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Royal commission calls for revamped primary care funding model
The recommendation was contained in the newly-released Final Report from the Royal Commission into Aged Care Quality and Safety.
The final report includes 148 recommendations designed to improve aged care in Australia. (Image: AAP)
The new model, is contained within 148 recommendations included in the aged care royal commission’s final report, and is designed to encourage the provision of ‘holistic, coordinated and proactive’ healthcare – but the RACGP has some concerns.
In response to the report, the Federal Government has set aside more than $452 million to address ‘immediate’ shortcomings in Australia’s aged care system, with a major focus on strengthening aged care provider governance and improving oversight of home care.
According to the report, the planned primary care overhaul will attempt to solve access issues associated with the current fee-for-service model, which Commissioners Tony Pagone and Lynelle Briggs agree is partly due to the amount of funding available for GPs providing aged care.
‘We heard evidence about the problems with the fee-for-service funding model, particularly that it creates an incentive for care that responds to an episode of ill health, rather than encouraging care that proactively attempts to reduce the risk of ill health,’ the report states.
‘Primary health care practitioners are either not visiting people receiving aged care at their residences, or not visiting enough, or not spending enough time with them to provide the care required. Access to general practitioners will continue to be a challenge for people receiving aged care unless something significant is done to fix it.
‘Commissioner Briggs considers that … part of the problem is the way in which, and the amount that, general practitioners are funded. Commissioner Pagone agrees that the funding of general practitioners for people in aged care is insufficient and is an issue that requires consideration.’
As a result, the commissioners have agreed with recommendations previously tabled by the Counsel assisting – QC Peter Rozen and QC Peter Gray – to establish a voluntary primary care model for people receiving aged care that contains the following characteristics:
- general practices could apply to the Australian Government to become accredited aged care general practices
- each accredited practice would enrol people receiving residential care or personal care at home who choose to be enrolled with that practice
- each accredited practice would receive an annual capitation payment for every enrolled person, based on the person’s level of assessed need
- the accredited practice would be required to meet the primary health care needs of each enrolled older person, including through cooperative arrangements with other general practices to provide after-hours care
- participation would be voluntary for general practices and patients.
However, while both commissioners support the establishment of a new model by no later than 1 January 2024, they differ on its implementation.
‘Commissioner Pagone recommends that the Australian Government should trial such a model for 6–10 years, after which time the Australian Government should undertake a thorough evaluation of the model,’ the report states.
‘He considers that a trial is necessary to determine whether it is viable to adopt a different model to improve access to health care for people receiving aged care.
‘Commissioner Briggs considers that the new primary care model for older people using aged care should be adopted now as it is the only viable option to address older people’s health access problems and will provide for better management of chronic and complex health conditions. She recommends that the model should be reviewed for enhancements progressively.’
The RACGP has
previously expressed concerns about such a model,
stating that while accreditation could see general practices receive an annual capitation payment, it would 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.
The submission states that these shortcomings could in fact serve as further barriers for GPs providing care to aged care residents.
Other recommendations that relate directly to general practice include:
- the establishment of a ‘comprehensive, clear and accessible’ post-diagnosis support pathway for people living with dementia, their carers and families, by 1 January 2023
- as part of this, the Australian Government should provide information and material to GPs and geriatricians about the pathway and encourage them to refer people to the pathway at the point of diagnosis
- improved public awareness of aged care by funding and supporting education, and the dissemination of information, by 1 July 2022
- part of this strategy involves bringing older people’s GPs to the centre of planning for ageing and aged care
- by 31 December 2021, the RACGP should amend its Standards for general practices to allow for accreditation of general practices which practise exclusively in providing primary health care to people receiving aged care and in their own homes
- the creation of specific Medicare Benefits Schedule (MBS) items to improve access to medical and allied health services
- amend the Pharmaceutical Benefits Scheme (PBS) Schedule by 1 November so that only a psychiatrist or a geriatrician can initially prescribe antipsychotics as a pharmaceutical benefit for people receiving residential aged care
- GPs would only be able to issue repeat prescriptions of antipsychotics as a pharmaceutical benefit for up to a year after the date of the initial prescription.
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