Health needs of Australians have changed in the four decades since the introduction of Medicare, the country’s publicly funded universal health care, but the system has failed to keep up with changes. This is according to public policy think tank Grattan Institute’s new report A new Medicare: Strengthening general practice.
GPs’ work has become much more complex, but the way we structure and fund general practice — our health system’s backbone — hasn’t kept up, according to the report.
“Despite patient care becoming more complex, appointments have been stuck at an average length of 15 minutes for the past two decades. GPs are struggling to meet their patients’ needs, and they lack the support of a broader team of health professionals to do so,” said Grattan in a statement announcing the report.
“Other countries have reformed general practice, and their rates of avoidable hospital visits for chronic disease are falling. But Australia is spending more on hospitals while neglecting general practice: the best place to tackle chronic disease.
“Patients suffer the consequences. People with chronic disease live shorter lives, with more years of ill-health and lower earnings. Poorer Australians suffer the most: they are twice as likely to have multiple chronic diseases as wealthy Australians.
“Australia’s healthcare workers are also struggling. Hospital staff are overwhelmed with demand. And GPs tell us they are stressed, disrespected and disillusioned.”
Grattan has made four key recommendations to turn the tide of chronic diseases, meet the growing mental health demand, best meet the needs of an aging population and bring Medicare into the 21st century.
Below are the recommendations:
Making general practice a team sport
Expand access by making general practice a team sport, with more clinicians using all their skills to share the load with GPs:
- Fund 1000 new nurses, physiotherapists, mental health clinicians, pharmacists and other allied health workers in the highest-need communities, to work within general practices alongside GPs and provide fee-free care.
- Engage an independent commission to remove regulatory barriers that stop primary care workers from safely using all of their skills, and to explain the new rules clearly.
- Reduce waits and costs for specialist care, by contracting specialist advice for GPs to help them manage complex cases without referring patients to private specialists or hospital waiting lists.
A new funding model for Medicare
Change funding to support team-based chronic disease care, match funding with need and close access gaps:
- Allow general practices to opt in to a new funding model that funds more care for patients who need it and supports GP leadership, team-based care and ongoing relationships with patients.
- In practices using this new model, expand access to the Medicare Benefits Schedule for nurse practitioners and physician assistants.
- In rural areas where access to care is low or at risk, fund Primary Health Networks (PHNs) to support fragile practices or set up new services in partnership with states and local hospitals.
Shaping the system
Set a clear direction and support improvement:
- Show where we are going, with a long-term strategy for general practice that outlines what good care looks like, how it should be delivered and how it fits into the broader system.
- Give PHNs real powers to shape markets by rolling out the new funding model, the new workforce roles and specialist support.
- Measure what matters and encourage improvement with new data and reporting on access to care, quality of care, patient satisfaction, health outcomes and who is being left behind.
- Develop a strategy to improve data collection and use across the health system.
Committing to change
Avoid another dead-end trial by committing to a long-term plan:
- Commit to rolling out the new funding model over 10 years.
- Give practices the help they need to adapt, including funding, expert advice, data analysis and leadership training for GPs.
- Invest in the capability of PHNs and the department of health to support and manage system performance.