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80% of Australians have a regular GP: The importance of continuity of care
Long considered a core component of general practice, continuity of care is becoming increasingly complex in the world of modern general practice.
Maintaining continuity of care is increasingly complex in general practice
Long considered a core component of general practice, continuity of care is becoming increasingly complex in the world of modern general practice.
The growing size of many practices, limitations of technology and the increasing prevalence of mental health issues all present challenges and solutions to the best practice ideal of a patient seeing a single GP or inter-connected group of health professionals over an extended period.
Regardless, Australia is faring well when it comes to continuity of care. As indicated by the RACGP’s recent benchmark report, General practice: Health of the nation 2017, almost 80% of people identified having a regular GP, increasing to more than 90% among those 65 and older. The majority of patients – almost three-quarters – felt they could see their GP whenever they needed.
But these numbers may not tell the whole story.
‘On the surface that’s pretty good, but it indicates there’s a proportion of people who can’t see their GP when they want, and there’s also a number who don’t have a GP,’ Dr Michael Wright, a GP and PhD candidate researching the therapeutic outcomes of continuity of care, told newsGP. ‘They are potential areas where we might try and highlight the importance to people of continuity of care and encourage them to pursue it.’
While Dr Wright noted that the changing nature of general practice is not at odds with the pursuit of continuity of care, the greater prevalence of larger practices is making it harder for a patient to see the same GP every time.
‘We’re now considering this idea of continuity of care around the practice as well, where it’s the importance of sharing information appropriately that might allow safer, high-quality care to happen,’ he said. ‘But we need to acknowledge that access to care and continuity of care are often a balance. It’s about navigating this fine balance, which is an ongoing policy problem.’
RACGP President Dr Bastian Seidel told newsGP that continuity of care remains important to patients and GPs; however, the time necessary to ensure this continuity may be somewhat threatened by the emergence of mental health issues as the number one reason for GP visits.
‘In the past, patients were referred very early on to see a psychologist, psychiatrist or mental health worker, but patients don’t want this,’ he said. ‘They don’t understand the situation: if you are the treating doctor who has seen them over the years for heart problems or for diabetes, then why do you suddenly want to send them away because they have a mental health condition?
‘It’s not natural for patients and they actively resist it. They say, “You are my GP. I trust you and you are going to help me through this time”, which is great, but it means GPs need more time.’
The complex interplay between mental health issues and medical conditions such as heart disease and stroke is also factor in favour of protecting continuity of care in general practice.
‘We’re getting better at exposing some of the distress patients have, and continuing professional development and student medical training is emphasising the need to find out about whether the physical ailment that brought the patient in has a psychological component,’ Dr Mark Morgan, Associate Professor in Health Sciences and Medicine at Bond University, and a member of the RACGP Expert Committee – Quality Care, told newsGP. ‘But it’s impossible to do that with a complete stranger in a short consultation, because you need to establish trust and rapport.
‘The relative value of a bulk-billed GP consult has dropped a long way behind what it used to be.’
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