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Previous Ticker Item Next Ticker Item Mental health still the number one reason people visit their GP, report finds Share * Share on Facebook * Share on Twitter * Share on WhatsApp * Print * Mail * Other share options + Reddit + Tumblr + LinkedIn + Digg + StumbleUpon + Close ABC Health & Wellbeing By health reporter Olivia Willis Close up male doctor writing in medical record. Australians access general practice more than any other area of the health system. (Getty Images: Hero Images) Share * Share on Facebook * Share on Twitter * Share on WhatsApp * Print * Mail * Other share options + Reddit + Tumblr + LinkedIn + Digg + StumbleUpon + Close Close up male doctor writing in medical record. Australians access general practice more than any other area of the health system. Getty Images: Hero Images (BUTTON) Close Mental health issues are driving Australians to visit their GP more than any other health concern. Key points Key points * Report finds psychological issues most common problem GPs treat, second year in a row * GP body says longer consultation times are needed to adequately treat complex illness * Government developing 10-year primary care plan to improve Medicare delivery But GPs say they're struggling to keep up with demand because mental healthcare is complex and often requires more time than a standard consultation allows. A survey of 1,200 GPs published today by the Royal Australian College of General Practitioners (RACGP) found two in three doctors reported "psychological issues" as the most common ailment they now treated. "If you think about where you can go if you've got a mental health issue, there are very few places," said Harry Nespolon, president of the RACGP. Dr Nespolon said the shift from institutional to community-based care for mental health patients, as well as a waning reliance on religious institutions for pastoral care, has led to more Australians using GP services for psychological support. "[GPs see] everything from relationship problems all the way through to people with severe schizophrenia," he said. "If you do come into a crisis … often a GP is a trusted person that's been taking care of you for 10 or 15 years." Bar graph displaying the most common health issues GPs reported dealing with. GPs were asked to list the three most common ailments they deal with. (Health of the Nation 2019) Share * Share on Facebook * Share on Twitter * Share on WhatsApp * Print * Mail * Other share options + Reddit + Tumblr + LinkedIn + Digg + StumbleUpon + Close Bar graph displaying the most common health issues GPs reported dealing with. GPs were asked to list the three most common ailments they deal with. Health of the Nation 2019 (BUTTON) Close But Dr Nespolon said the current Medicare structure favoured shorter consultations for straightforward health conditions, and undervalued longer consultations required for complex issues. "At the moment, there's really only one [Medicare] item number for mental health issues, which is a 20-minute consultation," he said. "In other words, you can sort out all mental health issues in 20 minutes — which we all know is not true." Without longer subsidised consultations, Dr Nespolon said many GPs were being forced to cram patients with complex needs into short appointments, charge patients for more time, or wear the out-of-pocket cost themselves. "We want to see the Government provide financial support for dealing with these complex cases," he said. The Health of the Nation report found out-of-pocket costs to see the GP were rising, and for the first time, all areas outside major cities had seen a decline in bulk billing. "This has a major effect on the 7 million Australians who live in regional, rural and remote areas," Dr Nespolon said. "The growing gap between the cost of providing care and the Medicare rebate will have a devastating impact on the sustainability and accessibility of general practice." Rebates explained Quick explanation of rebates * The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate. * Each MBS item has its own scheduled fee — this is the amount the Government considers appropriate for a particular service (e.g. getting a blood test or seeing a psychologist). * Rebates are typically paid as a percentage of the Medicare scheduled fee. In the case of GP consultations, the rebate is 100 per cent of the schedule fee. * This means that bulk-billing GPs agree to charge patients the Medicare schedule fee ($37.60 for a standard appointment) and are directly reimbursed by the Government, and there is no cost to the patient. * GPs who don't bulk bill charge a fee higher than the Medicare schedule fee, meaning patients must pay the difference between the schedule fee and the doctor's fee — out of their own pocket. * For example, if your doctor charges $75 for a standard consultation, you'll pay $75 and receive a rebate of $37.60 — leaving you $37.40 worse off. Longer consultations needed for complex care In Australia, a standard physical consultation of 20-40 minutes with a GP attracts a rebate