GPs’ experience with the National Disability Insurance Scheme

Amanda Lyons

9/05/2018 1:52:48 PM

Two GPs who provide care to patients with disability assess their experiences with the National Disability Insurance Scheme so far, and consider their hopes for the future.

Both GPs expressed concern that people with disability who have limited external support can struggle to properly access the NDIS.
Both GPs expressed concern that people with disability who have limited external support can struggle to properly access the NDIS.

Associate Professor Robert Davis, GP and Chair of the RACGP’s Disability Specific Interests network, believes the Federal Government’s obligations to its citizens with disability are clear.
‘Australia is a signatory to the United Nations Convention on the Rights of Persons with Disabilities, so it has signed off on people with disability having the right to full and effective participation and inclusion in society, one of the underlying reasons it set up the NDIS [National Disability Insurance Scheme],’ he told newsGP.  
However, the transition of people with disability to the NDIS has not been without its problems, and a recent evaluation by a team from Flinders University found that a large minority – about one third – feel no better off under the scheme, while a further 10–20% feel worse off.
‘There are some people with disability whose NDIS plans have been much more flexible and person-oriented than the previous plans were, and that’s been a benefit for them and their families,’ Associate Professor Davis said.
‘But to have a third of people no better off or worse off, there’s some real concerns about the way those plans have been rolled out.’
Associate Professor Davis has found that gaining access to the NDIS can be difficult, particularly for patients with intellectual disabilities and autism, because of the complicated planning and assessment process.
‘People with intellectual disabilities and autism are very dependent on families and carers to advocate on their behalf, and the amount of work involved in that can be quite overwhelming,’ he said.
‘The NDIS has set aside about 90 minutes to set up your plan, so if you don’t get all the bits and pieces of your plan in that time, it’s difficult to go back from there.
‘[Getting organised for that meeting] is also hard work, and you need to have some understanding of where to go for advice before a plan meeting, what is available for people with disability, and what parts of the plan can be realistically implemented.
‘Some people with disabilities, carers and families have those skills and networks, but others need supports to do that.’
Associate Professor Davis has also found this process is not helped by the fact many staff members involved in the NDIS planning process are not trained in disability care themselves.
‘[The Federal Government] is virtually developing a whole new system without people who have training or expertise in the disability area,’ he said.
Dr John Crimmins, a Sydney-based GP who travels to group homes for patients with disability, has identified a further issue with the NDIS process.
‘The GP, who looks after these patients’ psycho-social-biological needs, is not involved with the NDIS planning at all,’ he told newsGP. ‘We don’t even get a copy of the plan.
‘The NDIS is a great idea on paper, but I think the implementation, especially when you don’t involve the GP, is not going to benefit the patient.’ 
Dr Crimmins is also concerned about the advent of service providers offering ‘one-size-fits-all’ care packages in areas such as recreation that are not appropriate for all patients.
‘It is almost packaged care, depending on who the suppliers are,’ he said.
‘As an example, I have a patient who is nearing 65 and has multiple chronic diseases, and I questioned the recreational plan his [NDIS] provider had put him on because I thought he should have tailored retirement plan.
‘I had to write doctor’s certificates to stop him going on these recreational programs and we tailored an alternative, involving the Men’s Shed and the local RSL club with bowls and things like that.’
In addition to plans and services, Associate Professor Davis has been concerned by the changing landscape around the very funding of the NDIS.
‘It’s a bit of hollow logic when the Government says the funding’s guaranteed through the growing economy, 12 months after they had a deficit statement in the 2017 budget,’ he said.
‘People with disability want certainty.’
Dr Crimmins believes that more direct funding to general practice would do a lot to help people with disability, although he also advocates for extending GP services in this area.
‘As GPs are strong advocates for patients with disabilities in society, I think a larger proportion of the health budget – state and federal – needs to go directly into general practice care,’ he said.
‘But, equally, GPs have to step up, to provide more outreach and extend our hours for people with disability, because they do have special needs and access problems. So it’s not a one-way-street.’
Despite the issues that have presented for the NDIS during its national rollout, Associate Professor Davis is generally optimistic about the scheme and the future it presents.
‘I have no doubt things will improve under this scheme for people with disability in the long run,’ he said. ‘The NDIS is reviewing how things are going, so it’s actively involved in looking at the consumer response to its service, and that’s a good thing.’

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Solange Adad   11/05/2018 7:29:47 AM

My experience with the NDIS has been very frustrated. Patients that have the long-term disability who had the pension, because they do not a have carer; it has been rejected.
Patients keep come back to me asking for more information and crying after the office/telephone talk to undertrained staff who is unable to write for them what they need, why has been rejected. The only answer they get " you have not got the points" when I try to call NDIS, we are put on hold for a long time until given up.

I have asked few of my patients to go to the office with a letter saying write what is missing or phone me back, never got a reply.
Until now only one patient has got an interview, and I spoke over the phone to the occupational therapist and went through the process with difficulty but got it, no other yet succeed for me to give a better feed back.

Of course, I understand changes come with some difficulties, but this is accompanied by too many problems to be optimism about it unless the government reassess and train staff properly