RACGP calls for ‘blended’ aged care funding model

The RACGP has advocated for a number of reforms to aged care in a new position statement that provides a framework for supporting sustainable GP-led care for older people.
 
Greater funding should be dedicated to medical services for care provided in both residential aged care facilities (RACFs) and the community through ‘blended’ funding models, the college says.
 
Medicare-supported telehealth for aged care staff, family members and carers to consult with GPs – including when the resident is not present – is also among a host of other RACGP recommendations, such as voluntary patient enrolment (VPE) with additional resourcing.
 
The position statement comes in the wake of the aged care royal commission, which itself proposed a revamped primary care funding model – a prospect that has raised concerns among general practice.
 
Some GPs also reported concerns that the royal commission had overlooked the role of general practice in aged care, even though the sector provides the vast majority of medical care to this patient cohort.
 
RACGP President Dr Karen Price believes GPs play a vital, and often unrecognised, role in caring for older people.
 
‘The last year has seen an increased focus on aged care … and that shift could not come soon enough,’ she said.
 
‘People aged 65 and older account for 16% of the Australian population but represent nearly 30% of all general practice consultations.
 
‘Ensuring older people have strong access to general practice can make an enormous difference to their health and wellbeing.
 
‘We know people with dementia entering the aged care system are less likely to experience an increase in prescriptions for medications like antipsychotics if they retain a relationship with their usual GP who they know and trust.
 
‘So, by further strengthening and better equipping primary care we can significantly improve health outcomes and quality of life for older people across Australia.’
 
According to Dr Price, current models of care and funding arrangements mean there are significant barriers to GPs providing care to older people.
 
‘Sustainable funding reforms are needed to help GPs get on with the job of caring for older people,’ she said.
 
‘A voluntary patient enrolment system for all people over 65 living in the community, residents of aged care facilities and all Aboriginal and Torres Strait Islander people … would enhance continuity of care and achieve a stronger focus on preventive activities, early intervention and chronic disease management.
 
‘Medicare items for attendances at residential aged care facilities and home visits should also be increased to reflect the unique challenges of providing care in these circumstances.
 
‘The current structure is a disincentive to seeing more patients in one visit to an aged care facility and this must change because it will enable patients to maintain a relationship with their GP.’
 
Along with funding reform, the RACGP position statement also calls for interoperability of information and other technology systems between aged care services, pharmacy, hospital and general practice, and increased support for GP involvement in clinical governance, clinical oversight and aged care sector reforms.
 
‘GPs are highly skilled in medication management for older people, including for antipsychotic medications,’ Dr Price said.
 
‘We have ongoing relationships with our patients and so if we were to eliminate barriers for GPs to provide care to [RACF] residents, we could reduce inappropriate prescribing.
 
‘Greater funding to support GP case management, review and supervision is the key.’
 
Another recommendation is to have more Aboriginal and Torres Strait Islander leadership and participation in aged care decision-making and service delivery, while the RACGP has also called for improvements to workforce training.
 
‘We need more doctors supported and trained to provide services to older people,’ Dr Price said.
 
‘The RACGP supports a similar model to the [now ceased] Prevocational General Practice Placements Program to allow for a medical workforce pipeline into aged care settings.
 
‘Increasing the number of rotations and training placements for junior doctors in aged care facilities will strengthen their understanding of the aged care setting.’
 
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