Priorities for general practice reform must include reframing the workforce, formalising processes for secondary referral and the end of the fax machine.
With the GP deficit expected to reach almost 11,500 by 2032, reform must focus on increasing the nursing workforce, formalising secondary referral and the end of the fax machine.
General practice was the centre of discussion during the health reform session at last week’s Royal Australasian College of Physicians Congress in Sydney.
NSW chief health officer Dr Kerry Chant told delegates that, personally, her reform priority for the next five years would be to see primary care take centre stage as a “central coordinating healthcare delivery platform”, adding the caveat that she was not speaking on behalf of NSW Health.
Dr Chant said the system needed an “accountability mechanism” for the outcome of primary care services, to ensure that any new investment of taxpayer money was being well spent.
“While there are many exemplars of excellent primary care, I think the [lack of] quality and safety outcomes measurement for primary care is probably a gap,” she said.
Dr Michael Moore, a GP by training who moved to work in Primary Health Network administration, said that, on returning to general practice after a six-year gap “quite a few things have changed”.
When Dr Moore returned as a GP in North Sydney’s Hornsby in 2022, the practice was no longer taking on new patients and was consistently booked out.
“We also can’t find new GPs to come and work for us,” he said.
According to DoHAC statistics, the number of GPs has only just kept up with the increase in population in Australia, but this wasn’t the whole story, said Dr Moore.
“First off, the increasing number of part-time GPs means that [the number of] fulltime equivalent GPs in practice is actually not matching the population increase.
“In fact, the five-year trend is a 0.3% decline in GP availability every year over the last five years.”
According to Dr Moore, if he had to prioritise a change he’d like to see in the next five years to address this problem it would be more nurses in general practice.
“The number of nurses working in practice rose quite quickly 10 to 15 years ago when there was an emphasis on getting them in, but it’s plateaued in the last five years.
“There were nearly 13,000 in 2015 but in 2022, when I checked, there were still only 13,500.
“Given the increasing shortage of GP availability, it would be good to regain the recruitment momentum we had 10 years ago and create more incentives and more assistance, especially for small practices, to recruit and retain practice nurses.”
Dr Moore said he would like to see 5000 more practice nurses in general practice in the next five years to do vaccinations, wound care, health assessments and help manage prevention of chronic disease.
“We were getting practice nurses to do covid vaccinations and managed to get our cost of vaccination down to $12 per shot,” he said.
“I don’t think anybody could match that – they are incredibly efficient.”
Dr Moore said the ideal general practice model should have equivalent numbers of nurses and GPs.
Pharmacists were also an untapped resource, according to Dr Moore, but a slightly more costly one.
“A lot of the stuff that practice nurses do pharmacists could do as well,” he said.
“Obviously, you’d have to pay pharmacists more but there is a pool of young pharmacists out there who could be employed in general practice.”
Beyond the workforce woes, specialist access had also taken a turn for the worse over recent years.
“Now with regard to referrals, waiting times at public clinics are longer now than they were six years ago and that was immediately obvious when I got back [to general practice],” said Dr Moore.
“Six years on, private specialist access seems to vary: for some it’s harder but for other areas, it’s easier than it was.
“I do wonder, with GPs being busier and more time stressed, whether the threshold for specialist referrals has become lower, and specialists are seeing more low-acuity patients than previously.
“Affordability is definitely down compared to six years ago … psychiatry is the most extreme example.”
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Dr Moore said formalising processes for secondary consultations, like the GP psychiatry support line, could help circumvent the problem.
“Secondary consultations happen informally a lot within most general practices, where we pull knowledge in the corridors.
“GPs will also occasionally ring specialist colleagues for advice on management of a shared patient or one they’re about to refer.
“If there was a more formal way of approaching this so that we can do it more often, we could likely reduce clinical presentations to busy specialist clinics, which will give them more time to see new patients.”
And finally, it’s time to do away with the fax machine.
“We still get probably about 40% of patient reports [from hospitals or specialists] via fax,” said Dr Moore.
“For those of you that have not yet made the transition to using secure messaging, I would encourage you to make that transition.
“It’s 2024 guys, let’s keep it moving.”
The RACP Congress 2024 took place at the Sydney ICC on the 16 and 17 May 2024.
