4.3.1 Profile of GP respondents providing comment

Of the 203 respondents to the survey, 88 (43 per cent) provided additional comments regarding the Better Access initiative. Of these respondents who also provided their postcode of primary practice (93 per cent), 34 per cent were from Victoria, 27 per cent from New South Wales, 21 per cent from Queensland and 18 per cent were from South Australia, Western Australia or Tasmania. Eighty nine per cent of respondents were located in a major city or inner regional area. The remaining 11 per cent were from outer regional or remote areas.

4.3.2 Comments received on survey

Note: Comments that were not relevant to the project/survey have not been included.

Major cities

General Practitioner, Major City, NSW
The form of training is problematic: now, after years of undertaking the program in its previous form, you want me to go back to start and train again. Do you do this for specialists too, or is it only GPs who you demean so? (#23)

General Practitioner, Major City, NSW
FPS accredited GPs cannot work in their own settings, but only in accredited practices. This is an inappropriate restriction, and a waste of their expertise, qualifications and experience. (#28)

General Practitioner, Major City, NSW
A marvellous programme. integrates well with my group practice. Allows appropriate counselling of appropriate people, all benefit from access to clinical psychologists, no losses or failures. Major benefit, appropriate time to review and assess patients, (#30)

General Practitioner, Major City, NSW
I treat homeless men only in my GP. Better access seems useful but in reality, most are unable to keep appointments, do not have the cognitive skills to allow treatments to be effective and forming a good therapeutic relationship takes years not sessions. (#58)

General Practitioner, Major City, NSW
Don't stop it! It has revolutionised management of patients, making help more accessible especially financially. Most patients I have referred will need no more than the six sessions. A few long-term patients, eg with chronic depression or personality disorders, or . . . .(incomplete comment) (#63)

General Practitioner, Major City, NSW
Need more training programmes for ongoing CPD. A lot of paper work associated with mental health plans etc. (#74)

General Practitioner, Major City, NSW
I think there are a lot of people billing the item number without really doing the work. I have had patients not even aware that the item number has been used, some see it as a 'cash cow'. (#84)

General Practitioner, Major City, NSW
Generally a very good program but the benefit has not extended to access to psychiatrists. The frequency and quality of reporting feedback from psychologists is very poor. An improvement to the program would be a compulsion for psychologists to write back. (#93)
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General Practitioner, Major City, NSW
The Better Access Initiative has been the best thing that has happened in my time in medicine to enable those who need professional care with mental health problems to receive it. It has been brilliant!!!! . (#112)

General Practitioner, Major City, NSW
I think it has been a positive initiative for my patients with mental health conditions. (#132)

General Practitioner, Major City, NSW
Best initiative in a long time. It enables lower SES population access to high quality allied mental health care. However the state health system seems to have decreased its allied health providers which should not have been allowed unless the same state . . . .(incomplete comment) (#137)

General Practitioner, Major City, NSW
I don't believe that GPs need extra training for referring patients under Better Access initiative. (#142)

General Practitioner, Major City, NSW
  1. gap payments by some psychologists make referrals prohibitive
  2. has done nothing to aid psychiatry access in Newcastle
  3. psychologists seem to use 12 visits from January to December each year whilst GPs have been told it was from the date of the mental health plan. (#161)
General Practitioner, Major City, NSW
Receiving reports from allied health staff about the treatment/progress of patients is very poor!!! (#178)

General Practitioner, Major City, QLD
The paperwork associated with the preparation of mental health care plans and reviews etc can detract with establishing a therapeutic relationship. (#36)

General Practitioner, Major City, QLD
No benefit for my major psychiatric patients, schizophrenia etc as too expensive. (#44)

General Practitioner, Major City, QLD
I have still found many socially disadvantaged people not able to afford professional counselling services - specialised mental health services - as a result of fees charged by psychologists and clinical psychologists above those subsidised by the government. (#85)

General Practitioner, Major City, QLD
Access to affordable psychology services was long overdue, and has been a God-send for my patients. It has made a massive improvement in the management of the mental health disorders in the patients I see." (#88)

General Practitioner, Major City, QLD
Overall the program has been a huge success for my patients. I am no longer juggling their mental health problems while trying to care for their other health issues. I enjoy mental health care but the truth is it's better for patients to get some specialist care. (#97)

General Practitioner, Major City, QLD
It is great that it is remunerating me for time spent with these patients, but it could be made simpler. Especially the 2710 could be replaced by a referral letter. In a situation where GP numbers are very limited, it greatly frees up my time to help other patients. (#129)

