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Pro-bono dentistry, Commonwealth Chief Pharmacist, proper funding for general practice and mental health, and nursing workforce planning feature in pre-budget submissions

The Health Industry

Dentistry

The Australian Dental Health Foundation (ADHF), an organisation aligned with the Australian Dental Association focused on delivering pro bono basic dental treatment to socially disadvantaged members of the community. They stressed how a relatively small investment of $226,000 over three years can help deliver over $5 million of essential dental treatment to Australian’s most vulnerable people.

ADHF Chairman David Owen has implored the Government to provide a relatively modest figure that will play a vital role in helping the ADHF meet the 25% annual growth in the demand for the Foundation’s services.

“Whilst the significant dollar value of services delivered by our volunteers speak for themselves, there are many stories that illustrate how the ADHF is making a difference to people’s lives across Australia.

“With funding from the Federal Government, we will be able to increase the reach of our programs and make a difference to the lives of even more Australians by providing essential dental care that they would not otherwise be able to access.

“By working with private dental practices across Australia who donate their time, expertise and resources, the ADHF is able to coordinate delivery of oral health outcomes to a number of disadvantaged Australians who are not currently able to access the dental care they need” Chairman Owen said.

Pharmacy

In light of a recent report entitled Medicine Safety: Take Care, published at the end of January by the Pharmaceutical Society of Australia, the organisation believes that medicine safety should be a priority in the 2019 – 2020 Federal Budget.

According to the report, 250,000 people go to hospital each year because of medicine misuse, costing the health system $1.4 billion annually. This prompts the organisation to call for innovative and cost-effective solutions to current health system challenges.

PSA National President Dr Chris Freeman said, “Every day, pharmacists are faced with situations where the health system fails to meet their patients’ needs. Pharmacists want to use their knowledge to provide more effective care.

“The public considers pharmacists approachable, knowledgeable and highly trusted. People value pharmacists’ expertise and want to see it put to full use.

“However, structural and funding barriers are holding pharmacists back from participating in key Government initiatives. As the peak national body for pharmacists, PSA has made cost-effective recommendations for removing these obstacles and maximising the safe use of medicines.”

The key points of the PSA’s pre-budget submission are:

  • Provide seed funding to embed pharmacists in residential aged care facilities to improve the Quality Use of Medicines and in particular to reduce harm caused by overuse of psychotropic medicines, opioids and antibiotics
  • Grow the extensive immunisation network in primary care to boost vaccination rates
  • Facilitate the appointment of a Commonwealth Chief Pharmacist to improve the Commonwealth Government’s coordination and responsiveness to medication issues in Australia’s complex healthcare system
  • Establish funding mechanisms to facilitate collaborative practice between Aboriginal Health Services and community pharmacies
  • Add pharmacists to the list of eligible allied health professionals that can deliver MBS services to patients with chronic diseases under the allied health chronic disease management items.

Medicine

AMA

The Australian Medical Association pointed out two key topics in their pre-budget submission for 2019 – 2020 to achieve a long-term health reform:

  • funding in general practice; and
  • keeping all important and separate sectors of the health system linked

AMA President, Dr Tony Bartone said, “You cannot concentrate on one or two parts of the system and neglect the others – they must all be properly resourced and funded to ensure a quality patient journey.

“The key to successful long-term health reform is to properly fund and invest in primary care, especially general practice.

“General practice is the beating heart of the health system, and it must be supported.”

The AMA also discussed the need for fully-funded policies designed to meet the increasing health care demands of a growing and ageing population. Also, with the finalisation of signification reviews such as Medicare Benefits Schedule (MBS) Review and the implementation of the review of the private health insurance (PH) sector, the organisation will keep an eye on which MBS Review recommendations become Government policy.

Dr Bartone continued, “It has been our view from the start that the MBS Review must not be a cost saving exercise – it needs to be a credible clinical process to produce a strong contemporary MBS.

“The private health insurance reforms – the Gold, Silver, Bronze, and Basic policies – are already being introduced. But we are yet to see how they will be accepted by the public and the health professions.

“At the same time, the Government will be navigating the implementation of vital public hospital funding negotiations with the States and Territories via the Council of Australian Governments (COAG) processes.

“The Government, led by Health Minister Greg Hunt, has shown strong commitment to the Pharmaceutical Benefits Scheme (PBS), and we expect this ongoing commitment to be reflected in the Budget.

“The Aged Care Royal Commission will have impacts across the health system, which the next Government will have to manage.”

RACGP

The Royal Australian College of General Practitioners (RACGP) share the same sentiment with the Australian Medical Association, when President of the RACGP, Dr Harry Napoleon outlined the importance of a strong healthcare system, noting that the general practice is the first port of call for all Australians.

Dr Napoleon stressed, “General practice is the most efficient and cost-effective part of our health system, and it needs appropriate investment in order to ensure the health of all Australians.

