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Building Quality, Equity and Capacity in Health Systems: Revitalising General Practice

06 November 2009

In short, General practice requires major intervention to ensure sustainability. Australian general practice remains under valued, under supported and over stretched.

We need to

• build on what is proven to be effective: quality general practice
• create a future where general practice and primary health care disciplines are sought after career destinations
• embed a strong focus on quality and health outcomes across all primary health care services
• redistribute health system resources to increase investment in general practice and primary health care.

Introduction

What will general practice look like in 2020?

Major health system reform is agreed to be necessary, and will inevitably mean substantial change.

New directions will crystallise in early 2010 when the Australian Government formally responds to final reports from the National Health and Hospitals Reform Commission (the Commission), the National Primary Health Care Strategy, the Preventive Care Strategy and other major national review processes. These comprehensive review reports have led to an outpouring of views from many hundreds of individuals, groups and organisations, testifying to the widespread hunger for health system reform.

The necessity to strengthen primary health care is one of the strongest emerging themes. The Commission’s response to the depth of supporting evidence is to recommend the development of a person-centred, strong, equitable, integrated primary health care system. The Draft National Primary Health Care (PHC) Strategy and its associated Report subsequently proposed a broad strategic framework for PHC, and the Minister for Health invited further discussion to refine “the nature of changes and specific approaches to implementation” required. This is a welcome invitation that general practice and the PHC sector must take up.

This does not mean that when the health reform dust settles, the outcomes will adequately reflect the evidence. Many different futures are possible. Major reform presents Australian governments with a difficult challenge given global economic circumstances, and vested interests will advocate alternative futures despite the evidence. The lack of implementation detail in all reports leaves open multiple implementation options and outcomes.

Therefore, to preserve what is most central and valuable to our discipline and sector, general practice and primary health care organisations will need to present a sufficiently sound and united plan to move forward from a fragmented, under-resourced past, to a strong integrated future.

This is the first RACGP discussion paper focused on the general practice and primary health care aspects of national health reform.

This first paper Building quality, equity and capacity in health systems: revitalising general practice, draws on international resources to describe the characteristics of future quality general practice, while identifying issues that weaken the discipline, compromise its sustainability, and impact on the quality and capacity of general practice and primary health care.

A second paper might focus on broader primary health care issues, and how we might move from site to system solutions. While the first paper emphasises the need to build on existing quality general practice, the second paper would focus on the need for change in the discipline, including infrastructure and relationships with other system elements. The differing structures and processes needed at regional and local level, which are central to equity, capacity, and system evolution, are also explored despite limited attention in national reviews.

We are planning for our future communities’ needs, and for future generations of general practitioners and our colleagues in other primary health care disciplines. The challenges are formidable for both government and health professionals. The college seeks and welcomes your thoughts on these important issues. Readers are invited to contribute to the discussion by emailing the RACGP at healthreform@racgp.org.au.

This paper has been prepared by the RACGP’s Presidential Task Force on Health System Reform. The RACGP Council thanks Task Force members for their work in developing this, and subsequent papers.

Members of the Presidential Task Force on Health System Reform

Assoc. Prof. Di O’Halloran (Chair)
Dr Janice Bell
Prof. Claire Jackson
Dr Kathryn Kirkpatrick
Dr Rob Pegram

Publication Date: 6 November 2009
Authorised By: Office of President and CEO