NRGPN - The Road Ahead
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- Category: NRGPN News
- Published on Saturday, 27 October 2012 22:26
- Written by David Guest
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The Northern Rivers Division of General Practice commenced in 1993 in response to the commencement of a Federally funded program to support general practice. On April 1 2012 that funding ceased.
A lot has changed in twenty years of general practice. Medicare financing has become a well honed art by the Department of Health. Bulk billing, at least in the cities, has been the norm almost since the introduction of Medicare. Continuing medical education and practice accreditation are encouraged both professionally and financially,
In medicine computerisation arrived first and most extensively in general practice, largely because the location and nature of our work meant it was most able to make most use of the expensive and cumbersome early computers. Technology has progressed and there is increasing utilisation of information technology in hospitals and the general community, although it remains patchy.
Medical knowledge has grown considerably. and there has been increasing specialisation within general practice just as there has been in specialty medicine, itself. The days when the GP could do everything are gone. There is simply a lot more of everything to do. Skin cancer, Women's Health and Chronic Disease Management have been growth areas, as have Drug and Alcohol Medicine, Mental and Aboriginal health. Individual GPs can do anything but they can't do everything. By banding together in group practices with each other and ancillary staff, they can provide the vast majority of a patient's primary health care needs. The local surgery is the patient's "medical home". The place you start at when you are sick or need advice.
Financial, administrative and professional pressures have combined to favour larger group practices. The increasing administrative burdens imposed by various government programs are not appealing to many general practitioners. They are neither trained nor interested in this and would prefer to get on with helping their patients.
General practitioners are also, gradually, changing. The crusty, old, solo GP working 24/7 has gone. Group practice makes sharing after hours care and working part time feasible. It also facilitates holiday, sickness and study leave and is particularly important to GPs with young families. Bigger practices with bigger facilities has also enabled other opportunities in general practice. Practice nurses, again encouraged through government financial incentives, do the bulk of vaccinations and wound care in most practices. Sterilisation and assisting with minor operations are also part of routine practice nurse care. An increasing number are involved in diabetes, heart and lung disease and aged care. Their special skills and relationship with the patient provide valuable assistance to the overseeing GP.
Our collaboration with other health providers is also changing the face of general practice. For the last six years psychologists have been funded, under GP review, for a limited number of sessions through the Mental Health Care Plan program. This has been of great value to those in the community with short to medium term psychological problems. Similarly the Chronic Disease Management Program has assisted in providing ancillary care from physios, exercise physiologists, dietitians, podiatrists and others. When the knife and a pill doesn't cure, lifestyle modifications may.
Programs allowing earlier discharge from hospital, keeping elderly patients at home for as long as possible and monitoring those at home at risk of serious deterioration requiring hospitalisation are funded through various programs from State and Federal Health and DVA. These programs require general practitioner review and oversighting, activities that are difficult to perform during the course of a busy working day. It is hoped that the increasing use of electronic communication and shared health records will make this feasible and increasingly efficient.
A lot has changed in general practice over twenty years and so, reflecting this, the government has made changes to GP support organisations. Twenty two years ago the government debated whether their new primary care support organisations would be all encompassing or purely focused on general practice. The latter model was eventually adopted, partially because it was the easier to implement. It's a tribute to the success of Divisions that they lasted so long but it has been clear for several years that their days were numbered. Medicare Locals are here now to fulfill the vision for primary care first entertained two decades ago.
The question GPs are now asking is what can Medicare Locals do to help them look after their patients. Communications, eHealth, Palliative Care, Aboriginal Health and After Hours Care are all initiatives of the NCML. Progress is these areas is desperately needed and eagerly awaited.
GPs are also asking what role does the NRGPN have in this brave new world. We no longer have dedicated staff, equipment or premises. All projects have been handed over to the North Coast Medicare Local and our continuing liabilities are those of running a company limited by guarantee. We do have one significant financial asset, however. Through the excellent work over the last ten years by the NRGPN staff, Board and Chairman, Tony Lembke, we are sitting on about half a million dollars.
The NRGPN has always seen itself as the voice of North Coast GPs. As a result of our publications and public presentations we are considered one of the more advanced Divisions in the country and have led the way in a number of areas in general practice. Continuing this leadership role is the challenge.
However with few resources this will depend on members taking a direct role in running the organisation. We will also have to work smarter. We hope to contain costs by using electronic communications whenever possible. Our IT infrastructure will change to serve this role.
Many general practices have embraced the concept of the GP surgery as the medical home. I see the Northern Rivers General Practice Network bringing us together in the medical village. To help shape that debate I invite you all to attend the Annual General Meeting of the NRGPN at 7 p.m. on Tuesday November 27, at Tarmon's House in the grounds of St Vincent's Hospital, Lismore.
David Guest
NRGPN Chairman
