Presenting a roadmap for health reform

  10 August 2022  Dr Melissa Sweet, Andrew Masterson   

This article was written by Dr Melissa Sweet and Andrew Masterson and first published on on Wednesday 10 August 2022. We encourage you to support and subscribe to Croakey.

As the Federal Government’s Strengthening Medicare Taskforce develops a work program, it can draw upon many previous reports and recommendations, including those from a timely summit held in Canberra in May.

Key recommendations from that meeting included: voluntary patient registration; workforce incentive programs so practices can offer additional services such as allied health; and integrated healthcare neighbourhoods, reports Andrew Masterson, from the North Western Melbourne Primary Health Network.

Andrew Masterson writes:

The oft-repeated advice to talk things over with your GP is unquestionably sound, but it is also a revelation of privilege.

Many people in Australia do not have a GP. Some have no incentive to build a relationship with health professionals, while others have little opportunity to do so.

The exigencies of the COVID-19 pandemic have produced punishing surges in demand for prevention, diagnosis and treatment services across the health sector, but these represent only additional burdens to bear for a population already significantly impacted by flawed healthcare.

Australia’s Primary Health 10 Year Plan 2022-2032 revealed that just under half of us live with at least one of 10 common chronic conditions, with the numbers highest in areas of socioeconomic disadvantage, including rural and remote locations, and among First Nations communities.

Chronic conditions are best managed, and often first diagnosed, through primary healthcare – and most effectively through a stable relationship between practitioner and patient. Yet it is the people in higher-risk cohorts who are the least likely to be able to access – or to be persuaded to access – the sector on anything other than an ad hoc basis.

“The challenge facing the health sector and its state and federal funders is to build continuity of care into the system,” says Ray Messom, chief executive officer of WentWest, the primary health network that leads system integration across western Sydney.

“Not only is this better in terms of care provision, because it is well accepted that continuity of care is linked to better health outcomes, but it is also associated with greater experience of care for both patients and primary care practitioners and a more sustainable healthcare system.”

To explore ways to meet this and associated challenges, earlier this year Messom teamed up with Leanne Wells, chief executive officer of the Consumers Health Forum Australia (and more recently appointed to the new taskforce), to organise a meeting of major health organisations. The aim was to seek common ground on ideas to improve the current system – in particular, in terms of access and equity.

The meeting, characterised as a summit, took place in Canberra in May. It was attended by more than 200 delegates from all 31 Primary Health Networks (PHNs), the Australian Medical Association, Royal Australian College of General Practitioners, Australian College of Rural and Remote Medicine, Australian Primary Care Nurse Association, Allied Health Professionals Australia, Mental Health Australia, the National Rural Health Alliance, and the Aboriginal Community Controlled Health Organisation sector.

Some consensus

It would have been miraculous for unanimity to emerge from a discussion between such diverse bodies, but on some crucial central matters consensus did emerge. Three major changes found complete support.

In a document titled Strengthening Medicare and investing in Primary Health Care: a Roadmap for Reform, the delegates called for:

  • Voluntary patient registration (VPR): an opt-in system to promote long-term relationships between GPs and patients, making coordinated multidisciplinary care much easier to deliver.
  • Workforce incentive programs that allow practices to expand to include additional services – especially allied health, nurses, mental health and medicines advice.
  • Integrated healthcare neighbourhoods: a model for delivering affordable, accessible, preventative, quality healthcare in geographically defined communities, especially those in disadvantaged, rural and remote areas.

Expanding available services within a single-practice setting, and building integrated healthcare ecosystems that are defined by geography and community, are major reforms that rest on the creation of sustained patient-practice relationships. Voluntary patient registration is thus the key first change needed.

“On a practice level, it allows primary care practitioners to better understand the population they serve and their needs,” says Ray Messom.

“On a system level, VPR enables more targeted interventions to ensure funding, programs and support are channelled to the patient groups that most need them. Finally, for the community, it unlocks access to a comprehensive, person-centred, and holistic primary care system that will ultimately enable everyone to live healthier and more prosperous lives.”

It will also, says Leanne Wells, give general practitioners the confidence to build – notably by adding services to their clinics, thus making them more hub-like. Participants at the Canberra meeting called for this to be fast-tracked through a workforce incentive program.

“Locally integrated health ecosystems promote better care,” she explains.

“We must strive for primary healthcare services that offer affordable, timely, connected and coordinated multidisciplinary care through appropriately resourced and staffed patient- and family-centred general practices.

“The primary care system is under pressure to respond to the ever-increasing complex health and other needs of those with multiple chronic conditions. A review of the guidelines and a boost to the funding for the workforce incentive program would allow practices to offer a more extensive array of services, including nursing, allied health, pharmacy and health coaches.

“While consumers want to see a suite of reforms, this measure alone would make a significant difference to practice capacity and patient experience of connected care.”

Clear directions

According to Christopher Carter, chief executive officer of the North Western Melbourne Primary Health Network, enabling these reforms should not be the responsibility of a single funding source. If deep and permanent change is to be effective, he says, it requires cooperation and commitment from all major players.

“For example, Commonwealth, State and Territory governments need to lead and invest in voluntary patient registration as part of a system-wide reform agenda,” he says.

“There is goodwill among consumers, clinicians and the sector to implement these reforms. We currently have in power an Australian government for which the protection and strengthening of Medicare is a bedrock policy.

“The foundations of Medicare were laid in 1984, and over time – despite economic and ideological challenges – the system has consistently delivered world-first healthcare. However, today’s world is a different world, and today’s need for equitable access to treatment is more complex than it once was.

“Our Roadmap provides clear directions for much-needed change – a set of goals, if you like, which governments with aspirations to make real differences in the lives of Australians can pursue in the knowledge they have the backing of the sector.”

Ray Messom added that the procedural and legislative structures needed to begin the process of changing the system for the better are already in place.

“The necessary infrastructure is already available through Services Australia and Medicare to immediately deliver these initiatives and ensure more care is being delivered to patients in their communities and away from an increasingly overburdened hospital system,” he said.

Andrew Masterson is Communications and Media Adviser at the North Western Melbourne PHN