New government – what now for rheumatology?

4 minute read

What Labor promised in the lead-up to the election and developments since.

Allied health, the paediatric rheumatology inquiry and PBS changes – as the post-election smoke clears, what can rheumatologists expect from the new administration?

Where we left off

Paediatric rheumatology

Former Liberal MP Trent Zimmerman tabled an interim report into childhood rheumatic diseases about a week before the election was called and Canberra descended into mayhem.

Mr Zimmerman, who chaired the House of Representatives Standing Committee on Health Aged Care and Sport, specifically timed the release of the report “as the case for action is pressing and should not wait until the next Parliament has determined whether to complete a final and full report”.

The interim report itself found – to no great surprise – that there were not enough paediatric rheumatologists in Australia and, as a result, children were not receiving appropriate treatment.

Its big recommendation was to expand funding for training, with the aim of tripling the number of paediatric rheumatologists in the country by 2030.

It also recommended multi-disciplinary centres in major cities to support more connected allied health care for the paediatric patients.

Despite Mr Zimmerman’s sense of urgency, newly minted Minister for Health Mark Butler had not, at the time of writing, commented on the report publicly.

The Department of Health said the report was a matter for the government to work on.

Biologics prescribing

While the government was in caretaker mode, PBAC released recommendations relating to biologics prescribing which are yet to be green-lit by the health minister.

The proposed changes would reduce the administrative burden for rheumatologists prescribing biologics for adults with rheumatoid arthritis or ankylosing spondylitis by allowing patients to get their initial script via phone or online approval, with all continuing scripts on good to go with a streamline code.

The PBAC also recommended an amendment to the current authority requirements for subsequent continuing treatment for adalimumab, etanercept and infliximab originator medicines, changing it from Authority Required (Written) to Authority Required (STREAMLINED).

Patients on abatacept, baricitinib, certolizumab, golimumab, tocilizumab and tofacitinib will still require written authority for their first continuing treatment but receive subsequent continuing treatment on an Authority Required (STREAMLINED) basis.

It would be quite irregular for the incoming health minister to reject these recommendations from the PBAC; all that is left to do is wait for final approval.

Election cycle promises

Strengthening Medicare

Labor’s grand election promise for health was $750 million over three years to implement the Primary Health Care 10-Year Plan.

A major aspect of the plan is boosting multidisciplinary team-based care, with a strong focus on allied health teams.

While the details of the plan are still vague, the medium and long-term actions talk about exploring the use of primary care allied health professionals as a bridge for care transitions and implementing funding models that support team-based approaches.

The plan has reignited hope that patients with chronic conditions like rheumatoid arthritis will be able to access more Medicare-funded sessions with allied health professionals, rather than the current five per calendar year.

“If we do have properly funded longer term care with much more access to allied health, say 50 sessions not five – think fibromyalgia and chronic severe spinal pain as examples – then yes, it will be a good thing,” said Sydney rheumatologist and Rheumatology Republic editor, Dr Irwin Lim.

Rural and regional health

Both major parties pledged $146 million for rural and regional health, with most of that money going toward addressing the rural healthcare workforce shortage.

Labor also promised to reverse some of the cuts made to rural and remote telehealth, but at this point its promise will only extend to psychiatric consults.

Many of the programs which will be expanded by the additional funds, like the John Flynn Prevocational Doctor Program, work toward encouraging younger doctors to train in the bush.

There is growing evidence to show that doctors who train in regional and rural locations are more likely to work rurally later in their career.

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