Report highlights failure in primary health care

The Grattan Institute, a public policy ‘think tank’, has just published a report entitled ‘Chronic failure in primary care’ (see here). It is disappointing there is little reference to nurses in the report but that aside, it does give a good insight into the problems (and some possible solutions) in Australian primary health care.

Some highlights of the report are as follows:

  • Ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million a year in avoidable hospital admissions.
  • Only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.
  • Each year there are more than a quarter of a million admissions to hospital for health problems that potentially could have been prevented. Yet each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care.
  • Three quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death. Social, economic and environmental changes are the best way to prevent these diseases, but there are much better outcomes where good quality primary care services are in place.
  • The focus must move away from GP fee-for-service payments for one-off visits; a broader payment for integrated treatment would help to focus care on patients and long-term outcomes.
  • PHNs should be given more responsibility for local primary care services. The evidence shows that a consistent, coordinated approach to specific diseases helps primary care more effectively prevent and manage chronic conditions. In regional areas, clear targets and well-designed incentives for disease prevention are vital.
  • There needs to be a focus on more flexible services, which might include greater use of nurses and allied health staff for assessment, planning, coordination, review and support of people with chronic disease.
  • Practice and incentive payments are not working.

Do you agree there are fundamental problems with our primary health care system? Are there any easy, or even achievable, solutions? We would love to know what you think.

AMA’s Position Statement on nurses in general practice

Earlier this week the Australian Medical Association (AMA) published a position statement on nurses in general practice – General Practice Nurse Position Statement 2005. Revised 2015 (see here). This document is a revision of the original statement which was published 10 years ago.

This position statement came as a surprise to APNA, and as the peak professional body representing nurses working in primary health care including general practice it is disappointing we were not consulted in this process. Karen Booth, our President, has now written to the AMA’s President to express our concern around this.

While there are some positive statements about nurses contained in the position statement, it also contains a number of inaccuracies, such as outdated nurse data and a misunderstanding around nurse scope of practice. We have provided this feedback to the AMA and we hope the position statement will be amended.

It is important the role of the primary health care nurse working in general practice is clearly understood by fellow health professionals. Your experience, unfortunately, tells us that this is not the case – in the last APNA salary and conditions survey you told us that only 23% of GPs had a full understanding of nurse scope of practice in general practice and, more worryingly, 4% of GPs had no understanding of scope whatsoever. This lack of understanding is one of the many barriers faced by nurses working in the general practice setting.

Does the AMA’s position statement just add to this lack of understanding? What does the profession need in order to change attitudes and perceptions? Let us know your thoughts.