In its submission to the National Health Reform Agreement (NHRA) Addendum 2020-2025 Mid-term Review, the RACGP has called for improved collaboration and integration between general practices, other specialists, and hospitals.
To achieve this, the RACGP said the NHRA review should:
- put an end to hospital named referral requirements, which require GPs to name a specific specialist for a referral
- support hospitals and other health services to use standardised, secure, interoperable digital systems for data sharing, referral, and discharge between general practices and hospitals
- pilot data-sharing between hospitals and primary care to better identify at-risk patients, reduce low-value care and meet community needs
- set an objective to reduce demand for hospital services through Commonwealth- and state-funded preventative healthcare by GPs, with a future objective to add GP services in hospitals to coordinate care for patients with complex needs and identify and manage preventable admissions.
RACGP President Dr Nicole Higgins said patients, GPs, and the health system would benefit from cutting red tape.
"These changes would streamline the whole system," she said.
"GPs should be spending time with their patients, not on navigating long forms and frustrating processes that can be unique to each hospital. It's not facilitating quality healthcare, it's just exporting hospital bureaucracy into general practice. Hospitals know their staff and systems, GPs know the patients they are referring. Standardised digital forms that allow a GP to provide details of their patient and that patient's case to a hospital will help ensure GPs are able to move quickly to get patients the care they need.
"This is a waste of time that we could be spending with patients and on more appointments. General practices have moved past the era of paper, PDF forms, and faxes, yet too often, hospitals are using not just unique forms, but archaic systems. This is an opportunity to make the system both more effective, and more efficient.
"The same goes for named referrals. Named referrals allow public hospital outpatients to be treated as a private patient, with payment from Medicare rather than the hospital's state-funded healthcare budget.
"This is an option where someone wants to be seen as a private patient, not a requirement. That choice is for the patient, not a hospital. Yet some hospitals still imply GPs must make a named referral, or even reject non-named referrals, even though patients with a named referral may be treated by another doctor at the service.
"This is just using a loophole to shift costs away from public hospitals and onto Medicare. For a GP, this can mean reviewing pages of named specialists, which is especially frustrating given this is not about delivering quality healthcare. GPs are reluctant to make a complaint or debate regulations with hospitals as this could further delay patient care. Many GPs provide a named referral to ensure the patient is seen as soon as possible.
"The Department of Health has encouraged GPs to report this practice, and this review is an opportunity to make the rules crystal clear."
Standardised and secure digital systems that integrate with practice management software would not just address these time-wasting and inefficient approaches to referrals, but could improve patient outcomes by streamlining the hospital discharge process for patients, GPs, and hospitals and help to future-proof the system.
"The data shows that where patients who are discharged from hospital emergency departments receive appropriate follow up care from their GP, they are significantly less likely to end up back in hospital and more likely to have a positive outcome," Dr Higgins said.
"Improving discharge summaries to ensure GPs know details like the medications patients have taken, any adverse reactions to medication, what tests a patient has undergone and a recommended GP management plan when they return to the community will help speed up patient recovery and reduce hospital readmissions.
"This is also a smart investment as it costs the health system far less for a patient's health to be managed in the community by a GP than if they are in and out of hospital. Secure two-way data-sharing and electronic communication capabilities to facilitate this would also potentially increase the feasibility of virtual healthcare to improve access, especially outside major cities."
Previously, GPs voiced their frustrations about hospital-specific templates. Ballina East GP Dr Christopher Mitchell said the practice takes him away from patient care.
"Even when there is a single template approved, [some] clinics create a new front sheet requirement that must be filled in, and again it's sent to us as a PDF," he said.
"We already have HealthLink templates established that can autofill, so the solution is pretty simple. While the implementation does generate some costs, the current process costs too. It costs us time."
WA-based GP Olga Ward said hospital-specific templates can be clunky, full of boxes to tick, and wasteful of GPs' time.
"I'm starting to want the Danish system where all the health software across all systems has to – by law – be compatible, communicate and contain all the information readily available," she said.
"Imagine how many tests would not have to be endlessly repeated if you could see it all there at once and look up what has gone before."
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