Doctors ask for help to face looming health crises

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On the back of its `General Practice: Health of the Nation’ report, the Royal Australian College of General Practitioners (RACGP) is now calling on government to undertake genuine, sustainable, and properly funded health system reform to better support community-based healthcare.

The annual report that looks at general practice in Australia has found that almost three out of five GPs reported managing patient expectations about vaccinations to be one of the most challenging issues arising from the pandemic. In addition, repeated changes to vaccine eligibility requirements left many patients confused and frustrated and unfortunately some took this out on general practice staff.

“Community-based care must be front of mind in all major public health decisions, including changes to the vaccine rollout,” says RACGP President Dr Karen Price.

“Governments at every level must have nimble communication channels into every general practice to manage the changes required to allow for small business planning and adaption.  We can’t be put in the position where our patients are informing our staff of the latest changes or even worse, arguing with us over new guidelines and recommendations.”

Dr Price says that ensuring the long-term sustainability of the general practice workforce to better support patients must be a priority.

“This pandemic will have a lasting impact on the health of many Australians as well as our entire health system, and general practice will play a vital role in the years ahead,” she says.

“State health departments have this month called for Commonwealth crisis funding to help manage the expected pressure on hospitals as restrictions ease across the country and Covid-19 infections spike.

“General practice could alleviate pressure on emergency departments and hospitals. But currently, it is in the same position, only we will be managing Covid-positive patients or ‘long-Covid’ patients in the community and without the backing of hospital infrastructure. Government must act now to ensure GPs are funded to do this essential in-community, and in some cases, in-home care.

“We also can’t just focus on the here and now either. In order to support patients in communities across Australia, general practice must be resourced properly to manage the long-term fallout from the Covid-19 pandemic.

“The lack of meaningful resourcing has led to a critical juncture for general practice, with only 15.2% of final-year medical students in 2019 listing general practice as their first-preference speciality for the future – the lowest number since 2012. The time to act is now. International medical graduates will bolster the workforce, but we must also grow our locally trained workforce.

“So, we must address what is holding back future doctors from a career as a GP. A key part of that is putting general practice on a more sustainable, long-term financial footing.

“Our survey found that 26% of respondents ranked Medicare rebates as their highest priority. Almost half of all surveyed GPs indicated that they’re less likely to recommend general practice as a career to their junior colleagues compared to a decade ago. Those who would not recommend this career have strong concerns around their remuneration, recognition, and Medicare billing requirements.

“If we are serious about boosting the general practice workforce at a time when it has never been needed more by communities across Australia, we must address long-term funding arrangements. The task of attracting more junior doctors to this career path would be made that much easier and the savings for the entire health system would be immense.

“If we shy away from this challenge, it will be detrimental to the entire health system and the health of the nation.”

The RACGP President also called for changes to Medicare items.

“We know that more and more patients are presenting with mental health concerns,” she says.

“Our survey found that for the fifth consecutive year, psychological conditions were the most reported reasons for patient presentations.

“GPs are the first port of call for many patients with mental health issues and four out of five surveyed GPs reported that they have patients with mental health conditions that are mostly managed within general practice. The scale of this task has only grown in 2020 and 2021, especially in my home city of Melbourne which has now experienced more days in lockdown than any other city in the world.

“To help patients in need we need new Medicare items for longer mental health consultations so that we can really get to the bottom of what is going on.

“It’s also important to keep in mind that GPs are the only medical practitioners that specialise in managing patients with multiple health conditions, including complex health issues. Almost three quarters of surveyed GPs reported that most of their patients have multiple medical conditions.

“Unfortunately, during the pandemic we have witnessed patients delaying or avoiding screenings and consultations with their GP and this is particularly problematic for people with complex health issues that need to be carefully managed. Yet Medicare discourages GPs from treating more than one condition in the same consultation and this must change.

“Now more than ever, it is essential that we remove this barrier and incentivise longer consultations to support comprehensive care by GPs.”

Dr Price says that helping GPs working in aged care must also be a high priority.

“Not many people realise that GPs play a vital role in caring for older people in residential aged care and that it is often an acute or chronic health issue that led them to requiring this type of care,” she says.

“We also must not lose sight of the fact that most of the aged care services provided in Australia are delivered to people in the community and these people often require significant contact with their GP.

“Ensuring strong access to primary care can make all the difference. For example, people with Dementia entering the aged care system are less likely to experience an increase in prescriptions for medications like antipsychotics if they retain a relationship with their usual GP. We need preventive activities that start many years earlier to support longer, healthier years at home.

“However, there are barriers holding back our hardworking GPs. When asked what would make them more likely to work in aged care, two thirds of GP respondents said better remuneration via Medicare items. Furthermore, more than half of the GPs selected fewer administrative burdens and more clinical staff in residential aged care settings as key drivers of decisions about taking up more or less aged care medical services.

“So, by tackling these issues we can help our hardworking GPs get on with the job of treating older people in aged care.

“The time is right to reform our health system and give GPs a helping hand. GPs in Australia are highly trained and greater investment in general practice needs to reflect that capability.”