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Cost-effective GPs seeing more patients, treating more problems

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The nation’s GPs are treating more patients with increasingly complex health problems for a fraction of the cost of hospital based care, further undermining the Federal Government’s case for introducing a $7 co-payment.

The long-running Bettering the Evaluation and Care of Health (BEACH) study has found that 85 per cent of all Australians see their GP at least once a year, and in 2013-14 there were 35 million more GP services than a decade earlier, a 36 per cent increase.

The BEACH reports, A decade of Australian general practice activity 2004-05 – 2013-14 and Australian General Practice Activity 2013-14, showed that not only are GPs seeing people more often, but they are spending more time with them – the average GP consultation now takes almost one minute longer than a decade ago because their patients are ageing and presenting with a wider array of chronic and complex health problems. In all, GPs spend an extra 10 million clinical hours with their patients, a 43 per cent increase.

Underlining the cost effectiveness of general practice, the authors found that the same service provided by a GP for around $50 would cost between $396 and $599 if performed in a hospital emergency department.

AMA President Associate Professor Brian Owler said the findings showed that, far from taking money out of general practice, the Federal Government should be increasing its support for GPs if it wanted to save money.

“General practice keeps people healthy and out of hospital. It makes sense for the Government to invest heavily in primary care, and the most cost-effective quality primary care is provided by GPs,” A/Professor Owler said. “It is definitely not the time to be introducing disincentives  such as the Government’s proposed model of co-payments for GP, pathology, and radiology services – that would deter sick people from visiting their GP.”

The proportion of patients 65 years and older seen by GPs has surged in the past decade, from little more than a quarter to almost a third, bringing with them a multiplicity of concerns – the number of health reasons for each visit has multiplied, from less than 150 per 100 consultations in 2004-05 to 158 last financial year.

In all, there has been a 50 per cent increase in the problems managed by GPs since 2004-05, and a 36 per cent increase in consultations. Over the same period, the Medicare rebate for a standard level B consultation has risen from around $25 to $36.30, and the Government’s co-payment model would see that cut to $31.30.

Not only are GPs seeing more patients, the increase in the complexity of patient health problems has meant they are spending longer with each patient – the average consultation time has increased from barely 14 minutes in 2004-05 to 14.8 minutes last financial year. This has amounted to an extra 10 million hours of GP clinical time in the past decade.

Among the big drivers of the increase was a 40 per cent jump in the proportion of patients requiring blood tests (such as monitoring the effect of anticoagulants such as warfarin) and a 20 per cent rise in patients presenting with mental health problems. On the flip side, GPs saw proportionally fewer patients with eye, ear or neurological complaints.

According to the BEACH study, the health issues most frequently encountered by GPs were hypertension, health checks, vaccinations, colds and the flu, and in the past decade there had been significant increases in presentations for depression, diabetes, anxiety, nutritional deficiencies, bursitis and tendonitis.

Reflecting the older profile of patients, GPs are encountering more patients seeking help with managing chronic conditions.

The BEACH report found that, in 2004-05, 52 out of every 100 visits involved managing chronic conditions, and this proportion had risen to 56 per 100 by last financial year.

But, contrary to common perception, doctors are less likely than they have been to reach for the prescription pad.

GPs are managing more problems at each encounter, but they are doing so using fewer medications, the BEACH study found, though the authors said this was explained, in part, by a sharp 10 percentage point jump in the proportion of five-repeat prescriptions issued to almost 40 per cent of all prescription in 2013-14.

Adrian Rollins