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Professor Lyn Littlefield OAM FAPS
Executive Director 

Primary care system set for major reforms

The Federal Health Minister, the Hon Nicola Roxon, announced in June this year that fundamental reform of the primary care system was long overdue and a new policy was needed to focus on multidisciplinary care. Minister Roxon has stressed the need for reform to primary care as critical to improvements in the overall health system. As the frontline of Australia's health care system, primary care is increasingly seen to have a key focus on keeping people well and participating in life and work, rather than just caring for people when they are ill. There is growing recognition of the crucial role that preventative health care and early intervention can play in reducing chronic illness, episodes of acute care and hospital admissions with their associated costs.

To improve health outcomes throughout the community, Australia's primary health care system must offer an effective, comprehensive and timely response to people's total health needs, through access to expert multidisciplinary health care. It is most important to provide high quality services based on the best available evidence of effectiveness and to utilise the diversity of expertise available. This approach needs to be underpinned by new models of care and funding to produce equity and increased access to health services across Australia.

The need for primary care reform

There are a number of challenges facing the health system that demand significant reform, such as the ageing of the population, the chronic disease burden, workforce shortages and rising costs. As the Australian population ages, there is an increasing number of people living for many years with chronic medical conditions such as heart disease, diabetes and arthritis. However, the health system has been designed for acute care and brief medical interventions, not ongoing chronic care and patient self-management. As the focus of the health system shifts to primary care and prevention, there will be a growing need to access health professionals other than GPs through multi-disciplinary team-based care.

Another factor driving the need for reform is the inherent inequality in access to health care for disadvantaged groups in the current primary care system. The Medicare expenditure in remote and less well off communities is far lower than that spent in more affluent metropolitan areas, despite these more disadvantaged communities often having poorer health outcomes and a higher burden of disease.

The need for reform is especially urgent in light of GP shortages across Australia. The Australian Institute of Health and Welfare report, Australia's Health 2008, indicates that between 1997 and 2005 the overall supply of primary care doctors (mostly GPs) fell by nine per cent. Minister Roxon has stated that GP shortages are currently spread across 74 per cent of Australia and affect 59 per cent of the population. This problem can be partially addressed by increasing the number of medical graduates, but clearly other solutions are required.

The Minister believes the primary care system has developed in a piecemeal way with no overarching plan and that it is time for a thorough rethink of the design of primary care. In announcing the establishment of Australia's first National Primary Health Care Strategy, Minister Roxon hinted strongly that it will result in a greater role for allied health practitioners such as psychologists. She has also confirmed that one option may be to allow patients to go directly to an allied health practitioner for Medicare-funded treatment, without having to first obtain a referral from a GP. These possible reforms have generated much media interest and strong opposition from the Australian Medical Association over the past few months.

Development of the National Primary Health Care Strategy

The challenges currently facing the health system have led to the need to reconsider the fundamental design of primary care to ensure that the needs of Australians in the 21st century are met. Minister Roxon has appointed an external Reference Group to support the Government in developing the new primary care strategy, with a brief to produce a draft report by 2009. The expert group will be chaired by Dr Tony Hobbs, the current Chair of the Australian General Practice Network. I have been invited to sit on the Reference Group and will be joined by a number of medical practitioners and GP academics, allied health practitioners, and experts in Indigenous health and health policy. The expert input of the Reference Group will be complemented by consultation with the States and Territories, health provider organisations and other health stakeholders.

Reform of the primary care system is a significant challenge, and, if the recent media reports are any indication, is likely to stir up turf wars. I am looking forward to contributing to the robust debate and working towards ensuring that the primary care system provides consumers with access to the quality health care they need and enables health professionals to be fully valued and utilised for what they have to offer. We need to have a primary care system that enables people to see the right health professional for their needs, in an appropriate place at the right time.

Package for children with autism takes effect

Late in 2007, the then Federal Government announced a $190 million package called Helping Children with Autism, which was designed to support the increasing number of children with Autism Spectrum Disorders (ASD), their parents and carers. The new Federal Government is also strongly committed to this area of need and the initiative is now underway.

The Helping Children with Autism package is being implemented across three Australian Government Departments and consists of three broad initiatives to help children with ASD or any other pervasive developmental disorder (PDD), and their families, carers and schools. 

1. The first aspect of the package is organised through the Department of Health and Ageing (DoHA) and introduced new Medicare items on 1 July 2008 for diagnosis and early intervention treatment for children with autism or any other PDD. The Medicare items allow:

  • Consultant paediatricians and psychiatrists to diagnose and develop a PDD treatment plan for children aged under 13 years;
  • Psychologists, speech pathologists and occupational therapists to provide up to four services in total per child to collaborate with the psychiatrist or paediatrician on the assessment where required;
  • Psychologists, speech pathologists and occupational therapists to provide early intervention treatment following diagnosis (for up to 20 services in total per child).

2. The second and major component of the package is organised through the Department of Families, Housing, Community Services and Indigenous Affairs (FaHCSIA) and provides funding for intensive and targeted treatment of children with ASD.

