Primary health care is delivered through an integrated service system which provides high quality care across the country and actively addresses service gaps.
Potential Actions2.1 Promote health system models that facilitate long term relationships between consumers and general practices to enhance the health and wellbeing of individuals and their families throughout their lives.
When people are sick, a GP is generally the first clinical point of call in the health system. While many consumers have established relationships with a GP, those who have not can fall through the cracks and may not access timely and necessary care.
Encouraging long term relationships – a longitudinal link – between consumers and a general practice will provide a means of avoiding these issues and, in turn, place greater accountability on the practice to manage the care of that consumer. It also acknowledges the role of the GP, or in regional or remote areas a nurse practitioner, as a gateway into the broader health system for most people.
There is increasingly compelling international evidence that multidisciplinary team-based health care delivery models, such as patient centered medical homes (PCMH), contribute to improved health outcomes, enhance the consumer experience of care, and reduce the need for expensive and avoidable hospital and emergency care.14
Australian adults with complex care needs who reported as having a PCMH reported having better coordinated care, fewer medical errors and test duplications, better relationships with their doctors, and greater satisfaction with care. Top of page
2.2 Work together with primary health care providers and professional organisations to promote the development of multidisciplinary teams in which all team members are supported to fully develop their clinical skills and potential.
The Commonwealth is working with the States to plan for and develop the workforce needed to meet the challenges of the future, including significantly increasing the supply of GPs and other primary health care professionals across Australia.
It is important to recognise that there will be increasing pressures on the health workforce due to the range of issues driving demand for care and a desire to reorient towards a stronger primary health care approach as well as systematic approaches to training and recognition of other roles such as personal carers and attendants.
A growing demand for service provision will not be readily met, particularly in rural, regional and remote areas. In this environment the skills of health professionals should be maximised to enable all team members to work to their full scope of practice.
Health Workforce Australia, a Commonwealth statutory body, is also undertaking work on identifying new and expanded roles within the clinical workforce to fill gaps in current service delivery. For example, other countries have additional roles such as medical assistants and nurse anaesthetists.
By focusing GPs at the top of their scope of practice, this enables others within the care team, such as practice and community nurses, allied health and Aboriginal Health Workers, to work at the top of their scope of practice and better contribute to patient care. This will assist in promoting multidisciplinary teams in which all team members are fully supported to develop their clinical skills and potential. Further work also will be done to support the continued development of GPs with advanced or special skills that can help fill the gap between generalist and specialist care. Top of page
2.3 Explore funding models that include incentives for a focus on the health of the population, promote safety and quality and reduce preventable hospitalisations through primary and secondary prevention.
Australia currently has a mixed funding model, with a strong fee for service focus in the private sector and large-scale use of salaried arrangements in the public sector. Medicare, with its underpinning principle of universal access to a patient rebate for certain health services, remains a fundamental tenant of Australia’s health financing arrangements.
However, there are a range of international models that may be appropriate for certain services and/or localities. For example, there is increasing international evidence about the benefits of a blended payment system – mixing fee for service, pre-payment and pay for performance with salaried arrangements – where those payments are designed to work together to achieve both quality and coordination of care. There are examples of such mechanisms in Australia, for instance the Diabetes Care Pilot, which is looking at innovative funding models that provide payments to providers for improved care of their patients with diabetes.
These options should be further investigated for their applicability to primary health care in Australia. In particular, there may be a need to examine models to maximise the emerging value of new and evolving technologies, and the potential for rapid expansion of remote or virtual consultations.
In looking at emerging models, it is important that funding remains flexible to ensure the needs and circumstances of different localities are accommodated. This means a more effective and flexible use of existing funding as a priority for all stakeholders. Top of page
2.4 Translate both new and existing health system intelligence, including research, economic modelling and needs assessments, into evidence based planning and service delivery.
This action ensures that national health service planning takes account of the available data, evidence, workforce availability and infrastructure needs in order to provide the most appropriate models of care for each community, including innovative and multidisciplinary models. These three elements are critical for improving access to appropriate care.
The Commonwealth and States will use existing and emerging health system intelligence to inform service planning and design, to ensure that needs identified through these processes drive improvements in access to care for those most in need. Governments will also look to develop and expand this resource and draw on relevant expertise for advice. They will also look to improve the quality and accessibility of data to inform planning and service delivery particularly with a 'whole-of-system' viewpoint. Top of page
2.5 Maximise the opportunities of eHealth, including the Personally Controlled Electronic Health Record (PCEHR) and Secure Messaging initiatives.
The Commonwealth and States will work together to promote the use of eHealth to enable the secure exchange of information between Commonwealth and State services, and with private providers and non-government organisations in accordance with national privacy laws.
This will be achieved by expanding opportunities provided through telehealth, the National Health Call Centre Network, National Health Service Directory and the roll-out of the National Broadband Network. It also utilises advanced clinical software systems to support incorporation of best evidence, delivery of quality care, and continuing quality improvement.
Patient information management systems will support continuity of care by supporting better information exchange between health professionals over time and across different clinical settings. This will include the appropriate use of shared access to up-to-date patient information in the form of health summaries, referral documents, diagnostic results, notification of hospital admissions, inpatient care and discharge summaries, as agreed by the patient.
14 Deloitte (2008) The Medical Home: Distributive Innovation for a New Primary Care Model