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What does the new patient charter mean for general practice?

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Released in 2008, the original Australian Charter of Healthcare Rights (the Charter) was developed by the Australian Commission on Safety and Quality in Healthcare (ACSQH) to inform patients about what they can expect when receiving care within the Australian healthcare system.
 
This week saw the release of the Charter’s second edition, which has been updated to incorporate some of the changes in the healthcare space over the past decade.
 
‘We reviewed the Charter … to ensure it reflected what the wider community believe are their appropriate healthcare rights in today’s landscape, and to clarify areas that required further explanation,’ ACSQH Chair Professor Villis Marshall said.
 
Speaking at Thursday’s launch of the Charter, health advocate Luke Escombe described the Charter as ‘a vision of a new kind of healthcare provision in the 21st century’.
 
The updated Charter outlines seven fundamental patient rights: 

• Access
• Safety
• Respect
• Partnership
• Information
• Privacy
• Give feedback

 The Charter is embedded within the National Safety and Quality Health Service (NSQHS) Standards that must be met by all hospitals and providers of acute health services for accreditation.
 
But what does it mean for general practice?
 
Dr Mark Harris, Professor of General Practice at the University of New South Wales, believes patient rights listed in the Charter provide a helpful benchmark to which GPs can aspire.
 
‘They’re a tool for patients to use so they can be aware and become advocates themselves, but also for community effort, quality improvement … a set of goals and something that we should all try and achieve,’ he told newsGP.
 
Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), agrees with this view of the Charter, and is pleased it aligns with the RACGP’s General practice patient charter.
 
‘I think it is great to see a simple and clear document that outlines what people should expect from their healthcare,’ he told newsGP.
 
‘GPs have a deep understanding of patients’ experience – many times a day we find ourselves discussing patients’ experience of receiving healthcare in other settings.’
 
However, both GPs recognise the fact the Charter rights also highlight some challenges for practitioners, as well as areas that may require future investigation and reflection.
 
‘There were some unspoken balancing concepts that should be a matter of open public debate,’ Associate Professor Morgan said.

Professor Mark Harris believes the new Charter provides a helpful tool and goals that all health professionals should try to achieve.
 
Access
Professor Harris acknowledged access can be difficult for some patient populations.
 
‘For example, I did my clinical work with asylum seekers and they don’t have access to healthcare,’ he said. ‘So that first right is limited for them.’
 
Associate Professor Morgan pointed out that cost is often a barrier to this right, including in general practice.
 
‘It is difficult to balance access and affordability when patient rebates for services do not match the cost of delivering those services, making access feel very different depending on if you have money or live in an area with sufficient population density for services to be available,’ he said.
 
Associate Professor Morgan called for a public debate on rationing healthcare.
 
‘Should healthcare services and treatments that are of low value or poorly evidenced be provided if they meet a patient-perceived need?’ he said.
 
Safety
Both GPs agreed the second right is a core value in general practice, and Australian healthcare in general.
 
‘Certainly for all Australians, having safety and respect is fundamental, and that’s something I think we all support,’ Professor Harris said.
 
Associate Professor Morgan saw the inclusion of this right as a chance to think about how to improve it for the future.
 
‘Patient safety in general practice should include the proactive detection and amelioration of risks from acts of commission and omission,’ he said. ‘There is a wonderful opportunity to make much better use of our electronic medical records to identify patient safety events and to change the way we do things, to continuously improve.
 
‘Let’s hope we can do this without top-down interference and clumsy healthcare policy.’
 
Respect
Again, both GPs regarded this as a core aspect of Australian healthcare, particularly general practice.
 
‘I think GPs demonstrate this definition of respect all day and every day,’ Associate Professor Morgan said.
 
But he also acknowledged there can be tension between this patient right and what can be required for best-practice care.
 
‘Recognising and respecting patient views while still refusing to facilitate harmful choices is an ongoing challenge for me,’ Associate Professor Morgan said.
 
‘RACGP position statements and guidelines can help because they have been so carefully constructed with input from consumers and many thoughtful GPs.’
 
Partnership
This right has been updated from the original edition of the Charter, which instead featured ‘participation’, in order to further promote patient-centred care and active engagement from patients.
 
Professor Harris believes partnership is another core value of general practice – and that the Charter can serve as a helpful reminder to ensure this is incorporated into day-to-day practice.
 
‘Shared decision-making to the extent the patient wants has been part of medical student training and general practice philosophy,’ Associate Professor Morgan said. ‘It is good to see this enshrined in the Charter.’
 
Information
Information is another updated right, replacing ‘communication’ from the original edition of the Charter. This change was made to enshrine efforts to boost partnership and health literacy.
 
Professor Harris believes this right is vital to general practice, and suggests tools and techniques to assist GPs in this area.
 
‘Helping people to understand their health information is critical,’ he said. ‘But, again, that’s challenging; it’s difficult given the problems with health literacy that many patients have.
 
‘So this has implications for what we need to do about building health literacy, and also making sure we use techniques like teach-back, when we’re explaining things to patients and checking people have understood what’s being said.
 
‘We’re also in the lucky situation in Australia of having the telephone interpreter service available in general practice. That’s something many countries don’t have and provides a fairly accessible way of at least basic interpretation into other languages.’
 
Associate Professor Morgan observed that costs and waiting times are explicitly included in the Charter as an aspect of this right, and believes access to this kind of information could be improved to assist GPs and patients.
 
‘I think the health system could do a lot better in this space,’ he said. ‘Costs are not routinely available on specialists’ web pages, but perhaps they should be.’
 
Privacy
According to Professor Harris, the inclusion of this right is very important in the contemporary healthcare landscape. But he added that it is a particularly challenging area, citing the data breach experienced by the Singapore Government last year as a cautionary example.
 
‘One of the areas they’ve updated is information and privacy, and I think that’s particularly relevant with the My Health Record,’ he said.
 
‘So that’s an issue, and it’s something I’ve noticed GPs are increasingly concerned about.
 
‘It’s part of the RACGP standards that information be kept secure and confidential, and personal privacy respected. What’s important is that the information that can be used to identify the individual person is secure and not given to other parties without their consent.’
 
However, Professor Harris is also concerned that access to health data for the purposes of research be retained, a condition with which Associate Professor Morgan agrees.
 
‘I strongly believe that de-identified health information should and must be used for research, safety monitoring and continuous quality improvement,’ Associate Professor Morgan said.
 
‘Consumer advocacy groups seem to understand, accept and increasingly expect this information to be used to improve the health system; it would be great if this expectation was a component of the Charter.’
 
Give feedback
This is another updated right, changed from ‘comment’ in the original edition, to again promote greater partnership between patient and practitioner.
 
While Associate Professor Morgan agrees the right to complain, which is highlighted in the Charter, is important, he also believes feedback can be harnessed in other ways to promote improvement and partnership.
 
‘I would like to highlight the much more important component that points towards co-design and valuing patient experience of care to make health services better,’ he said. ‘This is stated as the right “to share my experience and participate to improve the quality of care and health services”.’
 
On the whole, both GPs see the Charter as an aspirational document that can be used as a platform to build more active and positive relationships with patients.
 
‘It’s a reminder,’ Professor Harris said. ‘And I think none of these rights are things we should have a problem with; this is what we should be doing and trying to achieve, the quality improvement and improving our systems and organisations within our practice.’

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ACSQH Australian Charter of Healthcare Rights Patient rights Patient-centred care

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