Speech - Breathing New Life into General Practice Conference
View by date:
Previous MinistersPDF printable version of Breathing New Life into General Practice Conference (PDF 264 KB)
The Great Hall, Parliament House, Canberra
19 March 2013
Thank you for inviting me to speak with you today.
I’d like to begin by acknowledging the traditional custodians of the land on which we meet, the Ngambri and Ngunnawal People, and pay my respects to their Elders past and present.
I would also like to recognise:
- Dr Ed Vergara, Chair of General Practice Registrars Australia
- Dr Liz Marles, President of the Royal Australian College of General Practitioners
- Dr Steve Hambleton, President of the Australian Medical Association
- Professor Richard Murray, President of the Australian College of Rural and Remote Medicine
When our Government took office in 2007, Australians were finding it increasingly hard to access the medical care they needed in reasonable time.
There were worsening doctor shortages in rural and remote locations.
And it was becoming clear that the health system was no longer equipped to address growing levels of chronic disease in a sustainable fashion.
In response, over the last few years, our Government has been engaged in an ambitious, deliberate and informed redesign of the health system through a series of integrated policy reforms.
And you have all had front row seats to this work.
But as you know, the problem with being in the front row, is that you sometimes don’t get to see the entire stage.
And so today, I wanted to share with you my view and briefly provide some context on what has been achieved to date – particularly in the area of primary care.
And of most relevance to GP registrars, I then wanted to indicate where the system will be heading by the time you gain your fellowship and enter independent practice.
Specifically, I wanted to touch on three things:
- Firstly, general practice being at the heart of Australia’s health system;
- Secondly, Patient-Centred Medical Homes; and
- Lastly, the findings of the HW2025 report and how we are responding to its findings.
The international evidence is clear. Health systems with strong primary healthcare are more efficient, have lower rates of hospitalisation, fewer health inequalities and better health outcomes. And those systems produce better health outcomes for the same investment.
As a Government we’ve acted on that evidence. We’re shifting the centre of gravity in our health system towards primary care.
Until the reforms of the last few years Australia had a health system with spiralling costs that was largely focussed on the best treatments for people who are sick in hospital. Important though quality hospital care is, it is of course better if people stay healthier and don’t end up there at all.
As General Practitioners, helping to keep people well is as much a part of your job as treating the sick. And it’s that approach we’ve applied and are spreading across the system.
That’s why this Government established Medicare Locals as community primary care organisations - organisations with general practice and patients at their heart.
Across Australia, I’m seeing first-hand the fruits of our more than
$1.2 billion investment in Medicare Locals. There are some truly inspirational and practical examples of how the better integration of general practice with allied health, community, and hospital services is making a real difference to people’s lives.
For example, the Metro North Brisbane Medicare Local is working in collaboration with the Metro North Hospital and Health Service to offer GPs the opportunity to provide their patients with planned care through the Team Care Coordination program.
Team Care Coordinators, who are all Registered Nurses with experience in general practice, work with GPs to prevent avoidable hospitalisation in patients with chronic complex problems. The Care Coordinators assist doctors in assessing a person’s health and care needs and arrange the services they need to stay healthy and active.
Care Coordinators have the capacity to assist with care planning, visit people either in their homes or at the practice, and liaise with GPs, patients, hospitals and other health services, and contribute to GP Management Plans.
Medicare Locals are also supporting General Practitioners to play a bigger part in decisions about how health services are shaped to meet the needs of their local communities.
Medicare Locals are centred on general practice, because GPs are at the heart of Australia’s world class universal health system.
Under Medicare, it’s a GP that most Australians will see first, and most often.
And as GP registrars, you are already providing valuable medical services to across Australia.
I thank you for your ongoing, strong commitment to bulk-billing under Medicare, especially for those most in need.
In Australia now, more than eight in every ten visits to a GP comes to no cost to the patient. GP bulk-billing rates are consistently sitting at record highs of around 82 per cent.
The Patient-Centred Medical Home
The ‘family GP’ is a great institution.
Family GPs are a trusted source of advice and care, often beyond the clinical.
It is that genuine, enduring and intimate relationship with patients that makes their clinical impact so powerful and it’s a relationship many of you will develop with your patients.
That relationship allows you to truly understand those patients, plan their care carefully, and even pre-empt their health needs.
As Minister, I have turned my mind to how government can best reinforce and grow the relationship between family GPs and their patients.
For those of you who were at the GP12 conference on the Gold Coast last year, you’ll remember I indicated we were investigating the Patient-Centred Medical Home model.
Well, the evidence in support of Patient-Centred Medical Homes is in, and it’s compelling.
As many of you would know, the experts in the field tell us that the Patient-Centred Medical Home means:
- access to a personal GP;
- GP directed medical practice;
- whole-person orientation;
- care coordination and integration; and
- quality and safety benchmarking through evidence-based medicine and clinical decision-support tools.