“As medical professionals we are constantly adapting to the changing needs of our patients, particularly as Australia’s population ages. The Australian Government absolutely must demonstrate the same commitment to the health of our nation, and appropriately funding general practice is the most important first step.”

The four key areas of focus in the RACGP submission are;

  • Reducing patient out-of-pocket costs and supporting GP services, by ensuring patient rebates reflect increasing costs of providing care,
  • Modernising medicine, by improving the options for patients who may not be able to come into a practice including rebates for phone and video call consultations,
  • Providing more support for mental health, supporting GPs to be able to spend more time with their patients suffering from mental health conditions, and
  • Supporting high-quality care for those who need it most, by improving the Medicare rebates to properly compensate patients who require more time with their GP

ACRRM

The Australian College of Rural and Remote Medicine (ACRRM) dedicated their pre-budget submission for 2019 – 2020 to call for the implementation of the National Rural Generalist Pathway with ACRRM President Dr Ewen McPhee advocating for the immediate action to formally recognise Rural Generalism as a specialised field within General Practice.

Dr McPhee cited several reasons why recognition of the Rural Generalism is significant for the health care system. He said, “Formal recognition of Rural Generalism is the first step to removing the bureaucratic road blocks to rural patients receiving the services they need from doctors who are trained, recognised and resourced to provide them.

“Rural Generalists are trained to provide skills across a broad scope on the understanding that their patients do not have access to many specialised services including emergency care, obstetrics and mental health.

“In recognising Rural Generalism as a specialised field we will enable these rural doctors to receive the full scope of training and recognition they need to best serve rural and remote communities and enable the regulatory systems to recognise, support and resource their practice across their full skill set.

“We will also recognise the vital role these doctors play in upholding the health, economic and social welfare of rural and remote communities throughout Australia.

Nursing

The Australian Nursing and Midwifery Association’s pre-budget submission for 2019 – 2020 outlines the budget needs of each sector in the nursing industry, highlighting that through good, well-funded Government policy, the nurses’, midwives’, and carers’ contribution in caring for Australians could be dramatically increased. Below are some of the main points the organisation pointed out in each category.

Nursing and Midwifery Workforce

  • Undertake workforce planning to ensure we can supply sufficient numbers of nurses and midwives to meet Australia’s future demand;
  • Undertake timely, accurate trend analysis of nursing and midwifery student numbers on enrolment, completion and employment rates to enable informed decision making
  • Increase employment opportunities for newly graduated and early career nurses and midwives by providing dedicated funding and resources to implement appropriate graduate transition to practice programs within the public health system, as well as in other areas of employment such as private hospitals, aged care, general practice and rural health services

Aged Care

  • Introduce legislative change that ensures mandatory minimum staffing levels and hours of care for all residents
  • Commit to full implementation of the required staffing and skill mix model for residential aged care by 2025 (in accordance with the ANMF’s implementation plan Aged Care Ratios
  • Provide better funding support and incentives for specialist health professional services to be delivered on-site at residential aged care facilities, including incentives for GPs to attend those facilities
  • Fund further home care packages, in particular level 3 and 4 packages, to significantly reduce the waiting list, while ensuring the allocation of available home care packages are appropriately triaged through clinical assessment by suitably qualified clinical professionals

Public and Private Health Sectors

  • Increase flexibility in the funding arrangements for public hospitals, the Pharmaceutical Benefits Scheme (PBS), the MBS and aged care so that regional health services are able to ‘pool’ some of these resources to meet the needs of their communities. For example, remote areas which are unable to recruit doctors could use the notional population share of the MBS to fund NP services for their communities.
  • To establish an independent Health Performance Commission to be a specialist health data analytics and performance reporting body for both private and public health sectors

Preventive Health/Primary Health Care

  • Re-establish a national dedicated preventive health body
  • Increase incentives to encourage changes in both health provider behaviour and individual behaviour, which will lead to better health outcomes
  • Establish primary care systems that encourage people to enrol in wellness maintenance programs as is now occurring widely throughout the world. This approach encourages people to take responsibility for their own health with assistance from a range of health professionals without using a ‘stick’ or other punitive measures
  • Ensure that primary health networks focus on disease prevention, health promotion, equity and social determinants of health

General Practice and Primary Care

  • Review the eligibility rules for the Practice Nurse Incentive Payment (PNIP) and the Workforce Incentive Program (WIP);
  • Remove the remaining six nurse MBS items numbers (10983, 10984, 10986, 10987, 10997,16400) and increase the PNIP/WIP payment accordingly;
  • Uncouple the PNIP/WIP funding for nurses and midwives employed in general practice from general practitioners; and
  • Fund the development of national terms and conditions for the employment of registered and enrolled nurses in general practice. As the professional and industrial organization representing almost 275,000 Australian nurses, midwives and carers, the ANMF is best placed to conduct this activity

Mental Health

  • Develop a clearly articulated policy framework that underpins health service provision, ensuring that the experience of mental health does not lead to and entrap individuals within homelessness
  • Provide adequately funded community-based mental health nursing services that can deliver a timely, flexible, tailored response and that seeks to address the current gap, in accessing after hours mental health care
  • Provide for more community based mental health in-reach nursing services to support residents within supported residential services (privately run supported housing), where they exist.

