The strengthening medicare taskforce: All healthcare workers are on the front line. Let’s get them on the front footSep 1, 2022
Following the outcome of this year’s Federal Election, Health Minister Mark Butler convened the Strengthening Medicare Taskforce (SMT).
At its first meeting, the Taskforce established five focus areas to guide its recommendations to the Australian Minister of Health and Aged Care.
The second aim of the Strengthening Medicare Taskforce (SMT) is “improving patient access to GP-led multidisciplinary team care, including nursing and allied health”.
There is no doubt that multidisciplinary team care is essential and already present in the existing primary health care (PHC) models. However, in the PHC of both the present and the future, it is difficult to see why (in all cases) it needs to be exclusively GP-led.
One can only speculate why such a significant limitation on health professional leadership was placed on planning for our future Medicare models. Whilst there is no doubt that, in many instances, general practitioners (GPs) are the centrepiece of primary medical care, it is not accurate to suggest that they are always the centrepiece of primary healthcare.
This is not to diminish the important role of the general practitioner (GP). However, it is important to remember that 1 in 5 Australians do not have a regular GP (RACGP 2017). It’s also vital to acknowledge that many rural and remote communities do not have access to GPs or general practices that bulk bill. Increasingly, general practices have been closing their patient list due to overwhelming demand. This has been due to many factors, including a shortage of experienced GPs, lower migration of overseas doctors to Australia and a concentration of GPs within major cities.
In this context, we should recognise that significant work exploring alternate models of care has been undertaken.
For almost a decade, the Commonwealth Department of Health has been funding the development of nurse-led clinic models through the Australian Primary Health Care Nurses Association (APNA). The positive benefits of these clinics include improved patient health outcomes, better access to care, and decreased rates of hospital admission. We also know that there are many communities who are served almost exclusively by nurses using different various models of care in various clinical settings including:
- Aboriginal Community Controlled Health Organisations and other health facilities in remote communities where Aboriginal health workers and nurses and nurse practitioners are the only, or primary group of, health professionals providing care .
- Corrective and justice services where nurses and nurse practitioners are the mainstay of community health programs, with medical practitioners seeing patients through designated referral clinics.
- Mental health where a good example is the Royal Melbourne Hospital is implementing community nurse-led models of family focussed care.
- Walk-in centres where nurse-led models of care working with teens in underserved community populations, the ACT nurse led walk-in centres and other community models work well.
- Nurse triage telehealth programs such as those offered by healthdirect Australia provide valuable after hours support for people when GP surgeries are closed and the only other (potentially unnecessary) option might be a visit to the emergency department.
- Midwifery services using models of care in rural communities that have enabled better continuity of maternity care and maternity services closer to home.
- Homeless outreach services where patients and others who do not have a regular GP access nurse-led care and support to manage multiple co-morbidities and social determinants of health.
This approach can be applied to other underutilised health workforces. A range of models have been suggested where allied health professionals can also lead a multidisciplinary team.
In a time of significant health workforce shortage and significant health service demand, the critical issue is not who leads the team, but who is most proximally placed to deal with the issues that the patients need addressed.
There is no suggestion of fragmentation of care. If these patients have a nominated GP, then that GP would be advised (with the patient’s permission).
In the context of lower availability of GP-led care to all Australians, and without other services such as those described above, the only alternative for free health care at the point of service is to attend the local emergency department.
The Aged Care Royal Commission specifically highlighted the role that NPs could and do play in bridging that gap for the elderly in residential aged care facilities and the role this plays in reducing unnecessary hospitalisations.
Thus, the second aim of the SMT seems to be at odds with the need to re-envisage PHC in the wake of our COVID lockdowns, when virtual healthcare became the norm and the need for all health professionals to work to their full scope of practice meant that work was often re-allocated as necessary to ensure that the right care was provided to the right person at the right time.
It is for these reasons that the emphasis on GP-led models of care as one of the five aims of the SMT seems to be retrograde and disappointing if the aim is to unlock the potential of all health care practitioners in primary health care and to improve access and equity for the Australian community.
Read the first article in this series.
The Communiques from the Strengthening Medicare Taskforce can be found here: