On 11 June 2008, the Minister for Health and Ageing announced that a National Primary Health Care Strategy will be developed by Government with assistance from an External Reference Group. The strategy will look at how to deliver better frontline care for families and set the future direction for primary care in Australia. By 30 June 2008, the Department had established the External Reference Group and made arrangements for its ongoing support, with a schedule for meetings through 2008–09 to consider the Minister’s priorities and provide advice and input to the development of the strategy.
In 2007–08, the Department worked to improve people’s access to doctors through initiatives that support the development of new after hours services, and help existing after hours services to enhance the care they provide. A major achievement was the execution of a further 70 funding agreements under the former Round the Clock Medicare: Investing in After Hours GP Services Program, and for 14 after hours services through the former After Hours Primary Medical Care Program. As at 30 June 2008, the total number of after hours services supported by the Department was 180 with funding agreements for a further 24 successful applicants still being negotiated.
The Department also moved to merge the former After Hours Primary Medical Care and the Round the Clock Medicare: Investing in After Hours GP Services programs from 2008–09. Under the new single program, titled the General Practice After Hours Program, up to 100 grants will be available each year to assist new and existing after hours general practice services to meet their operating costs. These grants will be for a maximum of $100,000 (GST exclusive) over two years, and will be allocated following a competitive, merit-based selection process. Funding will also be available to support existing services funded by the Department under the former After Hours Primary Medical Care Program.
During the year, the Department implemented changes to existing Medicare benefits arrangements to better help residents in aged care facilities to obtain access to general practice services. A major achievement was the increase of the call out loading for general practitioner attendances to patients in residential aged care facilities by an additional $18.90 to $41.35 from 1 November 2007. Medicare rebates were also increased by $18.90 to $62.30 where general practitioners contribute to the preparation of care plans for aged care residents and people in the community with chronic conditions and complex care needs. There were 8.8 per cent more general practitioner attendances to patients in aged care facilities between November 2007 and June 2008, compared with the same period in the previous year.
The Department also commenced work on restructuring the Aged Care GP Panels Initiative, which had the purpose of improving access to primary care services by residents of aged care facilities, into the Aged Care Access Initiative. This work followed recommendations arising from a 2007 review of the Aged Care GP Panels Initiative, which included consultation with stakeholders.
The revised program will focus on supporting direct service provision to aged care residents through incentive payments to general practitioners and the purchase of allied health services where these are not funded through Medicare or other government programs. Specifically, it will provide an incentive payment through the Practice Incentives Program directly to general practitioners who provide eligible services in aged care homes, and a payment for clinical care provided by allied health professionals in aged care homes.
The Sharing Health Care Initiative provides Australians with chronic disease information and strategies to assist in the management of their conditions. Funding was provided in 2007–08 for the development of tools to assist consumers in the self‑management of conditions such as osteoarthritis and rheumatoid arthritis, as well as a number of resources on chronic disease self-management to assist health professionals.
In 2007–08, the Department sought to expand the evidence base on the effectiveness of chronic disease self‑management interventions for people with a chronic disease, their carers and their families. The Department, in partnership with the National Health and Medical Research Council, is funding research grants to examine evidence-based chronic disease self-management techniques, with a particular focus on harder to reach population groups. Research applications were received in March 2008 and underwent a peer review process. Successful applications are likely to be announced in early 2009.
The Australian Primary Care Collaboratives Program helps general practitioners and other primary health care providers to work together to improve patient clinical outcomes, reduce lifestyle risk factors and maintain good health for people with chronic and complex conditions. It aims to achieve this through shared learning, peer support, training, education and support systems.
The first phase of the Australian Primary Care Collaboratives Program concluded in December 2007, during which time the Department provided funding to help doctors achieve best practice in diabetes care, coronary care and waiting list management. Almost 500 general practices and 43 Divisions of General Practice participated in the national program, achieving significant improvements in patient care. For example, the first phase of the program resulted in 105 per cent improvement in the proportion of patients with diabetes whose cholesterol was recorded at the acceptable level and also 45 per cent improvement in the proportion of patients who have had a heart attack in the last 12 months who are on the appropriate medication.
Following a selection process for a national implementation organisation, the Department established the second phase of the program in early 2008, contracting the Improvement Foundation (Australia) to deliver the program until June 2011. About 500 general practices are expected to participate in the second phase of the program to further spread the Collaboratives methodology. It is estimated that about 1.5 million additional patients will benefit through their general practitioners’ involvement in the program.