of $73.95. That increases once the consultation exceeds 40 minutes. By comparison, any GP mental health consultation longer than 20 minutes — excluding appointments to prepare or review mental health treatment plans — attracts a rebate of $72.85. Dr Nespolon said there needs to be recognition in the Medicare rebate schedule that dealing with mental health issues and other complex health conditions takes time. "We know that people with mental health issues tend to have many more physical problems … so the GP is there dealing with all the patient's issues, not just their mental health issue," he said. "We've been pushing for 40- and 60-minute [mental health] item numbers, so people get the time, and GPs are not acting as a charity when it comes to dealing with mental health issues." In July, the Federal Government ended a freeze on the Medicare rebate for GP visits as part of a $1.1 billion primary healthcare plan. The move was designed to close the gap on rising out-of-pocket medical costs. But Dr Nespolon said even with the lifting of the Medicare freeze, rebates still failed to reflect the true cost of delivering services. "GPs are small businesses. They need to pay staff, pay their leases or mortgages, and [these] go up at much higher rates than the percentage increase that the government provides," he said. "Like any small business, you've got a choice. You either recover your costs or you go broke. And that's exactly what we're seeing happening at the moment." The growing gap between the cost of providing care and the Medicare rebate was reflected in rising out-of-pocket costs, he said. In 2018-19, the average out-of-pocket cost for a GP service was $38.46 — a gap that's risen roughly $7 in five years. Out-pocket-costs varied across Australia, with patients in the Northern Territory, ACT, remote and very remote areas experiencing significantly higher costs. How mental health plans work How mental health plans work If you're living with a diagnosable mental illness, you are entitled to receive a Medicare rebate. Bulk billing rates predicted to decline The report also found bulk billing was not as common as Medicare statistics — or the Federal Health Minister Greg Hunt — have previously suggested. "Medicare statistics indicate that 86.2 per cent of general practice services were bulk billed in 2018-19," the report states. "While this figure provides an indication of total bulk-billed services in Australia over this period, it does not represent the number of patients who are bulk billed, nor does it represent the number of patients who are bulk billed for all of their general practice care." Since patients may receive a number of services during a single visit to a GP, with some services bulk billed and others not, the proportion of people who face zero out-of-pocket costs for care is much lower than the rate of services overall. "In 2016-17, while 86 per cent of GP services were bulk billed, nationally only 66 per cent of patients had all of their GP services bulk billed." Although the number of GP services being bulk billed has increased in the last four years, the RACGP predicts bulk-billing rates will decline from 2020, as the rate of increase continues to slow. In 2019, just 18 per cent of GPs reported bulk billing all of their patients, down from 29 per cent in 2017. ABC Science YouTube teaser ABC Science on YouTube [abc-science-youtube-tile-data.png] Want more science — plus health, environment, tech and more? Subscribe to our channel. Improving mental health for GPs, too In addition to access to mental health for the general public, Dr Nespolon said the mental health of GPs also deserved close attention. "Research shows that doctors experience higher levels of mental distress than the general population. Yet four in ten GPs report that they have personally delayed seeking treatment or care in the past two years," he said. Part of this could be attributed to time constraints, he said, but also to mandatory reporting laws, which posed a "significant deterrent" to doctors seeking care. "With the exception of Western Australia, all of Australia's states and territories require doctors to report their colleagues if they believe patient safety is at risk and this includes if a colleague has sought their help as a patient," he said. "We believe that doctors should be exempt from mandatory reporting so that they feel free to discuss their health issues confidentially ... so they can continue to provide the best possible care for all Australians." Medicare 'stronger than ever', Government says In a statement to the ABC, a spokesperson for the Minister for Health said the Government had committed $1.6 billion to support doctors and specialists to strengthen primary care to deliver improved access for outcomes. "Our goal is to make primary health care more patient focused, more accessible, and better able to provide preventative health and management of chronic conditions," they said. The spokesperson said the Government would increase Medicare funding by $6 billion over the next four years, to reach $31 billion of annual