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Health efficiency plan ‘misses opportunities’ for GPs

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An inquiry dedicated to delivering efficient healthcare has missed chances to bolster GPs’ core role in preventive care, according to the RACGP.
 
Released earlier this month, the Productivity Commission’s interim report, ‘Delivering quality care more efficiently’, includes recommendations to improve preventive care, streamline regulation and reduce healthcare fragmentation.
 
It is one of five reports published ahead of the three-day Economic Reform Roundtable in Canberra last week.
 
The Productivity Commission’s report recommends:

• increasing cohesion in quality and safety regulation across care services
• providing more integrated and tailored care through collaboration
• creating a national framework to support investment in prevention.

However, RACGP Expert Committee – Quality Care Chair Professor Mark Morgan, who sent an RACGP submission to the inquiry, said the report falls short of the standard set out by the college, saying GPs remain ‘central to high-quality prevention’.
 
‘The interim report misses opportunities to build on what we know works well – high-performing, enabled and well-funded general practice,’ he told newsGP.
 
The RACGP submission calls for measures to support general practice multidisciplinary teams, general practice-based pharmacists, and health assessments across the lifespan.
 
None of these were specifically endorsed in the Productivity Commission report.
 
The college also highlighted that Medicare funding for longer appointments is lower per minute than for shorter, less complex consultations and called for 40% more funding for long consultations.
 
While the Productivity Commission report acknowledges the system’s reliance on ‘activity-based funding and fee-for-service funding models which “reward throughput, rather than better health outcomes or prevention”’, it does not commit to supporting higher rebates.
 
A significant part of the report is dedicated to preventive care, with the Productivity Commission recommending a new framework to support government investment in prevention.
 
It references the preventive role of primary care, as well as the early detection and treatment of secondary care, and effective management of chronic conditions in tertiary care, all areas emphasised by the RACGP.
 
However, there is no mention of the concept of quaternary prevention outlined in the college submission – a concept designed to reduce the risk of harmful over-testing and over-medicalisation.
 
Professor Morgan said the interim report also does not recognised the ‘huge role that could be played by the volunteer and community sector in keeping people healthy and independent’.
 
‘Social prescribing – where a health practitioner connects a person to local, affordable, group activities is a way to tap into the volunteer and community sector,’ he said.
 
‘[It] can help address loneliness, mental illness, the need for physical activity. It goes further – by strengthening communities and providing meaning through opportunities to volunteer.’
 
While the Productivity Commission emphasised the need for collaboration, it set out recommendations for ‘collaborative commissioning’ with PHNs, Local Hospital Networks and ACCHOs working together to plan, source and evaluate local services.
 
‘The RACGP view is that GPs need to be key players in these collaborative commissioning partnerships,’ Professor Morgan said.
 
‘I look forward to a future where GPs inform a ‘one health’ approach to achieving regional health outcomes.  
 
‘This might require cost shifting from very expensive hospital services towards prevention-focused multidisciplinary teams working in general practice.’
 
Impact of red tape
The Productivity Commission also says that an expanded role for AI scribes will increase efficiency by reducing time spent on routine tasks such as vitals monitoring and logistics – with AI a significant focus of the Economic Roundtable last week.
 
‘Scaling these technologies could free workers to focus more on high-value, face-to-face care,’ it said.
 
For the Chair of the RACGP Expert Committee – Funding and Health System Reform Associate Professor Rashmi Sharma, however, the potential for cutting general practice red tape is another important area for improvement.
 
She believes the administrative burden on GPs is increasing and detracting from their clinical roles.
 
‘Delivering quality care more efficiently requires maximising the time GPs spend caring for patients or otherwise facilitating that care,’ she told newsGP.
 
‘Reducing red tape would free up appointment time and improve GP wellbeing – there is a lot of time that we spend at the end of our day wading through this red tape that is frustrating and excessive.’
 
MRI ordering restrictions, adapting government forms such as NDIS requests to integrate more effectively with clinical and practice software, the rejection of named referrals, and applications for PBS authority approvals are among the areas ripe for improvement, according to Associate Professor Sharma.
 
‘One in three GPs rate applying for PBS authority approvals as their greatest administrative burden,’ she said.
 
‘Applications for authority approvals are now made for almost seven million medications each year. There needs to be investment to integrate it with our IT systems.’
 
Professor Morgan again emphasised the fundamental role of GPs in delivering more efficient and effective care.
 
‘There is no doubt that high quality and well-resourced general practice underpins the health outcomes Australia wants to achieve,’ he said.
 
The Productivity Commission will deliver a final report after considering follow-up submissions, including from the RACGP, which are due by 15 September.
 
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preventive care Productivity Commission quality care

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