During the year, the Department worked to improve access to mental health services in primary care by managing the Mental Health Nurse Incentive Program – one of the Commonwealth components of the Council of Australian Governments Action Plan on Mental Health 2006-2011. The program aims to improve collaboration between mental health nurses, general practitioners and psychiatrists in the delivery of clinical support and services, to improve levels of care for people with severe mental disorders and to help reduce the likelihood of unnecessary hospital admissions. It also aims to keep people with a severe mental illness well and help them feel connected with the community.
Between April and June 2008, 4,543 people with a severe mental illness obtained more integrated care through the development of better team approaches between general practitioners, psychiatrists and mental health nurses. These people were provided with one-on-one coordinated care facilitated by highly qualified mental health nurses who worked in collaboration with doctors and other services to provide patients with the maximum opportunity to recover and fully participate in the community.
A major achievement was the introduction of shared employment arrangements between government and non government mental health services to increase integration of community based mental health services for patients. The arrangements will be monitored by the Department in collaboration with State and Territory Governments to ensure patients continue to receive the right services at the right time. The Department also commenced a pilot to include private hospitals as providers under the program, improving links between the public and private health systems.
A challenge for the Mental Health Nurse Incentive Program, however, was the lower than anticipated up-take of the program by eligible organisations due to the national shortage of mental health nurses and the reluctance of some organisations to participate due to stringent eligibility criteria required under program guidelines. A number of program enhancements have been introduced to increase uptake, including the introduction of shared employment arrangements, the transition from quarterly to monthly claims payments, and changes to the average nurse caseload from a minimum of two individual patients per session, to a minimum of two individual services to patients per session.
The introduction of the Mental Health Nurses and Psychologist Scholarships Subsidy under the 2008–09 Budget will also deliver additional nurses to work in the program.
People in rural and remote areas currently have less access to mental health services than people in metropolitan areas. Access may be compounded by shortages of mental health services and professionals in rural and remote communities.
In 2007–08, the Department funded 39 services provided by non government organisations to engage allied mental health professionals and mental health nurses to provide care through the Mental Health Services in Rural and Remote Areas Program. Mental health professionals included appropriately skilled social workers, mental health nurses, psychologists, occupational therapists, Aboriginal health workers and Aboriginal mental health workers. Organisations funded, including Divisions of General Practice, Aboriginal Medical Services and the Royal Flying Doctor Service, will deliver these services to communities in rural and remote areas in all states and the Northern Territory.
High quality primary care is dependent on the knowledge and skills of the sector’s workforce. In 2007–08, the Department provided funding to General Practice Education and Training Ltd to deliver regional, high quality postgraduate vocational education and training to medical graduates interested in pursuing a career in general practice, through the Australian General Practice Training Program.
Six hundred and nineteen medical graduates commenced in the Australian General Practice Training Program during the 2007 training year, filling all available places. This major achievement was complemented by a strong interest in the program’s rural pathway, which saw an 8 per cent increase in applications in 2007. While this is positive, there are indications of a declining interest amongst Australian medical graduates in choosing general practice as a career, with only around 27 per cent currently seeking to enter the Australian General Practice Training Program. General Practice Education and Training Ltd is working with key stakeholders to address this through activities such as marketing strategies and expanded scope of practice.
In 2007, vocational training towards Fellowship of the Australian College of Rural and Remote Medicine was included as a second qualification under the Australian General Practice Training Program, allowing registrars broader training and career development options. This will encourage more doctors to undertake rural and procedural training, such as training in surgical procedures and obstetrics.
During the year, the Department introduced a sliding scale of incentive payments for the Registrars Rural Incentive Payment Scheme, which awards registrars working in the most remote locations with the highest level of incentives and thereby encourages registrars to undertake training in these communities. The Department also extended the scheme to registrars on the general training pathway who show a commitment to rural general practice by training in rural locations for 12 months or more.
The Department managed the Rural Women’s General Practice Service in 2007–08 to improve access to primary health care services for women in rural and remote Australia who currently have little or no access to a female general practitioner, by facilitating the travel of female general practitioners to these communities either by air or road. This involved providing funding to the Royal Flying Doctor Service to administer the initiative.
Funding allowed the Royal Flying Doctor Service to continue and expand the Rural Women’s General Practice Service to an additional 24 locations in the Northern Territory, Queensland, Western Australia, New South Wales and Victoria. This brings the total number of locations approved to be serviced to 277. As a result of this growth, women living in these locations will have the option of discussing their health needs with a female doctor.
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