Primary Health Care Reform in Australia - Report to Support Australia’s First National Primary Health Care Strategy
What the Submissions said
Over 260 submissions were received in response to the Discussion Paper from a wide range of health professionals, governments, academics and researchers, public health groups and consumer organisations. Feedback from stakeholders supported the government’s commitment to develop Australia’s first National Primary Health Care Strategy and many submissions supported the 10 Elements of an enhanced primary health care system that were identified in the Discussion Paper as an appropriate framework. A brief summary of submissions across key stakeholder groups follows:
- Submissions were received from the majority of state and territory governments which welcomed the development of the Strategy, with one of the highest priorities raised being improving access to primary health care services for the most disadvantaged groups, particularly Indigenous Australians. They were generally supportive of workforce redesign and innovation, particularly stressing the importance of team-based care arrangements in primary health care. Flexibility at the local level (in funding and models of care) was also a recurrent theme as was the use of voluntary patient enrolment for targeted populations or specific services.
- Many of the consumer groups agreed that the Strategy needed to examine coordination and integration across sectors, highlighting the value of shared electronic health care records and a role for chronic disease coordinators. Equity, choice and affordability were of high importance as was incorporating consumer participation in service planning, resource allocation, service delivery and evaluation. Some consumer groups discussed voluntary enrolment and GPs as gatekeepers, identifying possible impacts on patient choice and affordability.
- Midwives, nurses and their representative organisations were broadly supportive of team-based primary health care and sought recognition and expansion of their current role, particularly in prevention activities and care coordination. These groups also raised their desire to be involved in independent and collaborative work with other health professionals, access to MBS and PBS rebates, and access to and training for eHealth.
- Common themes raised by submissions from allied health professionals were the need for an increase in the number of Medicare subsidised allied health consultations to improve access to care and for an electronic shared health care record to better facilitate multi-disciplinary care. Other key themes included a desire for inter-disciplinary health learning, increased incentives for working in rural and remote areas and an expansion of their responsibilities, particularly in the prescription of medicines and the ability to order tests. Many of these groups also supported team-based interventions with respect to chronic disease management, with greater scope for preventive services.
- Key GP groups discussed the role of GPs in coordinating team-based care arrangements. They also stated their preference that fee-for-service remain the core funding arrangement but sought an expansion of practice nurse incentives, increases in the cap on allied health visits and a broader scope for MBS items. These submissions were also supportive of an increase in the number of training places for GPs, nurses and allied health professionals and there was some support for use of blended payments, capitation and patient enrolment. Across GP groups, there was variation in views on the extent of reform warranted.
- A number of common themes were also present in submissions received from groups with an interest in pharmacy. Overwhelmingly, these submissions indicated the need for improvements to be made in managing patients as they transition from one care setting to another (eg pre/post-admission to hospital) and for pharmacy to play a role in this process. Other key issues included the role that eHealth can play in reducing adverse reactions to medications and prescribing behaviours, the importance of improved data collection and the need for pharmacists to be included as part of the primary health care team.
- Aboriginal and Torres Strait Islander representatives and organisations universally supported a holistic approach to primary health care including support for social and emotional well-being and increased levels of support and involvement of the community sector. Submissions also discussed the biggest obstacles in accessing primary health care services, ie the availability of effective, culturally safe and timely services. Options to address this issue included increased support for Aboriginal Health Workers and ACCHOs. The impact of chronic disease was also raised as a major concern with suggestions that the Strategy should include a focus on prevention.
- Submissions received from organisations in the research, safety and quality sector recommended prioritising investment in health care research for planning and quality improvement. It was suggested that this be supported through better information management including through the eHealth agenda. These submissions also highlighted the importance of building an evidence-based framework for preventive care which they suggested could provide significant benefits in avoiding chronic disease. Many groups also focussed on equity in access and resource allocation including the issues facing many Indigenous Australians. Issues such as patient-centred care, awareness of patient rights and building health literacy were also discussed.
- Education and training organisations indicated their support for greater investment in clinical training in the community setting to allow development of infrastructure and to acknowledge the time commitment involved for supervisors/teachers. Their views around increasing support and incentives for inter-professional collaboration, facilitated by horizontal integration of medical, nursing and allied health training activities, were also discussed. These groups also highlighted the importance of a generalist approach and the need for vertical integration across undergraduate, postgraduate and vocational medical training. Increasing remuneration and incentives, and support for primary health care students, was also raised.
- Whilst submissions from the many other key organisations and individuals were divergent, the common themes included a focus on better addressing disadvantage and inequity in access, and the view that the current system would benefit from better integration and a stronger emphasis on team-based care arrangements. Other key issues seen as significant objectives included the importance of improving access to health care in rural and remote areas with support for regional planning, the development of eHealth and improving health literacy in individuals.
A list of submissions is provided in Table 13. In addition, submissions are available from the Department of Health and Ageing website at: http://www.health.gov.au/internet/main/publishing.nsf/Content/primaryhealthstrategy-submissions.
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