If we can't fund our most effective GP research unit, how seriously does government take primary care?
Rebate freeze, new ePIP rules, PICRIS funding and now BEACH. GPs around the country are starting to circle the wagons and wonder why the government won’t back primary care anymore
With the axe still hanging over the data mine that helped kill off the GP co-payment and busted the six-minute-medicine myth, doctors are contemplating the unthinkable.
A world without BEACH.
The key centre of Australian general practice research, admired around the world for its unique data collection and analysis, has been guaranteed only a 12-month lifeline by the University of Sydney while it attempts to resolve a funding crisis.
BEACH (Bettering the Evaluation and Care of Health) has seen a fall in its mainstay income from contracts with drug companies and public agencies, but the Health Department’s abrupt decision to cut off its $300,000 annual contribution – about 18% of its operating costs – came as a shock.
“We did get a letter saying all funds would be put into a competitive grant round, and so it would be advertised, but nothing like that has happened. Has the money disappeared? I don’t know,” Professor Helena Britt, director of the university’s Family Medicine Research Centre, told TMR.
Explaining the pre-budget ambush, the department said it was not a major funder of BEACH and that it wanted a more contemporary approach to GP research.
“The government recognises the value of primary healthcare research and data and the value of a robust evidence base to inform decision-making,” a Health spokeswoman said.
“However, current reforms in primary healthcare require a refreshed approach to research and data.”
She cited a need to ensure “best value for money within an environment of scarce resources”, saying the department would seek “more contemporary means of accessing general practice and primary healthcare data to guide decision-making”.
GP software provider Medical Director has signalled interest in stepping up, using its general practice research network system which it says harvests and de-identifies doctor-patient data with minimal burden on practitioners.
Asked if the company intended to bid for a department of health contract, chief executive Phil Offer said: “Medical Director is always happy to talk with government on ways we can work together.”
But GPs say the dumping of the gold standard of general practice research, along with the defunding of the Primary Health Care Research and Information Service and the Australian Primary Health Care Research Institute, is unacceptable.
Dr Ewen McPhee, president of the Rural Doctors Association of Australia, said the disinvestment was bizarre and a cause for alarm.
“Because the details are sketchy, we are all very worried. To be disinvesting in primary care research when it’s given the biggest bang for the buck in terms of improving the care of Australians is a big concern,” he said.
The association was seeking “urgent clarification” of a department proposal to establish a new “Health Policy Research and Data Program” to cover primary healthcare research, with an anticipated start date of July 1.
The AMA and the RACGP have deplored the government’s decision and protested the lack of transparency.
Both say the purpose-built BEACH, developed with the help of 11,000 GPs over years, is the only source of valid, reliable and independent data about general practice in Australia.
“BEACH data allows us to measure patterns and change over time, providing valuable insight into the delivery of patient care, including consultation time, the number of problems managed in each encounter, and treatment provided,” RACGP President Dr Frank Jones said.
“None of this can be gleaned from the Medicare benefits schedule, pharmaceutical benefits scheme and hospital data.”
The AMA says BEACH has driven significant policy outcomes – and at bargain rates.
In its 18 years of existence, BEACH has got by on a total of $26 million, of which the commonwealth contributed only $4.6 million, or less than 20% of annual costs.
Before the 12-month reprieve was organised, TMR understands the department even rejected a plea to cover the cost of publishing a final run of BEACH reports, suggesting a tight-fisted mood in Canberra.
Dr Nick Zwar, professor of general practice at the University of NSW, said the flurry of disinvestment was ironic, coming after the Health Minister Sussan Ley’s primary healthcare advisory group had stressed to her the importance of good data.
He said routine data sets could not match the program’s systematic records of problems and their management, how GPs worked and information on morbidity and treatment.
“Routine data might one day fill that gap, but it doesn’t today.”
So what, given the uncertainty surrounding electronic health records and the unknown quality of research expected from the new primary health networks, explains the haste to see off BEACH?
Dr Brian Morton, chair of the AMA’s council of general practice, said a cynic might also take the view that BEACH data often did not suit the government’s narrative.
“They’d like to say high-volume GP care is driving up Medicare costs… and BEACH is able to come up with data showing average consult times are longer,” he said.
