Last night’s budget brought, at last, some more news of the Government’s intentions in primary care, including the release of the first national primary health care strategy.
Below are some initial reactions from experts in the field, Professor Mark Harris and Associate Professor Gawaine Powell Davies.
Professor Mark Harris, Executive Director of the Centre for Primary Health Care and Equity at the University of NSW, writes:
“While we are still digesting the budget announcements, it is clear that there have been some significant changes in thinking about primary health care. These are reflected broadly in the final primary health care strategy which was released with the budget and in two specific announcements:-
1. Although an additional 23 GP Super-clinics were funded (bringing the total to 58) there is recognition that these will, for the foreseeable future, provide only be a small part of the solution to providing more integrated care for chronic conditions. 425 grants were also allocated to “expand existing general practices and primary care, community health and Indigenous medical services, to deliver GP Super Clinic style services”. This recognises the need for a variety of models to scale up the approach used in integrated primary health care services such as GP Super Clinics to make high quality care more accessible to all patients.
2. The extension of incentive grants for all practices, not only those in rural areas, to employ practice nurses. This represents recognition that practice nurses have key role to play not only in addressing workforce need but also in enhancing quality of care. For example, our own research has demonstrated that practice nurses can play a key role in the prevention and management chronic conditions especially in conducting structured assessments, helping to coordinate care pans, providing patient education and facilitating referral to other providers and services and this can make a difference to outcomes for patients.
A little more detail on primary health care organisations (“Medicare Locals”) was also provided in the budget papers – especially their role in providing or facilitating after-hours services. However there are still many unanswered questions from the patch work of announcements about PHCOs over the past few weeks.
There is a high level uncertainty among community health staff who see their services being “absorbed” by these new organisations but lack clarity about their place in these structures. Resolving these issues is no doubt very difficult given the range of parties and interests involved. However, it is important to resolve this uncertainty as soon as possible.”
Associate Professor Gawaine Powell Davies, CEO, UNSW Research Centre for Primary Health Care and Equity, writes:
“One encouraging step in this budget is a move towards a more thoughtful use of fee for service payments in primary health care. Historically, the reliance on fee for service payments has enabled GPs to provide very accessible one-off care for ill health, but has not supported good ongoing care for chronic conditions or prevention. Practice nurses, in the city at least, were put on this treadmill with the practice nurse MBS items, and private health insurance set up the same game for allied health practitioners.
This budget continues the slow move away from undifferentiated fee for service in several ways:
· There will be a universal subsidy for GPs to employ practice nurses. This will allow them a much more flexible role than fee for service could, especially in chronic disease care. Let’s see how the GPs use this opportunity.
· People with diabetes will have an opportunity to register with a practice, which will receive a payment for delivering comprehensive care
· All new Medicare items will be subject to review, to see whether they meet their objectives.
This doesn’t give us a balanced system, not by a long chalk, but it keeps us on the road.
However calling Primary Health Care Organisations ‘Medicare local’ is hardly encouraging: it brings the echo of individual fee for service into what should be a population and prevention focused organisation.”
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