‘Locked into decline’: Call for healthcare overhaul

Morgan Liotta

5/10/2021 4:51:28 PM

New research examining how to repair Australia’s ‘fragmented, inefficient’ system aligns with RACGP recommendations.

Doctors in meeting
The college has consistently advocated for integrated models of care.

‘Put simply, our health system is fragmented, inefficient, inflexible, and organisation‐ rather than person‐focused; locked into decline without significant structural, governance and funding reform.’
That is Professor Claire Jackson, Director at the University of Queensland’s Primary Care Research and Centre for Health System Reform and Integration, and Professor Diana O’Halloran from Western Sydney University’s Department of General Practice, in their recently published Medical Journal of Australia (MJA) paper examining what is needed to reform Australia’s healthcare system.
In the yet-to-be-peer-reviewed research, the authors discuss the strains on the healthcare system, including the increasing burden on general practice and hospitals arising from the COVID-19 pandemic. Other issues, such as managing chronic conditions, specialist wait times, and the challenges facing junior doctors and the impact this has on their recruitment and retention, are also covered.  
‘National inquiries into aged care, mental health, productivity, and system reform demand change and propose workable solutions, but little concrete change seems forthcoming,’ the authors write.
‘While the concerted message is unambiguous, implementation presents a sizeable challenge to our dual‐funded, dual‐governed, crisis‐driven healthcare system.’
According to the MJA research, reform is achievable with significant overhaul and investment in several areas, many of which align with the RACGP’s policy recommendations for general practice.
One key focus area identified in the research that the college has consistently advocated for in its Vision for general practice and a sustainable healthcare system, is the need for integrated models of care.
The MJA paper says Australia is lagging behind other countries in this space, despite inquiries and royal commissions into sectors requiring the most urgent need for change such as aged care, disability, chronic conditions and mental health.

The RACGP strongly supports integrated models of care, and its latest submission to the Primary Health Reform Steering Group on the Draft Recommendations for the Primary Health Care 10 Year Plan details an integrated, one-system focus for reform and greater investment in general practice – which it says is in a ‘state of crisis’.
Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform, previously told newsGP that it is ‘more important than ever’ for general practice to be better supported to provide the care that patients need.
‘We’re now at a point where many practices are struggling to maintain profitability,’ Dr Wright said.
‘General practice is definitely at a crossroads. Throughout the pandemic – and prior to that – with the Medicare freeze, GPs and practices have been under increased pressure to maintain their viability.’
Increased investment and integrated primary care are both key areas in the college’s advocacy for the Mid-Year Economic and Fiscal Outlook (MYEFO) and Federal Election campaign.
Although funding is always welcomed, the RACGP has said it believes more is needed to maintain a sustainable future for the healthcare system and ensure ongoing comprehensive and coordinated care.
A significant issue is the current lack of consensus between federal, state and territory governments on reform, according to the MJA research.
‘State governments continue to fund acute and specialised service delivery along historical activity‐based lines, with the Commonwealth taking the heavy lifting on community general practice, pathology, radiology, specialist and aged care services,’ the authors wrote.
‘Without governance alignment, this allows little opportunity to develop fully integrated models of care.’
The authors cite New South Wales as an example of implementing effective vision and strategy in this area.
‘New South Wales has arguably been the most consistent, exploring integrated care over 15 years from early HealthOne demonstration sites to current maturing co‐commissioning models,’ they wrote.
‘Despite the many barriers to change, they have succeeded in delivering effective new models of care.’
In the LGA of Western Sydney, integrated care initiatives have been progressively incorporated into co-commissioning models of care, including:

  • specialist rapid access clinics for patient stabilisation and GP support, demonstrating a 32% reduction in emergency department (ED) presentations and a 34% reduction in admissions
  • diabetes outreach to general practice via specialist case conferencing, demonstrating enhancement in team capability and patient clinical outcomes
  • non‐prescribing pharmacists in general practices providing measurable change or deprescribing in complex care patients – a model the RACGP fully supports.
‘Co-commissioning has been the game changer, levelling the Local Hospital District/Primary Health Network playing field, equalising the governance model, and bringing state resources within scope for joint decision making,’ the authors wrote.
‘This is enabling true integration, with a shift in resources to community capacity-building, gradual closure of the hospital–community and health–social care gaps, and a rethinking of general practice financing outside the Medical Benefits Schedule.’
Co-commissioning in the state also incorporates eHealth developments, linking general practice and NSW Health data to enable analysis of patients’ journeys and outcomes.
Linkage via follow-up GP appointments after ED and hospital admissions is another of the RACGP’s priorities as part of its MYEFO and Federal Election advocacy efforts.
The MJA research calls for a nationwide implementation based on the successful factors forming models of care in New South Wales, by building on governance structures to bring critical organisations and service providers together.
According to the authors, this will enable joint planning and funding, along with the co-design, delivery, and ongoing evaluation of new health initiatives.
‘We must recognise that an increasing number of Australians need care that is complex and requires coordination by their ongoing community team in partnership with the broader health and social care sector − not care in silos,’ they wrote.
‘Health system governance and resourcing must now refocus. Although it is challenging, we must stop demanding band‐aid funding to prop up a fragmented, often wasteful, healthcare system, and declare a change in course.
‘This will require a focus locally on the identified root causes of current dysfunction, a system‐wide approach to solutions, the use of effective evidence‐based service reform focused on the needs of patients and families, and meaningful measurement and maturation.’
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