In part 5 of Croakey’s health election series, health policy analyst Jennifer Doggett argues that the Coalition’s health policy on general practice misses the mark. (This article also appeared in the Crikey bulletin on Friday)
Jennifer Doggett writes:
“It’s easy to see why the Coalition’s policy to take money from primary care programs and give it to individual GP practices won’t work. We simply need to look at our current system of general practice to see where the Coalition has got it wrong.
The majority of GP services in Australia are funded via fee-for-service in GP-owned or corporatised practices.
Overall, this system has provided convenient and accessible care to many Australians much of the time. It is well designed to cope with acute and episodic care for people living in the cities who don’t have complex health or social problems.
However, there are large groups of Australians for whom this system is not working.
For example, rural, regional and remote communities frequently experience shortages of doctors as most GPs prefer to work in cities.
The interim results from a survey by the National Rural Health Alliance and the Rural Doctors’ Association, released last week, show that more than half of rural Australians questioned reported waiting over a week for a routine GP appointment with 18% waiting more than 3 weeks and some waiting up to 6 months.
People with chronic and complex conditions, including many older Australians, also do not receive the sort of comprehensive and coordinated care which would optimise their health outcomes. That is why over half a million hospital admissions to Australian hospitals every year are for conditions which could have been prevented or managed in the community.
Population health measures, such as screening tests, are often neglected as GPs struggle to cope with the demand from patients coming through their doors. After hours care and home/aged care visits are also not undertaken by most GPs, resulting in further stress on our hospital system.
Financial incentives provided by Government have gone some way to addressing some of the shortfalls of the current system, as has support provided by Divisions of General Practice. These programs have assisted many GPs to change the ways in which they practice to meet growing community needs. However, they come at a cost and there is a point at which the returns from additional resource allocation in this area are not justified.
Also, there is a cascading effect with many of these incentives which results in a need to plough more and more money into the system to simply maintain the status quo. For example, incentives for doctors to work in remote areas attract doctors from rural areas so that subsidies to retain doctors in those areas are needed, which in turn attract doctors from regional areas causing shortages there in turn requiring more subsidies etc. If current trends continue, the only doctors NOT to receive an ‘area of workforce need’ subsidy will be those working in Toorak or Rose Bay.
The Coalition’s policy of ploughing more money into existing GP practices will do little to meet the needs of those communities currently missing out on optimum health care. It is a poor use of scarce primary care resources and will achieve only the politically tactical aim of keeping the AMA onside in the lead up to the election.
The Government’s policy on continuing funding for SuperClinics represents a far more efficient use of resources. SuperClinics complement traditional general practice by recognising and addressing the limits of current GP programs. They are not the only solution to problems with our system of primary care by any means but they will deliver more gains than additional funding to individual GPs and practices.
When it comes to ensuring all Australians have equal access to primary care, it is clear that neither party has all the answers.
But unlike the Coalition’s blind faith in a system which has amply demonstrated its flaws, at least Labor is asking the right questions.”
• Jennifer Doggett is a member of the Labor Party, has previously worked for Nicola Roxon, and wrote a paper on primary care for the Centre for Policy Development in the lead-up to the previous election
To see the previous posts in the election series: