A nurse practitioner, rather than a GP, may be the only practical solution to caring for older Australians in aged care homes, says a health services professor.
The primary care model in aged care will “inevitably” have to change, as incentives offered for GPs are not enough to make it viable, says the professor who led the design of the national aged care funding model (AN-ACC).
Last year, the federal health minister Mark Butler announced the new General Practice in Aged Care Incentive which will offer GPs who provide at least eight consultations and two care plans to residential aged care patients a $300 payment per patient per year.
Practices will also receive a $130 payment per patient per year, if all criteria are met.
Beyond the service requirements, the initiative, which is set to take effect in August this year, is subject to several conditions.
Telehealth can only be used for up to four regular visits a year in MMM 4-7 areas.
Additionally, only one of the regular visits can be delivered by a non-GP member of the patient’s care team each quarter.
According to a recent poll by the RACGP’s news outlet, newsGP, for over half (54%) of the 1587 respondents the incentives were meaningless, as they would not provide these aged care services no matter the incentive.
Speaking to The Medical Republic, adjunct professor of health services research at UNSW Professor Kathy Eagar, who led the development of the Australian National Aged Care Classification funding model, said that what surprised her about the response was that the percentage wasn’t higher.
“General practice is in general crisis and working in residential care with a group of frail patients with multiple comorbidities is really hard work,” she said.
“In the old days, nursing homes would be within close proximity of a GP, so they could go to a home and see half a dozen of their long-term patients in the same facility.
“Patients are now going to any number of homes and a GP, with the best of intentions wanting to follow their patients, might have to visit 10 different homes.
“The geographic spread and changing demography is really making it non-viable for GPs to continue to go into homes to follow their individual patients.”
The lack of GPs available to provide these aged care services was leading to a backlog of aged patients in hospitals, added Professor Eagar.
“When patients go to the aged care provider, they have to nominate a GP, leaving patients stuck in hospital for days and weeks on end in some places.
“[Patients] are sitting in a hospital bed at $1000 a day for lack of a GP … and clogging up public hospitals.
“But more importantly, [hospitals] are the wrong place for an older person – they decondition so fast when they’re sitting in an acute bed.”
Some GPs, albeit a small proportion, are now specialising in aged care and are choosing to avoid overheads by foregoing rooms and going mobile.
“They might support say 10 large homes, which they go to twice a week,” said Professor Eagar.
While this business model may work quite well for some GPs, ultimately the new incentive was likely too low to attract more GPs into the space, said Professor Eagar.
In fact, the newsGP poll found that a third of GPs would need the incentive to sit at $1100 for the respondents to consider providing the service and 9% said it would need to be between $300 and $900.
“The incentive money is not enough to warrant the extra work,” said Professor Eagar.
“Going to a nursing home is essentially no different to going on a home visit. There’s an opportunity cost when you could be seeing five other patients [in the same amount of time].”
But, added Professor Eagar, while GPs had “voted with their feet” in the survey, it was hard to guess what the outcome of the incentives would be until they were implemented.
“People in aged care are by far our most vulnerable citizens … they have multiple health conditions, which in combination mean they cannot live independently and are totally dependent,” she said.
“I think for a lot of GPs, even though it’s not economically viable, [working in aged care] gives them a great lot of work satisfaction to have that level of continuity with their patients.
“It’s actually the backbone of general practice.”
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But Professor Eagar said that, in her opinion, a change of model was “inevitable”, and would likely include more nurse practitioners taking on primary care roles and GPs working on a sessional basis in homes.
“We have to develop alternative models of primary care, and the best place to start that is in residential aged care,” she said.
“I think it is inevitable that in the future, a patient will be able to have a nurse practitioner, rather than a GP, as their primary care provider once they are in aged care.
“I think realistically, that’s the only practical solution in the foreseeable future.
“It’s a huge sector and this is a group that have got very high needs.”
