The future of general practice begins with VPE

Two high-profile GPs say that, love it or not, a formal link between patient and provider will make clear the value of primary care to the system.

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The true value proposition of voluntary patient registration is data connectivity, according to Medicare reform veterans Dr Steve Hambleton and Dr Walid Jammal.

Speaking at a Tonic Media webinar co-hosted by Dr Norman Swan last week, the two GPs laid out their vision of the future of general practice.

First, Dr Hambleton said, there needed to be a flexible employment model for doctors in the bush that completely reimagined the state-federal funding divide.

“That may be a salaried model for [rural] general practice, where they’re fully integrated with the public hospital,” he said.

“It’s one health service that’s integrated.”

If the infrastructure of general practice is collapsing, then rural and remote health has been the canary in the coalmine.

Unless it’s addressed first, Dr Hambleton said, there may come a situation where it becomes close to impossible to replace those rural doctors.

His vision for urban health reform, though, starts with each practice nailing down an understanding of its patient base.

“If want want to change the way we do business then, one, we want to understand who our population is,” said Dr Hambleton.

“So, I think you start with voluntary patient registration.”

Dr Hambleton was under no illusions about the popularity of VPR – “nobody likes the name” – but insisted that it represented the best path forward.

“It is a formalised link between patient and provider on which we can build new funding and new support,” he said.

“Because if you do have a person that’s diabetic, for example, who you see regularly and you maintain their health and you’ve saved the public hospital system money, [the system] needs to know who to reward [for] that.”

Dr Jammal explained the value proposition from the patient’s perspective.

“Patients expect their practice and GP to be the central reference [for all their health needs],” he said.

“Every person in the audience, I’m sure, has had patients walk into the room, look to the computer and say ‘as you can see doc, I saw the specialist last week when I was in hospital’.

“And you look at them and say ‘I have no idea what you’re talking about’.”

With patient registration, Dr Jammal said, not only will data and funding pathways be clearer, but so will information sharing.

Of course, for that vision to be realised, systems like My Health Record would need to be upgraded and there would need to be a nationalised version of NSW Health’s Lumos program.

Under the Lumos program, which is used by more than 500 practices in the state, deidentified patient data is shared across all levels of the health system.

“When a patient in a Lumos data-linked practice gets seen or interacted with within 48 hours after an unplanned hospital admission, the one-week readmission rate is reduced by 33%,” Dr Jammal said.

“That’s the sort of measurement … [you can’t have without] good linkage, use of data and registration.”

Another insight from the Lumos dataset has been that continuity of care reduces hospitalisations; if a practice sees 30% of its patients six times per year, for example, the entire practice population has a 10% lower admission rate.

VPR, Dr Jammal said, is what will strengthen and formalise the GP-patient connection, leading to those valuable data insights.

It’s not a leap from there to then using that data to prove to government just how valuable general practice is, and lobby for more funding.

While the recently released Strengthening Medicare Taskforce report touched on all these points, the big reveal on what is and isn’t funded won’t be revealed until the May budget.