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GPs are where the home is

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The AMA has called on the Federal Government to consult closely with the nation’s GPs in advancing plans to introduce its Health Care Homes model of primary care.

In its first major response to the Primary Health Care Advisory Group report finalised late last year, the Government has announced it will trial Health Care Homes as a way to improve care for patients with complex and chronic health conditions.

AMA President Professor Brian Owler said the peak medical group welcomed the Government’s acknowledgement of the pivotal position played by GPs in primary care, particularly in the ongoing treatment of patients with chronic disease.

Professor Owler said the Government’s Health Care Home concept reflected many of the principles recommended by the AMA, including voluntary enrolment, the continued use of fee-for-service for routine care, and a focus on patients with complex and chronic conditions.

But he said Health Minister Sussan Ley’s announcement left many critical questions unanswered, particularly the scale of investment the Government would make to support the initiative.

“I think this concept of a Health Care Home is a good one,” Professor Owler said. “Having a stronger bond between patients and a practice or a GP is a good thing, but we need to see how the funding is going to work. The proposals are good, but it needs to come with investment.”

The AMA President said he was particularly concerned that funds were not diverted from elsewhere in the health system to fund the initiative.

He said Australia’s GPs had been the target of repeated funding cuts in recent years, most particularly the current freeze on Medicare rebates, and if the Health Care Home concept was to improve patient care and reduce pressure on public hospitals, “significant new funding is needed”.

Internationally, the term Medical Home is used to refer to a model of primary care that is patient-centred, comprehensive, team-based, coordinated, accessible and focused on quality and safety.

It is envisaged patients would nominate or register with a GP or medical practice as their Medical Home, making it the hub for coordinating and integrating their care among a multidisciplinary team of health professionals.

Releasing the AMA’s Position Statement on the Medical Home earlier this year, Vice President Dr Stephen Parnis said in Australia these attributes were already embodied in general practice.

“The concept of the Medical Home already exists in Australia, to some extent, in the form of a patient’s usual GP,” Dr Parnis said. “If there is to be a formalised Medical Home concept in Australia, it must be general practice. GPs are the only primary health practitioners with the skills and training to provide holistic care for patients.”

The Medical Home concept is seen as a way to improve the care of patients with complex and chronic illnesses, helping them manage their conditions will living in the community rather than needing regular expensive and disruptive hospitalisation.

The Federal Government has made improved primary care of chronically ill patients a priority in order to reduce the pressure on the health budget.

While GPs and hospitals have greatly improved the efficiency and cost-effectiveness of the care they provide, the chronic disease burden has swollen as the population has aged and patients have developed significant co-morbidities.

Dr Parnis said the Medical Home concept had the potential to deliver improved support for GPs in providing well-coordinated and integrated multi-disciplinary care for patients with chronic and complex disease, and it made sense for this to be the focus of Government thinking on adopting the Medical Home idea in Australia.

Evidence suggests patients with a usual GP or Medical Home have better health outcomes, and 93 per cent of Australians have a usual general practice, and 66 per cent have a family doctor.

Earlier this year, the AMA issued a Position Statement in which it backed the concept of a GP-centred Medical Home, as long as it was tailored to local conditions and maintained the fee-for-service remuneration system.

“You can’t just transplant models of health care from other countries without acknowledgement of local conditions and what is already working well,” Dr Parnis said. “Australia needs to build on what works, and ensure that a local version of the Medical Home is well-designed and relevant.”

The AMA said establishing the Medical Home concept in Australia was likely to involve formally linking a patient with their nominated GP or medical practice through registration – a process it said should be voluntary for both patients and doctors.

The Government will appoint a Health Care Home Implementation Advisory Group to help steer the introduction of the scheme.

The AMA Position Statement on the Medical Home can be viewed at: position-statement/ama-position-statement-medical-home

Adrian Rollins

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