‘Embedding inequity right from the get-go’

There are calls for greater investment to support GPs in managing children’s health conditions, as a study reveals those facing higher risk have less access to care.
 
Published in the Australian Journal of General Practice, the research involved 22 general practices in Victoria and New South Wales and captured data from almost 50,000 consultations.
 
Results show the most common paediatric referrals in metropolitan general practices are for mental health and developmental-behavioural issues, such as attention deficit hyperactivity disorder (ADHD).
 
However, it also reveals a clear difference in children’s access to appropriate care depending on their socioeconomic status, according to co-author, paediatrician and University of Melbourne Professor Harriet Hiscock.
 
Her study found GPs who billed privately are around 1.7 times more likely to refer than bulk-billing GPs in the sample, and most referrals are to private billing paediatric specialists.
 
‘We know that children experience mental health issues across the socioeconomic spectrum, but they tend to cluster in low socioeconomic families, as do children with developmental issues, like autism, ADHD,’ Professor Hiscock told newsGP.
 
‘These children were more likely to attend bulk-billing practices and received fewer referrals for specialist care – if anything, these kids should be referred more to specialists, and we clearly saw that wasn’t happening.
 
‘We’re embedding inequity right from the get-go in a person’s life, because we know if left untreated, a lot of these things will just get worse.’
 
As well as exploring the case mix of children under 18 visiting GPs and patterns of referrals, the study also looked at key factors associated with referrals as well as health system costs.
 
The authors noted that wait times for public hospital emergency departments and outpatient clinics for paediatric care are rising, while private paediatricians are reporting long wait times or closing their books, especially to children with developmental-behavioural concerns.
 
‘The burden of this care likely falls back on GPs,’ they wrote.
 
Professor Hiscock said there is a clear need for greater investment in paediatric primary care, including properly funding longer GP consults and financial support for co-consults between GPs and paediatric specialists.
 
‘The study shows that GPs are dealing with a lot of different conditions in children – there’s complexity – and the results point to the need to better support GPs in frontline care, particularly for children with developmental issues and mental health issues, because they were the most commonly referred,’ she said.
 
‘We definitely need support for GPs to have longer consultations, because you can’t manage mental health and developmental concerns in a six-minute or 10-minute consult.
 
‘But also, I would love to see some sort of billing or funding mechanism to allow GPs to speak to paediatricians as specialists and get advice with or without the patient there.’
 
Professor Hiscock said she also wants to see more training in ‘broader paediatric health issues’ that GPs might not have had as much access to in their earlier years.
 
‘One of the issues with GP training is that they only get six weeks of paediatric-mandated training as they undergo their training as residents and registrars,’ she said.
 
‘While that tends to give them a good grounding in medical problems, particularly the unwell child, which is really important, it doesn’t tend to give them the grounding in these mental health and developmental-behavioural problems.
 
‘So, they refer these kids because they’re not sure what to do, and then we just end up with really long waiting lists, particularly in the public system, because we don’t have enough salaried paediatricians working in that public system to be able to meet the needs of these kids and families.’
 
The study comes as governments in NSW, Western Australia and South Australia have announced they will allow GPs to diagnose and treat ADHD. 
 
GPs in Victoria, Tasmania and the Australian Capital Territory have also called for GPs to be able to diagnose ADHD to improve access to treatment. In Victoria, a shared care ADHD pilot is underway with GPs and paediatricians.
 
RACGP Victoria Chair Dr Anita Muñoz said every child deserves access to the care they need, and the high cost of seeing a psychiatrist or paediatrician is prohibitive for many families.
 
‘Many families simply cannot afford ADHD assessment under the current model, but early intervention can be enormously beneficial for kids who need it,’ she said.
 
‘GPs have been successfully managing children with ADHD in Queensland for eight years without issues, and it’s great to see several states come on board to allow GPs to practice to their full scope. 
 
‘The RACGP is calling for nationally uniform rules to help people access vital care, regardless of their background.’
 
Log in below to join the conversation.

ADHD adolescents children children’s health children’s mental health developmental issues neurodevelopment