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