GPs warn of a ‘two-tiered NDIS’ leaving participants behind

Key points:

• Approximately 41 percent of NDIS participants are aged 14 years and under

• ‘Remote’ communities are categorised by the Modified Monash Model, 2019, which classifies locations into seven categories from major cities to very remote

• People living in outer regional and remote areas are 24 percent more likely not to receive help due to no service being available than those living in major cities

The Royal Australian College of General Practitioners has renewed calls for greater National Disability Insurance Scheme support in rural Australian communities following the inquiry into participants’ experience in regional and remote Australia.

The Joint Standing Committee on the NDIS received a submission from the RACGP that stated consumers living in rural and remote areas face complex and unique health challenges that are entrenched in historic disadvantage and isolation.

RACGP President Dr Nicole Higgins said that no communities should be left behind, as healthcare policy has, historically, not considered the complexity of these demographics.

“No person with a disability, irrespective of where they live, should miss out on the care and support they need,” she said.

“The NDIS is a game changer full of opportunities, but people with a disability in the bush are being left behind. We have the solutions to significantly improve the NDIS outside of major cities.

“The Medicare rebate system makes our job helping patients looking to access the NDIS near impossible and that must change.

A GP’s time is sorely limited and we aren’t remunerated for the time spent writing lengthy reports to support NDIS applications when patients aren’t present.

“This is particularly challenging outside of our cities, as rural GPs work within a varied scope due to limited local health services and play such a versatile role meeting the diverse needs of their community. So, for them, there is an even higher administrative and financial burden — also, Medicare doesn’t adequately recognise the work we do coordinating multidisciplinary care teams and we’re not supported to liaise with NDIS service providers.

The submission recommended that the government should:

• bolster the rural and remote healthcare workforce, including the GP workforce;
• end changes to payroll tax, to ensure that rural and remote practices can continue servicing rural and remote communities;
• support innovations in rural general practice, including flexible pathways for additional training, such as rural generalist pathways;
• commit funding to support additional college-led training programs to create rural-specific training and continuous professional development courses for GPs managing disability and NDIS pathways;
• review the recruitment process of the NDIS workforce and implement mandatory minimum checks and training requirements for working with vulnerable cohorts. 

“So, the government must reform Medicare or explore alternative solutions to help GPs help patients on the NDIS, something that is especially important in the bush. This includes providing adequate remuneration for GPs so that we’re paid for time spent preparing reports and other paperwork. We also recommend expanding the list of disability-related health supports funded by the NDIS to include some general practice supports not covered by Medicare.

“The entire rural and remote health system must be operating efficiently to get patients proper NDIS care and support. Right now, that just isn’t happening,” she added.

“Patients in the bush tell me about long wait times and having to travel gruelling distances, at their own expense, to access specialist care and other services. Inferior telecommunications infrastructure is holding back the potential of telehealth consults.

“There also just aren’t enough workers or available services, with one rural GP telling me about patients stuck on waitlists for two years just to seek appropriate evidence to submit their NDIS paperwork.

“Imagine the toll this is taking on patients just trying to get the right kind of support to make their lives that much easier.”

RACGP Vice President and Rural Chair, Associate Professor Michael Clements, said the government must repair a two-tiered NDIS.

“The government must urgently plug holes in NDIS service provision in the bush,” he said.

“Right now, we have a two-tiered NDIS — one for people in major cities, another for people living everywhere else. Rural GPs tell me about concerns regarding the quality of supports in rural and remote communities due to limited resources and an often under-skilled workforce.

“This is not to criticise workers doing their best in a challenging situation, it’s a system-wide issue. These same GPs also warn about a lack of transparency in understanding what services have been provided to patients by their support teams.

“So, the government should make fixing the NDIS workforce in the bush a priority, including minimum checks and training requirements. Let’s not stop there, the government should recruit advocacy-specific workers who understand the needs of rural communities and can fight for people in these communities. We also need annual reporting to be implemented for each NDIS participant so that GPs are kept in the loop.

“Let’s also make the NDIS as inclusive as possible. GPs have spoken to me about the need for further investment in culturally informed and appropriate care for Aboriginal and Torres Strait Islander people accessing the NDIS and concerted efforts made to recruit Aboriginal and Torres Strait Islander people to become NDIS support workers.”

The RACGP Vice President said that GPs should be spending more time helping patients and less time on paperwork.

“I call on the government to give time-poor GPs a break when it comes to red tape,” he said.

“The paperwork is cumbersome and inefficiently designed, we shouldn’t have to be experts in using the right type of phrasing to obtain approvals and the NDIS forms don’t integrate with our common Clinical Information Systems. This is a waste of time and energy, particularly for busy GPs in the bush, that could be spent helping patients with a disability.”

Assoc/Prof Clements concluded that the NDIS is changing the lives of people across Australia and that he didn’t want anyone, regardless of where they live, to be left behind.

Do you think more needs to be done to extend, enhance and advance the NDIS for people in remote Australia? Let the team at Talking Disability know and subscribe to the newsletter for more information, news and industry updates.

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