The Royal Australian College of General Practitioners (RACGP) is urging government to provide more support for general practice to enhance the health and wellbeing of older people.
It comes via the RACGP’s latest position statement on supporting sustainable GP-led care for older Australians.
RACGP President Dr Karen Price said that GPs play a vital and often unrecognised role in caring for older people.
“The last year has seen an increased focus on aged care and care for older people and that shift could not come soon enough,” she said.
“People aged 65 and over account for 16% of the Australian population but represent nearly 30% of all general practice consultations.
“Ensuring older people have strong access to general practice care can make an enormous difference to their health and wellbeing. We know people with dementia entering the aged care system are less likely to experience an increase in prescriptions for medications like antipsychotics if they retain a relationship with their usual GP who they know and trust.
“So, by further strengthening and better equipping primary care we can significantly improve health outcomes and quality of life for older people across Australia.”
The RACGP President said that current models of care and funding arrangements mean there are significant barriers to GPs providing care to older people.
“Sustainable funding reforms are needed to help GPs get on with the job of caring for older people,” she said.
“A voluntary patient enrolment system for all people over 65 living in the community, residents of aged care facilities and all Aboriginal and Torres Strait Islander people could prove a real game-changer. Under this system, patients are ‘enrolled’ with one practice and expected to receive most of their care from that practice with their preferred GP.
“It would enhance continuity of care and achieve a stronger focus on preventative activities, early intervention and chronic disease management before conditions worsen and require a hospital bed.
“Medicare items for attendances at residential aged care facilities and home visits should be increased to reflect the unique challenges of providing care in these circumstances. The current structure is a disincentive to seeing more patients in one visit to an aged care facility and this must change because it will enable patients to maintain a relationship with their GP.
“Reforming incentive payments to encourage more participation by GPs in the provision of services to older people and better rewarding those GPs that provide more services to patients in aged care facilities would also be enormously beneficial.
“We must do a lot more to support aged care staff, family members and carers in engaging with GPs regarding ongoing care. If the left arm isn’t talking to the right arm we won’t get anywhere, and research identifies family members and carers as critical members of the multidisciplinary care team for older people.
“One useful reform would be to ensure Medicare items can fund telehealth consultations between GPs, aged care staff and family member and carers. This will allow for a better sharing of information and support care that is responsive to changing circumstances and health conditions.”
Dr Price said that more support for GPs would also lead to significant improvements in medication management.
“GPs are highly skilled in medication management for older people, including for antipsychotic medications,” she said.
“We have ongoing relationships with our patients and so if we were to eliminate barriers for GPs to provide care to residential aged care facility residents, we could reduce inappropriate prescribing. Greater funding to support GP case management, review and supervision is the key.”
The RACGP also called for improvements to workforce training.
“We need more doctors supported and trained to provide services to older people,” she said.
“So, the RACGP supports a similar model to the Prevocational General Practice Placements Program to allow for a medical workforce pipeline into aged care settings.
“Increasing the number of rotations and training placements for junior doctors in aged care facilities will strengthen their understanding of the aged care setting.”
Other key recommendations include:
· involving GPs in the design, trial, and implementation of changes to clinical protocols, team care arrangements, implementation of new technology and models of care and funding (at local, state and federal level)
· supporting different models of care appropriate to Aboriginal and Torres Strait Islander peoples, including structures that embed shared decision-making within the aged care sector
· fit-for-purpose technology in the aged care sector. Many residential aged care and GP clinical information systems are not interoperable and don’t allow remote access to records or medication charts thus limiting the flow of information
· modernising medication management for residential aged care facilities, streamlining procedures for prescribing and supporting the use of Secure Message delivery.