Report calls for greater coordination and funding for Australian primary care

The Grattan Institute report, Mapping primary care in Australia, found that access to GPs depends on a patient’s income, with around one in 25 Australians delaying seeing their doctor because of the cost.
 
People who are older, from lower socioeconomic backgrounds and in rural locations face particular challenges in accessing primary care, the report found.
 
‘The Commonwealth and the states have made some progress through the National Health Reform Agreement,’ the report states. ‘But these reforms are limited and piecemeal compared with the major reforms introduced in areas such as home care and support, and disability services.
 
‘The Commonwealth government is meant to be responsible for managing primary care, but the states continue to have responsibility for a range of primary care and specialist community services. The result is that responsibility for policy, planning, funding, data collection, organisation and management is fragmented, ineffective and inefficient.’
 
The report calls for a comprehensive national primary care policy framework, implemented through the National Health Reform Agreement.
 
Dr Stephen Duckett, the Grattan Institute’s Health Program Director, co-authored the report. He told newsGP he wants to show there is an issue with access to primary care – and difficulties in coordinating care between different primary healthcare providers such as GPs, pharmacists, maternal and child health nurses, and allied health professionals.
 
‘Our way of seeing [primary care] is often blinkered by who we are and where we sit. What we really need is a reinvestment of both money and policy energy into this space,’ he said.
 
‘If you look at the by-elections on the weekend, all the commentary was on [hospitals] and there wasn’t much on keeping people out of hospitals,’ he said.
 
‘It’s very easy for people to slip into thinking healthcare equals hospitals.
 
According to the Grattan Institute report: ‘Much of primary care is delivered by small, privately owned professional practices working independently of one another. They operate next to a range of relatively small non-government and state-run agencies providing primary care and specialist community services.’
 
Dr Duckett said the best option for coordination would be to build on the existing Primary Healthcare Networks (PHNs), introduced in 2015.
 
‘At the moment, PHNs are seen as creatures of the Commonwealth. I see a tripartite opportunity for the Commonwealth, states and PHNs,’ he said.
 
Dr Duckett said looking after the needs of the one in five people with ongoing complex health needs represents a major gap in the system in the primary healthcare system.
 
‘The funding arrangements for GPs hasn’t changed enormously in the last 50 years, and yet we need to have things like nurses in practices who can ring patients and ask how they’re going and if they’re taking their medications,’ he said. ‘We need that funding arrangement.’
 
Dr Duckett said that most GP clinics in Australia still run as small businesses operating in isolation.
 
‘[GP clinics] are still a cottage industry, when primary care is so important and needs to be the foundation of the whole healthcare system,’ he said. ‘In the UK, they’ve grouped them into clinical commissioning groups who work on behalf of many GP clinics.’
 
The report states that, ‘General practices do not have the organisational capacity to develop, coordinate and manage integrated service delivery across a network of providers for people with complex care needs.’
 
Chair of the RACGP Expert Committee – Quality Care (REC–QC) Dr Evan Ackermann told newsGP the new report underlines the significance of primary care.
 
‘The importance of general practice in resolving Australia's health problems contrasts with the low priority both political parties give to it,’ he said. ‘Neither political party has a well-defined primary care strategy. The focus on hospitals, waiting lists and private health insurance has gone on too long.’

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