For example, the Commonwealth Fund 2007 survey found that for those Australians with a ‘medical home’, defined as having a ‘regular provider who knows you, is easy to contact and who coordinates your care’, 87% rated the care they received as ‘excellent’ or ‘very good’ compared with only 60% of those who do not have a ‘medical home’.
And other expert studies have indicated Patient-Centred Medical Homes have a positive effect on care quality in terms of:
- Improved access to care;
- Improved clinical outcomes;
- Better management of chronic and complex disease;
- Decreased use of inappropriate medications;
- Decreased hospital admissions and readmissions; and
- Improved palliative care services.
We also need to be clear about how, and which parts of the model would translate to the Australian health system.
To provide advice to Government on some of those important questions, we will be testing certain elements of the Patient-Centred Medical Home model with a small group of Australian experts. We will then move to broader consultations, including with the GPRA, in recognition of the critical role registrars will play.
I am confident this work will help us all navigate a smart, contemporary, evidence-based path to an even stronger, more successful general practice for families across the nation.
HW2025 findings
Let’s now turn our attention to medical workforce.
When Health Workforce Australia delivered its Health Workforce 2025 Report last December, it provided 3 key insights into the state of medical workforce in 2025 assuming that current policy settings remained intact.
First, we would have approximately enough doctors practicing overall.
Second, there would still be too few doctors working in rural and remote locations.
And third, there would be too few general practitioners relative to the number of specialists.
As an aside, the report also predicted a shortage of 109,000 nurses in 2025 – something I mention only to highlight that there is never a dull moment when you are the Federal Health Minister.
Achieving numerical parity
Re-establishing the medical training pipeline so that it will produce the right number of doctors for Australia has been a major accomplishment of this government.
And it has come at a significant cost.
In 2010-11, the Federal Government allocated $639 million to deliver an additional 5500 GPs, practicing or in training, 680 medical specialists, and 5400 Prevocational General Practice Placements Program places over the coming decade.
We have also funded the steady increase of Australian General PracticeTraining places so that by next year the intake will reach about 1200 places - double the number in 2008.
It should also be noted that when such large changes are made, ripples inevitably run through the system.
Last year this manifested most dramatically in an apparent shortage of intern places as the bulge of graduating medical students started to peak.
It was only through the combined good will and leadership of the Federal, WA, Queensland, ACT, NT and NSW governments that we saw an increase in the number of funded intern training positions.
To avoid this from happening again, and at the direction of the Standing Council on Health, HWA announced the establishment of the National Medical Training Advisory Network.
The Advisory Network’s goal is to look at medical training as a whole, from admission to medical school through to attaining fellowship.
It will help ensure the entire training pipeline is coordinated across jurisdictions and organisations in order to minimise the ripples experienced by trainees.
Similar ripples are also emerging in predicted shortages of GP supervisors, but again, I am happy to report that work being completed by HWA, GPET and the GP Supervisors Association will be developing considered, proactive responses to these concerns.
Training more doctors is necessary but not sufficient: When it comes to meeting the challenges facing the health system in the future.
We will also need to ensure they are working where they are needed, and practicing medicine in a way that addresses the health burdens facing the community.
Addressing vocational disparities
If we wish to support the shift in focus to primary care, then there can be no doubt that we will require more general practitioners in the mix of medical specialities.
Let’s take a moment to reflect on similar challenges being faced by China where Government officials recently flagged their intention to train and recruit no fewer than 400,000 extra GPs over the next 7 years.
While our challenge lacks the scale of China’s, it highlights the central importance that your chosen vocation will play in the future of delivering effective, efficient health care across the globe.
Again, this government is actively reviewing opportunities to build on its achievements to further expand the impact and reach of primary care.
Conclusion
Our shift in focus to primary care and general practice is very deliberate.
It is testament to the impressive commitment to your patients, and the great results you get for them. What you do works.
And it’s that success we want to work with you to spread across our health system.
As Minister, I look forward to continuing our partnership with general practice to ensure Australians get quality healthcare when they need, where they need it.
Help with accessing large documents
When accessing large documents (over 500 KB in size), it is recommended that the following procedure be used:
- Click the link with the RIGHT mouse button
- Choose "Save Target As.../Save Link As..." depending on your browser
- Select an appropriate folder on a local drive to place the downloaded file
Attempting to open large documents within the browser window (by left-clicking)
may inhibit your ability to continue browsing while the document is
opening and/or lead to system problems.
Help with accessing PDF documents
To view PDF (Portable Document Format) documents, you will need to have a PDF reader installed on your computer. A number of PDF readers are available through the Australian Government Information Management Office (AGIMO) Web Guide website.