AT the Royal Australian College of General Practitioners’ (RACGP) annual conference, GP19, which concluded yesterday, RACGP President, Dr Harry Nespolon launched an updated version of the College’s Vision for general practice and a sustainable health system (the Vision). The Vision outlines the benefits of a strong general practice within a patient-centred health system, and indeed the importance of general practice in ensuring the sustainability of the health system.
The Vision has been developed by practising GPs, with input from a broad range of clinicians and stakeholders. It outlines a framework for excellence in health care and provides solutions to a range of issues and pressures currently facing the Australian health care system.
The Vision describes a health system in which general practice plays a greater role in prevention, early intervention and chronic disease management; most care is provided in the community where patients live; and duplication, fragmentation and wasted health resources are reduced.
Why the Vision has been updated
The Vision was first released in 2015. Largely based on the concept of the patient-centred medical home, it was developed by frontline GPs for the Australian context using best available evidence. Since its launch, new research and evidence about effective models of care has emerged, medical home type pilots have been implemented, and policy makers have stated a willingness to implement such a model more broadly.
However, the challenges identified in 2015 remain. The population is ageing, chronic and complex diseases are more prevalent, patient expectations are changing, uneven distribution of the health workforce persists, and the cost of health care continues to increase, making the trajectory of health spending unsustainable.
The RACGP sees the Vision as critical in describing how the general practice of the future can operate, and how it needs to operate for the benefit of the whole health system.
Using a modified Delphi process, the RACGP appointed an expert working group, comprising of clinical and academic GPs and a practice manager, to review and update the 2015 Vision. The expert working group met eight times between April 2018 and July 2019, and was supported by a team employed by the RACGP.
Consultation included three rounds of member and stakeholder feedback. To start the process, RACGP members were invited in July 2018 to complete a survey regarding their views and understanding of the 2015 Vision. Following review of feedback received, the redrafted document, titled White paper – Vision for general practice and a sustainable healthcare system, was released for public consultation. Finally, the RACGP undertook targeted member consultation via an online survey in May 2019.
The new Vision includes a strengthened focus on patient-centred care, the need for prevention and early intervention, clearer recommendations in addressing misdistribution of workforce, and recognition of the increasing role of GPs as health system stewards and patient advocates. It is also framed within the quartet of aims of primary health care, which seeks to drive health care redesign to improve the health of the population, improve patient experience, reduce health system costs, and improve provider experience.
Importantly, there is a clearer focus on how the Vision can be implemented from both an individual GP and practice perspective and a health system perspective.
The document outlines the benefits of a strong primary health care system that focuses on the long term relationship between patients and their GPs. The Vision highlights the importance of GPs providing proactive population health in addition to reactive care, and their roles as health system stewards and patient advocates as central to ensuring health system financial sustainability. Importantly, it suggests patients identify a GP in their preferred general practice and voluntarily enrol at their practice in order to encourage continuity of care.
The core features of the Vision are:
- patient centred – to empower patients to be involved in decisions regarding their health care, supporting patient decision making as partners in care;
- continuous – to support the continuous therapeutic relationship between a patient and a GP, improving patient satisfaction, health outcomes, and health system sustainability;
- comprehensive – to facilitate patient access to a wide range of services, strengthening the provision of health care services within the community setting;
- coordinated – to improve the coordination of patient care both inside general practices and outside of general practices, ensuring a smoother patient journey through the health system;
- high quality – to recognise the role of GPs as stewards in the health system through quality improvement and clinical governance, reducing health system inefficiencies and unnecessary treatment; and,
- accessible – to ensure adequate infrastructure and effective management systems, enhancing patient access to timely and appropriate face to face and non-face to face care.
A series of implementation resources, intended to provide actionable frameworks, will expand on how patients, GPs and practices, other health providers and health funders can work together to strengthen the role of primary health care to achieve the four aims.
Given Health Minister Greg Hunt’s announcement of the development of 10-year plans for primary care, preventive health and mental health, the update of the Vision is timely.
RACGP President Dr Harry Nespolon, Australian College of Rural and Remote Medicine President Dr Ewen McPhee, and Australian Medical Association (AMA) Federal President Dr Tony Bartone are members of the Primary Health Reform Steering Group, which will be co-chaired by Dr Steve Hambleton, a practising GP and former federal president of the AMA, and Dr Walid Jammal, a practicing GP and Clinical Lecturer at the University of Sydney and Conjoint Senior Lecturer at Western Sydney University.
It appears there is broad agreement on how the system should look. However, the detail of the design and funding levers remain. The planned introduction of voluntary enrolment for people aged 70 years and over will be critical to the success of the 10-year plans, including how the process of enrolment is incentivised.
Dr Michael Wright is a Sydney GP, Research Fellow at the University Technology Sydney, and Chair of the Vision Redevelopment Working Group.
Mr Roald Versteeg is the RACGP’s General Manager of Policy Practice and Innovation.
The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.