Rural Health

  • Fund designated salaried positions for nurse practitioners in small rural and remote communities
  • Provide scholarships for registered nurses in rural and remote locations to undertake postgraduate midwifery education
  • Remove the restriction on rural and remote scholarship applicants by allowing access for those employed by state/territory governments

Aboriginal and Torres Strait Islander Health

  • Provide increased ongoing funding to CATSINaM to provide leadership for nursing and midwifery organisations to work towards health equality for Aboriginal and Torres Strait Islander peoples and to continue to support and grow the Aboriginal and Torres Strait Islander nursing and midwifery workforce
  • Establish a caucus of Aboriginal and Torres Strait Islander health organisations and representatives to provide regular and ongoing consultation on policies and activities that affect Aboriginal and Torres Strait Islander health and wellbeing
  • Support the increase of the Aboriginal and Torres Strait Islander nursing and midwifery workforce to 5% of the total Australian nursing, midwifery, and assistant in nursing workforce across health and aged care

Climate Change and Health

  • Develop and implement a standalone, National Plan on Climate, Health and Well-being based on the Framework developed by the Climate and Health Alliance (CAHA)
  • Invest in a sustainable health workforce to prepare the health sector to deal with existing and future health effects of climate change including increased government funding for climate resilient health systems and climate change mitigation research
  • Fund programs and initiatives that support those most adversely impacted by climate change including people living in drought and natural disaster affected regions in Australia and neighbouring regions in the South Pacific

Tax Justice

  • Reform tax concessions – limit access to growing tax concessions such as superannuation, which bring most benefit to those with high incomes, could provide additional funding for essential public services
  • Require all entities receiving $10 million in annual government payments to file full and complete financial statements with ASIC (or ACNC for non-profits), with no exemptions.
  • Eliminate reduced disclosure or special purpose filing options on annual financial statements filed with ASIC for subsidiaries of multinationals with over $500 million in annual revenues and any company with over $10 million in annual government payments
  • Establish a public register of beneficial ownership of all companies and trusts

Optometry

Optometry Australia CEO Lyn Brodie has said that “regular access to quality optometric care is essential to reduce the significant social and economic cost of preventable blindness and vision loss.”

Recommendations in the Optometry Australia pre-budget submission are:

The reinstatement of biennial Medicare rebates for comprehensive examinations for Australians aged between 45 and 64 years (it is currently every 3 years) at a cost of $9 million in 2019-2020

Expansion of the Visiting Optometrists Scheme in rural and remote locations at a cost of $1.06 million in 2019-2020

$1.5 million in 2019-2020 to support applied research on integrating sustainable optometric eye care into primary care and collaborations with tertiary eye care services

Psychiatry

The Royal Australian and New Zealand College of Psychiatrists published their 2019 – 2020 Pre-Budget submission stating a complete support for mental health resources citing that only 7.7% of government health expenditure is dedicated to mental health-related services despite mental illnesses ranking third highest behind cardiovascular disease.

“The RANZCP advocates that a proportional increase in mental health spending, including targeted investment in several key areas, is required. We believe that directing funds towards mental health care should be understood as an investment with the potential to generate high returns and that improving the mental health of the community is likely to have flow-on effects for the broader economy including increasing workforce participation and decreasing pressure in the health, social services and justice systems.”

The RANZCP recommends prioritisation of funding initiatives in 2019 – 2020 under the following seven key areas:

  • Rural access and the psychiatric workforce
    • Increasing funding for the training of psychiatrists including in rural areas by $500,000
  • Substance use and addiction
    • Revenue from alcohol taxation to go towards preventative health activities and alcohol and other drug treatment services
  • Aboriginal and Torres Strait Islander mental health
    • Funding to be needs based and at least 2.4 times that of the general population
  • Mental health needs of older people
    • Establishment of an Aged Care Information Strategy Standing Committee at a cost of $1,000,000 over 3 years
    • Expanding the number of Specialist Dementia Care Unit beds to 500 from 371 at a cost of $25,000,000 annually
  • Disability support and the NDIS
    • Ensure Primary Health Networks are investigating service gaps so people obtain suitable mental health care
  • Mother and baby mental health
    • Introduce models of care for management of severe mental illness in the antenatal and after birth periods
    • Improve data collection for perinatal mental health assessment at a cost of $120,000 per year for 3 years
    • Introduce public mental health mother and baby units in all Australian states and territories at a cost of $90,000 over 3 years
  • Suicide prevention
    • Allocation of funding for suicide prevention initiatives for specific population groups such as males aged between 15 and 34 and Aboriginal and Torres Strait Islander people in rural and remote locations