News

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RACGP frustrated with lack of consideration in Productivity Commission recommendations

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‘The fact the Productivity Commission ignored the RACGP’s recommendations on enabling patient choice and end-of-life care is frustrating and alarming,’ Dr Seidel said.
 
‘When the considered opinion of the country’s peak body for general practice is not heard on these types of important decisions, it is evident the Productivity Commission has prioritised the goals of competition and choice without due consideration of the potential issues and alternative approaches highlighted by the RACGP.
 
‘It is little short of a slap in the face for GPs all over the country, who are the coalface of these issues and have their patients’ best interests in mind.’
 
Enabling patient choice
The ‘Productivity Commission: Reforms to human services’ (the Productivity Commission) has recommended that the Federal Government amend regulations for referrals and diagnostic requests to require:

• GPs and other referrers to advise patients that they can use an alternative to any provider mentioned in a referral or request
• all referrals to specialists and allied health professionals, and requests for pathology and radiology services, to include a prominent and easy to understand statement advising patients that they can use an alternative to any provider mentioned in the referral or request.

Dr Seidel believes the Productivity Commission has fundamentally misjudged the key purpose of a referral, and he questioned how it established that patients do not currently have a choice when discussing referral with their GP.
 
‘Requiring a message intended for the patient to be placed on a letter from a GP to another specialist represents a misunderstanding of current referral practices, where a referral is a communication between two health professionals to facilitate patient access to appropriate care,’ Dr Seidel said.
 
‘The Commission quotes a survey where respondents agree that they would like to have the option to choose their own specialist when referred by a GP, which does not provide evidence that they are not in fact being provided with that option now.
 
The Productivity Commission has also recommended that the Federal Government should amend the Health Insurance Regulations 1975 to make it clearer that patients with a specialist referral can choose to have their initial consultation with any private specialist practising the relevant specialty.
 
‘Having referral experience and patterns, as well as existing relationships with other specialists, GPs are already supporting patient choice and quality,’ Dr Seidel said. ‘The RACGP is concerned with this recommendation, as inappropriate referrals may occur when patients make referral decisions without input from their GP.’
 
According to Dr Seidel, there are several reasons GPs should have input into when a patient is referred to another specialist.
 
‘For example, GPs and other medical specialists have existing relationships that can benefit the patient, GPs are the best equipped to guide their patients through the decision-making process, patients may lack the health literacy required to determine the appropriate medical specialist, and changes may increase pressure on health expenditure,’ he said.
 
End-of-life care
The Productivity Commission has recommended that the Federal Government should promote advance care planning in primary care by:

• including the initiation of an advance care planning conversation as one of the actions that must be undertaken to claim the ‘75-plus’ health assessment Medicare item
• introducing a new Medicare item number to enable practice nurses to facilitate advance care planning.

‘The RACGP does not support this recommendation as a mandatory requirement for completion of a health assessment with a patient aged 75 years and older. The health assessment can currently be used to facilitate initial discussion of advance care planning if appropriate,’ Dr Seidel said.
 
‘Making this a mandatory requirement does not recognise that it can be difficult for a GP and patient to plan for all contingencies.
 
‘Undertaking advanced care planning prior to an acute issue being present means the actions planned may be inappropriate when an acute issue arises.’
 
Given the time and complexity involved in presenting the idea of advance care planning in a general practice consultation, Dr Seidel believes any requirement to include more than an introduction of the concept and provide initial information within a health assessment presents unreasonable expectations for the GP and patient.
 
‘While recognising this, the RACGP suggested to the Productivity Commission that the possibility of an advance care plan discussion forming part of all health assessments be considered in order to foster greater involvement of GPs and patients,’ he said.

The RACGP does welcome the Productivity Commission’s recognition and support of practice nurses’ time in enabling advance care planning, but feels it remains unclear as to what requirements would be placed on practice nurses for providing this service.
 
‘That lack of clarity makes it difficult to fully support the recommendation,’ Dr Seidel said. ‘It is important to note that where a practice nurse facilitates advance care planning, the patient’s GP would still need to be involved in the preparation, development and sign-off of plans or directives for their patients.
 
‘GP and nurse time for this service thus needs to be accordingly recognised and reflected in any new MBS [Medicare Benefits Schedule] item numbers.’
 
Visit the RACGP website to access its full submission to the ‘Productivity Commission: Reforms to human services’.

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