NACOS recognises the key role of general practitioners (GPs) in managing obesity in the primary health care setting. While we acknowledge that Medicare provides Australians with access to ‘some health services at low or no cost’, none of the Medicare Benefits Schedule (MBS) items for GPs specifically apply to the management of obesity.
There are some provisions in the MBS available to GPs which could be used for this purpose but these are primarily for individuals with a ‘chronic medical condition’ via GP Management Plans (GPMPs) and for those with additional ‘complex care needs’ via Team Care Arrangements (TCAs). The NACOS also recognises that most Australians eligible for GPMPs and TCAs do not receive these types of enhanced models of primary care, possibly due to the ambiguity of the status of obesity as a recognised condition for accessing these schemes.
NACOS recognises that clinically severe obesity is challenging to manage in the primary care setting alone, especially in the presence of multiple medical, physical, and psychosocial complications. The complex health needs of patients with clinically severe obesity often require referral to a specialised obesity management service (or “specialist clinical obesity service”). Specialist obesity management services variably provide medically-led multidisciplinary team care, utilising intensive dietary and exercise interventions/support, psychological treatments, pharmacotherapies, as well as access to bariatric surgery when indicated and where feasible. The NACOS also recognises that most Australians with clinically severe obesity have very limited access to specialist obesity management services and intensive medical and surgical therapies.