A new report from Palliative Care Australia (PCA) sets a clear pathway for the next round of reforms that support the GPs, nurses, and multidisciplinary teams working in primary care around the country.
The report, titled 'The case for improved remuneration of palliative care in primary care' shares insights from PCA's 2024 National Palliative Care Workforce Survey, which included 129 respondents working in primary care settings.
The survey results paint a worrying picture of the how the current system remunerates palliative care in primary care:
- Most primary care respondents (72%) reported that demand for palliative care had increased in the last year.
- Only 11% agreed that their practice is adequately funded to deliver palliative care.
- Just 35% reported that they had sufficient time to meet patients' palliative care needs.
- General practitioners provide palliative care "out of compassion" for minimal remuneration and often forego payment for palliative care provided at end-of-life because they feel uncomfortable about billing grieving family members.
- Many primary care professionals find palliative care rewarding and want to do more of it, but they are held back by remuneration structures that do not sufficiently recognise this work.
"These findings echo what we hear every day and align with similar findings and insights from our partners in the sector," says Camilla Rowland, Chief Executive Officer, PCA.
"Primary care has a significant role to play in meeting the growing demand for palliative as Australia's population ages.
"The conversations and care that happens at this time of life are distinctly different and more complex to other kinds of care offered in primary care settings.
"GPs and nurses need to spend more time with patients and carers talking through a range of sensitive matters including prognosis and treatment, advance care planning, and care coordination.
"And what our survey tells us is that the current system, which is structured around how GPs bill for specific Medicare item numbers, and incentivises short appointments, doesn't fully embrace palliative care."
The new PCA report and its five recommendations to government, have been supported by nine other national health peak organisations as well as PCA's member organisations – not to forget the 30,0000 signatories on the 'Better access to palliative care' petition.
All agree that a new approach is needed to better remunerate palliative care in primary care. If this does not occur, the burden of care will continue to fall on already stressed emergency departments and hospitals. This is precisely the situation we need to avoid, given the rising costs of healthcare and the strong preference of most Australians to be cared for at home.
PCA proposes five reforms to primary care funding to increase access to palliative care:
- A new practice-level payment to remunerate palliative care – covering activities undertaken by primary care multidisciplinary teams that are not currently billable to Medicare.
- Further guidance for general practice about the use of existing longer consultation items (Level C, D and E) to be more explicit about their relevance to palliative care.
- Additional funding for home visits, after-hours care (in-person and via telehealth), and shared care arrangements with specialist palliative care teams.
- Creation of an expert working group to advise the Australian Government on how to best increase palliative care activity in primary care.
- Development of a Palliative Care in Primary Care Monitoring and Evaluation Framework, to fill the gap in knowledge about palliative care provision and quality in primary care.
"It's encouraging to see those who want to form government after the election are talking about empowering primary care through a stronger Medicare," says Ms Rowland.
"A stronger Medicare lifts us all, but our health system needs to reward good palliative care if we are going to properly care for Australia's ageing population."
The recommendations contained in 'The case for improved remuneration of palliative care in primary care' have been broadly endorsed by the following organisations:
- Australia New Zealand Society of Palliative Medicine
- Australian College of Nurse Practitioners
- Australian College of Rural and Remote Medicine
- Australian Healthcare and Hospitals Alliance
- Carers Australia
- National Aboriginal and Torres Strait Islander Ageing and Aged Care Council
- National Rural Health Alliance
- Palliative Care Nurses Australia
- Palliative Care Social Work Australia
- And Palliative Care Australia's state and territory based member organisations.
The full report can be viewed and
