Dr Rod Pearce, Chair of AMACGP at the Australian Health Congress, Sydney
Introduction
Ladies, gentlemen and distinguished guests, good morning.
As some of you may know, I'm a general practitioner who runs a long-established, but modern, medical practice.
In my practice, doctors, nurses and allied health professionals work collaboratively for the best patient outcomes.
The way I run my practice is logical and works well for both patients and staff.
And I know of many GP colleagues who run their clinics the same way.
To me, the way we run our practices is not all that different from what I hear the government asking for.
So I must confess I'm not really sure what all the fuss is about - why is there so much angst about primary health care reform?
It should be a straightforward process.
To put it simply, GPs want reforms that will ensure a sustainable GP workforce, to ensure all Australians have access to quality medical care when and where they need it.
A GP workforce that is assisted by nurses and allied health providers in delivering quality team-based and coordinated patient care.
A workforce properly recognised for the breadth of care it provides.
A workforce acknowledged for the vital role it plays in promoting better health and facilitating access to appropriate care.
A workforce not confined by bureaucratic red tape, prescriptive policies, or commercial interests as it strives to provide quality patient care.
At the same time, it appears Government wants to ensure universal access to medical care;
wants to better support the management of chronic disease;
to encourage multidisciplinary team-based care and support the role that GPs play in the health care team;
to be more pro-active about preventing illness; and
ultimately, wants to ensure a sustainable health care system for the future.
It would appear, broadly speaking, that we are all after the same thing.
But it seems a failure in communication - a misinterpretation of intent and effect - has resulted in an environment of turmoil, confusion, misunderstanding and frustration.
I hope in speaking with you today that I can impart to you - the politicians, the policy advisers, and the stakeholder representatives - a clear understanding of primary health care from the primary health care physician's point of view.
I see patients every day.
I hear about their concerns and their needs, every day.
I'm here today to share that knowledge with you - to help you understand what changes and support patients need, to ensure they continue to have access to quality, affordable health services.
I believe doctors and the government can work together to achieve this common goal.
Primary Care
So to begin this process of clear communication, let's first make sure we're working from the same definition of primary health care.
Primary health care, as defined by the World Health Organisation, is curative treatment given by the first contact provider along with promotional, preventative and rehabilitative services provided by multi-disciplinary teams of health care professionals working collaboratively.
Primary health care includes health promotion, illness prevention, care of the sick, advocacy, and community development.
Primary health care is the foundation - the heart - of any health care system.
In Australia, general practitioners are integral to the successful delivery of all the elements of primary health care.
In this country, the GP is the only clinician who operates in the World Health Organization's nine levels of care:
- Prevention,
- pre-symptomatic detection of disease,
- early diagnosis,
- diagnosis of established disease,
- management of disease,
- management of disease complications,
- rehabilitation, and
- terminal care counselling.
With that in mind, I'd now like to examine some of the major pressures on primary care in Australia today.
Current Major Issues
It's essential that any reform to primary health care be done properly from the outset, as the pressures on the front end of Australia's health system are only going to grow over time.
There are a number of major issues in today's medical environment that either impact now, or will impact in the future, on the delivery and accessibility of primary health care.
Chronic Disease
The first is one we often hear about - the increasing rate of chronic disease.
The reason we hear so much about it is because its impacts are debilitating not only to patients but to medical expenditure and the health system overall.
The World Health Organisation projects that in high-income countries, including Australia; deaths from chronic disease will increase by 11 per cent within the next 10 years.
This includes a 53 per cent increase in deaths from diabetes.
The worst part is that chronic disease in many cases is preventable.
According to the Australian Institute of Health and Welfare's report, Australia's Health 2008, almost three-quarters of deaths among people under 75 years are considered to be largely avoidable.
Where it is too late to prevent a chronic disease, better management can prevent the disease from progressing, reducing the need for more costly medical interventions.
The World Health Organisation believes we should be able to prevent at least 80 per cent of premature heart disease, stroke, and type 2 diabetes, and 40 per cent of cancer.
Prevention is achieved through interventions that encourage patients to establish a healthy diet, undertake regular physical activity, and avoid tobacco products and other harmful substances.
Ageing Population
The second commonly-talked about issue is the ageing population.
This impacts on the health system in two major ways.
The first is that patients are living longer.
Don't get me wrong - this is a good thing.
The challenge, of course, is to ensure that as people age, they maintain a good quality of life.
The longer we live, the more likely we are to develop a chronic disease - or two - and the longer we will have to treat and manage that chronic disease, or diseases.
The second is that our GP workforce also is ageing.
The proportion of Australian GPs aged 55 years and over was 16 per cent in 2006, compared with 12 per cent in 2001 Australian Institute of Health and Welfare, Australia's health 2008, p 359