The Royal Australian College of GPs (RACGP) has welcomed the final report of the Mid-Term Review of the National Health Reform Agreement (NHRA) Addendum 2020-2025, but warned the Government against compromising quality care.
The NHRA is an agreement between the Federal Government and all state and territory governments to improve health outcomes by coordinating care and ensuring the future sustainability of Australia’s health system. It forms the basis for federal funding contributions to states and territories for public hospitals and provides mechanisms to improve coordination between general practice, hospitals, and other parts of the health system.
In its submission, the RACGP advocated for a range of measures that would cut red tape for patients and GPs and reduce the burden on overloaded hospitals through investment in care by GPs.
RACGP President Dr Nicole Higgins said the College welcomes the report’s acknowledgement of flaws in the current NHRA around health system fragmentation, bureaucratic barriers to care, and a lack of focus on preventive care.
“Australia needs a holistic health system the recognises the interdependency between general practice, hospitals and allied health services,” Dr Higgins said.
“While the NHRA aspired to that, it hasn’t occurred in practice. We need an approach that has the flexibility to adapt to local needs, but there must be a shared vision, clear roles for different parts of the system and easy exchange of information between them, and clear accountabilities. Current funding models do not encourage continuity of care between settings; they, as the report acknowledges ‘discourage’ them.
“As we have been saying, by focusing on activity – hospital procedures – the health system has missed opportunities to support effective, efficient healthcare delivered by GPs. This has resulted in a health system that fails to apply the value of preventative health, where the Federal Government spends $3,166 per person per year on public hospitals, versus $437 on general practice. The result? Growing gap fees for patients and missed opportunities to reduce hospital presentations.
“When it costs the government $611 per person for a non-admitted hospital presentation, versus around $90 for a patient to see a GP, it’s clear where the value lies. As the report says, we need a health system that rightly values the work of GPs in preventative health and in the community after a hospital discharge.
“Conservative estimates suggest a 12% reduction in hospital readmissions could save the Australian health system a minimum of $69 million per year – and that’s conservative estimate isn’t even accounting for better quality of life.”
Health has been a major focus for the Federal Government, with a substantial $5.7 billion investment into general practice in the 2023 Budget that was described as a ‘gamechanger’ and a further $1.2 billion committed at the December 2023 National Cabinet meeting.
But Dr Higgins said the next agreement must have not just innovative approaches to funding the health system but give a clear signal to future GPs that their training will be valued.
“The fact is, you need to invest in the efficient parts of systems to get their benefit,” she said.
“The report discusses bundled funding to link healthcare delivered before, during, and after a planned hospital admission, for example, but we need to see real and significant investment in general practice after years of funding freezes and effective decline.
“General practice has a critical role to play in caring for people in the community and keeping them out of hospital. The report notes the growth in out-of-pocket costs in healthcare delivered by GPs, and workforce challenges across the health sector, but we need a clear commitment in the next agreement for appropriate funding for patients to see their GP when they need to, not just when they can afford it. Saving money on preventative care is how you face expensive hospital cost blowouts down the road.
“That also means the Government should not compromise on quality care. GPs and other healthcare workers want to work at the top of their scope, but we’ve seen states opt for cheap and cheerful approaches like pharmacy prescribing. This fragmented and reactive approach to people’s health might be tempting when a policymaker is looking for efficiencies, but the risks to patient safety of low value care means that kind of approach ends up costing you more in the long run, while delivering worse outcomes for patients. Too often, it’s just not worth it.
“The fact is, devaluation of general practice by successive governments has created workforce challenges. Tinkering around the edges won’t fix that – only investment can. Junior doctors and medical students need to know they’ll be valued and well-supported. It’s positive to see workforce signalled in the final report as a recommended priority in the development of the new health reform agreement.”
Dr Higgins also said there were further opportunities in data sharing that were supported in the report.
“This is also an opportunity to better integrate primary health and hospitals’ data,” she said.
“We can achieve this with pilot data-sharing arrangements between hospitals and primary care with the ultimate goal of better identifying at-risk patients, tailoring individual care/reducing low-value care, developing services tailored to the health needs of communities and funding support for specialist GPs located within hospitals to improve care.”
The Federal Government spends $3,166 per person per year on public hospitals, versus $437 on general practice.
It costs the government $611 per person for a non-admitted hospital presentation, versus around $90 for a patient to see a GP.
Conservative estimates suggest a 12% reduction in hospital readmissions could save the Australian health system a minimum of $69 million per year.
Australia needs a holistic health system the recognises the interdependency between general practice, hospitals and allied health services. While the NHRA aspired to that, it hasn’t occurred in practice.
We need a clear commitment in the next agreement for appropriate funding for patients to see their GP when they need to, not just when they can afford it.
This is also an opportunity to better integrate primary health and hospitals’ data.
The Royal Australian College of General Practitioners (RACGP) is the peak representative organisation for general practice, the backbone of Australia’s health system. We set the standards for general practice, facilitate lifelong learning for GPs, connect the general practice community, and advocate for better health and wellbeing for all Australians.