Section 1: Achieving a stronger healthcare system and a healthy Australia
The Vision for general practice and a sustainable healthcare system (the Vision) is a framework for excellence in healthcare and provides the solution to address a range of issues and pressures currently facing the Australian healthcare system. The Vision demonstrates how a well-supported general practice team can deliver sustainable,* equitable, high-value healthcare, benefiting patients, providers and funders. It is centred on evidence and experience-based recommendations regarding how the entire system can be improved.
The Vision has been developed by specialist general practitioners (GPs). As GPs, we interact with over 400,000 patients every day. With the assistance of our practice team, we provide more than 420,000 services to patients in Australia every day.1 Due to our unique role in connecting health services and by virtue of the scope of practice of our profession, we know where the system is working well and where it is failing.
* For the purpose of this document, ‘sustainability’ refers to business sustainability and the ability for general practices to maintain viable practices and continue providing high-quality care to their patients.
The health system in Australia needs transformation
Our country prides itself on economic stability and being a healthy, active society. Australia’s healthcare system is considered among the best in the world.2 However, the system is far from perfect. It was developed at a time when acute medical conditions were the main focus of healthcare, and is not fit for purpose in a society where half the population now have chronic health conditions. Care needs to be shifted out of the hospital setting, closer to where patients need it in the community setting. This changing focus of the healthcare system has been identified by many previous authors.3–8
The Vision sets out a pathway of reform that will deal with this changing focus.
The same report that ranks the Australian system as one of the world’s best also identifies it as one of the worst in terms of health equity.2 Our healthcare system is becoming increasingly outdated and unsustainable. High out-of-pocket costs for patients are masked by a deceptively high bulk-billing rate, creating an illusion of a highly equitable healthcare system.
In order for Australia to maintain a high-performing healthcare system that delivers high-quality care and health outcomes for the entire population, parts of the system must be transformed. The Vision identifies how appropriately targeted support for general practice is the most efficient use of health resources and will bring benefits for the entire healthcare system.
A vision for change
All patients must be supported to easily access their GP when they need to. Patients should be encouraged to talk to their GP, not only when they are sick, but also about how to stay healthy. When patients see their GP for preventive care and early treatment, they will be more likely to stay active in the community for longer, building and maintaining happy and healthy families, workplaces and communities. By having an established relationship with a practice and a nominated GP, patients can receive seamless, integrated and continuous care, where their needs are understood and prioritised.
When patients are unable to physically attend their practice, they should be able to appropriately communicate with their GP by phone or email.
Patients must be supported to access a range of services from their practice, reducing the need to visit multiple locations for the same issues and health concerns. This ensures that health issues are addressed effectively and in a timely manner. To facilitate this, GPs and their teams must be supported to communicate with all facets of the healthcare and social systems, making it possible and practical for patient care to be coordinated from a central point.
GPs should be supported to review their practice data and make sure that their patients are recalled for appropriate and timely care. Information collected needs to be analysed and used to improve the health of the whole population, not just one patient at a time.
The average Australian may be surprised to hear that not all of the care described above is supported by government. Many GPs and practices already provide care for their patients in this way, despite the barriers within the current healthcare system. However, without a commitment from government to fund the essential aspects of care that currently go unsupported, this type of care provision is unsustainable.
GPs want to modernise and improve the way that care is delivered in order to improve health effectiveness, accessibility and sustainability. However, a fragmented healthcare system, limited resources and poorly targeted, inflexible and inadequate health funding for patients, practitioners and practices means that GPs and general practices are finding it increasingly difficult to offer high-quality care.
Patients and their GPs are at the centre of the Australian healthcare system
General practice is the cornerstone of the Australian healthcare system, linking patients to all other health services. Australians see their GP more than any other health professional, with nine out of 10 people seeing their GP at least once a year.9,10
It is widely recognised that high-quality care is patient centred. Patient-centred care encourages patients to be engaged in their care and facilitates better targeted services for patients with chronic and complex conditions.11 Patient-centred care supports the effective and efficient use of limited health resources and leads to improved patient health outcomes. By providing long-term care in the community setting, GPs are best placed to provide care that will be patient and community-centred.
The Vision positions the patient at the centre of care in partnership with their GP. Due to this unique and important partnership, it is vital that all health professionals, policies and programs strive to ensure that a patient’s usual GP is involved at all stages of care.
Figure 1 provides a high-level overview of the interrelationships between patients and the Australian healthcare system.
*This includes GPs who look after specific patient groups such as Aboriginal and Torres Strait Islander communities, refugee communities, and patients from culturally and linguistically diverse backgrounds.
The Australian healthcare system
The importance of GPs as healthcare stewards and patient advocates
GPs are highly trained generalist medical professionals working at the interface between the patient and the broader healthcare system. Their diagnostic and management capabilities, together with their knowledge of individual patients (and their histories), enables them to formulate, implement and monitor management plans that provide high-quality, individualised and cost-effective care.
GPs provide a unique set of health services in the community, as they:
- are the first point of contact in matters of personal health and as such are constantly undertaking differential diagnoses
- care for patients of all ages, genders and cultures across all disease categories
- provide longitudinal care for patients for all life stages
- provide assessment and treatment for all patient health needs, including physical and mental health conditions
- take a whole-of-person approach to care provision in the context of a patient’s work, family and community
- can coordinate the complete care needs of patients and refer patients to other specialists
- provide care for acute illness as well as preventive care and wellness advice
- perform legal processes such as certification of documents and provision of reports in relation to motor transport and work accidents
- certify health status in order for patients to access many social support services.
In addition to their role in providing clinical care, GPs have equally important roles as patient advocates and stewards of the healthcare system. These additional roles are increasingly important as the complexity of our health system has grown. They also provide huge benefit to patients, health funders and the wider healthcare system and are the reason why all healthcare must be coordinated through a patient’s regular GP. Failure to involve a patient’s GP in all aspects of patient care disrupts continuity of care and compromises the provision of high-quality, cost-effective care through:
- fragmentation of care and medical records
- the potential for contradictory clinical advice
- unclear lines of responsibility – particularly for preventive healthcare such as cancer screening or vaccination programs
- diminished clinical governance/accountability
- duplication of patient services (eg pathology and diagnostic imaging)
- misdiagnoses or delayed diagnoses
- inappropriate or delayed treatment.
GPs’ role as stewards or ‘gatekeepers’ of the healthcare system is linked with cost-effectiveness through reducing both duplication of patient services and unnecessary use of secondary healthcare. Therefore, GPs have the ability to facilitate efficient use of health resources.
The GP’s role as health steward is expected and required in the current system, yet not appropriately supported or encouraged through adequate funding or recognition. GPs should have major roles in population planning at both a local and regional level. They should be supported to work with Primary Health Networks, local health districts and public health departments to ensure that changes to the healthcare system are well informed and best meet the needs of the population.