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A medical home – what you’ve told us

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Populations are ageing and the incidence of chronic and complex disease is rising. I see plenty evidence of this in my own practice.

Governments around the world, Australia included, are looking at new models of primary care to keep their populations healthy and contain rising health costs. The only thing missing here is a financial commitment in general practice to match this interest.

The goals are to keep everyone as healthy as possible through preventive services and early interventions, and to supply the needs of those older people with a high burden of chronic conditions.

It is not surprising that the focus is shifting to primary care and the central role played by GPs.

We know that the health of patients is improved if they have better access to GPs. Avoidable hospital admissions can be reduced and long-term savings to health systems are possible.

It is in this context that the Federal Government is exploring the potential of the “patient-centred medical home” model of primary care to strengthen the role of GPs in the health system and deliver better outcomes for patients by encouraging continuous and coordinated care. It is consulting with major health groups such as the AMA and the RACGP.

In broad terms, the medical home formalises the link between the patient and the GP or practice. It aims to facilitate partnerships between patients and their GP.

Based on a concept developed overseas, the medical home could involve voluntary patient registration with a GP or practice, and voluntary participation by the GP.

From my perspective, patients would only benefit from the medical home if fee-for-service is maintained and extra funding made available for the non face-to-face work undertaken by GPs.

Many of you may think that, registration aspects aside, the medical home is a simple extension of the family doctor, where the GP leads a team of health care professionals in the practice who collectively provide and coordinate patient care.

Indeed, our own research shows that 88 per cent of people have a family doctor and, therefore, a medical home.

In late May and early June we surveyed our GP membership to find out what you thought of the medical home concept.

More than half of you agreed that the term ‘medical home’ is an appropriate description of general practice.

Other key findings were:

  • nearly three-quarters of you believe the AMA should support the medical home model, provided that linkages are voluntary and reversible, and that the ability of the doctor to charge on a fee-for-service basis is maintained;
  • there is support for voluntary registration of patients at a practice, but strong opposition to compulsory registration;
  • more than half of you believe that you could manage the needs of your patients with chronic disease and co-morbidities more effectively with a defined patient population;
  • there is uncertainty whether an annual registration fee would be an appropriate means of charging for the cost of non face-to-face work done for our patients; and
  • more than three-quarters of you have some level of concern that the government will use the medical home concept to change the way general practice is funded.

So there you have it. The AMA is presently working up its position on the medical home, and we are being guided by the survey findings.

I understand that the RACGP sees great merit in the medical home. We are taking a more cautious approach, as there is the potential for more bureaucracy and capitated funding.

I’ll keep you posted on developments in future columns.

Thank you to those who participated in the survey.

If you would like to find out more about the medical home model and the full findings of the survey, go to: ama-member-survey-patient-centred-medical-home