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Researchers propose steps to ‘reinvigorate’ general practice

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GPs have long been aware of the multiple factors impacting the sector’s future – from an ageing workforce and a declining interest from medical graduates to widespread burnout.
 
This has been further exacerbated by the COVID-19 pandemic, coinciding with a rise in the prevalence of chronic diseases with complex comorbidities.
 
Health system reform is now in the spotlight, with Australians anticipating what could be the biggest changes since the establishment of Medicare. But what that reform looks like exactly is still unclear.
 
So what happens in the meantime?
 
In a new editorial, published in the British Journal of General Practice, a team of GPs and researchers from Macquarie University have proposed a possible interim solution – reinvigorating general practice as a Learning Health System (LHS).
 
To capitalise on the value that primary care systems can offer in their current state, the authors note the need for a ‘concerted effort from within the profession’ to enable the ‘creation and sustenance of high-performing general practice clinics’.
 
According to the authors, key features of an LHS include:

• science and informatics to measure real-time access to knowledge and digital capture of the care experience
• patient–clinician partnerships that engage and empower patients
• incentives that reward high-value care and emphasise transparency
• a continuous learning ethos that focuses on a leadership-instilled culture of learning and provides supportive system competencies
• developing organisational structures and governance mechanisms that take into account relevant policies and regulations, and facilitate collaboration, learning and research.

The authors say that if GPs draw on this framework, and work with effective teams in efficient operational models, that doctors can ‘avoid burnout while maintaining confidence in the impact their work is having on their patient population’.
 
Lead author and GP, Dr Darran Foo describes what general practice is currently experiencing as a ‘perfect storm’ with an urgent need to be proactive.
 
‘We need to create a primary healthcare system that consistently delivers reliable performance and constantly improves, systematically and seamlessly, with each care experience,’ he said.
 
‘In short, we need a system with an ability to learn.’
 
Dr Foo says the vision is for practices to operate more as teams ‘without every decision falling back to a GP’.
 
‘GPs will have better access to data, so that accurate patient records are quickly available,’ he said.
 
‘Clinicians can see that they’re achieving outcomes for their patients, and everyone in the practice can see how effectively they are working for all their patients.’
 
At Dr Foo’s MQ Health GP Clinic in Sydney, they have introduced an LHS developed with the Australian Institute of Health Innovation (AIHI). Similarly, an LHS approach has been adopted by Kaiser Health and the Department of Veterans’ Affairs, which manages healthcare for six million veterans, in the US.
 
‘I believe we can quickly make a difference for patients,’ Dr Foo said.
 
‘If, for example, you’re coming to see me with diabetes, I won’t have to spend the first 30 minutes reconstructing your history. I’ll have instant access to your wearable data including a continuous glucose monitor.
 
‘I’ll be able to empower you to manage your own condition, with appropriate measures and targets.’
 
Professor Mark Morgan, who is Chair of the RACGP Expert Committee – Quality Care, said Dr Foo and his co-authors have ‘beautifully summarised’ the challenges general practice is facing both in Australia and abroad. Though he believes LHSs ‘sound wonderful’ in theory, he told newsGP he doesn’t think the approach is practical for the average practice.
 
‘It is hard to imagine implementing this in practices struggling to meet patient demand, recruiting the next GP and maintaining income in the face of inadequate patient rebates,’ Professor Morgan said.
 
The Queensland-based GP acknowledges that LHSs do incentivise high-value care, but he says how this can be achieved has yet to be established.
 
‘LHSs use real-time informatics so that GP team members can continuously improve without formalised plan-do-study-act cycles,’ he said.
 
‘These real-time dashboards, reports, prescribing alerts and care prompts are built into software programs such as Primary Sense. But some of the features are yet to be widely available, such as the digital capture of patient-reported experience measures.
 
‘Plus, it is all too easy to design pay-for-performance systems that lead to unintended consequences when patient choice or complexity does not align with the system.’
 
AIHI founding director, Professor Jeffrey Braithwaite says successful implementation of LHSs in the primary care sector could have various benefits for GPs, patients and governments.
 
‘We could see improved population health, enhanced patient experience, reduced cost of care, and improved clinician satisfaction,’ he said.
 
‘We want to start a conversation with GPs to discuss what we can do at a local level, while government works out policy. It’s not a magic bullet, but an important component that will complement the large-scale reforms that are urgently needed.’
 
While Professor Morgan believes that working within an LHS would enhance ‘the sense of professionalism and joy’ in the workplace, he says Australia first needs some rescue policies to ‘pull general practice out of the hole it is falling into’.
 
‘You only have to look at the short-sighted and destructive machinations over payroll tax to see how little our sector is understood by government departments,’ he said.
 
‘For positive change to occur, GPs need to be seen as a valuable resource providing essential healthcare services. Instead, we seem to be viewed as an expense to be capped.’
 
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burnout general practice reform learning health system LHS practice software

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