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Blame game - GP hospital interface

Primary care is caught in the middle of the current hospital reform agenda. In this month’s column, GP Section Chair Dr Tony Bartone identifies the real blame game.

Well it is finally happening – a veritable plethora of policy press releases and newspaper and television stories and headlines on the much anticipated health reform initiatives. Most of the detail has been around hospital reform thus far, but the diabetes announcement does give us a disturbing insight into some potentially unwelcome changes for primary care and, in particular, family medical practice. As this goes to press the Council of Australian Governments (COAG) is ready to meet on the hospital reforms and the betting is that there will be a negotiated settlement despite all the pre-meeting posturing. 

Whatever happens, it is time to start to apply the blowtorch to that perennial chestnut – the GP-hospital interface. This is about more than just whether electronic discharge summaries sync into the system. It is about the timely exchange of relevant clinical information and consultation concerning everything from pre-admission right through to final discharge planning – not to mention outpatient follow up.

Don’t get me wrong, electronic health platforms are important. In fact some of the early reports from practices in the eastern suburbs are less than complimentary regarding the Healthlink systems used to download electronic discharge summaries from Eastern Health hospital providers. Some common complaints are that the information is in a less-than-clinically-friendly usable format, with little ability to dissect certain parts of the data. Interoperability and readily usable, clinically relevant information is essential to minimise errors and improve patient outcomes.

However it goes deeper than this. We are staring down what seems to be the inevitable local area hospital boards. Surely it is appropriate to insist now that local GPs are more than just token parts of these boards. We play a key part in championing patients’ quality care, especially across the interface. What about the frequent lip-service mentions of GP liaison officers in the hospitals? Who will lead the fight to insist in liaising with our specialty of primary health care just like any other hospital-based specialty? What about a primary care sub-committee on all hospital boards?

Part of ending the blame game involves hospitals working with doctors to ensure that there are a series of seamless interactions in the care of patients. How many times do we seek the help of hospital clinicians in ensuring care for our patients, only to wait months for an appointment and then to have the patient sent back with only a minor adjustment to medication and a review in six months? This is completely inadequate but it is just the tip of the iceberg.

Governments have paraded figures of the hundreds of thousands of unnecessary admissions into hospitals because of primary care failure. Well this is the real blame game that needs to stop immediately. State government and hospital boards need to work collaboratively with GPs, who ultimately have their patients’ well being at heart, to improve the quality of timely health care they receive from the system as a whole. This is just as important as any other plank of hospital reform.

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