The Vision for general practice

The model for high-quality patient care

The Vision for general practice
Download PDF
  1. Supporting resources
  2. Acknowledgements
  3. Disclaimer
  4. Provided under licence
  5. Search

Last revised: 21 Oct 2019

Section 3: The model for high-performing patient care

Core features of high-quality general practice

Primary healthcare system reform around the world is currently guided by the ‘Quadruple aim of primary healthcare’.36

The quadruple aim

The quadruple aim (Figure 2) seeks to drive healthcare redesign in order to improve the health of the population, improve the patient experience of care, reduce healthcare costs and improve the work life of health providers.

Figure 2

Figure 2

Quadruple aim of primary healthcare
Download View full size

Achieving the four principles of the quadruple aim is needed to achieve a sustainable healthcare system. The Vision is based on the quadruple aim, but provides solutions based in general practice. As general practice is the most frequently accessed part of the healthcare system, it is logical to introduce reforms in this sector.

The Vision adapts the quadruple aim to general practice and aims to achieve its principles through:

  1. enhancing the patient experience – by encouraging patient-centred, coordinated care, where patients are empowered to have an active role in their healthcare by establishing a long-term therapeutic relationship with a regular GP and practice
  2. improving the health of the population – by addressing the quality of care for people with acute and chronic conditions, while also prioritising  preventive care and ensuring that patients have access to evidence-based health services at their first point of contact with the healthcare system
  3. reducing per capita costs of healthcare – by recommending a shift in health funding to better support general practice and its focus on preventive care, and a move to providing care in the community and reducing reliance on expensive hospital services and tertiary care
  4. improving the work life of health providers – by ensuring that GPs are well recognised and supported to provide high-quality care to their patients  through funding for the implementation of systems to address burnout and increase role satisfaction for the profession.

Improved satisfaction of GPs will also increase the attractiveness of general practice as a profession, helping to grow and sustain the future general practice workforce.

International evidence suggests that there are several identifiable features associated with high-performing primary care. These features are often grouped together to form a comprehensive model of care, most notably referred to as either:

  • the ‘patient-centred medical home’23,37,38
  • the ‘10 building blocks of high-performing primary care’.39

The combination of these features is considered as best practice primary care, and has heavily influenced the RACGP’s Vision. However, the Vision has been specifically developed by Australian GPs to take into account the local context and needs of Australian patients, and therefore does not mirror existing models entirely.

Our Vision is underpinned by six core features of high-performing general practice (Table 1). While GPs have the ultimate responsibility for their patients’ care, the general practice team plays a vital role in supporting the delivery of care. Therefore, supports need to be given to both GPs and the practice in which they work for these features to flourish.

Table 1.

Table 1.

 Core features of high-performing general practice 
Download View full size

Many GPs and general practices are providing care according to the principles of high-performing general practice, but Medicare is limited in supporting the full range of services required. Unless support for the sector is increased and better aligned to high-quality care, the healthcare system will become unsustainable and unable to meet the changing needs of the population.


Benefits of high-performing general practice

The benefits of supporting these features of high-performing general practice will be felt by patients, healthcare providers and governments, as outlined in Figure 3.

Figure 3.

Figure 3.

Benefits to patients, healthcare providers and government
Download View full size


Actioning the features of high-performing general practice

To ensure that GPs and their teams are able to continue delivering high-quality general practice care, a number of actions are required. The majority of practices already recognise these features and are trying to implement them with varying success due to limited support. Additional funding and support is essential for practices to routinely achieve these features.

Foster engaged leadership

High-performing practices have GP leaders who are engaged in and responsible for developing and leading the implementation of a practice’s measurable goals and objectives.40 As well as having a leadership role within the practice, GP leaders also advocate for patients and general practice within the broader healthcare system.

All actions required to achieve quality general practice require an engaged leadership team (including GPs and other members of the practice team) to identify priorities for improvement, facilitate and influence change processes, and measure goals and outcomes.40

 
Patient centered

Patient centered

Coordinated

Coordinated

High Quality

High-quality


Ensure all patients have access to timely, holistic and comprehensive quality healthcare

A well-resourced practice can provide patients with a comprehensive and holistic range of services that address their current and future physical and mental health needs in a timely manner.

Effective comprehensive care provided in the practice setting can reduce the need for more expensive care provided in hospitals or by other specialists.45 It is associated with slower growth in health expenditure, as well as better system quality, equity and efficiency.46

 
Patient centered

Patient centered

Coordinated

Coordinated

Comprehensive

Comprehensive

Accessible

Accessible


Facilitate all patients to form a relationship with a usual GP within a general practice

An ongoing relationship with a GP or practice allows for the provision of continuous and comprehensive care throughout all life stages.47

Patients should be encouraged to form an ongoing therapeutic relationship with their GP, which will lead to both having a holistic understanding of the patient’s needs. This is of benefit to the patient as well as the GP.48 The ideal patient–GP relationship is based on mutual respect and shared commitment to the patient’s health.

