Poll reveals GPs want more disability care support

Dr Maya Luks knows firsthand about caring for patients with disability, but she is also on a mission to fill current workforce gaps for GPs providing this care.
 
As a GP and practice owner of a multidisciplinary clinic for people with a disability in Adelaide, Dr Luks is a member of RACGP Specific Interests Disability. She is also a current RACGP Future Leaders Program participant, with her project focusing on building capability of GPs in disability health.
 
Her advocacy effort comes as a newsGP poll revealed 60% of respondents are ‘not at all comfortable’ in their ability to help patients requiring disability care and management and need more support. Meanwhile, 31% feel ‘somewhat comfortable’ and 8% feel ‘very comfortable’.
 
Dr Luks said these results offer ‘really interesting’ insights into the current workforce.
 
‘This didn’t really surprise me, because based on discussions with colleagues who work in mainstream general practice settings, I know they do find disability care and management really challenging,’ she told newsGP.
 
‘That’s partly due to the complexity of the NDIS, but underpinning all of that is the lack of education medical students receive in their undergraduate or postgraduate training, and subsequently in Fellowship training, and that’s really seen across the board, not just in general practice, but also in other specialty training programs.’
 
Noting there is ‘very little’ taught about disability medicine, intellectual and developmental disabilities, Dr Luks said when GPs in training do learn these topics, it is usually more of a paediatric focus on what is normal development for a child, and picking up on red flags when development isn’t progressing normally.
 
‘Very little is ever taught about disabilities from age 18 onwards, and if you think about it, people spend most of their lives as adults, so it doesn’t make a whole lot of sense to ignore that aspect of training,’ she said.
 
‘And that’s really reflected a lot in the feedback I hear from families – parents will often talk about how their children get a lot of support through paediatric services, through children’s hospitals or private pediatricians, but once a child with a disability turns 18, a lot of those supports fall away, and a lot of the care then comes down to having a GP.’
 
Dr Luks highlights, however, the multiple barriers to people with disability being able to access GP care in the community – with those barriers further compounded if the workforce needs more support.
 
The RACGP has several resources to support GPs in this space, including a disability care contextual unit as part of its curriculum and syllabus, and opportunities for GPs who have a special interest to apply for a Recognition of Extended Skills in developmental disabilities.
 
RACGP Specific Interests Disability Chair Dr John Crimmins is hosting an upcoming webinar on managing key health issues in adult patients with an intellectual disability, with an on-demand recording available on identifying these health issues.  
 
Dr Maya Luks is advocating for GPs to be better upskilled in providing disability management and ongoing care. (Image: supplied)

Dr Luks also points to the National Centre of Excellence in Intellectual Disability Health’s recommendation that ‘where specialty training is available for a health profession, intellectual disability should be included in the core curriculum of that specialty training program’.
 
The National Roadmap for Improving the Health of People with Intellectual Disability backs support for healthcare professionals to ‘provide better care’ including curriculum development and CPD opportunities in intellectual disability health.
 
She is also hoping her Future Leaders project will build on this work, with a goal to secure a further commitment from the RACGP to upskill the workforce, starting from training onwards, and including a regular program of CPD for Fellows of the college.
 
‘At the moment there is no robust plan to try and upskill the workforce, it is ad hoc and dependent on individuals who work in this space, but I feel there does need to be more of a coordinated, college-led approach,’ she said.
 
She adds that with the recent NDIS overhaul, it is ‘not surprising GPs feel this way’.
 
‘GPs have been cut out of having any input into the design of the NDIS, yet we are asked on a daily basis by support workers of patients with a disability or other care providers to complete paperwork that is required by the NDIS,’ she said.
 
‘So it’s really been a lot of learning on the run that GPs have had to do, which is unfair on the profession.’
 
The RACGP has long called for GPs to be better integrated into the NDIS process and legislation, with its position statement on disability care recommending they have the opportunity to view and discuss draft NDIS plans with the patient, and provide feedback and advice to NDIS planners for consideration when finalising the plan. It also calls for GPs to be an ongoing part of patients’ health and social journey, supporting continuity of care.
 
With the college advocating for a greater presence of GPs within the NDIS, Dr Luks says regardless, GPs will still need to interact with the system, and potentially to a greater extent if further cuts are made to allied health providers, she notes in reference to the latest NDIS pricing guide.
 
‘If you’ve got funding cuts to NDIS services, potentially fewer providers into the future, combined with smaller NDIS plans, that’s going to ultimately mean less care, and they’re going to look to GPs to fill that shortfall,’ she said.
 
‘Because those patients have to look elsewhere for their care if they’re not able to access the same degree of allied health support because the funding has been cut, well, where else are they going to go?
 
‘GPs are often the ones who are left to pick up any slack in the system, not just in disability care, but just generally, and if our workforce is feeling unprepared for that, it’s not going to be good for the workforce, or for patients.’
 
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