Primary health care is the front line of Australia’s health care system. It is often the first point of contact a person has with the health system. Effective primary health care can help avoid unnecessary hospitalisations and improve health outcomes (AMA 2017; OECD 2017).

Primary health care encompasses a range of services delivered outside the hospital that generally do not need a referral. This includes unreferred medical services, for example, general practitioner (GP) visits, dental, other health practitioner, pharmaceutical, and community and public health services (AIHW 2019c). 

Primary health care professionals include GPs, nurses, allied health professionals, pharmacists, dentists and Aboriginal and Torres Strait Islander health workers and practitioners (Department of Health 2018a).

Health professionals deliver primary health care services in various settings, including allied health practices, community health centres, general practices, and through communication technology. The emerging use of telehealth and online health information websites such as healthdirect is playing an increasing and integral role in supporting primary health care service delivery.

During the COVID-19 disease pandemic, the Australian Government expanded Medicare-subsidised telehealth services for all Australians and increased Practice Incentive Payments. The new MBS items allowed Australians to access essential primary health services from home, to limit the potential exposure of patients and health practitioners to the virus. Additional incentives to GPs and other health practitioners provided support to practices to remain open, ensure continuity of care and reduce burden on hospitals (Department of Health 2020).

What is the scale and nature of primary health care?

Primary health care services account for a large proportion of health care services in Australia. In 2018⁠–⁠19, 83% of Australians aged 15 and over reported seeing at least 1 GP in the previous 12 months, and half (49%) visited a dentist, hygienist or dental specialist (ABS 2019b).

The National Health Survey conducted in 2014⁠–⁠15 estimated that, of the 92% of Australians who consulted at least 1 health professional, 28% saw a primary health professional other than a GP such as a pharmacist (8.1%), physiotherapist (8.0%) or an optician or optometrist (6.5%) (ABS 2017a).

Measuring primary health care service use

In Australia, most GPs and a limited range of allied health services are subsidised for Medicare card holders under the Medicare Benefits Schedule (MBS). In addition, government, non-government and private organisations are involved in funding and delivering primary health care outside the Medicare arrangements. See Health expenditure and Specialist, pathology and other diagnostic services for more information.

This section examines published data from the MBS, private health insurance benefits and Aboriginal and Torres Strait Islander health services reports. While these data are comprehensive and provide useful insights, outside of these sources data on primary health services are limited. 

Primary health care services

Over the 10 years to 2018⁠–⁠19, the rate of primary health care services claimed per person has increased. Nationally there were 158 million GP attendances, or 6.3 per person, in 2018⁠–⁠19, up from 5.3 per person (113 million) in 2008⁠–⁠09 (claimed through Medicare) (ABS 2019a; Department of Health 2019a).

For some primary health care services, there was more usage than 7⁠–⁠10 years ago (not controlling for population). Nationally there were:

  • 2.8 million practice nurse attendances in 2018⁠–⁠19 (claimed through Medicare), up from 806,000 attendances in 2012⁠–⁠13 (the latest comparable period) (Department of Health 2019a)
  • 571,00 nurse practitioner attendances in 2018⁠–⁠19, up from 70,400 in 2011⁠–⁠12 (the latest comparable period) (DHS 2019)
  • 3.6 million Indigenous-specific primary health care service attendances in 2017⁠–⁠18, a 72% increase from 2008⁠–⁠09 (2.1 million) (AIHW 2019a).

Figure 1 presents an overview of the scale, trends and type of primary health care services used in Australia over the past decade.
 

The figure shows the primary health care service use by type of service for the period 2008–09 to 2018–19. Over the whole period, there was an overall increase in the number of services accessed for all services except non-referred practice nurses. In 2018–19, the number of services was 157.9 million for GPs, 2.8 million for non-referred practice nurse, 24 million for Medicare-subsidised allied health and 52 million for allied health services claimed under private health insurance. 

Allied health

Allied health professionals encompass a broad group of health practitioners, excluding doctors, nurses and dentists (AHPA 2020a). Many primary allied health services are provided in the private setting (AHPA 2020b). Figure 2 provides an overview of allied health services claimed through private health insurance over the decade to 2018–19. For public allied health services, see Allied health and dental services, see Allied health and dental services
 

The figure shows the number of select private health insurance allied health services utilised over a ten-year period between 2008–09 to 2018–19. Optical, physiotherapy and chiropractic services have been the top 3 most utilised services over the 10 years. In 2018–19 there were 12 million optical, 11.8 million physiotherapy and 9.3 million chiropractic services.

 

GP visits and experiences

Of those who saw a GP, more than 6 in 7 people (85%) reported visiting a GP multiple times a year, according to the Australian Bureau of Statistics (ABS) Patient Experience in Survey (ABS 2019b). Over one-third (38%) of people visited a GP 2 to 3 times a year and 12% reported they saw their GP 12 or more times in 2018⁠–⁠. Generally, the number of GP visits increased with age, with almost half (49%) of people aged 75 and over reporting 4 to 11 GP visits a year.