funding in 2022–23. "We are working with GPs, specialists and consumers, including the RACGP, to develop a 10-year primary care plan that supports a more flexible and innovative Medicare, starting with a $448.4 million investment in a new patient enrolment model for patients over 70 years. "Medicare today is stronger and better protected than it's ever been." ABC Health and Wellbeing Newsletter Teaser Want more ABC Health and Wellbeing? Health in your inbox Get the latest health news and information from across the ABC. ____________________ (BUTTON) Sign up Related articles * article Number one reason why people see their GPs? Mental health * article What you need to know when choosing a mental health professional * article Victorian town in 'crisis mode' as doctor shortage looms * article Greg Hunt said fewer patients face costs to see a GP under the Coalition. Is he correct? Topics * Health * Mental Health * Doctors and Medical Professionals * Health Policy Top health stories 1. Tweeze vs freeze: Here's the lowdown on how to get rid of a tick 2. Bananas in Pyjamas director survives near-fatal decision to take health into his own hands 3. How can you avoid a sore back on a long car or plane trip? 4. Chinese scientist who 'gene-edited' babies jailed for three years 5. 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Additional stories Top Stories * Fires in NSW, Victoria and SA still burning out of control * Difficult day burns long into night: As it happened * NSW fires likened to 'atomic bomb', Sydney records hottest day ever * Army choppers evacuate Victorians huddled on sports ground as six remain missing * 'Our worst nightmare': Video shows luxury resort gutted by fire * Celebrity pleas spark massive bushfire donations, Pink chips in $500,000 * Government invests $20 million for four extra firefighting aircraft * Analysis: Can Morrison live down his George W Bush moment? * Heat records continue to be reset around the country * People in this fire-threatened town are putting their recycling bins out — here's why Just In * Fires in NSW, Victoria and SA still burning out of control * 'The prize of martyrdom': Qassem Soleimani and others farewelled in Baghdad * AnalysisSportMarnus Labuschagne's concentration once nearly cruelled his career * Celebrity pleas spark massive bushfire donations, Pink chips in $500,000 * 'Our worst nightmare': Video shows luxury resort gutted by fire * Heat records continue to be reset around the country * Police officer injured in 'riot' after thousands attend car meetup * Man charged with unlawfully starting fire in Tasmania during total fire ban * Indonesia tries cloud seeding as flood death toll rises to 46 * Army choppers evacuate Victorians huddled on sports ground as six remain missing Most Popular * article Difficult day burns long into night: As it happened * article Can Morrison live down his George W Bush moment? * article People in this fire-threatened town are putting their recycling bins out — here's why * article NSW fires likened to 'atomic bomb', Sydney records hottest day ever * article Plastic surgeon and pilot killed in Kangaroo Island bushfire catastrophe * article Army choppers evacuate Victorians huddled on sports ground as six remain missing * article Here's why the US killing Iranian General Qassem Soleimani is such a big deal * article 'We can't stop these fires': Emergency and evacuation warnings issued across Vic, NSW * article Canberra records its hottest temperature as fire conditions keep authorities on edge * article Government invests $20 million for four extra firefighting aircraft Analysis & Opinion * SportMarnus Labuschagne's concentration once nearly cruelled his career * Can Morrison live down his George W Bush moment? * SportAt the SCG, this was the day that didn't matter * Here's why the US killing Iranian General Qassem Soleimani is such a big deal * If Democrats lose to Trump in 2020, they may blame it on this factor * Would you be prepared to be turned into compost when you die? * We spoke to Black Saturday firefighters after 10 years and they had a simple message * Why is swearing still illegal when most of us do it? * SportThe one question every female sport presenter has been asked * 'This is not a warning, it is a threat': Trump's escalation of tensions with Iran may be a preview of 2020 Site Map Sections * ABC News * Just In * World * Business * Health * Entertainment * Sport * Analysis & Opinion * Weather * Topics * Archive * Corrections & Clarifications Local Weather * Sydney Weather * Melbourne Weather * Adelaide Weather * Brisbane Weather * Perth Weather * Hobart Weather * Darwin Weather * Canberra Weather Local News * Sydney News * Melbourne News * Adelaide News * Brisbane News * Perth News * Hobart News * Darwin News * Canberra News Media * Video * Audio * Photos Subscribe * Podcasts * Newsletters Connect * Contact Us This service may include material from Agence France-Presse (AFP), APTN, Reuters, AAP, CNN and the BBC World Service which is copyright and cannot be reproduced. 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