GPs are treating mental health issues more than any other condition, according to a new report released this week.
A survey of 1500 frontline GPs by the Royal Australian College of General Practitioners found that two in three were reporting psychological problems as one of the most common ailments they now treated.
As a result, GPs are struggling to keep up — many forced to cram often complex cases into six-minute consultations, charge their patients for more time, or wear the out-of-pocket cost.
With aged care now in the spotlight, GPs are also signalling that providing adequate care in nursing homes is becoming a major problem.
Dr Harry Nespolon, president-elect of the Royal Australian College of General Practitioners, told Radio National Breakfast that doctors are seeing people with a broad range of mental health concerns.
“It’s everything from people having problems in their lives, to the people who have significant complex mental health issues,” he said.
Dr Nespolon said the shift from institutional to community-based care for mental health patients led to a broader base of people utilising GP services.
“There is also a larger group of people who are now much more comfortable with going to see their GPs about their mental health issues,” he said.
In the survey, 62 per cent of doctors said the top reason for a patient’s visit was a psychological complaint.
And half said mental health was the issue causing them most concern for the future, followed closely by obesity.
“There wouldn’t be a day that goes by where I wouldn’t see a large numbers of patients with psychological problems,” Dr Nespolon said.
This is very different to when Dr Nespolon started in general practice 20 years ago.
“You’d usually have to sort of do a little bit of a dance before you actually got around to the fact that patients would talk about their depression in particular,” he said.
“Nowadays with a lot of the advertising, a lot of the community promotion about patients coming out and talking about their mental problems, you will literally get patients who will sit down and say, ‘I’m depressed’.”
Six minutes doesn’t get you very far
Dr Nespolon assured RN Breakfast that GPs are well equipped to help patients with mental health problems.
“They certainly are. It is part of their training,” he said.
“General practitioners are required to continue their professional development, and part of that development can be updating their mental health skills.”
But one of the difficulties is addressing a mental health issue within an individual GP’s standard appointment.
“Some patients take a while to get around to accepting the fact that they may have a mental problem. Other patients are really quite upfront about it and that makes it a much shorter consultation,” Dr Nespolon said.
“But, having said that, it is very hard to get through a patient with a complex mental health problem in under sort of 15 to 20 minutes.”
And that presents a funding problem for the GP concerned.
The Royal Australian College of General Practitioners has been advocating for an increase in the rebates for longer consultations.
“Most patients with significant mental health problems … aren’t as well off as they could be, and a lot of GPs do it out of, for want of a better way to describe it, the goodness of their hearts,” he said.
“They take care of these patients and they cop the lack of financial reward.
“If they do bulk-bill them … they are getting much less than they would seeing simple physical problems,” he said.
Doctors bill Medicare, the commonwealth government’s universal healthcare insurance scheme, against an item number for the service provided to a patient they have bulk-billed.
Medicare sets the scheduled fee for each item.
“In theory, all mental health care should be taken care of in 20 minutes,” Dr Nespolon said.
“So, the infamous six-minute consultation gets you a particular level of rebate, but the longer mental health consultation certainly doesn’t work proportionately to that level.”
Dr Nespolon said there needs to be recognition in the Medicare rebate schedule that dealing with mental health issues takes time.
And added to that, patients often come in with associated health problems.
“Often, they’ve got a number of physical problems that go with that mental health problem, and the more significant your mental health problem is, the more likely you are to have some significant physical problems as well.”
‘The GP has taken care of them all their lives’
Fourteen per cent of the doctors surveyed listed aged care and the ageing population among the issues they are most concerned about.
Dr Nespolon said GPs are concerned about the falling level of support in aged care over the years, including staffing ratios.
“Patients and their family will tell you that it can be really hard to get these hard-working nurses to actually come and see them when they’re needed.
“I can tell you about my own experience. If you go to a particularly large … facility, it can be hard enough just finding the part that they’re in, let alone finding a staff member,” Dr Nespolon said.
“Often the GP is the only person that someone who has moved into institutional care sees on a regular basis.
“Their GP is the person who’s taken care of them all their lives and will take care of them in a nursing home, which hopefully is reassuring for those patients.
“If their access is blocked … that’s an issue.”