Long GP Consultations Are on the Decline

Patients needing more time to discuss chronic disease management, mental healthcare and preventive health issues with their doctors are potentially missing out, as new research shows that long GP consultations are on the decline.

The role of Medicare funding arrangements in this shift is explored in a study published in the November 2013 edition of the Australian Healthcare and Hospitals Association’s journal, The Australian Health Review. Authors Michael Taylor, Dell Horey, Charles Livingstone, Siew-Pang Chan and Hal Swerissen found that “research shows that the overall decline in longer consultations is underpinned by … a decrease in average consultation provision per GP for longer appointments, and the effective abandonment of Level D (longest) consultations by GPs. Medicare reforms do not appear to be entirely effective in addressing these supply changes.”

The proportion of GPs providing ‘Level C’ consultations (longer than 20 minutes) is substantial (96%) and constant; however, the number of long consultations provided per GP decreased by 21% between 2006 and 2010. The proportion of GPs providing Level D consultations (longer than 40 minutes) decreased from 72% in 2006 to 62% in 2009, while the number of Level D consultations provided per GP decreased by 26%.

“While GPs are providing Level C consultations less frequently, most do offer some long consultations to their patients. However, those with very complex needs may be missing out, given the provision of longer Level D consultations has dropped markedly, with many GPs no longer providing these,” says AHHA Chief Executive, Alison Verhoeven.

The report authors offer several explanations for the decline in longer consultations, including the administrative burden placed on GPs and ‘audit anxiety’ related to meeting Medicare Benefit Schedule (MBS) requirements and auditing. The timing of the decline suggests some connection to increased auditing of general practitioners; for example, the May 2008 announcement of Medicare-imposed sanctions on GPs whose billing practices were deemed inappropriate but not sufficiently so to warrant referral to the Professional Services Review.

“Several reforms to the MBS were introduced in May 2010, including higher fees for longer consultations, aimed at steering service provision away from ‘6-minute medicine’. The intent was to ensure patients were better supported to manage their chronic conditions or to stay healthy,” says Alison Verhoeven.

“It appears that the May 2010 reforms and the greater reward associated with longer consultations have yet to realign Medicare with this policy objective.”

The report’s authors suggest that further investigation of GP responses to the different types of incentives and disincentives provided under Medicare is needed.

“This research would usefully inform any future redesign of Medicare to ensure its longer-term sustainability,” says Alison Verhoeven