Minister Mark Butler is now presenting the Strengthening Medicare Taskforce report to state and territory premiers and chief ministers, and later this week – possibly tomorrow – he will present it to National Cabinet for decisions. Collectively they will be considering the need for a team-based approach in primary care, involving both digital systems and new working relationships between health professionals. Ultimately, we hope that the implementation of the report’s recommendations will lead to improved access to care and increased equity in care across Australia. 

Benefits of team care for primary care and chronic disease management in Australia

At the moment, Medicare is structured to finance episodic care. While funding to subsidise nursing and allied health care has been introduced, it’s been piecemeal. The complexity of GPs’ work has increased significantly over the past decade due to an ageing population, with half of all Australians aged over 65 years, as well as the rise in rates of mental illness and chronic diseases such as diabetes, heart disease and cancer. Primary care visits have increased by 16% in the past year alone!

Team care in primary care is currently difficult to organise. For example:

• Medicare allied health rebates remained capped at 5 per year for most patients with chronic illness
• Primary care nurses are funded whether they operate at the full scope of their practice or not
• Specialists are not funded to provide advice directly to GPs to help them manage patient care
• Primary care is often not well supported to adopt digital systems to identify patients who would benefit from structured team care, nor to use digital health tools to monitor patient progress outside the clinic.

Well-funded and structured teams makes it easier for doctors, consumers, nurses, and other healthcare professionals to work together to achieve better health outcomes.

Challenges to implementing a team-based approach to primary care

International evidence shows that the key challenges to implementing a team-based approach to primary care include:

• Cultural resistance to change, and resistance to collaboration among different healthcare professionals
• Lack of clear roles and responsibilities among team members
• Difficulty in coordinating and integrating care among different team members
• Limited time for team meetings and effective communication
• Financial constraints and reimbursement issues for team-based care.

These challenges must be addressed in order to effectively implement and sustain a successful team-based approach to primary care.

However we’ve tried this several times before, with mixed results. An excellent article by Croakey summarises six lessons learnt from:

• Coordinated care trials (Mach I 1990s; Mach 2 2000s)
• Diabetes Care Project (2011-14)
• Health Care Homes (2012-21)

1. Show where we’re going

Mark Butler needs to invest more time upfront in engaging clinicians and the community in a shared vision for ‘a new Medicare’ in order to ensure GPs and patients understand the benefits of the new system.

2. Plan the journey

Careful planning and communication are essential for the successful design and implementation of a new model for general practice.

3. Bring people along

The Federal Government should appoint an independent expert advisory committee to draw on international expertise and engage with local stakeholders in order to reform Australia’s general practice workforce and funding models.

4. Help clinics change

To turn the vision of multidisciplinary team-based care into a reality, front-line implementation support is needed for general practices. The needs are generous change-support funding, expert facilitator support from PHNs, and an additional five percent funding boost.

5. Provide certainty with long-term commitment

Government should provide long-term commitment to staggered implementation of a new model for chronic disease management in general practices, carefully reviewing and refining it over the next five years.

6. Shared leadership

All the key players in Australia’s healthcare system need to work together to come up with a joint plan for reform, in order to overcome their disparate interests and mistrust.

More digital health reform is needed for effective primary care

The COVID-19 pandemic has had a significant impact on the use of digital health tools in Australia. The need for social distancing and the closure of physical health facilities has led to an increased use of telehealth and other digital health tools. This includes video consultations, e-prescriptions, digital pathology, and remote patient monitoring.

More use of digital health is required to support the team care reform, in seven categories:

1. Shared electronic health records (EHRs) that allow for secure sharing of patient data among health care providers both inside and outside the practice.

2. Clinical decision-support systems (CDSS) that can provide medical providers with access to evidence-based guidelines and clinical practice recommendations.

3. Telemedicine systems that enable remote access to medical care, including virtual visits, video conferencing and store-and-forward technology.

4. Health information exchange (HIE) platforms that allow for the secure exchange of health information between health care providers and organisations.

5. Patient portals that allow for direct patient access to their health records and communication with their medical providers.

6. Mobile health applications (mHealth) that provide access to health care information and services via smartphone or tablet.

7. Clinical analytics tools that can provide insights into patient health and outcomes.

The Strengthening Medicare – GP Grants Program

Already last month, the Australian government announced an investment of $220 million in general practices and Aboriginal Community Controlled Health Services (ACCHS) through the Strengthening Medicare – GP Grants Program. The purpose of this program is to support practices to make improvements and expand patient access, as well as provide better, safe and accessible care. The grants can be used for innovative projects, training, and equipment. Interestingly, it can also be used for minor capital works in one of the three investment streams: enhancing digital health, upgrading infection prevention, and maintaining accreditation standards.

Eligible practices include Medicare general practices and ACCHS that deliver general practice services and are not owned or operated by a state or local government. The program has a budget of $220 million and eligible practices can receive one-time grants of up to $50,000, depending on their size. This ensures that every eligible practice will have access to the grant funding and can make improvements to their services.

Conclusion

The Strengthening Medicare Taskforce report is likely to be released shortly, following Minister Butler’s presentations to premiers, chief ministers and national cabinet. It is likely to emphasise the need for more of a team-based approach in primary care, involving both digital systems and new working relationships between health professionals. This would lead to improved access to care and increased equity in care across Australia.

We agree that time will be needed to engage clinicians, practice owners and managers upfront, and to build a shared vision for ‘the new Medicare’. Ongoing front-line implementation support is crucial for general practices. This includes change-support funding, and expert facilitator support for change, and more funding.  We greatly look forward to analysing the report, and providing a summary and our thoughts.