The GP helping to boost veterans’ care

It is rare for a high-ranking Government official to be both as frank and upbeat as Dr Steph Davis, the Chief Health Officer at the Department of Veterans’ Affairs (DVA).  
 
The Canberra-based GP balances an honesty about the stymying impact of red tape, a frequent criticism of the DVA, with a striking optimism about the potential to improve health in her role, which she began last August.
 
Trained both in general practice and as a public health physician, she describes it as an ‘exciting’ time to work at the DVA, a label she acknowledges is not often applied to a government bureaucracy.
 
‘There’s this really interesting mix of policy and research and service delivery, and so there’s a real opportunity to make a difference here,’ she told newsGP.
 
‘There’s a real ... move to really try and prioritise treatment and to really see how we can actually make some differences in the system so we’re ensuring that veterans have the best access to evidence-based care.’
 
Drawn to the role partly due to personal connections – Dr Davis’s partner served in the Forces, as did her grandfathers in World War II and great-grandfathers in World War I – she has also enjoyed looking after veterans in her clinical practice.
 
In particular, she recalls caring for two World War II veterans when they were patients in their later years.
 
‘It was a really lovely and rewarding thing to do, a real privilege,’ she said.
 
Now she sees one of her key roles as helping those who need care to access it, as well as supporting providers to navigate the system, which in theory funds many more services than Medicare.
 
It is an approach with legislative momentum behind it, with reform due to kick in this July ‘so veterans and families can more easily get the support they are entitled to’, according to the Government.
 
It follows a damning final report from the Royal Commission into Defence and Veteran Suicide, in which one ex-Navy member described the DVA’s approach as ‘delay, deny, die’.
 
Dr Davis herself is candid about the challenges of navigating the DVA, which she knows for most GPs represents ‘a tiny bit’ of their work when compared to engaging with Medicare.
 
‘As a GP myself, who has treated veterans but I haven’t been a veteran-specific provider, it seemed quite opaque how the whole system worked,’ she said.
 
‘It’s a heavy legislative framework that governs what treatments are funded and what treatments aren’t funded.
 
‘We’ve certainly got a lot of work to do there around raising awareness and trying to make those systems and processes much smoother.’
 
She says a key area for GPs relates to the Coordinated Veterans’ Care program, designed to help manage veterans with chronic conditions and complex care needs. A recent evaluation suggests some GPs are not aware of the program, and reforms are underway, with input from the RACGP, to make it more effective.
 
Other work in progress includes collaborating with a team of DVA advisors on policy areas such as low-level blast injury, while she also references ‘really exciting’ work going into treatments for post-traumatic stress disorder (PTSD), depression and anxiety.
 
Last year, the DVA announced eligible veterans would be able to access funding for psychedelic-assisted psychotherapy treatments to address PTSD and treatment-resistant depression.
 
Another big call since Dr Davis came on board was the introduction of stricter criteria for funding medicinal cannabis, including the need for an initial face-to-face consultation.
 
She says the move was in response to a vertically integrated telehealth system driven more by commercial interests than the health interests of veterans – although she is careful to say that many have benefited from the treatments, particularly when used for chronic pain.
 
‘This is not to deny people access, it’s trying to make sure that we are funding things which are safe and effective and are not causing harm,’ she said.
 
While there has been some pushback, she said ‘the vast majority’ of feedback is supportive.
 
‘It’s been really heartening,’ she said.
 
‘It’s fair to say you’re not always the most popular person in the room when you say, “I’m here from DVA”.
 
‘But we’ve got really positive feedback from most people around these changes.
 
‘There is a high level of concern in the medical community around where this has been going.’
 
Dr Davis also welcomes the recent step by the RACGP to expand its Recognition of Extended Skills area to include military medicine and veterans’ health, a move which involved input from the DVA, and stresses her gratitude to GPs involved in the space.
 
‘We’re at the pointy end, and we all know the benefits of longitudinal comprehensive coordinated care that GPs can deliver so well and the impact that has on both individual and population health,’ she said.  
 
‘So just thank you.’
 
The highlights of the role so far, Dr Davis says, have been working with her team, and hearing from both health professionals and their patients.
 
‘I’ve got a whole bunch of doctors and allied health people … who are really committed to veteran health and a lot of them have served in the defence forces themselves,’ she said.
 
‘They’re just brilliant to work with.
 
‘I’ve also really enjoyed getting out and speaking to providers whenever possible. The best ideas always come from the ground.’
 
Perhaps as you would expect from a conscientious GP, she seems most struck by the moments the system has tangibly made a positive difference.
 
Dr Davis cites a recent conversation with a war widow who ‘had a really hard life’ and had a hip replacement funded through the DVA.
 
‘It was really touching actually,’ she said. ‘She was so grateful for having that opportunity to have that done.’
 
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