This relationship also enables practices to understand their patient population, enabling better-targeted and effective coordination of clinical resources to meet their patient’s needs.

 
Patient centered

Patient centered

Continuous

Continuous


Promote patient-centred care by supporting the involvement of patients in the planning and delivery of their care

Patient-centred care should be prioritised by recognising the patient as a partner in their healthcare. This partnership provides patients with increased understanding, confidence and awareness of decision-making regarding their healthcare needs and options for treatment.49

Patient-centred care extends beyond treating episodic illnesses, and may involve other individuals who support the patient, such as carers or family members.48

 
Patient centered

Patient centered


Enable the coordination and use of information within the practice team and the broader health system in a timely manner

In coordinating and using the information available to them, GPs and practices facilitate informational continuity of care. This involves using patient information held within the practice regarding past events and personal circumstances to ensure that current and future care is appropriate for the individual patient.23

As well as coordinating care within a practice, GPs and their teams have a crucial and trusted role in helping their patients navigate the wider private and public healthcare systems.

Improved collection and sharing of data will improve regional planning and provide practices with opportunities to reflect on their priorities and performance.

 
Patient centered

Patient centered

Continuous

Continuous

Comprehensive

Comprehensive

Coordinated

Coordinated

Accessible

Accessible


Support the multidisciplinary team

The Vision positions the GP at the centre of care provision, but acknowledges the importance and significant value of other members of a multidisciplinary team in providing care to patients.

A well-resourced, multidisciplinary GP-led team has the capacity to coordinate care and ensure that patient needs are met. This is particularly important for people with chronic and complex conditions.

Members of GP-led teams can vary significantly depending on community need, and often include nurses, allied health professionals and administrative staff.5

 
Patient centered

Patient centered

Continuous

Continuous

Comprehensive

Comprehensive

Coordinated

Coordinated


Prioritise disease prevention and early intervention activities

General practice is in a pivotal position to deliver preventive healthcare.
Preventive healthcare in general practice includes the prevention of illness, the early detection of specific disease, and the promotion and maintenance of health.50

Preventive care provided by GPs is critical in addressing the health disparities faced by disadvantaged and vulnerable population groups.50

Early access to health promotion and appropriate preventive care assists patients to stay more active in their community. This reduces the length of hospital stays and re-admission rates, and targets health resources to patients who will benefit most.

 
High Quality

High-quality

Comprehensive

Comprehensive


Support evidence-based patient care

Evidence-based patient care is a core standard for general practice in Australia.41,51 However, inadequate evidence relevant to primary healthcare can hinder GPs’ efforts to provide this care.

To facilitate patient access to safe, high-quality and evidence-based care from GPs, the primary healthcare system itself must be underpinned by rigorous evidence, for which primary healthcare research, and more specifically general practice research, is essential.52

Supporting general practice–specific research will facilitate patient access to contemporary, evidence-based medical services in the health setting they use most frequently.

 
High Quality

High-quality


Support education and comprehensive training of all health professionals

General practice provides a number of unique learning opportunities for all healthcare professionals. GPs have the skills and education to adapt to changing population needs. When given the appropriate training and support, they also have capacity to provide elements of care currently provided in a hospital setting.

Students of other health disciplines (both within and outside primary care) should be supported to undertake a placement in general practice to encourage a greater understanding of its value and role at the centre of the primary healthcare system. This will lead to better communication between the different sectors within the health system and, ultimately, improve patient outcomes.

Education and training are vital in meeting the quadruple aim of healthcare.

A highly trained and educated multidisciplinary team helps to ensure that all members can work to their maximum capacity, increasing efficiencies in providing care and improving clinician and staff role satisfaction.

 
High Quality

High-quality

Accessible

Accessible


Maintain a culture of data-enabled quality improvement and safety

The Vision encourages fostering a culture of quality improvement within practices, which will improve patient safety and care. GPs and practice teams should be encouraged and supported to reflect on their own performance and engage in quality improvement initiatives and activities. Quality improvement is an underlying feature of general practice care and is supported through practice accreditation and continuing professional development.

A culture of quality should support improvement to the provision of safe, high-quality, patient-centred care, based on the best knowledge and evidence. High-quality, evidence-based tools designed to improve the delivery of safe and high-performing care in general practice are needed. It is, and should remain, the role of the RACGP to design and set the standards for these tools.

