Cracks identified in health overhaul plan

GPs are bracing themselves for a radical overhaul of the primary care sector, with the Government now considering bold and wide-reaching reforms set to fundamentally transform the Australian health system.

Doctors and academics have criticised the National Health and Hospitals Reform Commission’s (NHHRC) final report, however its architect Dr Christine Bennett has challenged GPs to step up and make the reforms their own.

As expected, primary healthcare reform features heavily in the 123 recommendations.

At the top of the list is a Commonwealth takeover of all primary healthcare services, including family and children, drug and alcohol, and community health services.

The NHHRC report foreshadows the introduction of voluntary patient enrolment for patients with chronic and complex needs, which will in turn link to new “outcomes payments” that reward programs that achieve improved patient outcomes.

Comprehensive primary healthcare centres – virtual or physical “one-stop shops” where patients can access a range of medical, diagnostic and allied health services – are also flagged, a move that has concerned some GPs.

Sydney GP Dr Garyck Joseph questioned whether such centres would provide a solution to patient access.

“Whether you want to restructure and have these huge centres everywhere is another argument, but I think the problem is basically manpower and the running down of the facilities that we function out of,” he said.

While welcoming the overall direction of the report, Professor Gavin Mooney, professor of health economics at Sydney University, said the recommendations were too reliant on existing funding models and lacked a wide enough scope for innovative remuneration of GPs.

He also warned against the commission’s radical ‘Medicare Select’ proposal that would see Australia move towards a system of social health insurance, requiring citizens to enrol in one of several government-funded health plans.

“[Social health insurance] further endangers equity and moves health care more to the market end of the scale. Medicare is supposed to be a universal public system and it would be much better to bolster it than to undermine it,” he said.

Dr Bennett defended the report, saying the recommendations explored means of improving and expanding collaborative team care.

“Health is everyone’s business and if we leave it all and wait for the Government to do everything then we are missing a huge opportunity to change things from within the health system,” she said.

Prime Minister Kevin Rudd will now consider the report’s recommendations over the next six months.

What GPs say

DR PATRICK BYRNES
Group practice GP – Bundaberg, Qld

“The Commonwealth should have taken over the whole health system, and I think that that is the only way you will end the blame game – it will eventually evolve to that, but this is an interim step.

“[The report] does recog-nise the central place of primary care because it is talking about the need to embed early prevention and intervention, and really that is where general practice has its main strength.

“However, they make statements about a multidisciplinary team approach without realising the complications and that the logical step is someone has to be a team leader – there is only one generalist capable of doing that in the system... the GP.”

DR RUTH RATNER
Solo GP – Sydney, NSW

“They are talking about small practices as being past their use-by date, but what I see is that the bigger the practices are, the less responsibility doctors take for individual patients – so I object to them regarding small practices as ipso facto second rate.

“[Under a national role out of Comprehensive Primary Health Care Centres] personal responsibility for making sure the patient is looked after will be secondary to getting correct paperwork and referrals.

“In my area, there is absolutely no reason why GP access targets can’t be met, but in other areas there is clearly a problem – GPs don’t artificially keep their waiting lists long.”

DR JEFF TAYLOR
Rural GP – Naracoorte, SA

“At the end of the day, while the aim of the access targets is good, I think what you will see is that they won’t be able to be achieved in the short term, and they will want the nurse practitioners to come in to fill that gap, [but] this crisis is coming from a lack of doctors.

“Setting up these bigger bulk-billing [comprehensive primary health care centres] can help but it is bandaid medicine – it is not actually good disease control medicine.

“It highlights the importance of being in a group practice, and that the days of being a solo GP are probably long gone.”

For ongoing NHHRC coverage, click here