“Working better for Medicare” review – how will it impact your practice?

Commentary by Martina Stanley & Monique Giron

For those of us who have been working in “GP land” for the past 10-15 years, the recent “Working better for Medicare review” doesn’t bring any real surprises. In our view it’s a classic ‘back to the future’ approach—prioritising Medicare savings over addressing the genuine need to ensure there is sufficient access to primary care in all communities – regardless of whether they are in Metropolitan, regional, rural or remote areas.

When working with GPs relocating to Australia we regularly remind GPs that the current landscape of exemptions is the best we’ve ever seen – we are mindful that it may sound like a sales pitch, but it’s the reality of our experience over the last 15 years.  Unfortunately the recommendations in this report add further weight to our view. 

Looking forward, the changes being proposed could drastically reduce the availability of GPs, especially in outer metropolitan areas where families depend on accessible healthcare. Meanwhile, inner-city areas are likely to see further decline in GP services.

Asian woman smiling - GP Salary Australia

What will the future look like?

The report outlines 26 recommendations and while it is not clear when they will be introduced, we expect them in the coming months.  For the past decade, many GP practices have relied on overseas-trained doctors, using 19AB exemptions to staff the areas that need GPs most. If the recommendations of the review are implemented, we will be faced with a very different landscape: 

  • DPA will become the primary workforce distribution tool and other exemptions will become less accessible.
  • DPA areas may shrink considerably as the recommendation is to reduce these from 85% of GP catchments, to 40-45%.
  • Areas that are MM2+ will not automatically be given DPA status and each catchment will be evaluated individually 
  • Six month locum exemptions may be restricted and in a worst case scenario each doctor could only access one exemption during their entire moratorium period. Locums would mostly be limited to working in DPA areas
  • 19AB exemptions (e.g., spousal, academic, six-month locums) will no longer follow the standard criteria previously in place. 
  • Academic exemptions are unlikely to be available in the same way as they have been in the past.  Many universities have already stopped granting these and the report has singled these out as an area of concern and abuse. 
  • Approval of all exemptions will be overseen by panels led by the Department of Health and its agencies, in our view their focus has traditionally been on cutting costs rather than increasing access to care. Based on current utilisation of 19AB exemptions, we could see a reduction of up to 4,000 GP placements annually.

Is there any good news?

After hours exemptions will probably continue to be available for GPs only while other specialities will no longer be able to utilise these.

The changes don’t appear to have been implemented yet, so there may be a window of opportunity to get new arrangements in place.  Once a provider number has been issued, we have never seen cancellations of those numbers.

How will this impact the community?

We believe that these changes could reduce the number of GP services particularly in Metropolitan and regional areas.  In our experience 95% of GPs from countries such as the UK and NZ will only move to Australia if they can live in metropolitan or at best – regional areas.  They need access to high quality education for their children, work opportunities for their partners, and easy access to an international airport.  

It is also likely that the number of student placements available in some areas – particularly greater Melbourne will reduce as the Academic exemption is changed.  

As Australians and founders of Alecto, we have always been deeply committed to ensuring that all communities, including those in outer-metropolitan, regional, rural and remote have access to high-quality primary care. 

Are you a practice owner or manager wanting to prepare for the proposed changes?

Our 19AB Changes Workshop is designed to help you prepare effectively.

Click here to learn more and secure your spot.