MyMedicare Expands From Registration to Primary Care Reform

Australia has taken an important first step in primary care reform through MyMedicare. By formally connecting patients with a preferred general practice, the nation has begun to recognise something fundamental: primary care is not simply a series of disconnected consultations. It is an ongoing relationship. If we get this right, MyMedicare could become much more than a registration scheme. It could become the platform for the transformation for which we have advocated for years.

For years, Australian primary care has largely operated around a simple transaction: a patient sees a clinician, a consultation is provided, and an MBS item is claimed. That model has served us reasonably well for episodic care, but it is increasingly poorly matched to the needs of an ageing population living with chronic disease, multimorbidity and increasingly complex health and social needs. The question our system should increasingly ask is not simply, “what consultation can we fund?” It should be: “What does this patient or population need, and what is the most appropriate way for the primary-care team to provide it?”

That is a profound change in perspective. It shifts the focus from activity to need; from individual consultations to continuity; and from the GP as the default provider of every service to the primary-care team working to the top of its collective capability. The Australian Primary Care Nurses Association has been advocating for a funding system that follows patient need rather than professional ownership. A system that rewards prevention, continuity, coordination and outcomes, and gives practices and communities the flexibility to build multidisciplinary teams in which nurses can work to their full scope.

MyMedicare has the potential to provide the infrastructure for that transformation. By identifying a practice’s registered population, we can begin to understand who patients are, what they need and where gaps in care exist. But there is a danger. MyMedicare risks becoming patient registration layered on top of essentially the same GP-centric fee-for-service system. If registration simply enables a small number of additional payments while the overwhelming majority of primary-care funding continues to reward individual consultations, we have changed the administrative architecture without changing the underlying incentives. That would be a missed opportunity.

Imagine instead a primary care system in which funding reflected the needs of the population registered with a practice. A proportion could continue to reward clinical activity. But additional funding could support complexity, prevention, care coordination, population health, quality improvement and outcomes. And critically, the funding should enable practices to deploy the right clinician for the right need. APNA calls for funding arrangements that support nurse-led and nurse-enabled models of care – including chronic disease management, preventive care, health assessments, care coordination, outreach and nurse clinics. Current fee-for-service arrangements can make highly valuable nursing activity financially difficult to sustain because much of the work involves continuity, coordination, education and prevention rather than a billable episodic consultation. APNA has highlighted real-world examples where innovative nurse-led services are delivering good care but struggle because existing funding does not adequately recognise nursing coordination and complexity. We know that removing regulatory barriers is only half the job. There is little point enabling nurses to work to their full scope if the payment system still makes it financially unattractive for organisations to use them that way.

Australia has invested enormously in highly skilled health professionals, yet our funding architecture can prevent us from fully using that capability. We cannot simultaneously say that we have a workforce shortage and continue to design a system around the assumption that one profession must be the gateway to most primary care activity. A genuinely multidisciplinary funding model would allow clinical decisions about who provides care to be driven by patient need, professional capability and safety – not by which professional has the easiest access to a funding mechanism. This matters particularly as Australia faces growing demand for primary care and a constrained GP workforce. We will not solve the workforce challenge simply by training more people. We also need to redesign the system so that every appropriately qualified clinician can contribute fully to the care they are educated, registered and authorised to provide. That is the promise of MyMedicare – but it is not yet the destination. The next phase of reform should ask three fundamental questions: What does that population need? What is the best combination of professionals and services to meet those needs? Then we need a funding model that makes the answer possible.

Denise Lyons is president of the Australian Primary Care Nurses Association, a generalist primary care nurse practitioner, and a clinical editor.