The State’s responsibility to primary care

The State’s responsibility to primary care

The Premier has called on the Commonwealth to protect primary care but is ignoring other levers it could pull to ensure the sustainability of general practice.

The upcoming National Cabinet meeting is expected to focus on general practice and primary care reform. Weeks ahead of this meeting, the NSW and Victorian Premiers banded together to call on the Albanese Government to increase Medicare rebates and provide greater transparency around bulk billing.

In early January, Premier Dominic Perrottet told media: “This isn’t about a fight with the Commonwealth Government on money; this is about working together to provide better health services.”

Medicare rebates have failed to keep pace with inflation for several years and the AMA has been at the forefront of calls to increase the rebate. We also support transparency on bulk billing rates.

So, while these are valuable aims, the State leaders also have an opportunity to support general practice by tackling State-based threats – and are failing to act.

AMA (NSW)’s repeated calls for the State to grant a payroll tax exemption to medical practices has, to date, fallen on deaf ears.

Meetings and letters to the Treasurer, Premier, Health Minister and Regional Health Minister, as well as discussions with the NSW Revenue Office – none of this has resulted in an exemption that would alleviate pressure on already struggling practices. 

Payroll tax is a greedy state tax that effectively punishes practices for pursuing models of care that Federal Government has been encouraging doctors to adopt. 

Over the last two decades, regulatory bodies, professional and accreditation bodies, and governments have all encouraged medical practitioners to move away from models of solo medical practice. In general practice, practitioners are rewarded for doing so in the form of incentive payments.

Practitioners conducting their medical practice from a common location is seen as beneficial for patients and for practitioners. It also ensures there is professional support available to medical practitioners, and patients benefit from the opportunity for colleagues to confer with one another, and they also benefit by being able to readily access care from another practitioner at their regular practice if their regular practitioner is on leave or otherwise unavailable.  

The Premier is contributing directly to the collapse in general practice by refusing to act on payroll tax.  

The other opportunity the State has at its disposal to support general practice is to address scope of practice. The NSW Government’s plan to expand pharmacist prescribing undermines general practice and the provision of quality care. 

We support clinician-led team-based care with the doctor at the centre and know access is important. That’s why GPs have been at the forefront of adapting to new technology. Telehealth has transformed healthcare and should continue to do so.

However, healthcare access should not come at the expense of derailing a well-established, safe and rigorous system, that separates prescribing from dispensing. 

So, whilst we appreciate the Premier telling the Federal Government what it can do to support general practice, we suggest that it behoves the State to also take some action.