RACGP: Opportunities to improve patient access to GP care missed

Royal Australian College of GPs

The Royal Australian College of General Practitioners (RACGP) is warning that the Royal Commission into Aged Care Quality and Safety’s recommendations around a primary care model will make it harder for aged care residents to receive the care they need from their GP.

The Royal Commission has proposed a “new primary care model” intended to support access to general practice care. The RACGP does not support this model, as it creates more barriers for GPs wanting to care for their patients in aged care facilities. The model suggests fundamental changes to GP care and adds an additional layer to accreditation or credentialing requirements for GPs and practices that are already in place.

RACGP President Dr Karen Price said that GPs must be properly involved in the aged care system.

“This Royal Commission only highlights once again that there must be greater support for GPs to provide care in the aged care sector, particularly in residential aged care facilities. We must be better involved in designing systems which support older people to access health care,” she said.

“The sector is riddled with barriers to residents receiving GP care and this must change, and the recommendations do little to address this.

“Any additional cost and administration involved in accreditation or reporting against performance measures will likely deter participation. In addition, an accreditation scheme will likely introduce barriers to GPs from non-accredited practices providing care.

“As the RACGP has said time and time again – proposals that increase the burden on GPs or practices, or in effect exclude most GPs or practices from providing services to older people, will lead to further reductions in access to necessary and high-quality care.

“The recommendations do feature a boost in the Aged Care Access Incentive; however, it does come with it an increase in the number of services delivered to qualify.

“It is unfortunate that general practice has been marginalised when considering the health and wellbeing of older people, including those receiving aged care.

“There has been a tendency to exclude the RACGP and GPs from consultation and design processes, despite proposing various initiatives which would have a significant impact on the sector.

“GPs are core to keeping people well and, in their home, providing continuity over time, and supporting transition of care and oversight when a patient moves to residential aged care. GPs must be involved in reforms relating to aged care – we are an integral part of this process.

“When it comes to anti-psychotic medications, the RACGP does not support the proposal by Counsel Assisting the Royal Commission to restrict GPs from prescribing anti-psychotics. It is proposed that only geriatricians or psychiatrists can initiate prescriptions of antipsychotics.

“We believe that the increasing demand for geriatricians and psychiatrists may actually exacerbate current issues with access and deny the appropriate prescription of antipsychotics. A better solution to the inappropriate use of anti-psychotics is funding to support geriatricians and psychiatrists and GP case management, review and supervision.

“The RACGP also supports increasing the capability of multi-disciplinary teams to provide care to older people in aged care facilities.”

Dr Price said that the lack of support for GPs providing care in residential aged care facilities was particularly concerning.

“GPs are there for their older patients, including those in residential aged care facilities many of whom are at the most vulnerable period of their lives,” Dr Price said.

“However, it is a sad reality that providing care for patients in these facilities is simply not financially sustainable for the nation’s GPs.

“There is a substantial amount of work that goes unremunerated, including liaising with residential aged care staff regarding medical concerns or phoning or meeting with relatives.

“Improvements to technology would make it significantly easier for GPs to care for patients in aged care facilities too. For example, medication management for these patients’ needs to be modernised because it is currently largely paper-based. We also need to enhance remote access to patient records and medication charts.”

The RACGP President said that improvements could be made in many other areas, including Medicare items for telehealth.

“Under the current system, aged care residents must be present when receiving a Medicare service by video or telephone,” she said.

“Nurses or other health practitioners cannot represent a patient in a consultation with a GP without the patient being present.

“This requirement creates a barrier for patients to access care from their GP via telehealth. That is because it is common for GPs to discuss a resident’s condition with nursing staff at an aged care facility without the patient being present during this consultation, on request of nursing staff for advice and support.

“However, under current Medicare rules, patient rebates are unavailable for this type of care, despite it being clinically necessary. All we are asking for is separate items for GP services provided via telehealth for residents of these facilities, without patients being present.

“We also need to do a lot more to enable medical students and interns to have opportunities to provide aged care services through rotations and training placements be available. This will promote early exposure to, and interest in, the aged care field.

“If we boost positive exposure to specific workplace settings, including aged care facilities, we can improve the likelihood of the doctor choosing that setting to establish their career. This would help address longer term medical workforce shortages in aged care flagged by the Royal Commission.

“We could create a path into aged care work settings for junior doctors who decide to specialise in general practice by reinstating a model such as the Prevocational General Practice Placements Program.

“Another straightforward measure would be providing additional support for GPs performing home visits. Older Australians are more likely to suffer illnesses causing them to become housebound unexpectedly.

“However, many GPs are unable to provide a home visiting service due to lack of support to cover the costs and time involved. This has caused a larger number of GPs to refuse such visits even when there has been a long doctor-patient relationship spanning several years.

“It leads to a reliance on after hours locum services, which can create delays in accessing care, and assessments by unfamiliar doctors in more challenging environments – this leads to increased hospital admissions.”

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