Primary care in Australia is a renovator’s opportunity. Avoidable hospital admissions cost the health system more than $320 million each year. Providing better care for people with diabetes, asthma, heart disease and other chronic conditions could save a significant proportion of this, as well as improving the working and social lives of the people affected. Reforms identified in this report provide the basis for achieving those changes and reaping those savings.
The time to start the makeover is now. The 2017 Commonwealth Budget is expected to commit more than half a billion dollars over the next few years to lifting the Medicare rebate freeze. The Government should seize this opportunity to buy system change.
The primary care system – Australians’ first point of contact for health care – was designed in and for another era. It is failing on the prevention and management of chronic disease, the heaviest burden on to- day’s health system. We showed in our previous report, Chronic failure in primary care, that despite the government spending more than $1 billion each year on planning, coordinating and reviewing chronic disease management, many people with chronic conditions do not receive best care.
The Government recognises there is a problem. It has announced a trial of Health Care Homes, designed to improve the way general practices work with other health professionals to treat patients with chronic conditions. Health Care Homes may be a good start, but they will not be enough. More ambitious changes are needed, especially to the way we organise and pay for primary care services.
The first step should be to gather more information about what happens in general practice. We know, roughly, how long a general practice visit is, but we have no idea why the patient went to the doctor or what was decided. Without data, there is no sound basis for system reform. A new payment should be made to general practices to gather and supply the necessary data.
The second change required is to build on the development of local primary care systems. Primary Health Networks need to be strengthened and given explicit responsibility for creating more effective and efficient primary care systems in their local areas. In particular, they need to be held accountable for making improvements that will reduce unnecessary hospital admissions – those which could have been prevented with better primary care.
The Commonwealth and the states need to step up too. Commonwealth and state bickering and blame-shifting needs to be replaced by new Primary Care Agreements – an overarching deal for each state, supplemented by localised agreements signed by the Commonwealth, the state and the Primary Health Network. These agreements should set specific goals and create joint accountability for failure to meet them.
Over the long term, the fee-for-service payment system for GPs needs to change, so general practices get rewarded for getting the best outcomes for their patients.
But none of this will be possible without more data and better local systems. We need to start building the foundations for better primary care now.