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80% of Australians have a regular GP: The importance of continuity of care


Larissa Dubecki


22/11/2017 8:59:51 AM

Long considered a core component of general practice, continuity of care is becoming increasingly complex in the world of modern general practice.
 

Maintaining continuity of care is increasingly complex in general practice
Maintaining continuity of care is increasingly complex in general practice

Long considered a core component of general practice, continuity of care is becoming increasingly complex in the world of modern general practice.
 
The growing size of many practices, limitations of technology and the increasing prevalence of mental health issues all present challenges and solutions to the best practice ideal of a patient seeing a single GP or inter-connected group of health professionals over an extended period.
 
Regardless, Australia is faring well when it comes to continuity of care. As indicated by the RACGP’s recent benchmark report, General practice: Health of the nation 2017, almost 80% of people identified having a regular GP, increasing to more than 90% among those 65 and older. The majority of patients – almost three-quarters – felt they could see their GP whenever they needed.
 
But these numbers may not tell the whole story.
 
‘On the surface that’s pretty good, but it indicates there’s a proportion of people who can’t see their GP when they want, and there’s also a number who don’t have a GP,’ Dr Michael Wright, a GP and PhD candidate researching the therapeutic outcomes of continuity of care, told newsGP. ‘They are potential areas where we might try and highlight the importance to people of continuity of care and encourage them to pursue it.’
 
While Dr Wright noted that the changing nature of general practice is not at odds with the pursuit of continuity of care, the greater prevalence of larger practices is making it harder for a patient to see the same GP every time.
 
‘We’re now considering this idea of continuity of care around the practice as well, where it’s the importance of sharing information appropriately that might allow safer, high-quality care to happen,’ he said. ‘But we need to acknowledge that access to care and continuity of care are often a balance. It’s about navigating this fine balance, which is an ongoing policy problem.’
 
RACGP President Dr Bastian Seidel told newsGP that continuity of care remains important to patients and GPs; however, the time necessary to ensure this continuity may be somewhat threatened by the emergence of mental health issues as the number one reason for GP visits.
 
‘In the past, patients were referred very early on to see a psychologist, psychiatrist or mental health worker, but patients don’t want this,’ he said. ‘They don’t understand the situation: if you are the treating doctor who has seen them over the years for heart problems or for diabetes, then why do you suddenly want to send them away because they have a mental health condition?
 
‘It’s not natural for patients and they actively resist it. They say, “You are my GP. I trust you and you are going to help me through this time”, which is great, but it means GPs need more time.’
 
The complex interplay between mental health issues and medical conditions such as heart disease and stroke is also factor in favour of protecting continuity of care in general practice.
 
‘We’re getting better at exposing some of the distress patients have, and continuing professional development and student medical training is emphasising the need to find out about whether the physical ailment that brought the patient in has a psychological component,’ Dr Mark Morgan, Associate Professor in Health Sciences and Medicine at Bond University, and a member of the RACGP Expert Committee – Quality Care, told newsGP. ‘But it’s impossible to do that with a complete stranger in a short consultation, because you need to establish trust and rapport.
 
‘The relative value of a bulk-billed GP consult has dropped a long way behind what it used to be.’
 



Continuity-of-care



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Oliver Frank   21/11/2017 3:02:55 PM

"While Dr Wright noted that the changing nature of general practice is not at odds with the pursuit of continuity of care, the greater prevalence of larger practices is making it harder for a patient to see the same GP every time."

I see no logic in this statement that connects the size of practice with being able to see the same GP every time. There is no reason why patients can't and shouldn't be equally as able to do so in a larger practice as in a smaller one.

The real reason(s) why patients attending some practices can't see the same GP every time are:

1. More GPs practise part time, while others practise full time, but do so by deliberately choosing to practise part time in each of two or more practices that often are not related by common ownership, location or nature of the services being offered.

2. Some practices have a policy of not allowing patients to make appointments at all or with a particular GP, but have to see whichever GP the practice dictates at the time.

It is important to note that it is not true that patients ever were able to see the same GP every time. This is because all GPs are unavailable some of the time, on holiday, sick, at conferences or attending to family and personal matters.

Size of practice in itself has nothing to do with whether the patient can see the same GP every time.


Chris Bollen   21/11/2017 4:40:48 PM

Great points Oliver. And the other factor in 2017 to reflect upon regarding continuity is the ability to interact with a regular GP via technology- SMS, email or other asynchronous communication methods. Under current medicare "rules" a patient must literally "see" the GP in order for a rebate for "care" to be paid. Continuity can be enhanced via technology , as it is recognised with many chronic conditions and some acute conditions, the need for face to face interactions is reduced. However, the Medicare system is a current barrier to support a more patient centred experience. A good question for our colleagues would be to ask if there were payments for non face to face interactions, would they do more of this in order to support continuity? Or are they so busy seeing people, they would not have time allocate to other forms of consultations? It's an important discussion for the future, especially with many practices looking at the philosophy of Patient Centred Medical Homes, and the new funding models for Australia's "Health Care Homes". It also becomes important to reflect on how our primary care teams are formed and communicate. The role of "teamlets" and enrolled patients also becomes important for continuity. Again, the discussion about better management of chronic disease is now not how good a doctor a GP may be, but should be how good the practice system in which he/she works actually is, and how well supported the individual person with a chronic condition feels. Would be useful to hear from others on this topic.


John Billaby   22/11/2017 5:03:19 PM

That's exaggeration. Only 30-40% have regular GPs. With the advent of corporate walk in clinics,the situation is becoming worse. Patient's want to attend a particular practice but not a particular GP all the time. A corporate practice, say sees 300 patients a day and many of them might have waited upto 4 hours to see a random GP. On the contrary the practice will see the same number by offering 10 minute appointments and the patients will see their preferred GPs.

Healthcare is a serious business and it's corporatization will make it only worse in terms of quality.


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