 
Patient centered

Patient centered

High Quality

High-quality


Facilitate effective and efficient use of health resources

GPs and their teams contribute to the effective and efficient use of health resources by providing over 150 million patient services each year at a fraction of the cost of hospital services.53

GPs play a role in managing health costs by:

  • providing accurate entries into a patient’s electronic health record to foster continuity throughout a patient’s healthcare journey
  • enacting their role as healthcare stewards and ensuring that all referrals are appropriate and required
  • using evidence to evaluate the need for appropriate medical tests, treatments and procedures, and avoid such tests, treatments and procedures where evidence shows that they provide no overall benefit
  • providing opportunistic and systematic preventive services to stop or delay the onset of diseases and allow for early diagnosis of health conditions
  • encouraging patient self-care
  • avoiding complications of chronic diseases
  • managing presentations that would otherwise result in an emergency department presentation (such as injuries, wound care or acute infections).
  1. Department of Health. Annual Medicare statistics – Financial year 1984–85 to 2017–18. Canberra: DoH, 2018.
  2. The Commonwealth Fund. Mirror, mirror 2017: International comparison reflects flaws and opportunities for better US. health care. New York: The Commonwealth Fund, 2017. [Accessed 22 May 2019].
  3. Swerissen H, Duckett S. Chronic failure in primary care. Carlton, Vic: Grattan Institute, 2016.
  4. Duckett S, Swerissen H, Moran G. Building better foundations for primary care. Carlton, Vic: Grattan Institute, 2017.
  5. Swerissen H, Duckett S, Moran G. Mapping primary care in Australia. Carlton, Vic: Grattan Institute, 2018.
  6. Productivity Commission. Shifting the dial: 5 year productivity review. Chapter 2: Healthier Australians. Inquiry report no. 84. Canberra: Productivity Commission, 2017.
  7. Russell L, Dawda P. The role of Primary Health Networks in the delivery of primary care reforms. Hawthorn, Vic: Analysis & Policy Observatory, 2019.
  8. Royal College of General Practitioners. Fit for the future: A vision for general practice. London: RCGP, 2019. [Accessed 17 July 2019].
  9. Australian Bureau of Statistics. Patient experiences in Australia: Summary of findings, 2017–18. Cat. no. 4839.0 Canberra: ABS, 2018.
  10. Australian Institute of Health and Welfare. Australia’s health 2018. Cat. no. AUS 221. Health and welfare expenditure series no. 64. Cat. no. HWE 74. Canberra: AIHW, 2018.
  11. Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions. Canberra: Department of Health, 2015. [Accessed 17 July 2019].
  12. Australian Institute of Health and Welfare. Health expenditure Australia 2016–17. Health and welfare expenditure series no. 64. Cat. no. HWE 74. Canberra: AIHW, 2018.
  13. Steering Committee for the Review of Government Service Provision. Report on government services 2019. Chapter 12: Public hospitals. Canberra: Productivity Commission, 2019 [Accessed 22 May 2019].
  14. Productivity Commission. Report on government services. Canberra: Productivity Commission, 2019. [Accessed 20 January 2019].
  15. Steering Committee for the Review of Government Service Provision. Report on government services 2019. Public hospitals. Canberra: Productivity Commission, 2019. [Accessed 22 May 2019].
  16. Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors – A matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 2018;8(6):e021161-e.
  17. Barker I, Steventon A, Deeny SR. Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: Cross sectional study of routinely collected, person level data. BMJ (Clinical Research Ed) 2017;356:j84-j.
  18. Nagree Y, Camarda VJ, Fatovich DM, et al. Quantifying the proportion of general practice and low-acuity patients in the emergency department. Med J Aust 2013;198(11):612–15.
  19. Steering Committee for the Review of Government Service Provision. Report on government services. Canberra: Productivity Commission, 2018.
  20. Shen E, Koyama SY, Huynh DN, et al. Association of a dedicated post-hospital discharge follow-up visit and 30 day readmission risk in a Medicare advantage population. JAMA Intern Med 2017;177(1):132–35.
  21. Zhao Y, Thomas SL, Guthridge SL, Wakerman J. Better health outcomes at lower costs: The benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia’s Northern Territory. BMC Health Serv Res 2014;14:463.
  22. Dalton APA, Lal A, Mohebbi M, Carter PR. Economic evaluation of the Indigenous Australians’ Health Programme Phase I. Burwood, Vic: Deakin University, 2018.
  23. Baird B, Reeve H, Ross S, et al. Innovative models of general practice. London: The King’s Fund, 2018.