Overall, most people reported having positive experiences with GPs. In 2018⁠–⁠19, 81% of patients felt their GP always showed respect, 75% felt their GP always listened and 76% felt their GP spent enough time with them (ABS 2019b).

According to the 2016 Survey of Health Care, an estimated 1 in 4 (24%) patients aged 45 and over reported that there was a time when they felt they needed to see a GP but did not go. Of these patients, half (50%) reported that one of the reasons was that they could not get an appointment when needed (AIHW 2020). See Patient experience of health care.

Reasons for seeing a GP

GPs treat a broad range of health issues, and are often the first point of contact many people have with the health system. A report based on a survey of 1,200 GPs conducted in 2019 by the Royal Australian College of General Practitioners found that psychological issues (for example, anxiety, depression and mood disorders) are the most commonly managed health concern by GPs. Since 2017, the proportion of patients presenting with psychological issues has increased from 61% in 2017 to 65% in 2019. Other commonly managed health concerns in 2019 were musculoskeletal (for example, arthritis) (40%), respiratory (for example, asthma) (39%) and endocrine and metabolic conditions (for example, diabetes) (34%) (RACGP 2019).

The NPS MedicineInsight general practice insights report analysed data from 534 general practices (6.6% of all general practices) and more than 2.7 million patients (13% of patients who visited a GP) nationally, who had at least 1 encounter with a GP in 2017⁠–⁠18. Within the study sample there were 13.8 million clinical GP encounters—an average of 5 GP encounters per patient per year. Hypertension (15%), depression (14%) and dyslipidaemia (13%) were the most common conditions recorded among patients (at any time in the medical record) of the selected non-communicable conditions measured in this report (NPS MedicineWise 2019).

Spending

In 2017−18, primary health care accounted for over one-third (34% or $63.4 billion) of Australia’s total health expenditure. Of this expenditure, Australian Government programs (including MBS and PBS) spent $28.1 billion, non-government entities (individual, private health insurers and other private sources) spent $25.3 billion, and state and territory governments spent $10.0 billion. In comparison, hospital services accounted for nearly 40% ($74.0 billion), and referred medical services for 11% ($19.4 billion) of the total health expenditure.

Between 2007⁠–⁠08 and 2017−18, Australian Government expenditure on primary health care grew 3.3% each year in real terms—an increase of $7.8 billion over the decade (AIHW 2019c). See Health expenditure.

Patient access

Access to primary health care services helps reduce the number of avoidable hospital visits, improves population health and reduces inequality. It is important for the prevention and treatment of risk factors and conditions as well as improving health outcomes (Swerissen & Duckett 2018).

For many Australians, complex health needs, geographical, cultural and socioeconomic factors may influence their ability to access primary health care. For instance, people living in rural and remote areas tend to have poorer access to health care, due to the uneven distribution of many health professionals in Australia (Department of Health 2018b). See Rural and remote health.

Understanding primary health care

The availability of reliable high-quality data on our primary health care system is limited. In particular, there is a gap in understanding the patient journey and experiences—this includes the reasons patients attend primary health care, diagnoses and conditions treated, actions taken and their outcomes. This makes it difficult to report on primary health care with the same rigour as is applied to hospital care, and to identify and monitor areas where improvements might be needed.

The AIHW is currently working to make an enduring data asset to address gaps in primary health care data. Key issues raised at the data asset consultation workshops with consumers, clinicians, commissioners of primary health care, and researchers included improving the visibility of:

  • primary health service needs in rural and remote communities
  • the wide range of primary health care professionals operating in the primary health care sector—for example, nurse practitioners, allied health workers and dental health workers (see Primary health care data development) (AIHW 2019b).

This section examines data from the ABS Patient Experience Survey (ABS 2019b) to explore the experiences of people using primary health care. While as much detail as possible is included in this section, this provides only a partial picture of primary health care.

Access to primary health care has improved over time

Access to GPs and after hours GPs has changed over the years. Between 2013⁠–⁠14 and 2018⁠–⁠19, the proportion of people who delayed or did not seek GP care decreased from 30% to 23% and from 34% to 30% for after-hours GP care (Figure 3).
 

The figure shows the trend of people who delayed or did not seek GP or after hours GP care when needed between 2013–14 to 2018–19. Over this period, people who delayed or did not seek care decreased for those seeing GPs (from 30% to 23%) and after hours GPs (from 34% to 30%). 

Cost barriers

There were notable differences in those who reported delaying or not seeking GP care due to cost among various populations groups.

The 2018–19 Patient Experience Survey estimated that, of those who reported delaying or not seeking GP care:  

  • 3.4% of people delayed or did not see a GP due to cost, and 20% stated that cost was not a reason
  • people living in Outer regional, Remote and Very remote areas were 1.3 times as likely to report cost as a barrier to seeing a GP, compared to people living in Major cities (Figure 4).