General Practitioner, Major City, QLD
It is a pity we can't just diagnose a recognisable mental illness and then write a letter to the allied health professional we want the patient to see. Why all the forms and tick the box requirements? (#143)
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General Practitioner, Major City, QLD
The overall concept is good, ie. improve the access to counselling for groups of people who will benefit more from counselling than through a medical model psychiatric care. However, the implementation is the challenging part. (#159)

General Practitioner, Major City, QLD
The formatting of the case notes is poor. As a level 2 provider of FPS, I have patients referred who have already had a 2710 by another GP but done inadequately and I can't be renumerated for doing one thoroughly.. (#160)

General Practitioner, Major City, QLD
Quality of reporting back from allied health is truly dismal much of the time, skill of allied health professionals highly variable, costs of psychologists have soared with rebate access under Medicare. (#167)

General Practitioner, Major City, SA
FPS-trained GPs should be recognized for what they carry around in their heads, not the chair they have to sit on to do the work - an accredited practice is not necessary. Some of us work at locations that would never get accredited, such as residential care. (#54)

General Practitioner, Major City, SA
Better access initiative is well intentioned, but like most things has been misused. As a GP with many years experience and training in mental health issues, I resent referring my patients to a social worker or OT with a counselling degree, who has a large . . . .(incomplete comment) (#113)

General Practitioner, Major City, SA
Better Access is great, is needed, but could be improved. For GPs, feedback from psychologists and psychiatrists is still below an expected standard, and this limits GPs from giving even better service and getting better results. (#127)

General Practitioner, Major City, SA
The financial incentives within MBS have meant more GPs are prepared to do mental health consults, but because the MBS benefits for allied health remain low, most patients cannot afford the (necessary) gaps the allied health need to charge to stay viable. (#193)

General Practitioner, Major City, VIC
Simply: Better outcomes has improved access to affordable mental healthcare to those who don't really need it and could afford it anyway. (#4)

General Practitioner, Major City, VIC
Include integrative medicine perspectives and approaches. Mind/Body/Energy Medicine. Consider the effectiveness, and cost efficiencies of some of the less 'mainstream' modalities, eg Meridian therapies, Emotional Freedom techniques, www.emofree.com (#21)

General Practitioner, Major City, VIC
It was difficult to find a list of psychologists specialising in children, adolescent and drug and alcohol related issues. (#24)

General Practitioner, Major City, VIC
An invaluable pathway for improving treatment options due to increased availability and decreased cost. (#45)

General Practitioner, Major City, VIC
Many of the psychologists either do not write back or write very little - not good when it's part of the program that they feed back to the GP who then continues to manage the patient(s). (#47)
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General Practitioner, Major City, VIC
Mental health services are still difficult to access for the unemployed, those on low incomes and the elderly (especially those in residential aged care facilities) except in acute "crisis" situations - the gap fee after the Medicare rebate still precludes. (#61)

General Practitioner, Major City, VIC
It has really helped people who previously would not have been able to afford counselling to get this vital source of treatment and support - a great scheme.(#69)

General Practitioner, Major City, VIC
There has been significant leakage with the public assuming (and at times reporting they have been told by another provider) that they can get counselling for a variety of issues that are not defined mental health problems. (#75)

General Practitioner, Major City, VIC
We need a more appropriate template for a mental health plan. It is too formal, doesn't include much of the information likely to be gained by the GP. It is totally focused on patient deficits rather than their strengths and competencies. (#83)

General Practitioner, Major City, VIC
The availability of allied mental health at low cost has been an important assistance to already over stretched GPs in the management of these patients. (#86)

General Practitioner, Major City, VIC
The emphasis in BOMH is on allied health practitioners providing mental health services and those GPs who have provided or continue to provide focussed psychological strategies are poorly supported by government (Medicare) and the RACGP. (#89)

General Practitioner, Major City, VIC
One of the frustrations as a GP is patients often come in when a mental health care plan needs to be done (ie needs minimum 30 minute appointment) having been told by the allied health professional "they just need a referral from their GP". (#90)

General Practitioner, Major City, VIC
Referrals are overly bureaucratic requiring a specified format. Further training is an insult to already appropriately trained professionals. (#99)

General Practitioner, Major City, VIC
Communication from allied health providers is mostly late, unhelpful and usually consists of a request for a further six visits with no justification or discrimination. (#101)

General Practitioner, Major City, VIC
The reports I have received back have varied markedly from quite helpful to non existent. In my experience, psychiatrists with one or two exceptions have always been quite useless at writing to GPs and this has not changed. (#139)

