Grounds for optimism

A message from NWMPHN Board Chair Associate Professor Ines Rio.

The past year has seen the lifting of many of the restrictions imposed by the COVID-19 pandemic on general practice and other health services. However, as we welcome people back who have deferred their care, the barriers to being able to provide the comprehensive, quality and integrated service we all wish for have been thrown into stark focus.

Once again, we are forcibly reminded that a system geared around the provision of care in 6-minute increments is bad for patients. It is also neither personally nor professionally satisfying for clinicians. 

We have also seen the gaps between primary and hospital care turn into chasms. As wait times for specialist outpatient and surgical services balloon to years, general practice and community care are band-aiding people suffering through the worsening of illnesses. At-risk patients unable to access private care are suffering most. 

However, in the new financial year there are grounds for optimism. The frightening, widespread effects of a denuded general practice and primary care system have become increasingly apparent to decision makers, producing a significant shift of policy and support. 

The Victorian government has offered payments to support moving registrars to general practice, and to fund primary care priority centres and home-based hospital services. Hospitals will soon have to publish real-time waits for services. Improved provision by hospitals of timely clinical advice for general practitioners is being discussed. 

For me, as a coal-face GP, among the most important elements of the Australian Government’s Strengthening Medicare package is the fledgling voluntary registration scheme, MyMedicare. This aims to build closer, more accountable and measurable connections between practices and patients, improving continuity of care. 

What is currently proposed is modest and restricted, but it has the potential to create a structure and mechanism that improves general practice quality, capacity, comprehensiveness, innovation and funding. 

NWMPHN has long advocated for a patient centred medical home (PCMH) model. The international evidence shows that widespread meaningful development and support of PCMH improves access and continuity, supports coordinated, comprehensive and multidisciplinary care, improves preventative measures, decreases gaps and duplication, improves patient experience and reduces provider burnout. 

Patient registration is fundamental to a PCMH. NWMPHN’s position is far from radical. It is, in fact a solidly conservative stance that brings Australia into line with the global status quo and is supported by the AMA, RACGP and the Strengthening Medicare Taskforce.   

MyMedicare, if introduced well, may solve many of the care and communication issues that frustrate me as a GP, and impact the health of my patients. 

Several times a week I discover that new patients with long and complex histories have already seen other GPs who have ordered the tests or referrals I recommend. 

Other patients aren’t sure what screening tests they’ve had, raising the risk of duplicating or missing them. I often miss out on hospital communication because there is no record of the patient’s GP. 

These scenarios are repeated in every general practice, every day. This fragmentation is not merely frustrating and time wasting; it also directly and negatively impacts patient care and health.   

The other thing that can go astray when patients attend multiple general practices is less tangible, but critical. It is about relationships that are built over time: the slow building of understanding, trust and accountability between patient and GP.

Forging closer relationships should be a driving principle for health care reform. To this end, I applaud changes that enhance provision of coordinated multidisciplinary care as well as greater connection between general practice and aged care. Primary care is a team endeavour, needing collaboration across all professions and sectors. 

The wicked and worsening problems of health care access have improved cooperation between federal and state governments. They now understand they need to work together, and with community, patients and providers, to design and implement services in primary care, hospital care and mental health care. The current Strengthening Medicare initiatives, including MyMedicare, will not solve all the issues, but they are a necessary foundational piece. 

Time will tell what challenges lie ahead.  Whatever they may be, I sincerely thank my fellow board members, the staff at NWMPHN, the various expert advisory groups, Community and Clinical Councils and People Bank. 

For they, along with you, work hard, selflessly and passionately in pursuit of a healthy community, and system. Thank you. 

Finally, I would like to extend our heart-felt and profound thanks to Paul Montgomery, who retired after nine years on the Board. His knowledge, wisdom and values have left a lifelong positive legacy on Melbourne Primary Care Network.