RACGP ‘deeply concerned’ by aged care proposals

Matt Woodley

14/08/2020 3:32:50 PM

The aged care royal commission has drafted propositions that could dramatically affect GPs, including a ‘new primary care model’.

GP in aged care home
The RACGP has warned some of the changes would hinder resident access to high quality healthcare, while undermining existing effective models of service delivery.

The RACGP has outlined its concerns with a number of draft ‘propositions’ developed by the Royal Commission into Aged Care Quality and Safety in a submission that would significantly impact general practice.
The proposition of most concern, CH21, would see the Federal Government implement a new primary care model for aged care recipients by 2022 and require general practices to apply to the Government to become ‘accredited aged care practices’.
Accreditation could see general practices receive an annual capitation payment, but it would likely be attached to a requirement to provide after-hours care, along with an obligation to accept any person who wishes to register with them (subject to geography).
It would also see practices held to account against a range of performance indicators – including immunisation and prescribing rates – require them to initiate and take part in regular medication management reviews, and compel practices to prepare an ‘Aged Care Plan’ for each enrolled person that includes referrals for appropriate allied health services and dentistry.
According to the college submission, no GP or RACGP representative was consulted regarding the floated changes, despite the fact the proposed new model was tested by various witnesses at public hearings last month.
‘The RACGP is disappointed with the lack of engagement with the GP community regarding not only these draft propositions but all health needs for older people,’ the college submission states.
‘This lack of engagement will be to the detriment of the work of the royal commission and consequently the health and wellbeing of older Australians.’
While the underlying mechanism laid out in CH21 aligns with the RACGP’s preferred model for promoting continuity and coordination of care in the community, the college submission indicates it also contains significant faults that could decrease aged care access to general practice care.
‘The RACGP acknowledges that few details have been made available … [but] as a general statement of principle, if chronic underfunding is the issue affecting the provision of services to older people, then these changes are not likely to improve the situation,’ the submission states.
‘Furthermore, any proposal that seeks to create or define a separate stream of general practice providing services solely to older people is neither an appropriate solution nor acceptable to the RACGP.
‘This effort may actually hinder access while undermining existing effective models of service delivery and important components of high-quality general practice care, such as the long-standing therapeutic relationship between a patient and their preferred GP.’
The submission also indicates that CH21 may inadvertently create new challenges without sufficiently addressing the issues underpinning existing problems with access.
‘Any additional cost and administration involved in accreditation and/or reporting against performance measures will likely deter participation,’ it states.
‘In addition, an accreditation scheme will likely introduce barriers to GPs from non-accredited practices providing care. Initiatives that increase the burden on GPs or practices, or in effect exclude the majority of GPs or practices from providing services to older people, will lead to further reductions in access to necessary and high-quality care.
‘The majority of practices are independent businesses; though the size of the business varies, a commonality is often low profitability. No business case has been made that suggests the viability of this scheme, particularly with reference to the financial sustainability of engaged practices.
‘As a result, many GPs and practices will interpret the proposition as a risk to business viability.’
Other issues highlighted in the submission relate to propositions that would change the way allied health, mental health and oral health services are delivered and received.
In general, the expansion of funded services is perceived to likely benefit patients; however, the submission cautions that services must be both evidence-based and delivered according to individual assessed needs.
In particular, the submission lists concerns regarding:

  • the suggestion that introducing psychiatrist mental health treatment plan items negates the need for funding of these plans prepared by GPs
  • the proposal for the use of a mental health peer workforce to cover gaps in provision of mental health care to older patients
  • the proposal to specify a minimum interval between allied health appointments, which the RACGP states is clinically inappropriate
  • a suggestion that a residential aged care facility resident requires a minimum of 22 minutes of allied healthcare per day. The RACGP instead recommends that needs assessment and the agreed goals of treatment guide the ‘dose’ of allied healthcare delivered
  • insufficient attention being given to the consultation–liaison roles of allied health and the scope of allied health to supervise care assistants and nurses to effectively administer interventions
  • a need to ration dental services in an open and transparent way to avoid issues that developed with Australia’s previous Chronic Disease Dental Scheme.
‘While there are a number of positive recommendations, the RACGP is deeply concerned by many of the draft propositions,’ the submission states.
‘The RACGP considers that the logic underpinning many is flawed and does not grasp the fundamental issues and challenges that the sector faces.
‘In light of the significant changes set out by the draft propositions and other findings arising from the royal commission, the RACGP strongly recommends further engagement and collaboration with us and the general practice profession so that the commissioners and staff assisting may more fully understand the implications.’
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Dr Paul Kevin Nylander   18/08/2020 8:10:01 AM

It would really be nice to simplify the model of General Practice in Australia. There are too many bandaids and politically expedient special fixes. We are mostly self employed. Costs need driving down and fees net of expenses should be the yardstick. I think we have been driven into an abnormal way of life which means that we work long hours without toilet, eating, exercising and mental health breaks just to remain viable. As you age burnout is inevitable as are higher rates of mental illness, suicide, alcoholism, drug abuse, poor practice and marital problems. New model is needed but so is consultation. Reward for time thinking not just procedures needs to be implemented. Sub specialisation everywhere has made GP and medicine generally poorer. Not in my scope of Practice and not taking responsibility is lame. I am retired now but bear deep scars of the last 35 years. Sadly only Narcisists and Sociopaths and those on the Spectrum “survive” but our poor standing in community is sad.

Dr Christine Linnette Troy   18/08/2020 10:13:41 AM

As a consumer within the NDIS system for my children, I see the fees per hour for speech pathologists, occupational therapists, other allied health being paid at $220 per hour. Carers are paid at $30 to $40 per hour. I wonder what NDIS would pay a GP?
I think we are worth $300 to $400 per hour.
Aged Care is not well remunerated as it is, However if there was an Aged Care Insurance System that paid even $220 per hour to GP's to care for and coordinate the allied health care required for the Aged, that would be worth more than the $38.75 currently expected to be bulk billed per person (and decreases the more people seen).

Dr Ian Mark Light   18/08/2020 12:57:49 PM

If many more General Practitioners can be more encouraged to work in home visiting Aged Care Facilities and Patients in their homes this will be very good .
Medical education is continual so that is needed .
The College and the “Guideline “ people need to work out the details for excellent care .

Dr Graham James Lovell   18/08/2020 11:09:09 PM

Aged care work is just a luxury for those of us who are now older and financially secure and are prepared to generate low low hourly income compared to my private billing clinic ,as it is working in an inefficient time-wise consulting environment. The "Accredited Practice " proposed regulations , which would be another nightmare like practice accreditation will be an anathema to the majority of us doing the lions share of quality GP aged care visits - leaving well ? a great gaping hole in service provision...... its going to be a very sad, but possibly unavoidable event as it seems like a juggernaut with unstoppable momentum , and once we are gone I doubt that we will ever be convinced /encouraged to come back (or be replaced in any clinically competent form) .