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Episode 5

GPs and aged care

Show notes

Welcome to Generally Speaking, the conversation for all GPs. Join GPs Dr Gill Singleton and Dr Billy Stoupas as they discuss some of the most pressing topics and issues surrounding the operations of a GP.

In this episode, Dr Stoupas and Dr Singleton discuss GPs and aged care – a specialised area for Billy – sharing insights into the impact of the COVID-19 pandemic, the aged care royal commission and how choosing to practice in aged care can make a difference to this vulnerable community. Joining our hosts in this conversation is Dr Paresh Dawda, Director of Prestantia Health in Canberra, and Fellow of the Royal College of General Practitioners (RCGP).

06 May 2020 - 03:19 PM | 17 min 21 sec

(01:17) Are you able to give more context into the aged care royal commission and its impact on you as a GP?

Dr Stoupas believes that the royal commission from a GP’s perspective was sparked through a series of issues concerning the aged care, disability care, and areas of need where people are living in self serviced units. The Government thus provided a number of resources and tax dollar funding to these sectors to support them. They hope to answer a number of questions with this program, including:

  • Is what they are providing now enough?
  • Do they have enough staffing and practising doctors on board?
  • Is there enough resources going into a specific area?
  • Are there enough nurses on the floor?

(02:55) There are a number of parallels with people in aged care being a vulnerable population generally in need of oversight and access to quality care. Do you believe this to be true?

Dr Stoupas agrees with this sentiment, and believes that they’re looking to reform the system and make it more streamlined for patients in aged care to find funding and resources. At the moment it’s quite complex and convoluted in regards to access and the nature in which someone is delivered care.

(03:05) So Billy, why aged care?

Dr Stoupas believes that aged care is essential, a responsibility that he believes he has in giving all his attention and resources to a sector that is somewhat marginalised. Omitting from any clinical sessions, Billy’s passion lies in these communities, getting to know a variety of different patients in a variety of different settings.

(04:00) Did the interim report that came out of the royal commission’s program highlight any major changes that may affect the operations of a GP?

Dr Stoupas welcomes the program that the royal commission enabled, with the interim report highlighting the deeper consideration they are asking of these services in regards to documentation. There have also been questions surrounding the appropriate medication, re-considering what has been performed and administered in the past.

(05:30) If you were trying to get a young register into aged care, how would you do this?

Dr Stoupas acknowledges that there is a level of diversity in the practice of going into aged care, stating that there is flexibility in hours as the care is chronic and long-term, allowing for a considerable amount of time to build not only relationships but solutions. He also believes that the problems surrounding care for the elderly are only going to become more complex as we have a more dense elderly population, and believes the work is not only important, like any care, but becoming innovative and progressive. Dr Stoupas cites the RACGP aged care clinical guide is an important piece of information for new registers thinking of entering the sector.

Introduction of Dr Paresh Dawda

 

(06:53) What’s your opinion on the implications of the royal commission on the aged care sector?

Dr Dawda firstly acknowledges the activity that has been sparked by the announcement of the royal commission, and the attention that the media is giving the issues that he’s seen for years. He also recognises the level of regulation and compliance that is now placed on GPs, with a significant increase in what classifies safe practice.

(08:11) Do you think these changes are going to be good in the long run?

At the moment there’s a key effort being made to focus on the idea of improving things, turning patients and their situations into analytics and hoping that with more rigorous regulation and some resources the statistics will improve. However, what Dr Dawda is hoping for is going beyond complacent-driven approaches and committing to new structures and processes that will become the norm in care delivery.

(09:27) Do you think these changes that are being promoted are placing more pressure on not prescribing certain medications? If so, what do you think about this new practice?

Dr Dawda believes that there are a number of factors that influence prescribing practices. Some are dependent upon the nature of the patient, and also from the external environment. These external factors have become more rigorous since the inception of the royal commission as they’ve sparked an adjustment in structure and processes throughout the aged care sector.

(10:55) How do you think the RACGP aged care clinical guide (Silver Book) can assist those working in aged care?

The Silver Book looks at the practice of aged health care in three key parts:

  1. How do you go about looking at the common clinical conditions within aged care and how do you go about managing them?
  2. Examines elements that concern the challenges of ageing, the delivery of healthcare, and the principles of medical care and this cohort of people and the population.
  3. The organisational approaches to aged care.

Ultimately, Dr Dawda understands that this practice is not only complex medically, but complex ethically, psychologically and socially, therefore, the Silver Book provides practical guidelines for various levels of care in the sector.

(13:00) Do you think the Silver Book provides any practical alternatives for the use of chemical restraints by staff in aged care facilities?

Noting that chemical restraints are used primarily for people with behavioural and psychological symptoms of dementia within aged care facilities, Dr Dawda believes that the Silver Book assists in assessing and managing these symptoms. It also simplifies how doctors go about dealing with a patient experiencing dementia, making it more black and white, while also considering the complex nature of each patient’s situation. If pharmacological management is chosen as a tool for this patients care, they’re provided specific guidance that’s holistically understood and practised throughout the entirety of the sector.

(15:37) Do you think if more money was directed towards these facilities being staffed, this would solve a lot of the problems?

Dr Dawda believes that just increasing resources isn’t the answer, rather it involves a combination of this and a deeper level of commitment to new and productive structures and practices.

(15:31) Do you think the recent change to MBS item numbers might affect some GPs going into aged care facilities?

Dr Dawda believes that there will be a few winners and a few losers, but the magnitude of the win or the magnitude of the loss is actually, in the grand scheme of things, pretty small.

  • The ‘Hawthorne effect’ is a reactive symptom whereby individuals modify an aspect of their behaviour in response to their awareness of being observed.
  • Some of the key influences on prescribing practices since the inception of the aged care royal commission include:
    • need and welfare of the patient – their values, their careers, their families
    • changes in practice, structure and processes of aged care facilities as a consequence of regulation
    • compliance campaigns.

‘Well, certainly [in] my practice and from what I hear from colleagues, the impacts of the royal commission has been really to put on everyone’s antenna, so to speak.’

‘If we really want to sustain quality and if we want to sort of make quality practice the core of this, we really need to sort of go beyond complacent-driven approaches to ones that are more focused on commitment, which look at structures and processes, and hardwire that into the care delivery process. That way there’s much more sustainable improvements.’

‘I think aged care … it’s a complex environment. It’s complex medicine but it’s also got complex ethical, moral, psychological and social issues connected with that.’

– Dr Paresh Dawda

Generally Speaking is an RACGP podcast, sponsored by CommBank and hosted by GPs.

Resources referred to in the podcast and on the webpage are not necessarily endorsed by RACGP and views of the presenters are their own.

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