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.”