We need a joined-up health system: AMA

Covid has underlined the weaknesses of coordinating primary and tertiary care under different levels of government.

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The splitting of Australia’s primary and tertiary healthcare systems over different levels of government could prove catastrophic for our ability to cope with endemic covid, says the AMA president.

Dr Omar Khorshid told a Senate hearing this week that as Australia moves to a national approach to “live with” covid, an integrated health system would be vital for coordinating patient care.

He also said the federal government would need to expand remuneration options for GPs, who would be expected play a major role in the community management of covid infections.

“There’s no doubt the Commonwealth has a role to play in the community management of covid as the primary funder of primary care and general practice,” he said.

“However, it’s also critical that the measures that are put in place are linked to our hospital system, because it’s very clear that the management of covid-19 in the community requires a fast escalation pathway [where patients can] access the hospital quickly and effectively when they need it.”

Under the AMA’s radical proposal, federal, state and territory governments would work together at a local level to enable greater funding and support for GPs – ultimately supporting the management of more covid patients in the community.

But as Dr Khorshid told the Senate Select Committee on Covid-19, this reality was far from the current situation, where GPs were funded under the Commonwealth’s fee-for-service model and state and territories were left to coordinate hospital care.

“I think some of the solutions are going to revolve around innovations to use GPs to prevent hospital admissions,” he said.

“When it comes to covid [we need to work] out how we can use our primary care networks to monitor covid-19 patients in the community and look after them without them having to go to hospital.”

Dr Khorshid said the AMA would like to see the Commonwealth consider specific funding programs for GPs that operated outside the usual MBS model.

Given the complex nature of managing covid patients in their homes, GPs would have to be funded in a way that enabled them to be available to patients who were deteriorating, or requiring ongoing visits.

“That would be quite a significant alteration, if it were to become funded,” Dr Khorshid said.

While the Commonwealth was “very aware of the important role that general practice plays”, there were aspects of how general practice was organised and funded “that don’t sit well with this kind of task, which is effectively running many hospitals within people’s homes,” he said.

“It’s not really fee-for-service care, it’s coordinated longer-term care, in consultation with the hospital.”

But there were several caveats to this plan, Dr Khorshid said, such as the need for appropriate vision, cooperation, and an end to the “blame game” that has long dominated Australia’s two-tier health system.

And while it would be federally funded, this collaboration between primary care and hospitals would require organisation at state or local level.

“It’s not something that has worked well in the past when it’s tried to be run out of the Commonwealth level,” he told the senators. “That’s our caveat: that we support Commonwealth involvement, but the actual organisation has to happen at the local level.

“There is a program in NSW that we understand is working reasonably well, and I’m aware of discussions [happening] in South Australia looking at trying to utilise the general practice workforce, but it’s something we haven’t done before.”

Dr Khorshid acknowledged that while challenging, a health system that could respond to covid would be one that allowed better coordination of non-covid care.

“If it turns into a way for hospitals to work out how to communicate and collaborate better with general practitioners within their area, then that will be another silver lining that comes from the pandemic,” he said.

Asked about hospital capacity and bottlenecks, he commented on the underinvestment on hospitals in his home state, Western Australia, where even with no covid and no flu, elective surgeries had been cancelled and there had been about 6500 hours of ambulance ramping in the month of August.

“In a state with a budget surplus of over $5 billion, it does seem hard to reconcile that lack of investment from the state government … So the AMA is very keen on a new conversation about public hospital funding. There does seem to be some interest, at least from our state health ministers, in having that conversation, but it does mean each level of government being honest about their own contributions and making sure that a greater contribution from one level doesn’t lead to a reduction in contribution from the other level.”