Pressure grows for ‘visionary reform’

A push is under way within the AMA for Medicare reform to reward GPs for continuity of care and wind back the current “perverse incentives” in general practice.

The Medical Republic understands the proposal has been the subject of substantial discussion among AMA members after being floated at the peak body’s national conference in May.

Putting a draft motion to the conference floor, NSW delegate Dr Ross Kerridge said the AMA should show leadership with ACRRM and the RACGP to develop a new MBS item recognising continuity of care. 

“The most valuable service GPs provide is not rewarded,” Dr Kerridge, a Newcastle-based anaesthetist, said.

The motion called for the AMA to work on a redesign of Medicare to recognise and support the central role of GPs in providing long-term healthcare. 

It should also address  “perverse incentives that the corporates are brilliant at exploiting” and determine how this could support long-term sustainability, Dr Kerridge said.

With a federal election possibly only months away, AMA President Dr Tony Bartone has made it clear he will use the platform to demand significant new investment in primary care. 

The Melbourne GP says it is the association’s job to devise “visionary policies” for both sides of politics to take to voters, centred on general practice.

“Over the next few months, the AMA will be working to shape and inform these policies,” he said in a recent communiqué.

“We need a comprehensive vision for positioning general practice as the solution to managing the growing burden of disease and assisting the strategic allocation of healthcare resources.

“This vision will require additional infrastructure funding as well as clear resourcing to assist in managing the complex navigation of patients with chronic disease, leveraging our skills further with judicious and intelligent use of GP-led multidisciplinary care.”

Dr Kean-Seng Lim, a western Sydney GP and president of AMA NSW, says the government needs to consider the cost of inaction on addressing the burden of chronic disease.

 “The latest evaluation by Western Sydney Diabetes is showing that of all patients admitted to Blacktown Hospital there is year-on-year growth of 1% in the prevalence of diabetes,” the former RACGP GP of the Year told The Medical Republic.

“Of all patients screened for diabetes in western Sydney, 47% have results in the diabetic or pre-diabetic range,” he said.

“The question of ‘if not now, when?’ becomes far more relevant under these circumstances, because if we keep seeing that translation of 1% more patients with diabetes – each of those probably spending 30% more time in hospital than other patients and probably costing about 30% more to care for – we will see a huge exponential increase in costs.”

Despite its shortcomings, the government-backed Health Care Homes pilot has made a “fantastic” start in developing training resources for multi-disciplinary primary care, Dr Lim added.

“We can’t tinker at the edges. We need to look at what a high-performing system should look like.”

So far, the RACGP has its sights on the goal of lifting the MBS rebate for longer consultations by 18.5%, to bring GPs in line with other medical specialist items.

“The RACGP encourages all specialist GPs and their patients to ask the federal government if we are any closer to seeing complex care rewarded more appropriately,” RACGP President Dr Bastian Seidel told The Medical Republic. With a federal election looming, “now is a great time” for the government to start showing their commitment to preventive healthcare.

The call for more emphasis on continuity of care coincides with fresh evidence that patients who remain under the care of one doctor tend to fare better.

The first systemic study of the topic, published in the BMJ in June, found consistently across nine health systems that continuity of care was linked to lower mortality rates. 

“Although all the evidence is observational, patients across all cultural boundaries appear to benefit from continuity of care with both specialist and generalist doctors,” the University of Exeter researchers led by Sir Denis Pereira Gray, wrote.