  24. World Health Organization. The world health report 2008: Primary health care now more than ever. Geneva: WHO, 2008.
  25. Australian Institute of Health and Welfare 2018. Emergency department care 2017–18: Australian hospital statistics. Health services series no. 89. Cat. no. HSE 216. Canberra: AIHW. [Accessed 22 May 2019].
  26. Department of Health. GP workforce statistics – 2001–02 to 2016–17. Canberra: DoH, 2018. [Accessed 3 May 2019].
  27. National Health Performance Authority. Hospital performance: Costs of acute admitted patients in public hospitals in 2011–12. Sydney: NHPA, 2015.
  28. Steering Committee for the Review of Government Service Provision. Report on government services 2019. Canberra: Productivity Commission, 2019.
  29. MBS Online. Medicare Benefits Schedule – Item 23. Canberra: Department of Health, 2019. [Accessed 23 July 2019].
  30. Australian Public Service Commission. How employee health and wellbeing affects organisational productvitiy. Canberra: APSC, 2018.
  31. Laplagne P, Glover M, Shomos A. Effects of health and education on labour force participation: Staff working paper. Melbourne: Productivity Commission, 2007.
  32. National Health and Medical Research Council. Research funding statistics and data. Canberra: NHMRC, 2017 [Accessed 8 July 2019].
  33. Scullard P, Abdelhamid A, Steel N, Qureshi N. Does the evidence referenced in NICE guidelines reflect a primary care population? Br J Gen Pract 2011;61(584):e112–17.
  34. Steel N, Abdelhamid A, Stokes T, et al. A review of clinical practice guidelines found that they were often based on evidence of uncertain relevance to primary care patients. J Clin Epidemiol 2014;67(11):1251–57.
  35. Beasley JW, Starfield B, van Weel C, Rosser WW, Haq CL. Global health and primary care research. J Am Board Fam Med 2007;20(6):518–26.
  36. Bodenheimer T, Sinsky C. From triple to quadruple aim: Care of the patient requires care of the provider. Ann Fam Med 2014;12(6):573–76.
  37. Phillips RL, Short A, Kenning A, et al. Achieving patientcentred care: The potential and challenge of the patientas-professional role. Health Expect 2015;18(6):2616–28.
  38. Sidani S, Collins L, Harbman P, et al. Development of a measure to assess healthcare providers’ implementation of patient-centered care. Worldviews Evid Based Nurs 2014;11(4):248–57.
  39. Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med 2014;12(2):166–71.
  40. van Walraven C, Oake N, Jennings A, Forster AJ. The association between continuity of care and outcomes: A systematic and critical review. J Eval Clin Pract 2010;16(5):947–56.
  41. Western Australia Primary Health Alliance. Comprehensive primary care: What patient centred medical home models mean for Australian primary health care. Belmont, WA: WAPHA, 2016.
  42. World Health Organization. Continuity and coordination of care: A practice brief to support implementation of the WHO framework on integrated people-centred health services. Geneva: WHO, 2018.
  43. The Royal Australian College of General Practitioners. Standards for general practices. 5th edition. East Melbourne, Vic: RACGP, 2017.
  44. Sripa P, Hayhoe B, Garg P, Majeed A, Greenfield G. Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: A systematic review. Br J Gen Pract 2019 May;69(682):e294–303.
  45. Bazemore A, Petterson S, Peterson LE, Phillips RL, Jr. More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Ann Fam Med 2015;13(3):206–13.
  46. Southey G, Heydon A. The Starfield Model: Measuring comprehensive primary care for system benefit. Health Manage Forum 2014;27(2):60–64.
  47. Institute for Patient-and Family-Centred Care. Patient-and family-centred care. Bethsheda, MD: Institute for Patient- and Family-Centered Care, 2018 [Accessed 29 January 2019].
  48. Phillips RL, Short A, Kenning A, et al. Achieving patientcentred care: The potential and challenge of the patientas-professional role. Health Expect 2015;18(6):2616–28.
  49. Pulvirenti M, McMillan J, Lawn S. Empowerment, patient centred care and self-management. Health Expect 2014;17(3):303–10.
  50. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. 9th edn. East Melbourne, Vic: RACGP, 2016.
  51. Margolis S. Editorial: Evidence-based medicine. Aust J Gen Pract 2018;47(6):325.
  52. The Royal Australian College of General Practitioners. Pre-budget submission 2017–18. East Melbourne, Vic: RACGP, 2016.
  53. The Royal Australian College of General Practitioners. Overview of the federal Budget 2018–19 (Health). East Melbourne, Vic: RACGP, 2018.
This event attracts CPD points and can be self recorded

Did you know you can now log your CPD with a click of a button?

Create Quick log
Previous Next

Advertising