RACGP advocates for people with cognitive disability

Anastasia Tsirtsakis

17/04/2020 3:22:40 PM

The college has made a number of recommendations on how to remove barriers to healthcare in a submission to the disability royal commission.

Young girl with Down syndrome
Removing financial barriers and increasing GPs’ role in NDIS planning are among the RACGP’s recommendations to the royal commission.

‘Having worked in this area for over 30 years now, GPs are very well placed to provide services for people with disability. They have that link with the social situation of the individual and often have a lifelong relationship with their patients, they’re fairly accessible – but there are some barriers.’
Associate Professor Robert Davis, Chair of the RACGP Specific Interests Disability network, made a significant contribution to the college’s submission to the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability issues paper on healthcare for people with cognitive disability.
Around 18% of Australians have some form of disability. For those with a cognitive disability, health outcomes are stark compared to that of the general population, with research suggesting they are more likely to experience an avoidable death that could have been prevented with appropriate healthcare.
The recommendations, based on member feedback, include:

  • removing the financial barriers people with cognitive disability face when they attempt to access care
  • providing education to disability workers, carers, health professionals and people with cognitive disability themselves
  • providing funding for advocacy services
  • fostering greater collaboration between the health and disability sectors to enable multidisciplinary care
  • increasing the role of GPs in National Disability Insurance Scheme (NDIS) planning
  • establishing clear pathways to report instances of violence, abuse, neglect or exploitation.
One key recommendation made by the RACGP is removing the financial barrier to care by increasing Medicare Benefits Schedule (MBS) rebates to reflect the cost of providing ongoing comprehensive, patient-centred care to people with cognitive disability.
‘People with disability can’t afford to pay the excess on top of the Medicare rebate, so they are very reliant on services that bulk bill entirely. So that does restrict them,’ Associate Professor Davis told newsGP.
‘And if you’re living in a country community with limited services, that can be a problem.
‘They are in that lower socioeconomic group and may need to wait for simple things, simply because there’s just such a long waiting list.’
This added wait time further exacerbates matters for patients, given they often already have more complex care needs compared to the standard patient that presents in general practice.
‘Because of the complexity of their problem and also their communication difficulties, the length of time it takes to assess them properly is often longer,’ Associate Professor Davis explained.
‘You may be using a carer, so you have to get the information from the carer, you have to then spend time making sure that that information is carried back to whatever supports they have’.
‘And it’s very important that information is passed back to whatever organisation is supporting them, so that whenever an intervention is recommended [it] is carried out.
‘There’s all sorts of other things like filling out the forms … that relate to this group. So there’s a financial disincentive for GPs to take on large numbers of this population.’
Another recommendation raised by the RACGP is that young people with disability be moved out of residential aged care facilities, where they face social isolation and are unable to receive care targeted to their particular needs.
‘For a young person, moving into an aged care facility takes them away from their peer group,’ Associate Professor Davis said.
‘When a person has a disability like this, taking them away from their family support can have a great impact on their mental health, and will be likewise for the families. It’s such a difficult thing to have your relative move away.’
This is where services need to be person-centered rather than centred on the facility. But for that to happen, Associate Professor Davis says there is a great need for further infrastructure and training.
‘Our health system has been able to keep people reasonably functional, despite quite complex and serious health issues and disabilities,’ he said. ‘But I think we don’t have the services that would support those individuals. Some of those services could instead be provided in the home.
‘But that would require a degree of organisation and training, and are often more available in metropolitan cities as opposed to rural settings.’
When it comes to the NDIS, Associate Professor Davis has long said GPs should play a bigger role in its planning. While he acknowledges the scheme is funded for supporting people with disability in their community and not health services specifically, he says there is certainly a crossover, which should be considered. 
‘At the moment there is not a lot of communication between NDIS and the GPs. If that does happen, it’ll happen through the client, which is appropriate I guess, but it’s an opt-in situation rather than an opt-out,’ he said.  
‘If a person does have a relationship with a GP, the GP can provide very valuable information when they are having a plan; they can also facilitate the implementation of the plan. Often with many patients, or clients with disability, the GP is the one constant; the GP’s been there for a number of years. Whereas some of the other supports are fairly transit.’
Associate Professor Davis says it is not a matter of cost, but one of greater organisation.
‘One of the problems is that the NDIS is based around supporting people with disability – there’s not that level of expertise around health associated with it,’ he said. ‘Those sorts of services need to be built from the ground up, so it’s a challenge.
‘It’s probably one of the more difficult things that NDIS will have to face.
‘Unfortunately, it’s been a little bit postponed by the COVID-19 situation, but NDIS has been talking with [the RACGP] about how we might better interact, and I see that as very positive thing.
‘What I’m looking forward to is the NDIS and the Government coming to the table and working on ways we can better service this population.’
Access the RACGP’s submission on the RACGP website.
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