Mental health issues are driving Australians to visit their GP more than any other health concern.

Key points: Report finds psychological issues most common problem GPs treat, second year in a row

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

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."

GPs were asked to list the three most common ailments they deal with. ( Health of the Nation 2019 )

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."

Quick explanation of rebates The Medicare Benefits Schedule (MBS) is a list of medical services for which the Australian Government provides a Medicare rebate.

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).

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.

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.

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.

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.

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.

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."