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Stop the use of named hospital referrals: RACGP
The proposal is among a suite of reforms put forward by the college in its submission to a review of the National Health Reform Agreement.
Reforms to the health system are required to keep patients living healthier, longer lives, the RACGP has said.
Hospitals should be stopped from using named referrals for patients to access care, according to a new RACGP submission.
Under the suggestions put forward by the college for a review of the current National Health Reform Agreement (NHMA), officials should work to prevent the use of named referrals – long a bugbear among GPs.
‘Ultimately the practice of named referrals uses money that has been allocated for primary health to pay for the hospital sector,’ the submission states.
The proposal, which the RACGP says would help safeguard Medicare’s finances, is among a series of detailed measures to address what the college calls ‘significant gaps’ in the NHMA that have rendered the health system ‘fragmented and unsustainable’.
The submission was sent last week as part of feedback for the agreement’s mid-term review, with the college describing current pressures on primary care access as well as emergency departments ‘pushed to their limit across Australia’.
While the RACGP welcomed the tripling of bulk billing incentives and increased Medicare indexation announced in this month’s Federal Budget, the submission says more needs to be done to help general practice keep patients out of hospital.
The current NHMA addendum was endorsed by state and Federal governments to run from 2020–2025 with the stated intent to ‘improve health outcomes for all Australians and ensure our health system is sustainable’.
The college acknowledges actions designed to improve the health system but notes that they ‘are yet to significantly impact the delivery of primary care’.
‘While the NHRA Addendum discusses reforms in primary care, this has not been accompanied by the additional government investment in general practice required to support any reforms,’ the submission states.
The RACGP calls for more investment in primary care innovation as well as long-term reform to support the financial sustainability of general practice and its workforce.
For Dr Michael Bonning, a member of the RACGP Expert Committee – Funding and Health System Reform (REC–FHSR), the review is an important avenue to suggest improvements to the way primary and secondary care work together.
‘The breadth of the NHRA is that they encompass a huge amount of care that is delivered for Australians and therefore they are a particularly powerful tool in trying to create collaboration,’ he told newsGP.
As well as strengthening measures to stop named referrals, specific proposals described in the college submission include:
- greater support for ‘standardised, secure, interoperable digital systems for data sharing, referral and discharge between general practices and hospitals,’ as well as ‘to facilitate fast and easy clinician-to-clinician communication’
- pilot data-sharing arrangements between hospitals and primary care aimed at improving the identification of at-risk patients, as well as providing better individual care and care ‘tailored to the needs of communities’
- more places for hospital-based doctors in the John Flynn Program, as well as sustained funding for junior doctors to do a rotation in general practice
- beefing up general practice liaison (GPL) units to help communication between primary and secondary care
- enhancing the ways GPs can liaise with hospitals about patients’ unplanned admissions
- resuming data-gathering activities based on the Bettering the Evaluation and Care of Health (BEACH) project, which stopped in 2016, and remains widely viewed as the most reliable general practice dataset in Australia.
Broader reforms should also bring in a specific objective within the NHRA to support general practice in delivering preventive healthcare and reduce the strain on hospitals, the college advises.
According to Dr Bonning, such an aim would signal a welcome shift in focus.
‘One of the challenges of the review and reform of arrangements between states and the Commonwealth around hospitals and primary care is to recognise that our overall responsibility is to deliver good health services to where the patient is, and to make sure that those are done to promote good care and long healthy lives rather than focus solely on ill health,’ he said.
‘If you work in a system with more accessible primary care physician/GP services, you have a system that is invariably lower cost, and one that is easier to access for more people’s health needs, which reduces their long-term needs for hospitalisation.’
The reforms should go alongside ‘guaranteed, long-term, recurrent and indexed investment from both Commonwealth and state governments,’ the submission authors write.
Other proposals would look to reduce the remuneration gap between GPs and other specialists, as well as increase the exposure of medical graduates to general practice.
While the latter move is designed to boost interest in a career in general practice, Dr Bonning also makes the point that all GPs have worked within the hospital system, but the reverse is not always the case for hospital doctors.
‘We would think that over time access for all junior doctors to primary care rotations during their pre-vocational years would be very valuable,’ he said.
‘Even if many of those doctors did not end up in general practice, they would have a better appreciation for both the strengths and challenges of general practice, and a greater opportunity to understand how they can work collaboratively from the hospital setting.’
Within the submission, the college says the introduction of more blended funding would support comprehensive care and reiterates its ‘cautious’ support for the recently announced MyMedicare patient registration program, dependent on the details.
On a broad level, Dr Bonning believes that reform is needed to deal with an increasing number of patients with long-term, complex morbidity.
‘The overarching view on all of this should be that ways in which the care of the patient can be better orchestrated through the primary care and secondary care space will make for better health outcomes,’ he said.
The NHRA review process is being overseen by the Council of Australian Governments Health Council (CHC) and is due to be completed by the end of the year.
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