North Nowra Medical Practice GP Rod Sloane on Medicare overhaul

He was responding to news the Federal Government would overhaul Medicare and include nurses, paramedics, pharmacists and other allied health professionals in the delivery of primary care.

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Prime Minister Anthony Albanese says the system is struggling to keep up with demand. But Dr Sloane says, the Government is not addressing underlying problems.

"They're just looking to reduce costs," Dr Sloane said.

He believes the devaluation of general practice by successive governments has broken primary health care in Australia.

"They haven't kept rebates in-line with CPI, which has forced general practitioners to take reduced fees," Dr Sloane said.

"The rebate now is less than half of what most GPs are charging, and in most cases it's actually less than what the AMA [Australian Medical Association] recommends.

"There wouldn't be too many professions where you could get away with saying: 'I want you to charge 50 per cent of what you should be charging.'"

From a cost/benefit point of view, Dr Sloane believes investment into primary care will reduce costs and improve health outcomes.

"Where do you get this much bang for your buck? The answer is, not in high-tech scans during hospital admissions," he said.

"You do much better by preventing the diseases in the first place, which happens in general practice."

Dr Sloane pointed at Denmark as an example.

"They actually put more money into primary health care and they closed a whole bunch of hospitals because they didn't need them anymore," he said.

The Government is asking GPs to shoulder more of the workload and work long hours for less money, Dr Sloane says.

"It's really hard to take," he said. "And our businesses at the same time are becoming unviable."

Of the proposed changes, Dr Sloane said the Government was moving away from fee for service and toward block funding for chronic health issues.

"This has been tried around the world, and it actually can work when you get that balance right," he said.

For Dr Sloane that balance would require a genuine approach by the Government to put the money into a system that rewarded practitioners for good outcomes.

But both sides of Government have broken that trust, he says.

"They've been very clear in saying we are not going to put more money into this system, which tells me they're going to restructure the system and it will be a different balance of cost per consultation," he said.

"But at the end of the day, I'm not going to end up any better off and my business is not going to be any less on the edge."

Dr Sloane was "hesitant to be completely negative" but called on the Government to reward GPs for meeting "achievable, reasonable and relevant" outcomes.

"And negotiate in good faith with the ROCGP [Royal Australian College of General Practitioners] and the AMA [Australian Medical Association]," he said.

North Nowra Medical Practice, which has 20 working GPs, will change its system of billing.

"We have been given no choice," Dr Sloane said.

"Theoretically we are a full fee paying practice, which means that we charge a full fee without automatically bulk billing anyone. Our rate up until now has been under the AMA rate, and we bulk bill pensioners."

About 20 per cent of patients pay full fees and 70 per cent are bulk billed pensioners.

"When you're getting paid 50 per cent of what the services were, it's very hard to make ends meet," Dr Sloane said.

He's torn on the suggestion that general practice be opened to other health professionals including nurses, paramedics, pharmacists and other allied health services.

"I don't see any role for paramedics in primary health care," he said.

"General practice is a specialty. They talk about, 'and the specialties' well, we are a 'specialty'.

On the role of pharmacists in general practice, Dr Sloane said the issue was not new.

"The Pharmacy Guild has been trying to expand the role of pharmacists," he said.

"I value pharmacists very highly, and should they be part of a multi-disciplinary team? Yes. But their role should be in exactly what they're trained to do, which is dispensation of the medications."

In his opinion, upskilling pharmacists will devalue care.

"How many years did it take me to get to this point? It's a huge process with a lot of ongoing education," Dr Sloane said.

"To say a pharmacist can do 20 hours online and then they're right to do this is not viable."

He's also concerned about the conflict of interest for pharmacists moving into general practice.

"The system as it stands works for a number of reasons, one being that there's no conflict of interest in prescription and dispensation of medication," Dr Sloane said.

"If you get the same person writing scripts and dispensing them, there's a pressure and incentive for you to prescribe."

Dr Sloane is disillusioned by what he sees as a plan to push general practitioners into taking on the more complicated patients for reduced pay.

Less doctors are going into general practice due to this and people are leaving the profession, he says.

"The only result I can see coming out of this is to charge full fees to most people, which is going to worsen health outcomes and have far more people taking up the hospital emergency department," Dr Sloane said.

"What I can do in general practice I can do at a fraction of the cost that a hospital ED can do, for most things. And they're going to lose this."