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13 Mar 2019

BY DR RICHARD KIDD, CHAIR, AMA, COUNCIL OF GENERAL PRACTICE

With pharmacists seeking independent prescribing rights and nurse practitioners seeking independent billing rights, it is time we all start thinking about what is truly best for the patient and work collaboratively within the scopes of our practice – but with the clinical oversight from a GP.

General practice in Australia has steadily been embracing the concepts of the medical home model of primary care. Over the last decade or so we have seen the size of practices increase, not only in the number of GPs, but in the number of other health professionals that work with GPs within the general practice to support patient care. Certainly, for example, it would be uncommon now for a practice not to have a practice nurse. More than 63 per cent of practices have at least one. The General Practice: Health of the Nation 2018 report indicating that 62 per cent of GPs reported their practice employed an allied health professional and 14 per cent reported their practice employed a pharmacist.

General practices are steadily building their multidisciplinary healthcare teams in order to meet the healthcare needs of their patients. Incentives such as the Practice Nurse Incentive Program (PNIP) and access to MBS items for specific allied health services have assisted practices to do this. The transformation of the PNIP into the Workforce Incentive Program (WIP) should enable this further. Accredited practices in all locations will now be able to participate and receive support for employing allied health professions, including non-dispensing pharmacists.

An integrated health care team spearheaded by the GP is best placed to improve health care provision for patients and to avoid fragmentation of care. Worldwide the evidence across a variety of models of care demonstrate that the key to success is a collaborative environment where the healthcare team works together, and not at cross purposes, to address the healthcare needs of the patient.

It is therefore, frustrating when calls to provide services at the edge of, or beyond, scopes of practice and outside of a collaborative framework are continually made and receive airtime. Worse still is that the claims made to justify it are often exaggerated or inaccurate.

The ‘it would ease the burden on GPs’ and ‘GPs are difficult to access’ are the common catch cries. Yet, the Productivity Commission recently stated that only four per cent of the population reported delaying or not visiting a GP in the previous 12 months due to cost. The Commission also reported that around three-quarters of patients could get a GP appointment within 24 hours, highlighting the access furphy for what it is.

Many practices set aside a number of appointments each day for attendances for an urgent or acute health problem, or are willing to squeeze patients in where necessary, and newer GPs to a practice often having more available appointments meaning patients will usually be able to access an appointment with a GP within their practice when they ask.

When it comes to easing the burden on GPs, fragmenting patient care is not the way. It only adds to the burden for GPs and contributes to unnecessary costs to the health system overall. Fragmenting patient care increases the chance of delivering poorer outcomes for patients through delayed diagnosis, inappropriate or unnecessary diagnostics or referrals, inappropriate or delayed treatment, culminating in preventable hospitalisations.

The provision of patient centred quality care should be paramount for all medical and health professions. By working together as a team, we can make the best use of our various skills and scopes of practice, to provide timely, pro-active, preventive and holistic patient care.

Certainly, we need appropriate funding channels to support this, and the AMA is working to secure a blended funding model that will support general practice in providing coordinated, quality and longitudinal care.

First and foremost, though, the centrality of general practice and the role of the GP must be recognised and reinforced to ensure clinical oversight is maintained as models of care evolve to make better use of the team in delivering care for our patients. It is reassuring to see this recognition underpins the MBS Review’s General Practice and Primary Care Clinical Committee reforms as outlined in its draft report. It is likewise reassuring to see the Pharmaceutical Society of Australia talking about collaborative prescribing models. 

Together, working within the paradigm of the Quadruple Aim, we can deliver better outcomes for patients and population health, greater satisfaction for the providers of care and reduced costs to patients and the health system overall.

AMA advocacy will continue to focus on the development of the medical home ensuring appropriate collaborative arrangements exist to support quality health care and the principles of continuity, coordination, comprehensiveness, accountability, accessibility and patient centredness are enshrined within.

 


Published: 13 Mar 2019