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Indigenous education
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Primary health care expert backs the diabetes reforms

Further to the previous post on today’s announcement of reforms to diabetes care, Professor Mark Harris, Executive Director of the Centre for Primary Health Care and Equity at the University of NSW, writes:

“Both the National Health and Hospitals Reform Commission and the Primary Health Care Strategy recommended introduction of some form of voluntary enrolment of patients in primary health care in order to improve access to multidisciplinary care and coordination of care.

Today the Government has announced the introduction of voluntary enrolment for patients with diabetes and linked this with access to additional allied health services and performance payments for the GP.  I believe this is a positive move.

It seems to be something of an over-reaction to characterise this, as some have, as the end of fee-for-service medicine.   In effect there have been two measures already in place that have sought to achieve much the same thing for over five years:-

  • The Service Incentive Payment for GPs who provide a full “annual cycle of care” for patients with diabetes (which is in effect a performance payment)
  • Team care arrangements (multi-disciplinary care plans) which provide access for patients with chronic diseases (including diabetes) to 5 occasions of service from allied health providers.

Today’s announcement extends these programs that were already in place.  There are however two major advantages:-

1. There is a more active role for patients – who must actively enroll with their GP to the program.

2.  It will allow a more flexible approach that allows the GP, patient and other providers to develop a care plan that is tailored to the patients’ needs.  Thus for example it may allow a different combination or quantity of services than is currently possible under the Team Care Arrangement.

Our own research suggests that these will help reduce the quality of care gap that currently exists.

Of course we are still waiting on the details of what is planned for current state community health services (including diabetes services) under the reform proposals.  Understanding how these will be funded and organised will be important in ensuring continuity of care and care for those more complex patients with complications (such as renal disease) or who require more intensive approaches.”

Update, April 1: Dr Christine Bennett, former chair of the National Health and Hospitals Reform Commission, was supportive of the plan on ABC’s Radio National this morning, and noted the importance of evaluating its impact in one group of patients before rolling it out more broadly. She noted the history of unintended consequences in health policy.

Meanwhile, this is the statement from the Doctors Reform Society:

“Today’s announcement of specific funding for GPs who have enrolled patients with diabetes  is to be commended as a recognition of the importance of primary care of chronic disease in our community and the need for an integrated approach to managing such diseases,” said Dr Tim Woodruff, President, Doctors Reform Society.

“This program has the potential to benefit many patients with diabetes and to improve the primary care approach to this chronic disease,” said Dr Woodruff. “But we need a systemic approach to improving primary care and to improving management of chronic disease. Targeting one disease ignores others. Targeting a disease by funding through doctors ignores patients who don’t see doctors often enough or at all.”

“Patients who have difficulty getting to see a doctor will not have any extra funds spent on their care. Patients who can’t find a doctor with whom they want to enrol will not have any extra funds spent on their care. Many of the most needy patients in our community, in nursing homes, boarding houses, and rural and remote areas, who already seldom see doctors except when they need admission to hospital, will be unaffected by this program”.

“This is another program which will deliver some benefits, and has some excellent principles such as voluntary enrolment of patients”, said Dr Woodruff, “but it is still just another program run from Canberra, ignoring local needs, with yet another layer of red tape paperwork for doctors. Whilst 30% of preventable admissions to hospitals are related to diabetes, that means 70% are not, and this small but important program ignores all those patients.”

“What we need are structural changes to how we fund and run primary care to focus on all patients; not on specific diseases, not on doctors, not on nurses, so that those patients in need, whatever their disease, have access to integrated care, rather than just the universal entitlement to care under Medicare”, said Dr Woodruff.

“What we need after nearly three years of consultation is a vision of a health system which is patient centred, needs based, structurally integrated, and accountable. We hope the major reform announcements are still to come.”

Comments 5

  1. Trevor Kerr says:

    Oh Gawd, here we go again. Never take a forward step.
    First, bundling (apparently) all forms of diabetes. Those who have grown up with insulin dependence and know something about the diabetogenic nature of many foods. And the huge volume of lifestyle diabetics who have ignored the role of foods for decades.
    Then, those Care Plans have been enormous successes. Like, the Mental one and the Dental one. Since GPs will now be paid to get their patients in the correct aisle in the grocers, how about calling this one the Lentil Care Plan?
    Overall, though, a stroke of genius. Threatening to shift funding from the Hospital Industry to the GP Industry. Cue “Thunder and Blazes”.

  2. Doctor Whom says:

    Oh dear. Curates egg so near Easter. Yes its good to do something about diabeties – does anyone suggest otherwise?

    But this is giving me an uncomfortable feeling in my tummy about the future with Kev and his office taking a “dominant” role in health.

    How on earth do patients enroll? Where do they enroll? At the doctors’ practice that only uses a fax? Or at the one that is set up super dooper with IT systems. Would it be a coincidence that the lower socio economic areas with the most danger from diabeties are also those where there are not only fewer GPs but also fewer GPs with sophisticated IT systems.

    How does the hospital notify MBS, PBS, HIC, Kevs Office, GP, patient, Private HIC and whoever that a patient who is enrolled has been seen at A&E or at a Specialist Clinic or admitted?

    How does a hospital know if a patient is enrolled?

    In hospital =BAD
    Out of hospital = GOOD

    is simplistic.

    Sometimes an admission or treatment by a hospital may be the best early intervention and be ordered by the GP – who cops the demerit points or financial fine?

    This has good intentions – ok principles – schemmozzle implementation written all over it.

  3. Fly_texan says:

    Headline on Sky channel -> concerns that doctors will pocket the Cash!
    As a GP I can see that easily happening even with the best of intentions.
    I have probably 50 patients with diabetes registered in the practice therefor I have just added $50k to the bottom line. Living in a rural area there are few allied health services within Cooee so I assume I get to keep the cash. And since I control the admission to hospital hmmm – perhaps a conflict of interest here too!

  4. Bathurst Doc says:

    More bureaucracy from Canberra that lacks commonsense- tell me, how many times do you think a GP is going to see a diabetic patient in a year when there is no financial reward for extra visits? And who came up with the flawed ideology that said it was OK to limit access to medicare benefits for the sickest patients in our community?

    Assuming that most older patients with complex illness of diabetes and a serious co morbidity such as hypertension or ischaemic heart disease require fortnightly visits “to keep them out of hospital”, and simplifying the current medicare rebate to approx $45 a visit and $200 for 6monthly care plans and team care arrangements, by my calculations the $950 payment will lose value after 8 months of general practice visits.

    Seriously, do we really think that GPs are going to be so kindhearted as to see their sickest patients for free by the time September rolls around every calender year? More importantly, do we really expect patients to sign away their right to universal health care and medicare access for the sake of a few dietitian visits? Let’s hope not.

  5. Doctor Whom says:

    fly texan – lets assume you have another 50 patients – (assuming you have more patients than just the 50 with diabetes) who are pre-diabetes – you know overweight etc etc etc.

    The financial incentive is to let the pre diabetes ones develop full blown diabetes and collect $50,000 rather than bust your gut (small diabetes pun) with no incentives for you to to stop the pre guys developing diabetes.

    Not to mention you’ll have to hire three admin assistants (hated bureaucrats) to fill in the inevitable paperwork demanded by Canberra.

    My tummy is now really acting up each time I think about the feds running things only calmed slightly by the fact the idiotic referendum will fail.

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
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PHAA conference 2013
2014 conferences
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AIDA Conference 2014
Congress Lowitja 2014
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Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
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Population Health Congress 2015
2016 conferences
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2017 conferences
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