  • All children aged six and under who are diagnosed with an ASD and are not yet at school will be eligible for up to $12,000 for structured and intensive early intervention services such as one-on-one intensive activities, behavioural therapies and tailored group and individual programs;
  • Up to 40 Autism Advisors will be appointed to assist families and carers of children diagnosed with an ASD by providing specific information and referrals to the most appropriate early intervention services.
  • A national program of workshops will be delivered to assist families and carers to better support their children following diagnosis and to undertake effective early intervention activities in the home.
  • An ASD website will be established to offer information, online resources and interactive functions to support parents, carers and professionals. It will also include the locations and contact details of the advisory services and approved early intervention services.
  • Playgroups will be established for children with ASD or ASD-like symptoms and their families and carers across Australia.

3. The third arm of the Helping Children with Autism package is being implemented by the Department of Education, Employment and Workplace Relations (DEEWR) and consists of the following initiatives:

  • Professional development for up to 1,800 teachers and other school staff to support school students with ASD to achieve better educational outcomes.
  • Workshops and information sessions, including access to online workshops and information for up to 5,800 parents and carers of school students with ASD.

Apart from provision of the new Medicare items, there are numerous opportunities for psychologists to be involved in the major (FaHCSIA) component of the Helping Children with Autism package, either through providing the intensive treatment packages or acting as an Autism Advisor. Members will be provided with further information as these initiatives are implemented and more information can be obtained by calling the Helping children with autism hotline on 1800 289 177 and TTY 1800 260 402. Further information on the new Medicare items is provided below.

Autism or any other PDD Medicare items for psychologists

Eligibility to provide the new autism or any other PDD Medicare items is open to all fully registered psychologists who have a Medicare Provider Number, and the Medicare rebate for the items has been set at the same rate as the general psychology mental health items. Details of the requirements for providing the new Medicare items can be found in the table on the following page.

In order to facilitate quality service provision by psychologists delivering the new autism or any other PDD Medicare items, the APS has compiled a list of identified psychological practitioners with training and experience in the assessment and treatment of autism and PDD. The list is available to referring paediatricians, psychiatrists and other health practitioners from the APS website. Inclusion on the list of identified practitioners is voluntary and is not an eligibility requirement to provide the new autism or any other PDD Medicare items.

Registered psychologists are eligible for inclusion on the APS Autism and PDD Identified Practitioners List if they meet one of the following criteria and can provide documented evidence to support this.

  1. Postgraduate qualifications in professional psychology with a component of developmental psychology including assessment and treatment of autism or PDD; or
  2. Acquired proficiency through training and workshops on the assessment and treatment of autism and PDD, equivalent to 14 hours or two days in duration and conducted by an expert in the area; or
  3. Attendance at an APS endorsed two-day workshop on the assessment and treatment of autism and PDD. A series of workshops will be organised by the APS nationwide in the first six months of the new initiative.

Further information on how to apply for inclusion on the list of identified practitioners can be found on the Medicare pages of the APS website (www.psychology.org.au/medicare/#s3).

 

  Autism or any other PDD Medicare items  
Psychologist PDD assessment item (82000) Psychologist PDD treatment item (82015)
Referral requirements A referral must be made by a consultant psychiatrist or paediatrician from an eligible Medicare service. A referral must be made by a consultant psychiatrist or paediatrician (from an eligible Medicare service), who is managing the child under a PDD treatment plan.

Eligible children 

Children must be aged under 13 years to be eligible to receive the PDD assessment item. 

Children must be aged under 15 years (and must have been aged under 13 years at the time of receiving their PDD treatment plan) to be eligible to receive the PDD treatment item. Children must be aged under 15 years for the entire period in which they are receiving treatment.

Services to be provided 

  • Assessment to assist the referring medical practitioner with their diagnosis of the child; or
  • Assessment for the purpose of contributing to the child's pervasive developmental disorder (PDD) treatment plan, developed by the referring medical practitioner

Treatment services must be consistent with the PDD treatment plan prepared by the referring psychiatrist or paediatrician, and in keeping with commonly established PDD interventions as practised by the psychology profession and appropriate for the age and particular needs of the child being treated. 

Duration of service and number of services

The service must be of at least 50 minutes in duration.

Medicare rebates are available for up to four allied health assessment services in total per eligible child. The four services may consist of any combination of services from eligible psychologists, speech pathologists or occupational therapists.

The service must be of at least 30 minutes in duration.

Medicare rebates are available for up to 20 allied health treatment services in total per eligible child. The twenty services may consist of any combination of services from eligible psychologists, speech pathologists or occupational therapists. 

Reporting requirements 

A written report must be provided to the referring consultant psychiatrist or paediatrician by the psychologist after providing the PDD assessment service(s) to the child. 

On completion of a course of treatment (up to 10 treatment services) a written report must be provided to the referring consultant psychiatrist or paediatrician by the psychologist.  

Schedule fee and rebate

Schedule fee (session of at least 50 minutes duration) = $90.15

Rebate = $76.65

Schedule fee (session of at least 30 minutes duration) = $90.15

Rebate = $76.65

 

Full information on the Medicare items is available on the Medicare pages of the APS website: www.psychology.org.au/medicare/#s3.