Outcome 5: Primary Care > Part 1 Outcome Performance Report

Major Achievements

• Increased access to mental health care through the introduction of new Medicare Benefits Schedule items as part of the Government’s contribution to the Council of Australian Governments (COAG) Mental Health package.
• In line with the COAG agreed timeframe, provided 24 hours a day, seven days a week telephone access to health triage, information and advice, to specific jurisdictions through the implementation of a National Health Call Centre Network.
• Since commencement of the Chronic Disease Management items in July 2005, more than one million patients received a General Practitioner Management Plan and/or Team Care Arrangements from their general practitioner.
• Supported general practice through the Divisions of General Practice Program which addresses key priority areas including access to services, chronic disease management, prevention and better links between general practitioners and other parts of the health sector, including specialists, hospitals and allied health.
• Increased uptake of training places for general practice registrars in rural and urban areas. Six hundred and twelve registrars commenced training on the Australian General Practice Training Program in 2006–07.

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Challenge

• The full expenditure of funding assigned to some incentives and support programs for general practitioners to provide services in rural and remote Australia has been historically problematic. This has been due to optimistic initial utilisation estimates and a lack of community awareness concerning program benefits. Attempts to remedy this under expenditure required close monitoring to enable early judgements on program changes.

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Key Strategic Directions for 2006–07

Implementation of the Council of Australian Governments Health Services Measures

The Australian Better Health Initiative

During 2006–07, the Department worked towards implementing the COAG Australian Better Health Initiative. The initiative focuses on promoting healthy lifestyles, supporting the early detection of those at risk of chronic disease, and supporting people to adopt healthier lifestyles. Risk factors that may lead to a chronic disease include unhealthy lifestyle choices such as smoking, lack of exercise or poor nutrition; biomedical factors like high cholesterol and obesity; or family history of chronic disease.

Under the initiative, the Department introduced the 45 year old Health Check on to the Medicare Benefits Schedule. Available as of 1 November 2006, the check provides an opportunity for the general practitioner to detect chronic disease risk factors in people aged 45-49 (inclusive) and put in place early intervention strategies where appropriate. Uptake of the Medicare Benefits Schedule item has been very positive, with 88,597 services claimed in the first eight months of operation. Discussion on the Australian Better Health Initiative can also be found in the Outcome 1 and Outcome 10 chapters.
Education, Training and Support for Chronic DiseaseThe Department worked closely with key stakeholders across the primary care, tertiary and vocational education training sectors, to identify ways to integrate chronic disease self-management principles into the training and education of the existing and future primary health care workforce. The results of stakeholder consultation and analyses of current training options across the health sector will inform the development and subsequent roll-out of targeted training. Understanding of the principles of chronic disease self-management will better
equip primary care health professionals to support their patients to develop the skills and confidence they need to self-manage their condition more successfully. This will enable patients to become informed, active participants in their own health care to maintain health, and prevent or slow the progression of their disease.
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Implementation of the Council of Australian Governments Mental Health Package

The need for improved mental health services in Australia was a priority this year. The Department helped address this issue by introducing a range of new Medicare Benefits Schedule items in November 2006 that allow the community to access team-based mental health care from general practitioners, psychiatrists, psychologists and other allied mental health professionals through Medicare. The first eight months of uptake for the new Medicare items has been positive with more than 1.2 million new Medicare services claimed in the period to 30 June 2007. Discussion on this initiative can also be found in the Outcome 3 and Outcome 11 chapters.
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Establishment of a National Health Call Centre Network

Focus in 2006–07 was on leading the implementation of the National Health Call Centre Network. A COAG initiative, the network aims to provide all Australians with access to nurse-based telephone health triage, information and advice 24 hours a day, seven days a week. The network will also provide a platform for the delivery of add-on services such as mental health support, and will be able to assist in emergency situations such as major health threats and disasters.

