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‘A focus on innovation and reform’: NHRA Review revealed

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First announced in 2011, the National Health Reform Agreement (NHRA) was designed to improve outcomes for all Australians and ensure the health system’s sustainability.
 
But 12 years on, a new report shows that as Australia’s population ages and complex conditions increase, the agreement has become ‘less successful in delivering the right care in the right place at the right time’.
 
Released on Thursday, the independent assessment made 45 recommendations to the agreement, acknowledging there are significant flaws in the current NHRA.
 
These include the need for a more connected health system and holistic NHRA, as well as a long-term vision for reform, as healthcare continues to fragment.
 
‘There was no place where a holistic health system view could be taken, including to identify and respond to current and future system pressures, or to incorporate the views and responsibilities of different sectors and players,’ the review said.
 
Its 10 key recommendations are:

• Create a single collaborative health system agreement and an audit of existing health-related agreements
• A focus and platform for intersectoral collaboration
• Prioritise the development of optimal models of care that both respond to, and shape demand for health services
• Enable transparency, adequacy and risk sharing through financing reform
• Reinforce a shared national commitment and program of action on long-term health reform areas, and a focus on prevention activities
• Establish a dedicated Schedule in the NHRA for improving equitable access to healthcare services in rural and remote areas
• Make a clear commitment to closing the gap for First Nations’ people
• Embed workforce and digital health as key enablers of the health system
• The need for a health system performance framework to access the success of the agreement
• Learn from COVID-19 and prepare for future events

RACGP President Dr Nicole Higgins has labelled the review ‘a good start’, and agress significant changes are needed to streamline all sectors of the healthcare system.
 
‘I’m pleased to see the report acknowledges the potential dangers of care fragmentation, and the need for health services to use standardised and secure system for referral and discharge between general practices and hospitals,’ she told newsGP.
 
‘GPs are the solution to many of our healthcare challenges and this is an opportunity to make the system both more effective and more efficient for everyone.
 
‘Improved collaboration and integration between general practices, other specialists, and hospitals is vital to providing the best possible care to our patients.’
 
The review highlighted the need for a renewed focus on prevention activities to address Australia’s rising burden of disease.
 
‘The NHRA does not provide sustainable funding for preventive care, hindering initiatives for healthier communities and addressing health inequity gaps,’ it said.
 
‘Limited progress has been made on achieving the objectives of the [long-term health reform] area of prevention and wellbeing.’
 
In its submission to the report, the RACGP called for a range of changes to the agreement, with its future to be underpinned by significant funding into general practice.
 
It said with hospitals across the country now bursting at the seams, GPs are perfectly placed to keep communities healthier, with a focus on primary care and preventive action.
 
Specifically, it called for an end to hospital named referral requirements, piloting data-sharing between hospitals and primary care to better identify at-risk patients, and future objectives to add general practice services in hospitals to coordinate care for patients with complex needs.
 
The RACGP has welcomed much of the report but called for the agreement to devote greater attention to empowering innovation in primary care, ensuring the GP workforce has financial sustainability.
 
Dr Higgins said the review represents a significant opportunity to drive integration and collaboration between primary and secondary health systems, providing maximum return to both.
 
‘The NRHA could support the GP workforce by creating greater exposure to general practice for junior doctors and reducing disparities in employment conditions between GPs in training and hospital-based trainees,’ she said.
 
‘Significant investment and a prioritisation of primary care is desperately needed; general practice remains the cost-effective engine house of Australia’s health system and we can help people live longer and healthier lives and reduce that pressure on hospitals.
 
‘Addressing the key barriers and red tape putting pressure on GPs would make an immediate difference to the long-term success of general practice and a stronger, healthier nation.’
 
However, despite acknowledging GPs’ increasing workload – and the subsequent pressure this can place on hospitals – the review contained no strong wording on increased investment into general practice care, and did not mention Single Employer Models as an innovative new model.
 
‘The decline in GPs nationally is resulting in a medical staff shortfall in primary care, with up to 70% of primary healthcare positions occupied by agency nursing and visiting medical officers,’ it said.
 
‘Workforce pressures are contributing to high system costs despite increased vacancies and leave utilisation, with increased reliance on agency and locum staff to fill vacancies and cover leave.’
 
One of the report’s two independent reviewers, Rosemary Huxtable, concluded that there is now a significant opportunity to broaden the scope of the NHRA into the future.
 
‘To take a whole of health system view, to better manage the interface between care sectors, to embed innovation and reform into its operations,’ she said.
 
‘To incorporate the key system enablers of workforce and digital health and to establish priority actions in the areas of First Nations’ people, mental health, prevention, and rural and remote health.’
 
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National Health Reform Agreement NHRA primary care

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