General Practitioner, Major City, VIC
Other than the preparation of an MH plan and review of such, other item numbers haven't been helpful to me. If anything they are restrictive. They make no provision for prolonged consults. Very hard to find (still) psychiatrists who will do long term counselling. (#146)

General Practitioner, Major City, VIC
I have noted the costs of some psychological services have increased by a similar amount to the Medicare rebate, i.e., the out of pocket costs for patients have remained much the same. (#149)
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General Practitioner, Major City, VIC
I don't always perform a formal mental health plan on every mental health patient, hence I would like an item number that is a 2713, but for a level "D" consultation, not just a level "C". I am level 2 trained, but don't usually use the fps item numbers. (#165)

General Practitioner, Major City, VIC
Better Access allowing referral to psychologists/social workers and OTs is unable to be used in patients residing in Aged Care facilities. All older people should have access to these services. One other issue is the cost including out of pocket expense (#168)

General Practitioner, Major City, VIC
I feel that too often patients get sent to their GP for a "Medicare funded referral" suggested by the psychologist they were already seeing and paying for willingly. I feel there should be greater regulation so that people with greater financial need are . . .(incomplete comment) (#172)

General Practitioner, Major City, VIC
Access to psychiatrists remained to be unaffordable to the majority of people with mental illness even with the introduction of Better Access Initiative. (#173)

General Practitioner, Major City, VIC
The Initiative has been tremendous for my patients. The Medicare requirements for reviews and new mental health care plans have proved to be quite difficult to understand. I have run into problems of not knowing what to do when a different GP has started. (#175)

General Practitioner, Major City, VIC
This Initiative is the single most important factor that has changed my working life in the past five years. Prior to this, dealing with mental health problems was nothing short of a titanic struggle for the average busy GP. (#195)

General Practitioner, Major City, WA
Many people referred have problems that are relatively minor and so block places for more severe cases. Still a significant shortage of psychiatric services for children. (#32)

General Practitioner, Major City, WA
Caters to those who can afford the gap and who are easy to look after (those who attend appointments on time, not complex), for the more complex, they can't afford or are not really as welcomed by providers. A lot of money for a small group, but very popular. (#96)

General Practitioner, Major City, WA
Would like easy access to a central registry of psychologists, their qualifications and special areas of interest. (#98)

General Practitioner, Major City, WA
I am very pleased to be able at last to have accessible and affordable psychology services for my patients, and item numbers which reflect the content of my mental health consultations. I also suspect that the availability of psychology has decreased the . . . .(incomplete comment) (#171)

General Practitioner, Major City, WA
Mostly accessed by the milder illness patients who can afford the gap. I am unsure that it has been helpful for those with severe illness who cannot work and cannot afford gaps of up to $50. (#191)

Psychiatrist Major City NSW
Psychologists seem to be charging exorbitant fees and have just soaked up the Medicare rebate. It is very hard to find a bulkbilling psychologist. This program has improved access for the wealthy to a Medicare subsidy. What level of scrutiny is there. (#200)
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Psychiatrist Major City SA
My impression is that Better Access referrals to allied health professionals are for low morbidity problems. There seems little quality control in the treatment people receive from this wide variety of allied health professionals, who at times seem to us . . . .(incomplete comment) (#10)

Inner regional

General Practitioner Inner Regional NSW
Having worked in small rural towns with NO access or very limited crisis only Mental Health access, the BAMH scheme has made outcomes and treatments less drug focused and more diverse leading to improved outcomes. It is an amazing initiative (#5)

General Practitioner Inner Regional NSW
The fee from providers has dramatically increased. As a result the gap is about the same now as it was prior to the program commencing. It seems to me all that one major result that has occurred is remuneration has increased for the psychologists. (#51)

General Practitioner Inner Regional NSW
I worked in headspace where young people get to access a great variety of mental health support. I think it's great that there is Better Access for these people as for some of them a problem can be squashed or detected before it becomes a problem in their lives. (#55)

General Practitioner Inner Regional NSW
The above aren't the questions relevant to me, and I think many GPs. The required referral pathway is too complex and time consuming, albeit adequately paid by Medicare rebate. Usually, the referral happens in reverse order, patients request one.(#70)

General Practitioner Inner Regional NSW
I feel that if GP assesses patient as requiring psychological services then they should be able to refer without doing a mental Health Plan. I don't find that doing a health plan adds any benefit other than enabling patient to access Medicare benefits. (#72)

General Practitioner Inner Regional NSW
There is still a great tendency for allied health professionals to say to patients 'just get a referral from your GP', including to those who do not qualify as having a mental disorder. This is either disingenuous of those allied health professionals or s. . . .(incomplete comment) (#94)

