• Christopher M Harrison, Helena C Britt, and Janice Charles.
• Family Medicine Research Centre, School of Public Health, University of Sydney, Sydney, NSW.
• Med. J. Aust. 2012 Aug 6; 197 (3): 170-2.

ObjectiveTo compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers.Design And SettingAnalysis of Bettering the Evaluation and Care of Health data relating to management of depression from April 1998 to March 2011, with the Better Outcomes period defined as January 2002 to October 2006 and the Better Access period defined as November 2006 to December 2011.Main Outcome MeasuresRates of depression management by GPs, including rates of mental health care item claims, referrals, prescribing and counselling, by patient location and socioeconomic group.ResultsDuring the study period, rates of depression management increased and rates of referrals to psychiatrists halved. Compared with Better Outcomes, Better Access resulted in: increased depression management for advantaged major city and disadvantaged non-major city patients (16.0% and 21.5% increases, respectively); a small decrease in prescribing for advantaged major city patients; decreases in GP counselling; increases in referrals to psychologists for all patient groups (three- to fourfold increases), with advantaged major city patients referred more often than patients in other groups; and increases in mental health care item claims for all patient groups (44-65-fold increases), with more claims for advantaged major city patients than both non-major city patient groups.ConclusionFar from becoming "glorified referrers", GPs remain heavily involved in the management of depression. Better Access brought about an enormous increase in access to primary care management of depression, although advantaged major city patients gained most. Any changes to the system must not compromise the strong improvements in access that have occurred for all groups.

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