“Locked in decline”: call for an overhaul of health care

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New research examining how to fix Australia’s “fragmented and inefficient” system aligns with RACGP recommendations.

The college has always advocated integrated models of care.


“Simply put, our health care system is fragmented, inefficient, inflexible, and organizational rather than person-oriented; locked into decline without significant structural, governance and funding reform.

They are Professor Claire Jackson, Director of the Primary Care Research and Center for Health System Reform and Integration at the University of Queensland, and Professor Diana O’Halloran of the Department of General Medicine at the University of Western Sydney, in their recently published report Australian Medical Journal (MJA) document examining what is needed to reform Australia’s healthcare system.

In research that has yet to be peer-reviewed, the authors discuss strains on the healthcare system, including the growing burden on general practice and hospitals resulting from the COVID-19 pandemic. Other issues, such as chronic disease management, specialist wait times and the challenges junior physicians face and the impact this has on their recruitment and retention, are also discussed.

“National surveys on elderly care, mental health, productivity and system reform demand change and offer viable solutions, but few concrete changes appear to be coming,” the authors write.

“While the concerted message is unambiguous, implementation presents a significant challenge for our dual-funded, dual-governance, crisis-driven health system. “

According to MJA research, reform is achievable with overhaul and significant investment in several areas, many of which align with RACGP policy recommendations for general practice.

A key area of ​​interest identified in research that the college has always advocated in its Vision for general medicine and a sustainable health system, is the need for integrated models of care.

The MJA The document says Australia lags behind other countries in this space, despite inquiries and royal commissions in areas needing the most urgent need for change, such as elderly care, disability, chronic disease and mental health.

The RACGP strongly supports integrated models of care, and its latest submission to the Primary Health Care Reform Steering Group on the Draft Recommendations for the Ten Year Primary Health Care Plan details an integrated approach and system for reform. and greater investment in general practice – which he says is in a “state of crisis”.

Dr Michael Wright, Chairman of the RACGP Expert Panel – Health System Financing and Reform, previously said gp news that it is “more important than ever” that general medicine be better supported to provide the care patients need.

“We are now at a point where many practices are struggling to maintain profitability,” said Dr. Wright.

“General medicine is definitely at a crossroads. Throughout the pandemic – and before it – with the freeze on Medicare, GPs and practices have come under increased pressure to maintain their viability.

Increased investment and integrated primary care are two key areas in the college’s advocacy for the Mid-Year Economic and Fiscal Outlook (MYEFO) and the federal election campaign.

While funding is always welcome, the RACGP said it believes more is needed to maintain a sustainable future for the health system and ensure comprehensive and coordinated continuing care.

A significant problem is the current lack of consensus among federal, state and territorial governments on reform, according to the MJA research.

“State governments continue to fund the provision of acute and specialized services along historical activity-based lines, with the Commonwealth taking the brunt of the work on community general medicine, pathology, radiology, specialty services and patient care. elderly, ”the authors wrote.

“Without alignment of governance, this leaves little opportunity to develop fully integrated models of care. “

The authors cite New South Wales as an example of implementing an effective vision and strategy in this area.

“New South Wales has arguably been the most consistent, exploring integrated care over 15 years, from the first HealthOne demonstration sites to the current maturing co-commissioning models,” they wrote.

“Despite the many obstacles to change, they have managed to come up with new, effective models of care. “

In the Western Sydney LGA, integrated care initiatives have been gradually incorporated into co-commissioning models of care, including:

  • Rapid access specialist clinics for patient stabilization and general practitioner support, demonstrating a 32% reduction in emergency department (ED) referrals and a 34% reduction in admissions
  • diabetes awareness of general medicine through specialist case conferences, demonstrating improved team capacity and clinical outcomes for patients
  • Non-prescribing general practice pharmacists bringing measurable change or deprescribing in complex care patients – a model that the RACGP fully supports.

“Co-ordering has changed the game, leveling the playing field for the local hospital district / primary health network, leveling the governance model and bringing state resources within the reach of joint decision-making”, wrote the authors.

“This allows real integration, with a reorientation of resources towards community capacity building, the gradual closing of the hospital-community and health-social care gaps, and an overhaul of the financing of general medicine outside the scale of medical services. “

Co-provisioning in the state also incorporates e-health developments, linking general practice and data from NSW Health to enable analysis of patient journeys and outcomes.

Liaison via follow-up appointments with the general practitioner after emergency and hospital admissions is another of the RACGP’s priorities as part of its MYEFO advocacy efforts and the federal elections.

The MJA research calls for nationwide implementation based on the success factors shaping models of care in NSW, leveraging governance structures to bring together core organizations and service providers .

According to the authors, this will allow joint planning and funding, as well as the co-design, delivery and ongoing evaluation of new health initiatives.

“We need to recognize that a growing number of Australians need complex care and require coordination by their ongoing community team in partnership with the broader health and social service sector – no siled care,” said they wrote.

“The governance and resources of the health system must now be refocused. While this is a challenge, we must stop demanding makeshift funds to support a fragmented, often wasteful health system and declare a change of course.

“This will require a local focus on the identified root causes of the current dysfunction, a systems approach to solutions, the use of effective service reform that is evidence-based and focused on the needs of patients and families, as well as significant measure and maturation ”.

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