Despite the fanfare surrounding reforms, so far not much has changed in day-to-day practice, writes Dr Linda Calabresi
Hard to believe another year is about to come to a close. So this is perhaps the opportune time to reflect on how GPs fared in 2018.
Looking back, the year started with plenty of attention on the health system and the promise of major reforms that would improve efficiencies and better serve future generations of ageing and unwell Australians.
After much debate and amid much controversy (and at great expense), the Health Care Homes project was launched back in late 2017, having announced which PHNs were to be involved and with plans to enrol 200 practices and Aboriginal health care services in the trial.
So, this year was supposed to be the year where all this chronic care management, coordinated by a patient’s designated practice for an annual fee, was proven to be worthwhile and superior to our age-old fee-for-service model. This was going to be the prototype of how chronic disease should be managed in the future in general-practice land.
Unfortunately it hasn’t quite worked out like that.
For a start, the coordinators of the project have only managed to get 175 practices enrolled, and instead of the 65,000 patients they were hoping to be treating under the scheme by now, they have only a few thousand (just over 2000 in June according to a department statement).
Critics would point to the inadequate remuneration for doctors treating patients in the scheme as the major barrier to success, but the reality is likely to be more multi-faceted than that. I may be wrong, but at this stage, the Health Care Homes trial is facing a pretty massive F rating when it comes to judgment day late next year.
That brings us to that other great health initiative that promised to make a significant difference in our clinical practice in 2018. The My Health Record!
So much has been written about this particular project it makes it a little hard to sum up – the opt-ins, the opt-outs, the carrots, the sticks and the money … the huge amount of money that has been thrown at this initiative, and here we are, at this point in time with only around 25% of Australians having their own electronic health record and the opt-out period extended yet again until early next year as authorities tweak legislation to try and allay public concerns about security and privacy.
So at the end of 2018, we’re still doing chronic care plans and managing patients on a cost per visit basis, and we’re storing all our notes in our medical software. The impact on our day-to-day practice, despite all the fanfare has been very little, at least so far.
But other things have made a difference to Australian GPs, and mostly in a good way.
First and foremost, the Medicare freeze has thawed. About bloody time of course, but at least this year we haven’t effectively gone backwards in terms of income. I doubt any of us is ordering a new Maserati with our new-found wealth, but it’s something isn’t it?
Medicine-wise we’ve taken on the new cervical cancer screening program, and aren’t we popular when we can say to women they don’t need that test repeated for five years? We took on flu vaccination with gusto, juggling the smorgasbord of options and consequently had one of the quietest flu seasons to date.
As a profession we also looked beyond our own consulting rooms and raised our voices in defence of the vulnerable and those in need.
Doctor suicides, children in detention on Nauru and Manus Island, the inadequate care and sometimes abuse of the elderly in aged care, were the focus of many of us in 2018, and we were united in our concern and desire to make a difference.
We spoke out against the bullies in our own profession, in our own way joining forces with the #metoo campaign. We defended our right to freedom of speech against ambiguous changes in the Medical Board’s code of conduct.
All in all, it has been a good year to feel good about being a GP. And it’s not because of posters on the sides of buses. Or that our various representative bodies, all of whom have had a change of leadership this year have been particularly outstanding (not that they are not good – it’s just this groundswell of concern has often developed independent of the colleges or the AMA).
It’s more that what the general public and even fellow GPs are perceiving our specialty’s priorities to be, namely the health and well-being of our patients, our colleagues and our community are real, worthwhile and worthy.
We can and do make a difference.
Hopefully you will get some time to relax and enjoy the company of good friends and family over this holiday period.
Take care and happy holidays.
