GPs – The drivers of patient-centred health care

Australia has a very good health system, the envy of many in the world. It has been built around the central role of general practitioners.

GPs are highly trained specialists. They are uniquely positioned to diagnose and treat illness, and coordinate care working in collaboration with their patients, other specialists, and allied health care professionals.

General practice is delivering great value for patients, the community, and government. GPs are achieving very good health outcomes for patients – with modest out of pocket costs, and spending on general practice representing only six per cent of total health spending.

General practice has embraced team-based care, with many practices employing practice nurses and allied health professionals. For example, there are over 12,322 nurses working within general practice. It is estimated that over 60 per cent of practices employ at least one practice nurse.

GPs are making use of Chronic Disease and Mental Health items in the Medicare schedule to support patients in accessing the care they need.

GPs have embraced technology, with general practice in Australia now highly computerised.

This is making a world of difference. While many patients have their preferred GP, if they need to see another doctor or health professional in their practice, their patient record is readily available. This supports high quality care.

The care provided by GPs is built around the needs of the patient.

GPs occupy a gatekeeper role in our health system. This not only helps patients to navigate what can be complex and confusing, it also ensures close collaboration between GPs and other specialists in delivering care. It is one of the reasons why our health system delivers the high quality results our patients expect and deserve.

We cannot forget that fragmentation of care is the enemy of quality care.

Too often, other health professions seek to expand their role and scope of practice, at times at the expense of the quality of care. One of the reasons why health costs in the United States are so high, and outcomes poor in comparison to ours, is their fragmented approach to health care, with poor coordination and duplication being major problems.

We need to build on what works, with a strong collaborative approach to care.

Other health professionals need to be able to work autonomously to their full scope of practice. This is something that the AMA fully supports. However, the patient’s care needs to be well coordinated and it needs to be built around medical diagnosis.

We must never forget that care is about the patient. Other health professionals want to carve out new roles, often based on the premise that they will be looking after relatively simple presentations, and that this will free up time for doctors to do more complex work.

To be perfectly clear, there is rarely such a thing as a ‘simple’ presentation. GPs know their patients’ histories. So-called ‘simple’ symptoms can be a sign of a far more complex and potentially dangerous condition. GPs are trained to look for enigmas like depression and alcoholism.

In reality, a ‘simple’ visit to the GP can make a big difference to a patient’s health. Comprehensive, longitudinal care is about much more than just seeing patients when they are sick.

Vaccinations and basic acute presentations all represent an opportunity to talk about prevention and a patient’s overall health. Every visit is a health promotion opportunity.

Simple advice can make big changes to a patient’s health and wellbeing. Every consultation has the potential to uncover more serious health issues, with early intervention often the key to a good prognosis.

While it is important that patients get access to the right care from the right health professional at the right time, we need to build on what we know works well for patients. Doctors are not afraid of workforce reform, but it must be grounded in the fundamental principle of quality.

Any changes to scope of practice for different health practitioners must be underpinned by sound arrangements for:

  • setting accreditation standards for education and training programs;
  • assessing education and training providers against those standards;
  • setting practice standards; and
  • assessment of practitioners for registration against those standards.

The AMA has previously said that there is an urgent need for an independent entity to be set up to assess and evaluate the future health workforce needs of the Australian community.

Reforms must be driven by evidence, and build on a collaborative approach to care – as opposed to individual professional interests.

The Australian community will not accept second best when it comes to the quality of their health care. Near enough is not good enough.

We are training more doctors than ever before, with around 3,700 new medical graduates entering the workforce every year.

We know that there are problems with distribution of the medical workforce and that problems in rural and regional areas persist. Some specialty areas are also in short supply. But problems in accessing care are being addressed.

We must build on this training investment by having in place policies that support doctors working in the locations and specialties where they are desperately needed.

This will require greater investment in post-graduate training and well-crafted policies that target areas of workforce shortage.

We long ago moved beyond the 2005 Productivity Commission Report and the medical workforce shortages that existed at the time.

Our challenge is how to best deploy a rapidly growing medical workforce so that we meet community need, working closely with our colleagues in other health professions, rather than being bogged down in inter-professional rivalries that are not in the interests of either our health system or the patients we serve.

Australians want and deserve the best quality primary health care.

GPs are the key providers and coordinators of patient-centred care.

Over 30 years, Governments from both sides of politics have undermined and undervalued General Practice. It is time that they realised their value and supported them in their essential primary health care role.