In line with the COAG timeframe, first calls were taken by Health Direct Australia, the National Health Call Centre Network company, in July 2007. Working in collaboration with all jurisdictions, the Department developed the overarching framework for the establishment of the National Health Call Centre Network company. The company was incorporated in August 2006 and became operational in early 2007. It was responsible for ensuring the roll-out of the call centre service in July 2007 with full national coverage to be achieved by July 2011. The Commonwealth, the Australian Capital Territory, New South Wales, the Northern Territory, South Australia, Western Australia governments and the company agreed to the framework in the first half of 2007. Queensland, Victoria and Tasmania have signalled their intention to join.
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Continued Financial Incentives to General Practitioners

Bulk Billing Incentives

The Department continued to provide financial incentives to general practitioners in 2006–07 to encourage bulk billing. Incentive payments were made to those doctors who bulk billed Commonwealth concession card holders and children up to 16 years old in eligible metropolitan areas. A higher bulk billing incentive was also paid to general practitioners in eligible metropolitan areas with low bulk billing rates and a medical workforce shortage.

The continuation of the higher bulk billing incentive payment and ongoing bulk billing incentives for general practitioners in rural and remote areas and doctors in metropolitan areas contributed to continued increases in the national rate of general practitioner bulk billing. In 2006–07, 77.4 per cent of general practice services were bulk billed, compared with 75.6 per cent in 2005–06. This increase corresponds to an additional 1.9 million services in 2006–07 where patients faced no out-of-pocket costs when visiting their doctors.

Support for General Practitioner After-Hours Services

In two separate funding rounds, the Department continued to support general practitioners by approving over 130 applications for grant funding under the Round the Clock: Investing in After-Hours GP Services Program which resulted in the delivery of a range of after-hours services throughout Australia in 2006–07. Additionally, another 15 after-hours services and/or projects continue to be supported through the After Hours Primary Medical Care Program. The combination of these initiatives has resulted in increased community access to high quality, convenient after-hours services and improved continuity of care. For general practitioners, it has enhanced stability and sustainability in after-hours workloads and in-hours service delivery.

Divisions of General Practice Program

The Department continued to provide funding to the Divisions of General Practice Program to provide services and support to general practice at the local level to achieve health outcomes
for the community that would not otherwise be achieved on an individual general practice basis. All Divisions provide core programs to address access, prevention and early intervention, supporting integration and multidisciplinary care, and an increased focus on population health and the better management of chronic disease.

The program provides funding of $302.4 million from 2004–05 to 2007–08 to the Divisions network which comprises the Australian General Practice Network, eight State Based Organisations and 119 Divisions of General Practice. In January 2007, the Government announced continued funding for the program of $243 million for three years from 2008–09.

Divisions also delivered a range of Government programs which included More Allied Health Services, the Aged Care General Practice Panels Initiative, the General Practice Immunisation Incentives Scheme and a range of mental health programs.
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Encouraging Team-Based Primary Care

Through the general practitioner chronic disease management Medicare items, the Department continued to encourage team-based primary care. Patients with a General Practitioner Management Plan and Team Care Arrangements in place are eligible for Medicare benefits for up to five allied health services per calendar year when referred by their doctor. This greatly enhances access to appropriate care for patients with chronic medical conditions and complex care needs. The number of Team Care Arrangements claimed increased from 254,181 in 2005–06 to 399,052 in 2006–07. The number of Medicare allied health services claimed increased from 530,761 in 2005–06 to 930,599 in 2006–07.
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Provision of Targeted Support and Financial Incentives for the Rural General Practice Workforce

In 2006–07, the Department continued to provide targeted support and financial incentives to recruit and retain general practitioners in rural and remote communities through a range of initiatives. For example, the Department provided funding for Rural Workforce Agencies’ activities to attract, recruit and retain general practitioners. It also provided grants to help rural and remote procedural doctors maintain their skills and encouraged medical students to consider rural practice through the HECS Reimbursement Scheme. In addition, grants were paid to general practitioners who stayed long term in rural locations. Discussion on the range of incentives provided can be found in the following section of this chapter.