The proportion of people reporting cost as a barrier for seeking GP care may vary by the availability of bulk-billing services.

MBS data show that:

  • in 2018–19, the bulk-billing rate for GPs outside of the hospital was 86% (136 million attendances), an increase from 80% (89 million) in 2008–09 (Department of Health 2019a)
  • in 2017–18, the rate of bulk-billed GP services was lower in regional Primary Health Network (PHN) areas (569 services per 100 people) than in metropolitan PHN areas (621 services per 100 people), after adjusting for age (AIHW 2019d)
  • in 2016–17, patients living in metropolitan PHN areas were less likely to have out-of-pocket costs (48%) than patients in regional PHN areas (53%) (AIHW 2018).

It should be noted that the above bulk-billing rates refer only to services where a bulk-billing option was provided. It should also be interpreted that these rates do not describe the proportion of patients who were entirely bulk-billed for their services.
 

The figure shows the proportion of people who delayed or did not seek care when needed due to cost by socioeconomic area. People living in lowest socioeconomic areas were more likely to report delaying or not seeking care from GPs (3.9%) and after hours GPs (2.8%) compared to those in the higher socioeconomic areas (3.0% for GPs and 1.5% for after hours GPs).

Waiting times

In general, most people (81%) reported having acceptable waiting times to get an appointment with a GP in 2018–19. Only 1 in 5 people (19%) reported waiting longer than acceptable, but this varied by age group. People aged 65 and over were most likely to report experiencing acceptable waiting times, while younger age groups (25–54) were more likely to feel they waited longer than felt acceptable (Figure 5).
 

The figure shows the proportion of people who reported they waited or did not wait longer than felt acceptable to get an appointment with a GP. Overall, people in the older age groups (55 years and above) were less likely to report waiting longer than acceptable compared to younger age groups (less than 55 years). Only 10% of people in the 75-84 age group, and 12% of people in the 85 and over age group reported waiting longer than acceptable, compared to 21% in the 35–44 age group. 

Challenges and strategies

The Australian health care system faces ongoing challenges including the provision of effective, equitable and coordinated care, an ageing population, workforce pressures, rising prevalence of risk factors (for example, Overweight and obesity and Insufficient physical activity), and the increased incidence of chronic disease and multiple chronic diseases (see Chronic conditions and comorbidity). Various initiatives aim to address these challenges. 

National Health Plan

In August 2019, the Hon. Greg Hunt, MP, Minister for Health, announced the Government’s Long Term National Health Plan. The plan aims to build a ‘mentally and physically healthy Australia’, with mental health being rated equally alongside physical health. The plan also aims to facilitate better support to manage and prevent conditions such as cancer, diabetes, heart disease and mental illness. 

Priorities for primary health care include implementing a 10-year primary health care plan and supporting more flexible care models to improve preventive care and management of chronic issues (Department of Health 2019b).

Health Care Homes

The intent of the Health Care Homes (HCH) program is to deliver coordinated, team-based care for the management of an eligible patient’s chronic conditions. The program bases care on the needs and goals of the patient, to facilitate a partnership between the patient, their families and carers, their treating general practitioner and health care team.

Stage 1 of the HCH trial began on 1 October 2017. In December 2018, the Australian Government announced the extension of the program for an additional 18 months to 30 June 2021.

Some of the data captured during the trial will be collected specifically for a program evaluation. The evaluation stream data will be provided to the HCH program evaluators, Health Policy Analysis, by patients, HCHs, Primary Health Networks, the Department of Human Services, the Department of Health, the AIHW and state and territory governments (Department of Health 2019e).

Practice Incentives Program Quality Improvement

The Practice Incentives Program (PIP) provides incentives for general practices to carry out continuous improvement and quality care activities, enhance capacity and improve access and health outcomes for patients. From 1 August 2019, there are 8 incentives under the PIP including teaching; eHealth; Indigenous health; after hours; aged care access; the procedural general practitioner payment; rural loading and a new PIP Quality Improvement (QI) incentive.

General practices enrolled in the PIP QI Incentive commit to implementing continuous quality improvement activities that support them in their role of managing their patients’ health. They also commit to electronically submitting the PIP Eligible Data Set to their local PHN quarterly (Department of Health 2019c).

The incentives program builds on the 68% of general practices that already voluntarily share their practice data with PHNs for quality improvement and population health purposes (Department of Health 2019d).

Improving primary health care data

Primary health care is a vital component of Australia’s health care system, encompassing a broad range of professions and services. Despite this, the availability of primary health care system data is limited. This limits the ability to assess the positive impact of this sector on the health of Australians and/or identify where improvements are needed. The AIHW is working to improve primary health care data, through the development of the National Primary Health Care Data Asset.

Where do I go for more information?

For more information on primary health care, see:

Visit Primary health care for more on this topic.

References

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