RACGP’s ‘building block’ to improve shared care

When patients with chronic conditions are referred for specialist care, a disconnection with the GP can sometimes arise.
 
But a Shared Care Model – when patient care is shared by clinical providers of different specialties – aims to ensure that the management of comorbidities and preventive activities remain prioritised, aligning with the GPs’ central role of holistic care and coordination of care.
 
That is according to the RACGP, outlined in its newly released position statement on the Shared Care Model between GP and non-GP specialists for complex chronic conditions, which also details proposed solutions to barriers in existing models.
 
Underlining the importance of patients having regular contact with a GP, particularly people with complex needs who also access non-GP specialist medical care, the college supports Shared Care pathways, which should be ‘established and embedded in practice’ to improve care for people with complex chronic conditions.
 
While shared care is already in place in some settings, the college recognises it is not yet normalised in the management of serious or complex conditions.
 
Chair of the RACGP Expert Committee – Quality Care and Bond University Professor of General Practice, Mark Morgan, told newsGP the position statement is ‘a building block in a wider process’ to embed better collaborative practice between GPs and specialist teams.
 
‘It is an aspirational statement about the way the RACGP would like healthcare to evolve,’ he said.
 
The impact of chronic disease in Australia is increasing, with cancer, musculoskeletal conditions, cardiovascular diseases and mental and substance use disorders placing the most burden on health, accounting for 35% of the total national health expenditure in 2018–19.
 
Recognising that ongoing and effective management of complex, chronic diseases is a significant challenge facing health professionals and patients, the RACGP position statement outlines proposed solutions to existing barriers in Shared Care Models to ensure ‘all people with complex chronic conditions can benefit from GPs working in coordination with non-GP specialist teams to manage their condition’.
 
Professor Morgan said that while the complexity of healthcare in the community continues to increase, people are ‘much more likely’ to survive years after diagnosis of ischaemic heart disease, progressive degenerative conditions, serious mental illness and cancers. But continuity of care with the GP central to the process remains key.
 
‘Often these conditions lead to specialist referral,’ he said.
 
‘Sometimes that means the GP no longer feels able to make clinical management decisions about the patient’s specific condition. Sometimes it goes further, and the patient stops seeing the GP altogether for months while the patient’s complex condition is managed by specialist teams.
 
‘Many specialist letters received by GPs describe the current management but lack detail about ongoing plans. Clinical practice guidelines used by specialist teams can be at odds with guidelines developed by GPs.
 
‘When patients lose contact with their GP, management of the patient’s other comorbidities suffers. Preventive health takes a back seat. Titration of treatments can be painfully slow waiting each time for the next specialist appointment.
 
‘Shared Care Models try to address these deficiencies.’
 
And although there are ‘great examples’ of effective Shared Care Models, Professor Morgan said that they are the ‘exception rather than the rule’.
 
‘Shared Care Models mean the patient continues to regularly see their GP,’ he said.
 
‘The Models require protocols that are agreed by GPs, specialist teams and patients that make it clear what needs to happen, when, where and by who. Models of Shared Care work best when there are good communication tools that go beyond unidirectional letters sent to the GP after each periodic specialist appointment.
 
‘An essential element is the mutual respect that must underpin Shared Care Models.’
 
Examples of care coordination Professor Morgan provides include in rural and regional practices, where reduced access to non-GP specialists often leads to GPs sharing the clinical decisions to co-manage complex conditions. And antenatal care lends itself to a pattern of visits that make most use of the skills of GPs and specialist providers.
 
The RACGP also supports the need for enhanced communication, information exchange and intercollegiate clinical practice guidelines – it has advocated for funding to develop the latter – to ‘actively integrate and facilitate’ evidence-based care between GPs and non-GP specialists.
 
‘Health professionals alone cannot bring about sustainable change without health system improvements to support them,’ the position statement reads.
 
‘By establishing more appropriate funding, IT infrastructure and Shared Care pathways (such as protocols) for care between GPs and non-GP specialists, patients with complex, chronic conditions will achieve better health outcomes.’
 
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chronic disease management coordination of care non-GP specialists shared care model