The government’s vision brushes off the role of general practice and puts undue weight on early diagnosis, its submission says.
Dementia should be and is a “core business” of general practice, but the proposed National Dementia Action Plan fails to acknowledge the skills of GPs, the importance of continuity of care, and the lack of MBS support, according to the AMA.
Public consultation on the Action Plan closed today (31 January) with the final plan to be “finalised in 2023”, according to the Department of Health and Aged Care.
The AMA released its public submission yesterday and was scathing of the plan’s attitude to general practice.
“The crucial role of GPs is not adequately considered or incorporated into strategies by the Action Plan,” the submission said.
“[The plan makes the] presumption that education and training, as well as additional guidelines, are needed to enable GPs to diagnose dementia adequately and deliver dementia care, without adequate consideration for structural changes needed to ensure that diagnostics happen and that GP practices are sustainable into the future.
“Unfortunately, the current reality is that the MBS system actually penalises those GPs who provide care to patients living with dementia.
“Adequate dementia care and chronic disease management care cannot be provided in short 15-minute consults.
“Similarly, for GPs who visit aged care homes and care for people with dementia, MBS items fail to cover the basic cost of the visit.”
“The AMA members are tired of this continuous approach from the government and the Department of Health where GPs are underappreciated and told they are not qualified to do their jobs,” AMA president Professor Steve Robson told The Medical Republic.
“In this particular consultation paper, anecdotal evidence was used to push for dementia ‘semi-specialist’ GPs. Not only is it disrespectful to GPs who currently diagnose and care for their patients with dementia, but if implemented it will further fragment and undermine patient care.
“Dementia is core business for the majority of GPs. What GPs and patients need is more support, more time to be spent with the patient during consultations, better sharing of information between different care providers (including disability and aged care) and better care coordination for people living with dementia.
“There is measurable evidence both in Australia and internationally that continuity of care for patients living with dementia by their usual GP leads to improved health outcomes, lower rates of delirium, lower hospital admissions and lower healthcare spending, yet all the 10-year National Dementia Action Plan could come up with is educating GPs and delivering ‘semi-specialisation’ to be able to access specialist dementia MBS items. The AMA finds this disappointing.”
Continuity of healthcare – a crucial need for patients with dementia, particularly during transition times between diagnosis, care at home, moving in aged care facilities and in and out of hospitals – “is not even referenced” by the plan, according to the AMA submission.
It cites a recent UK study that found patients with dementia regularly seen by their own GP had lower rates of delirium, incontinence and emergency hospital admissions, leading to better overall health and quality of life; another study from the US which found that lower continuity of care was associated with higher health care spending; and a similar Australian study that came to the same conclusions.
“Yet somehow, a 10-year Dementia Action Plan does not even consider this and fails to elevate the important role of GPs in health care of older people,” said the AMA.
The plan includes seven draft objectives:
- Tackling stigma and discrimination
- Minimising risk, delaying onset and progression
- Improving dementia diagnosis and post-diagnostic care and support
- Improving treatment, coordination and support along the dementia journey
- Supporting people caring for those living with dementia
- Building dementia capability in the workforce
- Improving dementia data and maximising the impact of dementia research and innovation.
It places heavy emphasis on the importance of early diagnosis, a “blind assumption” the AMA said was not realistic.
“[The] Action Plan repeats the blind assumption that seems to be axiomatic within the dementia advocacy groups, that a very early diagnosis somehow changes everything,” the AMA submission said.
“Unfortunately, the reality is that an early diagnosis often does not add to management or prevention of progression unless adequate needed supports are put in place in an equally early manner.
“AMA members report cases where early diagnosis increases stress and distress of patients rather than helping them manage their journey.”
One proposal from the National Dementia Action Plan is the creation of “semi-specialist dementia GPs”. In Objective 6 – Building dementia capability in the workforce – the plan says “GPs are not always well equipped to recognise dementia or manage dementia”.
“Exploring the opportunities for semi-specialist GPs or nurse practitioners to focus on dementia care, with extra training and to access to MBS remuneration” is listed as a proposed action for developing “a skilled, dementia aware health and aged care workforce”.
The AMA response was unequivocal.
“The AMA absolutely rejects the introduction of ‘semi-specialist’ GPs in dementia … Not only is it disrespectful to GPs who currently diagnose and care for their patients with dementia, but it will also fragment and undermine patient care,” said the submission.
“Dementia care should be and IS the core business for the vast majority of GPs. GPs who care for patients in aged care will be exposed to it more, but the AMA is against formalising the requirements to access MBS remuneration.
“Establishing ‘semi-specialist GPs’ would essentially create a two-tiered system where continuity of care would be broken, to the detriment of the older person.”
The AMA queried the merit of a suggestion that could lead to a person with dementia losing contact with their regular, perhaps even long-term GP: “Would this mean that patients who have a long-term relationship with their GP, that the moment they are diagnosed with dementia, their GP, if not accredited as ‘semi-specialist’ would no longer be able to care for them?”
NOTE: This story has been updated to include Professor Robson’s quotes.
