‘We need to be more aware of the impact of disability’

The Chair of RACGP Specific Interests Disability has backed recommendations to improve training and development for the treatment of patients with a disability – but said more is needed to help GPs provide the right support.
 
Associate Professor Robert Davis describes the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability report, which includes 12 volumes and 222 recommendations, as ‘a positive document’.
 
However, he believes work remains to clarify general practice’s role in addressing the underlying issues.
 
‘I am sure [the report] will make a difference,’ he told newsGP. 
 
‘Even though it is very comprehensive, looking at solutions and developing plans to overcome the issues that they’ve identified is probably another piece of work in itself.’
 
While the report focuses on violence, neglect and abuse, healthcare access is also addressed, with one volume highlighting the issue of ‘shadow diagnosis’.
 
‘This can result in delayed diagnosis or a failure to diagnose a treatable condition for a patient with disability, which can clearly have profound consequences,’ the report says.
 
The authors also recommend peak health professional bodies look at accreditation standards ‘to address whether cognitive disability health is sufficiently covered,’ and refer to evidence heard in one public hearing.
 
‘Each college provides some training on cognitive disability health,’ they wrote.
 
‘The evidence indicated it does not systematically cover the core aptitudes in cognitive disability health.’
 
For Associate Professor Davis the recommendation makes sense.
 
‘I personally totally support there being a focus on undergraduate training to make sure that future health professionals are taught about identifying and supporting the health issues of people with intellectual disability,’ he said.
 
‘I’ve been involved in providing training at undergraduate level and we’re developing this recognition of advance skills through the college.’
 
The report contains a similar suggestion for CPD, recommending the development of specialised training content in cognitive disability health.
 
‘You need to come at it from a number of angles,’ Associate Professor Davis said.
 
‘It’s in education of undergraduates, provision of advanced skills for GPs with a special interest in the area, and a willingness from GPs across the board to consider issues of disability.
 
‘We’re looking at over 20% of the population with a disability of some description.
 
‘It’s bread and butter stuff for GPs, and we need to be more aware and cognisant of the impact that disability has, and that often disability has been driven by some sort of health issue.’
 
Associate Professor Davis also points to a shift in billing patterns in recent years, with those from poor socio-economic backgrounds – who he says are more likely to live with a disability – more reliant on bulk billing.
 
‘The number of bulk-billing GPs has taken a hit with the Government’s historical freezing of Medicare,’ he said.
 
‘To make health services more accessible, it needs to be recognised that the current limited availability of bulk billing, particularly in rural and more isolated settings, is going to be an ongoing problem.’
 
He notes that the report covers the challenges of providing multidisciplinary care. In Volume 6, the commission recommends an increase in ‘capacity to provide supports and adaptations through improved guidance, funding and accessible information’.
 
It also says hospital and primary healthcare funding models should be reviewed ‘to ensure these adaptations and supports can be implemented in all relevant settings’.
 
On a similar theme, in a submission to an independent NDIS Review last month the college proposed seven ‘overarching principles’ to support GPs in disability care and management.
 
‘By providing evidence of disability and functional impact, essential care coordination, facilitation of appeals processes and support of patient health literacy, we play an important role in assisting patient access and navigation of the scheme,’ that submission states.
 
Associate Professor Davis believes the way this is supported is a core issue.
 
‘If you expect extra responsibility and time to be taken by GPs, the remuneration needs to be appropriate,’ he said.
 
‘It relates to a fundamental problem with Medicare rebates for GPs, which have been predicated on the idea that GPs will see fairly simple problems that are quickly dealt with, rather than what it’s increasingly becoming, which is working with chronic and complex healthcare.
 
‘By its very nature, disability brings another complexity to that health consultation.’
 
While the role of GPs in NDIS planning is not directly addressed in the report, Associate Professor Davis says there are already clear signs of improvement.
 
‘We as a college are largely supportive of the underlying principle of the NDIS in supporting people with disability,’ he said.
 
‘It’s important that the NDIS has high-level interaction with the college so that we can work on some of these issues – and that’s happening.
 
‘Early in its development that was missing.’
 
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