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Systems

Systems

Recent debate on Medicare rebates for patients attending general practice causes me to think more deeply about the systemic drivers of performance and practice. How much of what we do in general practice is driven by community need, professional judgement, or funding mechanisms? Inevitably these all play a part in the type of care we choose to, and are able to deliver.

Medicare is obviously part of the system that can drive behaviour and care. The corporatisation of general practice, with large numbers of short consults, the emergence of multiple after hours service providers, and the increase in care planning claims all stand as testament to this.

Nurses have been increasing in number in general practice, initially with the support of Medicare for specific item numbers and associated tasks. With the removal of the specific item numbers in favour of the Practice Nurse Incentive Payment, practices will be tempted to use nursing time to generate further income, probably through care planning and upload of My Health Record data. Will this lead to the best possible health outcomes?

GPs in Australia value their independence, and are generally resistant to submitting to a salaried system such as the NHS. Where does that independence sit, in terms of future health planning and care from the government perspective? What structure will encourage clinical behavior that delivers the best outcomes from general practice as part of a linked up and coordinated health system?

It seems clear that many politicians and bureaucrats do not understand general practice. This is perhaps not surprising given the complex nature and massive scope of the work we undertake on a daily basis. We also understand that we can’t fix everything, perhaps the best we can do is to carry on regardless? This no longer seems to be a solution, and I believe more than ever that general practice must lead the conversation on systems required for a successful future health system. To do this effectively we need to continue to educate the community and decision makers on the potential of high quality general practice. This requires transparency and collaboration on the part of general practice and general practitioners. This is a challenge for many, who have had their trust and respect for the system eroded over many years, but I believe this is an area that an organisation like AOGP can assist. Our experience and understanding of general practice along, with our independence are the main enablers of this, along with our established networks and relationships. The Benchmarking available through the AOGP Quality Practice Network is an example of this strategy in action. Check it out now, and see what we can do for you.

Tim Kelly

Tim Kelly
tim.kelly@aogp.com.au