Primary care is a “renovator’s opportunity” in urgent need of planning for population needs, a report from the Grattan Institute says
Primary care in Australia is overdue for a renovation targeted at regional service coordination by neutral bodies and planning for population needs, a new report from the Grattan Institute says.
The document – Mapping primary care in Australia – says the lack of a comprehensive national framework for primary care is letting patients down.
“In particular, primary care services are not organised well enough to support integrated, comprehensive care for the 20% of Australians who have complex and chronic conditions,” it says.
“Nor is primary care well organised to prevent or reduce the incidence of conditions such as type 2 diabetes and obesity.
“Broader community-level functions of primary health care – such as developing self-help groups and promoting healthy environments – are also being neglected.”
Professor Stephen Duckett, the institute’s health program director and a co-author of the report, noted that pro-active primary care had proven far-reaching benefits.
Overseas evidence showed that having nurses based in general practice who don’t just respond to demands from patients but reach out to monitor them, improved hospital admission rates, he said.
“It’s proactive care for a particular subset of people who are at risk. It’s this sort of thing we should be thinking about and trialling in the Australian concept,” Professor Duckett told The Medical Republic.
The fragmentation of primary care – “typically delivered by many thousands of small, private businesses” – is accompanied by a lack of data to plan services and monitor quality, it says.
To replace the current situation of governance and accountability split between levels of government and numerous agencies, it suggests a new national framework underpinned by formal agreements between the Commonwealth, the states and Primary Health Networks.
“What we would argue is that you need to intervene first at the level above general practice – at the regional level – maybe the PHNs,” Professor Duckett said.
“We think PHNs have a role. There are stronger PHNs and weaker PHNs across the country, but they are the only game in town at the regional level. “
The PHNs should be “neutral ground”, where they can be used by both the Commonwealth and the state for regional coordination of services, he said.
“At the moment we’ve got the Commonwealth micromanaging the PHNs, which means the PHNs live in fear and they are not as innovative as they ought to be and the states see the PHNs as creatures of the Commonwealth.
“The Commonwealth needs to lift its game in this.”
The report calls for a sharper focus on prevention and early intervention in chronic disease. While not offering specific solutions for payment models, it says blended payments in general practice should be investigated further.
Previous Grattan Institute research suggested that many patients who presented to GPs with key risk factors did not have those factors addressed, the report says.
“These initiatives require action in a variety of community settings, and strategies for targeting relevant minority and at-risk groups.”
One of the main messages is that primary care is a lot bigger than general practice, Professor Duckett said.
“It’s a whole host of things, and to understand primary care, you have to look at the whole picture,” he said.
“Secondly, there are reform directions that everyone is talking about which need to be taken seriously.”
The lack of progress and leadership on these reforms so far could be put down to “timidity” in Canberra, but also the preoccupying effect of the five-year Medicare rebate freeze.
“The freeze continued for so long, I think it crowded out other issues getting on the agenda.”
Still, the profession needed to ask questions asked about the lack of progress and leadership by the Commonwealth, doctors’ groups and consumer advocates, he added.
The report notes that cost remains a barrier to GP care for 4% of Australians, but also that one in five people delay dental care because of cost and wide disparities remain in the availability of allied health services.
