RACGP responds to primary care recommendations

Jolyon Attwooll

27/07/2021 5:38:12 PM

Greater funding is ‘critical’ to address risks to high-quality general practice care, according to an official college submission.

Graphic representing business of general practice.
The RACGP’s Dr Michael Wright says many practices are struggling to maintain profitability and reform is needed.

‘A state of crisis’: that is how the RACGP defines the situation confronting general practice.
The scale of the challenges facing the profession is outlined in a detailed college response to the Primary Health Reform Steering Group’s recommendations for the long-term future of primary care.
‘Funding has stagnated, there are critical gaps in workforce supply, and the high-quality care GPs provide is at risk,’ RACGP President Dr Karen Price writes in a letter accompanying the submission.
‘We must see large-scale investment to rebuild the primary care sector to provide high-quality, patient-centred care.
‘Central to this reform should be greater investment in, and utilisation of, general practice.’
The submission, which includes responses to each of the steering group’s 20 recommendations, carries a warning that the reforms ‘must not tinker around the edges of a failing system’.
One of the steering group’s key recommendations is to ‘deliver funding reform to support integration and a one system focus’.
In its submission, the college expresses in-principle support for the recommendation and actions suggested, and cites its Vision for general practice and a sustainable healthcare system.
Chair of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), Dr Michael Wright, was closely involved in putting together the response.
‘We’re now at a point where many practices are struggling to maintain profitability,’ he told newsGP.
‘General practice is definitely at a crossroads. Throughout the pandemic – and prior to that – with the Medicare freeze, GPs and practices have been under increased pressure to maintain their viability.
‘It’s now more important than ever that general practice is better supported to provide the care that patients need.
‘The Vision for general practice outlines a lot of similar recommendations from the steering group, but with more detail of how it might be achieved.’
The response sets out the need to modernise and invest in the fee-for-service funding system to reflect GPs’ skills and the costs of providing high-quality care, and backs reform to support longer consultations for more complex patients.
There is also a push to evolve the healthcare system towards a more comprehensive, preventive approach through investment in primary care.
Economic analysis of the RACGP Vision suggests investment in general practice will save $1 billion in the first year and $5.6 billion over the next five years, as well as improving health outcomes.
As part of this, the college advocates for more support to help reduce preventable hospitalisations, a stance articulated in response to the steering group’s first recommendation.
‘Dedicated time to see a GP following an unplanned hospital admission will help to reduce the chance of a readmission,’ the submission states.
‘Australian research shows that patients who see their GP within seven days of an unplanned hospital admission have a significantly lower risk of readmission within 30 days.’
Conservative estimates suggest general practice can prevent at least 12% of readmissions through follow-up consultations, with annual health system savings of around $69 million.
Other reform areas considered include a move to ‘formalise and strengthen the relationship of individuals, families and carers with their chosen primary healthcare provider and practice’. Here, the college articulates its cautious support for an ‘appropriately funded’ Voluntary Patient Enrolment (VPE) model alongside the fee-for-service system.
However, there were significant caveats, with the college reiterating strong opposition to any compulsory model of enrolment, as well as to any model that replaces fee-for-service or reduces GPs’ capacity to decide appropriate care in partnership with their patients.
Any VPE model would also need to be receptive to clinician feedback and have additional funding support, the submission says.
Among other recommendations backed by the RACGP are the commitment to support the National Agreement on Closing the Gap for Aboriginal and Torres Strait Island peoples; structural reform to address the poorer health outcomes in rural and remote communities; and moves to address GP shortages.
The wide-ranging role general practice plays within the healthcare system is also stressed in the RACGP response, including details of how Australians see their GPs more than any other health professional. Almost 90% of Australians consulted their GP in 2019–20, the submission states.
The 26-page document was submitted this week.
The accompanying letter concludes: ‘The recommendations put forward by the Steering Group are a step in the right direction.
‘However, the Steering Group must seize the opportunity to direct government to address the challenges facing the primary care sector and build a sustainable system that meets the needs of all Australians.’
The Primary Health Reform Steering Group was established to provide independent expert advice for the forthcoming Primary Health Care 10 Year Plan, which will sit within the broader framework of Australia’s Long Term National Health Plan.
According to the Department of Health website, the steering group has met 16 times since its formation in spring 2019, and its draft recommendations were released for consultation last month.
The recommendations are due to be finalised by the end of this year, after which they will be submitted to the Government.
Dr Wright is clear that reforms will need to be substantiated with extra support for general practice.
‘Introducing reform without additional funding is just bureaucracy,’ he said.
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