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What are the major healthcare challenges facing the new government?


Matt Woodley


30/05/2022 5:02:14 PM

RACGP state and territory faculty chairs lay out the main general practice issues confronting their area.

Map of Australia.
RACGP state and territory faculty chairs believe more investment is needed in primary care.

Australia is 4000 km wide and nearly just as long. The sixth-largest country on Earth, it is home to more than 26 million people, all with their own individual healthcare issues and needs.
 
But despite the different priorities found in cities and towns across the country, two issues appear to be ubiquitous: there are not enough GPs, and primary care funding is far too low.
 
That is according to RACGP state and territory faculty leaders, who spoke with newsGP last week to outline what they believe are the main healthcare concerns that need addressing in their jurisdiction by the new Federal Government.
 
Other issues include encroachment on areas of medicine traditionally assumed by general practice, a disconnected healthcare system, and business sustainability.
 
Read their responses below in full.  
 
West Australian Chair Dr Ramya Raman
Emergency departments are under pressure in WA. Improving overall community health, which requires appropriate support for the GP workforce, is key to reducing the strain.
 
Our call for greater investment in rural healthcare, including workforce incentive payments for GPs with advanced skills is part of a wider set of priorities that I would like to see implemented along with those the college has called for in its Federal Election Statement.
 
The time to enact such reforms that promote sustainable general practice is now.
 
Conversely, the proposed urgent care clinics could run the risk of creating more problems than they solve.
 
We are keen to see a funding model that enables sustainable GP-led after-hours services for acute care that leverages existing practices and infrastructure without needless waste. It is essential that fragmentation of care is not inadvertently promoted through duplication of services through a mis-implemented urgent care model.
 
Detailed consultation with the college will be essential. 

Victoria Chair Dr Anita Muñoz
What we need is meaningful system reform rather than the plugging of gaps in a siloed fashion.
 
So we really need to see the health system as an entity that is integrated and interconnected, and we need a willingness to dispense with the strict lines of federated funding models.
 
There should be flexibility and innovation in the way we think about health funding, so that we’re making decisions about how to spend our health dollars based on better patient outcomes, better integrated care, better efficiencies, and also creating an environment for healthcare workers that is sustainable and not so prone to burnout and attrition.
 
There is also a need for meaningful investment in primary care, because it is totally irrefutable now based on all of the evidence that we have internationally and domestically, that investment in primary care makes for a more efficient and sustainable health system.
 
It also improves outcomes, and it makes patients happier and healthier. We can’t continue to ignore the fact that community primary care and general practice are the absolute basis of a healthy health system.
 
If we continue to only invest in the most expensive end of health, which is when patients are at their sickest, and not invest in preventive care that stops people from becoming increasingly sick, then we’re really only ever dealing in downstream solutions. And we know downstream solutions are the most expensive solutions.
 
So, we have to think upstream models, and we have to be prepared to cross over old boundaries and barriers in terms of funding and responsibilities.
 
Tasmania Deputy Chair Dr Toby Gardner
Our major current issues are:

  • workforce, as we are at least 60 FTE GPs short currently
  • recruitment and retention of GPs to rural areas, as Tasmania is the most decentralised state per capita
  • the drift of medical students to the non-GP specialist colleges
  • the care of our complex, chronic and aged patients, who are the oldest and sickest in the nation.
These are not easy things to fix overnight and require significant long-term investment in primary care. My proposed starting point for finding solutions are:
 
  • increasing rebates for longer consultations to improve quality of care
  • (funded) voluntary patient enrolment to improve continuity of care
  • increased intake of students into medical school from rural areas (eg increasing quota by 10%)
  • better incentives for those working in rural areas, including promotion of the HELP debt waiver scheme that was recently introduced
  • access to relevant specialist MBS items for rural doctors with extra skills, and service incentive payments (SIPs) for providing care to patients in residential aged care facilities.
South Australian and Northern Territory Chair Dr Daniel Byrne
There are three main issues in SA and the NT for the new Federal Government:
 
1. A need for meaningful rural GP support including financial, training and education incentives.
 
2. Outer metro GPs are starting to feel the pinch from workforce shortages. We must have improved Medicare support. In 2019 just after the last Federal Election the outer metro incentives were removed by the Coalition. Obviously, they need to be brought back.
 
3. General practice as a career choice needs to be competitive with other specialities. Decent incomes need to be on offer to attract more applicants to general practice.
 
I look forward to seeing what is on offer from the new Government to repair the damage done to general practice by both major parties over the past 10 years.
 
Queensland Chair Dr Bruce Willett
Much like everywhere else in Australia, for general practice the number one issue is Medicare rebates.
 
For Queensland, specifically, I think clinical practice is definitely under threat from encroachment into what we do. This threat stems from our non-GP specialist colleagues, who are taking work that’s traditionally been in general practice away from general practice, but adding additional expense and complexity, as well as pharmacy and nurse practitioners, which is also a threat to the coordination of care for patients.
 
I think they will continue to be concerns and may actually become slightly bigger concerns with the change in government.
 
The problem is, we’ve seen general practice underfunded continuously now for a couple of decades and become a less and less attractive prospect, which has created a workforce shortage that people are now trying to solve by fragmenting patient care.
 
In the long run, this approach is going to lead to a less efficient system.
 
We know that the top performing countries around the world in terms of health outcomes and services are those with a really strong general practice base, and that’s really consistent – across the world that’s always the case.
 
Unfortunately, general practice is becoming more and more difficult to work in with increasing red tape and bureaucratic incursion into what we do.
 
NSW&ACT Chair Associate Professor Charlotte Hespe
The biggest challenges for the incoming Labor Federal Government in New South Wales and ACT are about addressing the acute primary care gaps that exist – how do we actually rebuild a solid foundation for general practice?
 
At the moment, we’ve got problems with funding and we have problems with the actual healthcare system – how we interact and work as a unit across New South Wales and ACT.
 
Also, we talk all the time about rural and remote, but workforce issues are also increasingly apparent in our urban settings and until we actually address that as well, we’re not going to solve our rural and remote shortage.
 
We need to have the conversations about sustainable general practice that works in an integrated fashion with the New South Wales and ACT systems.
 
And, at the end of the day, funding is essential – we cannot continue to have conversations with government without them committing proper funding into general practice.
 
We just need more funding or it’s going to topple. Everybody is at breaking point.
 
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Dr MT   31/05/2022 7:50:54 AM

I am the only GP in Canley Vale, NSW 2166.
During the Covid pandemic, our LGA was hit hard by the infection, the death rate, the lockdown, the economic and mental health crisis. I was working throughout the pandemic without a break. I was seeing my patients and patients of other GPs who chose to stay home. I conducted numerous Telehealth consultations for the disadvantaged patients. I took part in the vaccine roll out. Now I have more patients than before the pandemic. Now the rule of 80/20 will be reintroduced. How could I refuse to see my patients, refuse to even conduct a Telehealth, just because I reach the limit? This rule 80/20 now including Telehealth really put enormous stress on GPs.
I am appealing to A/P Charlotte Hespe, to lobby to Federal Health authority, to abandon the rule 80/20 please. You are always talking about shortage of doctors, why would you prohibit the doctors to serve their patients?
Sincerely Yours,
Dr MT