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Future Directions for Primary Healthcare in Australia

This overview explores the current state of primary healthcare in Australia, including the implementation and evolution of the General Practice (GP) Strategy. It highlights the need for reform and explores potential options for the future, including new models of care, workforce changes, and funding and remuneration models. The importance of a coordinated, multidisciplinary approach and the potential for one level of government to take responsibility for healthcare are also discussed.

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Future Directions for Primary Healthcare in Australia

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  1. PRIMARY HEALTH CARE IN AUSTRALIA: OVERVIEW & FUTURE OPTIONS Robert Wells

  2. PHC in AUSTRALIA • PHC in Australia = General Practice • Especially since introduction Medibank/Medicare from 1970s • Myth that Commonwealth funds primary care & states by & large run acute services • In fact states provide significant services, eg public dental, drug & alcohol counselling, prisoners’ health • GP by far the largest-over 100m services pa

  3. THE GP STRATEGY • 1992 GP Strategy funded by Commonwealth • Intended to address • Isolation GPs from other providers • High & growing GP numbers • GP costs (actual & flow-on) rising faster than increase in population

  4. GP STRATEGY (2) • Key elements: • Established divisions of GP • Rural incentives program • Better Practice program • GP evaluation • Standards & accreditation for GP

  5. GP STRATEGY: EVOLUTION • GP Agreement: • Contain growth in costs • Created pool of $ for doctors to use for improvement • Extended primary care items- links with other providers • Service Improvement Payments (SIPS), eg diabetes & asthma • Better Outcomes in Mental Health

  6. GP STRATEGY: MEDICARE PLUS & SINCE • Principally about access/price for consumers • Limited MBS access to other professionals • But under GP control • 2005 change to EPC items: GPs can now do care plans without involving other professionals

  7. WHERE TO NOW? • Decade of reform trending to more team- & multidisciplinary approaches to primary care • Perhaps these have peaked & might even be some ‘correction’ • Yet increasing evidence that doctor-centred, fee-for-service based primary care system not best fit for Australia into the future & unsustainable

  8. UNSUSTAINABLE • Cost • Suitability for ageing population with chronic health care needs • Workforce shortages

  9. KEY OBJECTIVES for REFORM • A more team-based approach to care • Teams ‘fit for purpose’ • Effective integration of acute care & PHC

  10. CURRENT HEALTH CARE MODELS • Doctor intensive • Strong professional demarcations: little flexibility • Increasing specialisation • Medicare $ demand-driven rather than strategically applied to need • Basically a ‘one size fits all’ model • Rural operates as a ‘pale reflection’ of urban models

  11. WORKFORCE: PROBLEMS • Workforce shortages in all health professions • Over reliance on temporary foreign workers is risky- the problem is world wide • Baby boomers exiting the workforce • Declining local school leavers by 2020 • Reduced workforce participation by both males & females • Cannot fill all our GP training places • Difficulties retaining nurses

  12. CHANGE THE SYSTEM • New models of care- evidence based • New approaches to workforce • New funding & remuneration models • One level of government

  13. NEW MODELS OF CARE • A decade of research, trials & pilots, eg Hospital Demonstration, Rural Health, General Practice • Many innovative models to be evaluated • Synthesising & evaluating this material in a systematic & policy-focussed way a first step

  14. DIRECTIONS for CHANGE • Health care based around defined populations • Entities to be responsible for health of those populations • Potential entities: division-like structures; area health services; whole of jurisdiction (eg NT)

  15. NEW APPROACHES TO WORKFORCE • Why is Australia still asking ‘whether’ rather than ‘how’ • Multidisciplinary teams: • Nurse practitioners & physician assistants • Need major reforms to education & training • Expand the education, training and research infrastructure provided through rural clinical schools & university departments of rural health • Productivity Commission report on Workforce

  16. NEW FUNDING & REMUNERATION MODELS • Time to review fee for service from care and workforce perspectives • Would per capita funding better suit chronic disease & rural health needs ? • More flexibility in budgets & accountability • Investment in infrastructure

  17. ONE LEVEL OF GOVERNMENT • Problems in funding divide problematic, eg primary care/hospitals & in rural areas where there are fewer resources to go around • Could one level of government take total responsibility for health care? • Tony Abbott: if there is one reform to be made, this would be it (2005)

  18. SOME DIRECTIONS • Widespread pressure for continuing reform in primary care • States and divisions working together, Vic primary care partnerships • Workforce initiatives mooted by states • Calls for a national primary care strategy

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