General Practitioner Inner Regional NSW
Excellent items, easy to use, good communication 2 way between GP and psychologist. Good access for patient who can't afford private fees to psychologists, enables people to get back to work by treating their mental health disorder. (#102)

General Practitioner Inner Regional QLD
Empowering patients, self help strategy learning, less medication reliance, demystifying mental illness etc = huge benefits. affordability & distance options are brilliant too. (#145)

General Practitioner Inner Regional QLD
I refer patients for short term psychological treatment as CBT. CBT is an evidence based very powerful technique to treat anxiety disorders and depression and I am very happy that Better Access made it available to a greater audience. (#154)

General Practitioner Inner Regional TAS
Many providers are not trained adequately and their standards of practice are not ensured enough. Only those using proven therapies should be subsidised and only those properly trained e.g. clinical psychologists should have services subsidised. (#144)

General Practitioner Inner Regional VIC
  1. I have never received clinical reports from psychologists. Why?
  2. I have no clear understanding of the professional skill and competence of the various psychologists in our region.
  3. The Better Access Initiative does allow more affordable services b. . . .(incomplete comment) (#64)Top of page
General Practitioner Inner Regional VIC
Better access would be a much better use of money and resources if access to psychologists etc could be direct or by a well written meaningful GP referral rather than a formulaic wordy not generally appropriate mental health plan that requires a long appointment time. (#95)

General Practitioner Inner Regional VIC
l am pleased to continue to fund this initiative - cut the red tape and remove the mental health plan hurdle. (#204)

General Practitioner Inner Regional VIC
The contribution of MH trained GPs (ie those eligible to provide focused psychological strategies) should be recognised as valuable and not overlooked because they as a group are numerically smaller than allied health professionals. (#205)

Psychiatrist Inner Regional TAS
Ill-conceived, poorly monitored. (#11)

Outer regional

General Practitioner Outer Regional QLD
Has not increased number of mental health providers in rural areas, especially in areas of Child/Youth Mental Health or Indigenous mental health. (#59)

General Practitioner Outer Regional QLD
To build further upon this initiative. (#71)

General Practitioner Outer Regional QLD
Great in terms of improving psychology access but no improvement at all in provision of psychiatrists. (#76)

General Practitioner Outer Regional QLD
In our area, there are a limited number of Allied workers using languages other than English, and no-one with an ATSI background. The cost of the co-payment is prohibitive, leading to continued poor services to the poor and ATSI folk. (#124)

General Practitioner Outer Regional QLD
A lot of patients don't complete or come back for review. They consider it as just like any other referral. Reverse Referrals after a patient has seen a psychologist are very awkward and often inappropriate and should be actively discouraged. (#197)

General Practitioner Outer Regional SA
Has greatly freed up my time as a rural GP to see more patients, as I'm not having to do as much counselling. Excellent scheme - well done Government. Could do lots more for inpatient mental health services though. (#38)

General Practitioner Outer Regional TAS
I find that there is lack of mental health providers specialising in drug and alcohol services in our area. (#68)

General Practitioner Outer Regional VIC
Still limited numbers psychologists in the country. (#100)

Remote

General Practitioner Remote WA
In principal it would have been great if one had enough psychologists and psychiatrists, paper access initiatives go no-where without these people actually existing. And they had not. (#49)

Region unknown

General Practitioner
This is an excellent programme. This has not only made access to mental health a little bit easier but has also improved outcomes of mental health disorders. (#25)
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General Practitioner
1. I am mental health level two trained. I need further specific training in my area to strengthen my CBT IPT skills and other skill but no such work shop is available for this triennium to sustain my mental health level 2. (#34)

General Practitioner
Better access initiative has been a miracle - patients who could never afford counselling have been able to access services, would be good to have more salaried psychologists - as many still have a hefty gap which is difficult for disadvantaged to pay. (#106)

General Practitioner
I don't think the outcomes are better over time, eg the number of patients who benefit from six sessions only from eg CBT is probably no better than the number of patients who get better anyway over time through regular contact with a GP like me who has a specialist mental health training. (#153)

General Practitioner
I think the Medicare funding is excellent but do not feel there is a need for the complex GP item for referral. Referrals could be done just as appropriately with a "normal" referral letter like a GP does for any other referral (which would often be more). (#164)

Psychiatrist
Most patients bypass psychiatrists altogether. Patients now receive poor quality care with poorly trained GPs and psychologists. Patients now have about 6 months more illness and accumulated complications before they get referred to a psychiatrist. (#9)