GPs need more backing to improve aged care: RACGP President

RACGP President Dr Nespolon also stated inadequate remuneration, communication breakdowns and a lack of physical infrastructure in residential aged care facilities (RACFs) are further barriers to GPs providing onsite care, when he spoke at the Royal Commission into Aged Care Quality and Safety.
 
‘There is a progressive decrease in the number of GPs who are willing to work or go and see patients in nursing homes,’ Dr Nespolon said.
 
To support his position, Dr Nespolon presented excerpts from a blog that describes two weeks in the life of a GP who previously provided care to patients at RACFs, but was compelled to stop due to the unsustainable nature of the work.

The blog, written by Canberra GP Dr Thinus van Rensburg, lists issues including unpaid travel time, note making and consultations, problems communicating with staff at under-resourced RACFs, and a lack of nurses on site after hours as the reasons why he decided to stop treating lifelong patients.

‘There is a lot of non-face-to-face work that is involved which there is no rebate for,’ Dr Nespolon explained.

‘What you don’t see is the time out of practice. A lot of these consultations are done out of hours because it’s the only way it makes any economic sense, because if you leave your practice during the day you’re not seeing patients that you would normally see.

‘It also underlines the poor staff handover – instructions not to send people to hospital or instructions to call the doctor are often ignored, and I should have added earlier on, this is quite a common story.’
 
As a result, Dr Nespolon said GPs often become the default for all the inefficiencies of the system.
 
‘Whatever needs to be done, the GP is meant to do it and they really can’t just say, “Well, I’m not going to do it” because the patient needs that care,’ he said.
 
‘What this case doesn’t illustrate is the lack of physical infrastructure which is often found within a nursing home to assist the GP in providing better care for their patients.
 
‘This is all underlined by general practices de-funding over the last five years. It makes the time spent out of your practice dealing with nursing home visits so much more relatively expensive than they have been in the past.’
 
Dr Nespolon said this lack of funding is leading to a system in which a single GP assumes the care for all patients within RACFs, meaning new patients often see a different GP during what is a ‘very traumatic’ time in their life.
 
‘As the relative funding drops it means that people need to use different models of providing that care, and one of the efficient ways of doing that is to see more patients in a single visit,’ Dr Nespolon said.
 
‘It does lead to some specialisation of care of elderly patients, but the college would still say that we should be encouraging GPs to take care of their patient all the way through their lives.’
 
The commissioner also raised the supposedly high use of chemical restraints within RACFS; however, Dr Nespolon said he believed this had been overstated and, while not ideal, is often necessary for the safety of other patients and staff members. He also said further regulation is not the solution.
 
‘It doesn’t take into account the thousands of different situations and contexts that people find themselves in. There are so many factors that are involved in this, and sometimes you’ve just got to trust the medical staff and the nursing staff to do the right thing,’ he said.
 
‘I would suggest that most of my colleagues are doing the best for their patients. They’re trying to decrease the amount of medication, they’re trying to keep them as comfortable as they possibly can and that can be really difficult at times.’
 
Dr Nespolon added that increased funding, improved records management – something he believed My Health Record would assist with – higher RACF nursing staff levels and regular use of intake assessments would lead to better long-term care for patients.
 
‘It is a virtuous circle – if there is that support you will find that there are more GPs doing nursing home work, and … I would like to hope that the care that the patient gets is much better and the experience of the staff within a nursing home is actually better,’ he said.
 
‘Rather than sort of running from one patient to the next, they’re actually providing care for that patient.’
 
The royal commission will provide its interim report by 31 October, with the final report due no later than 30 April 2020.

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