26 July 2021

Primary health reform: the future is vague


GPs have till tomorrow to have their say on a draft document that could determine the next 10 years of their profession, and the future of primary care.

The report, published at the end of last month, presents the draft recommendations of the Primary Health Reform Steering Group which called out the “significant weaknesses” in the current funding structures supporting general practice.

Representatives of the RACGP, AMA, ACRRM and a number of other peak organisations were involved in the steering group and the draft recommendations.

But curiously, for a paper that is supposed to inform the Australian Government’s Primary Health Care 10 Year Plan, it was not widely circulated among the profession or the media.

In addition, the sector was only given four weeks to provide feedback on the draft recommendations, despite the report setting the course for the next decade of primary care.

GPs have until tomorrow, Tuesday 27 July, to have their say on the draft recommendations.

You can read the full report and submit your feedback here, or by emailing primaryhealthcarereform@health.gov.au.

The report, which was originally due in September last year but delayed due to the covid pandemic, is a culmination of the discussions of the steering group (which has met 16 times since it was established in October 2019) and its consultation about 400 additional stakeholders.

There are 20 draft recommendations in the draft paper, grouped into eight themes:

  • Person-centred health and care journey, focusing on one integrated system
  • Adding building blocks for future primary health care – better outcomes and care experience for all
  • Leadership and culture
  • Primary care workforce development and innovation
  • Innovation and technology
  • Research, data and continuous improvement of value to people, population, providers and the health system
  • Emergency preparedness
  • Implementing reform that delivers on the Quadruple Aim [i.e. improving the patient experience of care, the health of populations, the cost-efficiency of the health system and the work life of health care providers]

In the executive summary, the steering group point out that the current health system is no longer sustainable for the community’s changing needs.

“The current health system was designed to respond well to individual presentations but given the growing burden of chronic disease and the need to focus on population health, system integration and prevention, it is no longer fit for purpose,” the authors wrote.

“Without attention, the primary health care system will have limited ability to respond to challenges in caring for Australian people over the next ten years and beyond.”

The report suggests some radical reforms to the funding mechanism for general practice, including enabling “integrated one health system thinking” by leveraging the National Health Reform Agreement (NHRA) Addendum 2020-2025.

The steering group also said it would like to see a minimum percentage of all health care spending be allocated to primary health care.

But the report received criticism for not outlining how a move away from a fee-for-service model might be implemented.

Adjunct Associate Professor Lesley Russell from the Menzies Centre for Health Policy, writing for Croakey Health Media, said it added little to the 2009 National Primary Health Care Strategy Report and had several serious omissions. These included the unfitness of fee-for-service care in a landscape of chronic illness, and detail on how the reforms would be “driven at the coalface”.

Professor Russell said the paper also ignored the out-of-pocket costs for patients, and the role of specialist care.

“Absent brave leadership and concerted action from all stakeholders – not seen in 2009 nor in the years since – this report is unlikely to deliver the primary care system Australia needs and Australians deserve.”

In the coming months the steering group will review submissions before submitting its final report to government.

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