWSLHD and Bowral's Health - 52

Better Access cuts will go back into mental health: Roxon

Byron Kaye   all articles by this author

 

 Medical Observer

HEALTH Minister Nicola Roxon has given GPs a guarantee that every cent saved through the controversial cuts to the Better Access scheme will be reinvested elsewhere in mental health services.

In a robust question and answer session before more than 1000 delegates at the AGPN National Forum in Melbourne this week, Ms Roxon also all but ruled out meeting long-running GP demands that MBS rebates be indexed to match inflation.

Ms Roxon was asked by former AGPN chair Dr Tony Hobbs, one of the architects of the Medicare Locals (ML) program, about the government’s plans for the $580 million it is expected to save by slashing GP Better Access.

Dr Hobbs said there were already concerns that the cuts, since taking effect on 1 November, had led to patients being “quarantined” before being treated by their GP, and demanded a guarantee that all savings go back into the ML-run Access to Allied Psychological Services (ATAPS) program.

“I can absolutely commit that that is going into mental health,” Ms Roxon replied.

“We have a very firm commitment about how that money is going to be spent – in mental health.”

She added that it was “just not possible for us to continue to meet growing demands” without reviewing existing spending, but “money that gets saved in one area… will absolutely flow through to mental health”.

However, Ms Roxon was less amenable to calls for indexed MBS rebates and urged GPs to show what additional services they could deliver before asking for extra funding.

Noting GP pay was “still very generous” and the MBS had so far been spared the cuts other parts of the health system had faced, Ms Roxon said there was “no appetite in government” for a “big jump” in the MBS.

“Big licks of money will only ever be considered by government if you can show us what additional benefits patients will get out of it,” she said.
Byron Kaye reports from the 2011 AGPN National Forum in Melbourne.

Tags: MBS, better access, Nicola Roxon, AGPN, mental health, rebates

Comments:

 

John Miller
18th Nov 2011
3:27pm

There's some odd logic here. Ms Roxon talks of "extra funding" while GPs talk of "maintenance funding" ie, keeping pace with inflation.
It's quite interesting to compare the position of the Medical Board of Australia which recently raised its already exorbitant fees by the CPI, with that of Medicare which never raises its rebates by anything near the CPI. On this basis, given sufficient time, the annual registration fee will eventually exceed the annual income of a GP.
In reality, no logic will work on this or any other politician while BB rates remain high.

 

Sniper
18th Nov 2011
5:35pm

If I could see the sense in the government wasting so much money on outdated and bloated PBS subsidies , heading towards the billions and going into the bloated profits of Pharmacy chains then I might not feel so piqued at her intimation that we are over payed. My understanding is that both her parents are/were pharmacists. She has probably been weaned on anecdotes of "how the noble pharmacist saved the dumb Dr". She is presiding over the over spend of billions yet she quibbles and quips about a GPs worth. There is a whiff of nepotism about Roxon.

 

inkblot
18th Nov 2011
5:36pm

A lot of the funding that is bankrolled from these cuts is going into mental health services, however, these are being aimed mostly at centre-based programs for young people aged 15 to 25. But there are no plans in place for people over 25, despite that the highest rates of suicide for any age bracket is for middle aged and older men (with men aged 40-44 years having the highest suicide rate - over 26 deaths per 100,000 males).

The full impact of the cuts wont hit us yet, because by Jan 2012 people are entitled to another 10 (the count zeros out every year). By about April 2012 though, there are going to be folks who have used up all 10 sessions and still need more treatment, but Medicare will stop funding it. If people cant afford to fund their own treatment, then they will be left in the lurch for 8 months. After that, psychiatrist appointments are going to be more difficult to get as mental health consumers turn to them in droves. Psychologists like myself will still be providing services to the wealthier folks in society who can afford therapy, while those who are struggling get cut short at 10 appointments. We have to set aside the fact that it costs a lot more for Medicare to fund psychiatrist consultations and even one hospital bed day for a mental health patient is around $1500, which is incidentally the total cost of Medicare funding 18 psychologist sessions per year for an individual. But the hardest hit of all will be people in rural Australia, as the focus of the Government turns to building big mental health treatment centres in cities and large towns, which only some people will access due to the stigma and visibility of these places. As one rural mental health advocate put it, these cuts are 'ten kinds of stupid': http://betteraccess.net/images/stupid.jpg

 

Stratmatonman
18th Nov 2011
6:33pm

Hey Ms Roxon, it isn't GP Pay - it's patient rebates ! And guess what - I am now privately billing it where previously I would have bulk-billed it. The sooner you're gone the better - you've done more to devalue GPs than ANY Minister in Australian Government history - you're a disgrace.

 

SJDoc
18th Nov 2011
7:25pm

Let's face it - this is the old labour chestnut of redistributing wealth. We could not have all this money being earned by doctors, heaven forbid! Let's take it off them and give it to mental health nurses or psychologists or social workers but pray, not doctors.... those uncaring parasites that make their living off the sick. But, colleagues, it is in our hands - after all, the Medicare rebate has been cut, but, I for one, continue to charge the same fee and I am not shy about telling my patients whose fault it is that their rebates have been cut!

 

smart
18th Nov 2011
9:48pm

Obviously she is a powerful and rude actress that refuses to answer the questions directly and plays with words and makes false promises for the future.
GPs need to act and pull her down from the position that she does not deserve to have. Until GPs are a bunch of silent lambs , it goes like this and never ends.
Tomorrow this government and its health minister might pass a legislation asking the GPs to work under supervision of nurses and I am afraid that GPs might obey that because they have no unity or courage to stand and fight for their rights.
I feel really sorry that GPs do not believe in their power if they act together. Look at the nurses , they fight for what they want and get it.

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

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.