Issue 38 / 8 October 2013

TEAM work has been a prominent feature of palliative care since it emerged in the modern era.

Indeed, since the time Cecily Saunders pioneered the field of palliative medicine in the 1960s, palliative care service has been based on team work.

However, team work is an aspect of care that clinicians are poorly trained to deliver and that Medicare has failed to adequately support, presenting a barrier to good palliative care in the community.

Earlier this year Palliative Care Australia welcomed the federal government’s aged care reforms. We now wait with interest to see how the new government will work to ensure that effective team work is supported as it implements these reforms.

Effective team work has been a long-term challenge for GPs, who have suffered from a lack of respect and support for the pivotal place they hold in the development of good health maintenance in aged care.

In fact, GP time in aged care must be supported as well as respected if the aged care reforms are to succeed.

The following aspects of the reforms offer hope for GPs’ place in the aged care team:

1.    The opportunity to improve palliative care knowledge and expertise, with funding available to create a specialist palliative care and advanced care planning advisory service. There is also a greater investment in the Program of Experience in the Palliative Approach (PEPA), giving GPs and aged care workers better skills training.
2.    Funding of $14.2 million over 5 years to support multidisciplinary care of people in residential and home care services. This will also improve access to GPs through video consultations. While welcome, it will come up short unless it is complemented by improvements in Medicare team care rebates. Too often we start something good without embedding it into long-term practice.
3.    Funding of innovative models of care, which gives some hope for better care of Australians suffering from dementia in particular. Earlier diagnosis and support for a person-centred approach for people with dementia and their carers is significant to general practice, and there will be opportunities for GPs and practice nurses to receive training and education in dementia care.
4.    A focus on community-based care, giving older people choice and supporting those who stay at home. This has been a theme in aged care for some years now and it is good news that an even greater emphasis will be placed on community care in the reforms.

More frail, older Australians with more comorbidities are still living at home and, as they age, are becoming increasingly disconnected from good primary care and good specialist care. The hope is that, as part of these reforms, this growing problem for those living longer at home will be addressed.

The future of aged care clearly lies in a multidisciplinary team approach and these reforms are a start to making improvement in this area.

The main reason why Australia lacks good team development in primary care is because we don’t pay for it, which is why the new government must support better investment in the team approach. This will enhance early decision making in palliative care and good skills in managing suffering at the end of life, both currently lacking in general practice.

Aged care is about people who deserve our respect and access to a system that delivers them person-centred care.

These reforms are another step in the right direction, but there will be a need for many more.

 

Dr Scott Blackwell is the immediate past president of Palliative Care Australia and a GP practising in WA.

One thought on “Scott Blackwell: Team challenge

  1. Dr John B. Myers says:

    Whether care is delivered in a team format or not is not the issue. Teams often fail because there is no leadership nor understanding of the patient’s condition, needs and goals. A bureaucratic push for teams is simply that. Appropiate and adequate care is determined by patient “happiness”(1), not team satisfaction or priority of agenda of any of the individuals on it, which is the dominating model in age care and pallaitive care. Too many patients have died because teams not focussed on patient need are involved in the patient’s care and are headless in being run by nurses or docotrs who are not patient appointed, i.e. someone in whom the patient has trust, who may be a specialist in or general practitioner involved at their level in their care.

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    Myers JB. ‘Duty to care’, or, ‘duty of care’ and the goal of medical treatment. Intern Med J, 2007, Vol 37(3), 211.

     

     

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