Report on Government Services reveals need to shift from EDs to general practice

Morgan Liotta

2/02/2018 3:23:14 PM

The Federal Government’s Productivity Commission this week released its 2018 Report on Government Services, which details the performance of health services and provides a snapshot of Australian general practice.

RACGP President Dr Bastian Seidel believes the hospital system should be encouraged to refer patients back to their GP, where appropriate.
RACGP President Dr Bastian Seidel believes the hospital system should be encouraged to refer patients back to their GP, where appropriate.

The 2018 Report on Government Services (the Report) reveals that although general practice consultations are on the rise, with an 8.6% growth during the 2016–17 period, potentially avoidable GP-type presentations at hospital emergency departments are high, with 2.8 million presentations during the same period.
‘I was not at all surprised by the finding that many Australian patients are choosing to go to the emergency department with conditions which could be treated by their GP,’ RACGP President Dr Bastian Seidel told newsGP.
Dr Seidel recognises that patients may go to the emergency department for a number of reasons, including that they may think it is more convenient or affordable. However, he believes that the hospital system should be encouraged to refer patients back to their GP, where appropriate.
‘They can have an X-ray, their bloods taken and access medication, all while they are at the hospital,’ he said. ‘But if patients presenting at an emergency department are assessed immediately then referred back to their GP, they will receive better care for a far smaller cost to the taxpayer.
‘On average, a single presentation to the emergency department costs at least $250 for the taxpayer. I could see five patients for that amount.’
The Report reveals some issues that could be contributing to avoidable presentations to emergency departments, including cost barriers and accessing GPs in certain areas.
Nationally in 2016–17, 4.1% of the Australian population reported that they delayed or did not visit a GP in the previous 12 months due to cost, and 7.3% reported they had delayed or did not purchase prescribed medicines in the previous 12 months due to cost. The average number of general practice visits per person each year increased again to 6.5, up from 6.4 in 2015–16 and 5.9 in 2011–12.
The Report also presents details of increased government expenditure, with the total expenditure on healthcare services in Australia estimated to be $170.4 billion in 2015–16, up from $161.6 billion in 2014–15. The Federal Government’s total expenditure on general practice in 2016–17 was $9.1 billion ($371 per person), an increase from $8.7 billion ($365 per person) in 2015–16.
The RACGP proposes that patient education, health literacy and ensuring Medicare adequately supports patient access to care, are part of the solution to reducing hospital emergency department presentations, both for acute and chronic issues over the long term.

Productivity-Commission Report-on-Government-Services

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Philip Dawson   6/02/2018 9:00:52 AM

The article didn't mention some ED interns are keen to play GP and invite patients back for daily dressings, wound checks, plaster checks removal of sutures etc. Clearly there is a lack of supervision and instruction of the function of EDs.

Mai Maddisson   6/02/2018 10:41:01 AM

I can't speak for all A and E staff but perhaps I do have my finger on the pulse a little given one of my sons is an A and E Physician. The concern of those doctors is to learn to optimise the management of patients who are not adaptable to GP management, to ready them for a return to the GP.
Perhaps looking at it thru a potential patient's eyes
1. No one likes to be shoved in and out of the door in 7-10 minutes, no matter how clever the doctor because apprehensive patients always forget to say something in that time.
2. General practices tend to show up in a harried presentation, and indeed A and Es while overworked often to present with a greater 'ambience' for want of a better word: You know that gentle look from the passing nurse or a doctor etc.
3. The booking system presents badly. The traditional 1/4 hour appointment times generate an allusion of 10-20 minutes allowing for flexibility. The ones ending in x.y0 apart from on the hour and half past generate an allusion of 5-15 minutes. Perhaps marketing needs to be considered.
4. Also under the marketing letter head is the clutter of what seems to be advertising doctors' wares, eg options like vaccinations etc. in the waiting rooms. It generates a sense of pushiness. Something more restful, even simple el cheapo pictures (prints) would present better. And patients would expect a GP to personalise what they offer.
5. The lack of availability of doctors at reasonable hours *. People's jobs have become increasingly insecure and patients can't afford to be perceived to be ill: It could cost them their job. With astute receptionists triaging giving those patients the 6-8 pm appointments would discourage A and E visits. But then doctors need to be prepared to be available as such at least once per week- perhaps with a late start the next day.
6. I have heard, from direct questioning of patients that they see the size of the precinct to be representative of the knowledge of the doctors: Also high drama from screaming ambulances tend to generate a sense of being able to manage more complex pathology.
7. The treatment seems to be for gratis: patients don't realise that they are paying for it out of their wages tax.
8. Society has become very fragmented and patients no longer have objectivity re what is serious, if it is serious or where time and if self TLC will fix the issue: Commonly learned from interacting with people living nearby.
9. There is no continuity in GP care these days: A and E staff are perhaps more 'stationary'.
10. The waiting rooms in the large corporate lounges are like airport terminals: When patients are unwell they like a little space also they like a little 'privacy' not to have the person a few doors away gawking at them. A and E's in that regard tend to generate more anonymity. Rows of chairs don't emulate that-- has anyone ever been to a cosy coffee shop? The chairs the are clustered while not crowded in. Padding for a short time is probably not so salient.
And as doctors we need to do our bit.
1. To be available at a patient's time of need NOT want.*
2. Patients' lack insight: there may be validity in one or two longer consultations explaining what is responsible use of GP time. Diplomatically done I have found this to be very effective.
3. Insisting on triaging appointments so those patients with more flexible times are offered times which others cannot use optimally.
4. Making elective appointments eg repeat medications well in advance to optimise mutual convenience.
5. Suggesting to patients that bringing in kids immediately after school is mutually unbeneficial: the kids are scatty and disrupt waiting rooms where more ill patients are also present-- A and Es tend to segregate! Managing scatty kids is more time consuming for the GP.
6. And some of this begins with reducing expectations from patients. Why have toys scattered around the waiting rooms for the elderly to risk #NOFs etc. Surely the parents can be educated to bring along a kid's favourite book and read it to them (quality parent- child time!!), or some equivalent. It will teach the children some patience for their adult life.


FACEM   6/02/2018 10:24:06 PM

You could see five patients and provide consultation, radiology, pathology, plaster materials and medications all for $250? Are we comparing apples with apples?