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Promoting General Practice

The Prime Minister has unveiled a major health reform blueprint, arguably the biggest recasting of the way health care is funded in this country for over 30 years. It is a bold plan that gives the Commonwealth greater responsibility and a greater stake in the complicated processes by which governments fund our public hospitals.

This is long overdue and, at last, we are seeing a serious coordinated attempt to address the waste and duplication of scarce health dollars and provide for the increasing cost of health care into the future.

It is big-ticket health reform but in isolation it is not the panacea for all the woes in our health system. It is the framework – a vital first step – for the other major reforms we need to see before the election later this year.

The other reforms will need to be in place before patients relying on a robust sustainable high quality health care system can see how this week’s reform will improve their lives and the care that they receive. They need to see the whole health reform picture before they fully understand how the new health system will give them better access to health services and a better environment in which to provide health services.

The AMA has provided the Government with strong advice on the priorities that are necessary to complete the big picture of health reform.

One thing is certain about any reform, and that is, it requires change. Our challenge is to embrace change courageously. So too governments, as they reconfigure the system in the interests of patients to better meet the health needs of the community.

As this debate progresses, we must be determined to embrace the changes that direct more resources to the bedside, to surgeries and into the community so that, not only can we address sickness more quickly, but we can also promote wellness more concertedly.

To start with, we need increased capacity in our hospitals to take pressure of Emergency Departments and to shorten waiting lists. This means more beds and more doctors and nurses as well.

We need more sub-acute facilities and capacity within hospitals and in the community to provide rehabilitation care to help patients recover more quickly.

To provide more doctors to work in the hospitals we must have the time, the infrastructure, the funds and the teachers that together constitute a modern professional high-quality training environment in our public hospitals.

Building hospital capacity alone will not fix the hospital problem. The Government must also build the capacity of general practice to meet the primary care needs of the community. It cannot be an either/or solution. It must be both.

The trap for reformers is to think that bureaucratic structures and processes can solve what are essentially service demand issues. Some current reform proposals suggest that we create new organisations that will fundamentally ration and manage primary care, as opposed to governments providing benefits and entitlements to patients to ensure they get all the care they need.

General practice works. Patients want to see their family doctor. So the answer is to build the capacity of general practice and support GPs. To place a constricting bureaucratic organisational bubble around general practice would be a disaster.

The Commonwealth directly funding the new hospital networks, rather than sending money through State bureaucracies, is a principle that should apply in general practice. We don’t need extra layers of bureaucracy organising general practice. We need streamlined and efficient funding for patients to access the services they need - when and where they need them.

What is also heartening about the Prime Minister’s new approach to hospital funding is that he has committed to pay for the services actually provided, and not place artificial rationing caps on the number of hospital services he is prepared to fund.

Similarly, this must apply in general practice reform. The Government’s reform in this area must not recreate the types of problems we must now address in the public hospital system.

Dr Andrew Pesce is President of the Australian Medical Association. This column first appeared in Medical Observer on 4 March 2010.

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