23 March 2020

We need urgent action to save those in frontline primary care

General practice Policy TheHill

We are all collectively participants and witnesses to perhaps the most significant health crisis the world has experienced in the past 100 years.

Those of us involved in healthcare governance, management and delivery are fully cognisant of the enormous challenges frontline healthcare providers are now facing on an hour by hour basis. The complexity of dealing with a rapidly spreading viral pandemic while having to continue to provide ongoing routine care means that the normal service delivery rules and care models are being been severely tested. Healthcare delivery is under a massive assault.

General practice is at the frontline of primary care delivery and it is being stretched and stressed. It is highly possible that as a consequence of this crisis many general practices will struggle and some will be at risk of collapse. This is based on a combination of factors including:

  1. Workforce factors: Illness, exhaustion and or unavailability of doctors, nurses and staff,
  2. A lack of personal protective equipment, and
  3. A lack of cashflow and cash reserves creating financial unsustainability.

The above may also hold true for Medical Deputising Services that provide care for and on behalf of general practice to vulnerable Australians and to residential aged care in the after hours period.

The concern is that if frontline primary care services start failing, where will, and how will, routine primary care continue to be provided?  And what does this mean in the longer term for Australia if some, perhaps many primary care services simply cease to operate? Will this result in increased pressure on the public hospital system? Will this result in Australians have reduced access to healthcare services with an inevitable risk of a long term increase in morbidIty and mortality?

The late Barbara Starfield’s research showed that investing in primary healthcare is the way to a successful health system. General practice urgently needs within the next few days a broader support package to ensure its continued existence. The key GP stakeholders and industry leaders have over the past few weeks provided a number of key recommendations to government including but not limited to:

  1. Expansion of the recently introduced limited telehealth item numbers to cover all Australians. This is now an absolute imperative given the impeding Australia wide lockdown. If all patients cannot access MBS rebatable Telehealth services they will either not seek care or will be forced to attend their general practice in person which creates risk and undermines the principles of social isolation,
  2. Permitting MBS restricted deputising doctors to provide healthcare in daytime hours for and in behalf of general practice, and
  3. Authorising electronic transfer of prescription (ETP) to be a legal method for prescribing and dispensing prescriptions.

These measures can (like all other government healthcare initiatives) be monitored via existing compliance processes and controls to protect against inappropriate use and low value service delivery.

It is extremely frustrating that government has been slow to accept these now time-critical recommendations.  I am now imploring the national cabinet and governments of Australia not to wait another week to implement these and other well considered recommendations provided by the general practice sector.  Australia needs decisive action now.

Dr Nathan Pinskier MBBS, FRACGP, FAAPM, FAAQHC, Dip Prac Man, CPM

Director Medi7 General Practices

President General Practice Deputising Association

Medical Director DrDr After Hours Deputising Service

President General Practice Deputising Association

Board Member Peninsula Health

Clinical Advisor ADHA Secure Messaging

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