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Non-vocationally registered GPs

Background

The Government introduced vocational registration in 1989 to recognise general practice as a discipline in its own right, improve professional standards and to reward high-quality practice.

Between 1989 and 1995, medical practitioners already practising in general practice who met the eligibility criteria could apply to be grandfathered on to the Vocational Register. The grandfathering period for the Vocational Register ended in November 1996.

The introduction of the Vocational Register effectively created two classes of GPs: those who were vocationally registered (VR GPs) and had access to higher A1 Medicare rebates, and those who were not (the Non-VR GPs) and only had access to lower value A2 Medicare rebates. The A2 rebates were set initially at 93 per cent of the A1 rebates but have never been eligible for annual indexation and so are proportionally worth much less than A1 rebates over time.

Key issues for patients

The difference in rebates coupled with non-indexation means that patients who attend Non-VR GPs now receive a significantly-reduced Medicare rebate, in comparison to patients who attend VR GPs. These patients also potentially face higher out-of-pocket expenses, making access to their GP less affordable.

For example, the rebate for a 15-minute consultation for the patient of a Non-VR GP is $21, compared to that for a similar (Level B) A1 consultation of $34.90.

Key issues for the Government

The Government should act on the recommendation of the 2005 Biennial Review of the Medicare Provider Number Legislation and provide one more opportunity for doctors who meet the necessary criteria to be grandfathered on to the Vocational Register. This is particularly important given that a number of these medical practitioners, while eligible, were excluded from the Vocational Register because at the time of their application they were on maternity leave, raising a family, undertaking further training, or overseas, and missed the opportunity to apply.

Having recently increased the number of GP training places to help address shortages in the GP workforce, the Government could further enhance the immediate availability of experienced medical practitioners to the GP workforce by addressing the longstanding anomalies that exist in funding and recognition of Non-VR GPs.

AMA POSITION

Non-VR GPs should be recognised for their considerable experience in both general practice and other areas of medicine. Grandfathering these practitioners will help retain and increase their numbers in the general practice workforce and encourage them to increase their hours.

Specifically, the AMA calls for a final round of grandfathering for all of the Non-VR GPs who had access to GP Medicare rebates prior to 1 November 1996 and have predominantly been in general practice for a minimum of five years since that date.

In addition, in order to further reduce the inequity in rebates for any remaining Non-VR GPs, after this grandfathering opportunity, the A2 rebates should be increased to reflect the differential that existed when the vocational recognition structure was introduced. For those practitioners who are not eligible for grandfathering to the vocational register, A2 rebates should be increased to 93 per cent of the A1 rebates and indexed appropriately on an annual basis. This would address the inequity in these fully qualified medical practitioners receiving a rebate similar to, and in the future potentially less than, that received by lesser-trained health providers such as nurse practitioners.

Based on 2005 Department of Health and Ageing figures, there are around 2,500 Non-VR GPs, including 1,500 currently accessing A1 rebates through various incentive programs. Those already having access to A1 rebates will not represent any increase in expenditure for the Government. Of the remaining 1,000, it is estimated that fewer than 20 per cent would qualify for the final round of grandfathering, with the rest eligible for rebates at 93 per cent of A1 rates. This would represent a $22 million increase in expenditure for the Government.

Comments

Submitted by Dr James Moxham (not verified) on

This is a policy position that was greatly appreciated by Non VR GPs back in 2005. However, there are a few facts here that might require updating to 2012. Firstly, the grandfathering period required 5 years of practice as at about 1989, and allowing for some exceptions, anyone who graduated between 1989 and 1996 found it very difficult to get grandfathered. Secondly, the number of Non VRs has increased since 2005, and as of 2012 there are 4,150. Thirdly, virtually all of these GPs are now on A1 rebates, and due to various schemes lobbied for successfully by the Non VR College, most Non VRs can claim higher rebates than VR GPs. So this AMA policy position may require a review. Oh, and the Non VR issue has cost each AMA GP member a million dollars in terms of losing the RVS and the 7 tier restructure and every time the AMA lobbies publicly for higher VR rebates and conveniently excludes Non VRs, we Non VRs go and lobby for lower VR rebates. It is time to end this fight that has so far collectively cost AMA GP members twenty billion dollars. Unfortunately, this AMA policy position as it stands would result in Non VR GPs having their rebates decreased, so perhaps this policy may require updating?