Let’s hope the upcoming Strengthening Medicare and Scope of Practice reviews amount to more than just ‘political football’.
PHN CEOs were set the straightforward task of outlining how to create “an accessible, affordable and available healthcare system that’s fit for purpose” at the 2024 Greater Western Sydney (GWS) Future Health Forum on Friday.
Queue buzz topics: scope of practice, interoperability and single patient records.
Speaking at the forum, CEO of Southwestern Sydney PHN Dr Keith McDonald said primary health care was probably the biggest burden in the area.
“A study was released only last week by the government, which said that New South Wales now has a shortage of 460 GPs. I think that’s an underestimate,” he said.
“Within four years, that will be 1000 GPs.
“And given that GWS is the biggest growth corridor in the country, we’re [taking on] the wider share of that burden in terms of shortfall in southwestern Sydney.
“In 18 months, we’ve had 33 practices close.”
The sentiment was echoed by Nepean Blue Mountains PHN’s executive manager of primary care development and acting CEO Kate Tye.
“Just in the Blue Mountains alone, 20% of our GPs are over the age of 65 years of age,” she said.
“There’s poor succession, we have workforce policies that are currently under review, but they’re outdated, and they’re not thinking about the needs of future workforce planning that’s required.
“It makes it really difficult … particularly in this area of significant growth.
“Yet we can’t apply any workforce incentives to these growth areas until we’re at GP shortage. It makes it very challenging.”
WentWest CEO Andrew Newton, having recently moved from the acute to primary sector, said it was prudent to recognise the demands on the acute sector.
“But within five minutes in the primary health sector, I want to comment on how hard the GPs are working in western Sydney, which is my patch,” he said.
“There is an increasing demand and supply issue, but it’s wider than GPs, it’s practice nurses and allied health practitioners.
“The funding model does not lend itself to a sustainable workforce.
“What’s been really welcomed is the review of the workforce incentive program to have a sustainable workforce beyond GPs and allow GPs to practice at level, and let the other practitioners do patient care that does not need a doctor to do.”
Outlining key “choke points” for the workforce, Dr McDonald said GPs weren’t being attracted to areas of highest need, demonstrating the need for a socioeconomic lens on health.
“We need to do something about the inverse care law,” he said.
Dr McDonald also called for the reintroduction of the Prevocational General Practice Placements Program and the expansion of the single employer model for registrars.
“At the moment, there’s been trials in rural areas of the single employment models for GP registrars.” he said.
“We would like to see that in outer metro Sydney.”
Ms Tye called for a rejig of the Modified Monash Model to allow for eligiblity exemptions for workforce incentives.
“One of the biggest challenges we have is the upper Blue Mountains,” she said.
“If you think about Katoomba, it doesn’t have access to resources. It’s very much a regional town, and yet it’s classified as MMM1 which means that, from a workforce perspective, they’re competing with Parramatta, with Blacktown, with Sydney, and it doesn’t have an opportunity to access workforce incentives.
“So what we would really like to see … are the opportunities to look at the nuances … for some sort of exemption.”
Touching on the ever-contentious scope of practice expansions, Mr Newton said it was important to focus on “value add”, and ensure GPs were freed up to work at the top of their scope.
Ms Tye said scope expansion was broader than just nurses.
“We need to be looking at allied health professionals and their role, and how they can also take pressure away from our acute settings, but also from general practice as well.
“At the moment, nurse practitioners, can’t actually bill within general practice, most of the [billing is] very much tied to GPs.
“There’s a lot of reform that’s required in relation to that.”
Dr McDonald said the issue with the primary care system, at the moment, was the reliance on private practice.
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“If you want to get a public good out of the expanding scope of other providers, including pharmacists, nurse practitioners and the like, then there needs to be some public investment incentivising that and … heavily incentivising general practice.
“There is a movement around, rationalising the MBS and increasing blended payments.
“Care needs to be taken that that’s still incentivises [team based care], doesn’t just put people in opposition.
“Also you don’t need everyone under one roof … it’s networks.
“The flipside of the scope of practice review, you can’t be used as just a policy substitution.”
Dr McDonald added he was “encouraged” by the Strengthening Medicare Review, but emphasised that it had to remain about “genuine investment” in strengthening the sector, not just “political football”.
Ms Reay was excited by the potential of the 10-year primary health care plan.
“There are great opportunities for it to come to fruition, but there’s a lot of work.
“I think it’s an exciting space, it’s the biggest reform that primary care has seen in Australia.”
Speaking on integration and interoperability within the health system, Dr McDonald said a single patient record that could translate across both the acute and primary system would change the game.
“The big game-changer, which nationally we’re trying to drive through a national blueprint but we are testing in southwest Sydney, is around clinical information exchange in real time between the clinicians for the primary purpose of patient care,” he said.
“We’re testing that in practices now, so the technologies exist.
“The issue is we now need to try and push for change in legislation. The only system that allows opt-out currently is My Health Record.”
The interoperable system allows information to be available within seconds on the single sign on platform for anyone with access.
Ms Reay agreed with the benefits of a single digital system.
“We certainly hear from GPs that they don’t know where their patient is within their journey across the health system, and so that would change the way that happens,” she said.
Mr Newton pushed the need for not only digital interoperability, but strong partnership between primary and acute care.
“From a connectivity perspective, we do have a once in a generation opportunity coming up with a single patient hospital records.
“We really need to think about connectivity back into general practice and primary care, on how we can really have that single digital patient record that’s really all about the patient, not by system.”
The Greater Western Sydney Future Health Forum 2024 was held at the Western Sydney Conference Centre in Penrith on Friday 23 August 2024.
