In overcoming significant disadvantage, it is the capacity of the general practice workforce that will provide the biggest impacts in realising improved health outcomes over time. General practice is by far the most efficient and cost-effective part of the healthcare system. GPs are often relied on the most, particularly by those most in need and with complex and chronic conditions.
General practice is already an efficient part of the healthcare system. GPs also have a very large remit. In any given year, almost all Australians – or 85 per cent – will visit a GP at least once. Yet government expenditure on general practice is relatively low at around $6.8 billion, under 5 per cent, of total recurrent health spending.[i] When compared to the significant cost to the sector for hospital services - expenditure on public hospital services is at around $61 billion – general practice offers value for money.[ii]
There is clear global evidence that health systems with strong primary care will secure long term efficiencies. Benefits from prioritised investment include achieving lower rates of hospitalisation, fewer health inequities and better health outcomes including lower mortality. The findings captured by Starfield for one make a convincing case for primary care investment and are not new, but so do so many studies that have followed it.[iii] [iv]
A broader population health policy framework that recognises the role of primary care and general practitioners in addressing health disparities makes really good policy sense. But how do we convince our policy makers – firmly fixed within their short-term electoral cycles and need for quick wins - that a strong investment now will provide real and significant returns for a healthier future?
It’s clear that policy makers are not short on evidence around the benefits of prioritising these areas. These are critical funding decisions that impact quality, access, and coordination of health service delivery.
There is significant unmet need with access to primary health care still one of the main barriers to achieving equitable health outcomes. This is the case for many disadvantaged Australians and certainly for Aboriginal and Torres Strait Islander communities. National studies have shown that health outcomes improve with improved access to GPs in areas with relatively high predicted need for primary health care.[v] But we are not seeing anywhere near the level of investment needed to make the shifts required in supporting those most in need.
Embedding more preventative health interventions in the primary health care setting also needs focus. Primary care and preventative health go hand in hand. A rising disease burden requires a stronger emphasis on preventative health and GPs are key in terms of delivery. We clearly need to be prioritising both areas and with the level of investment warranted to secure strong health outcomes. We need investment in both prevention and primary care with recognition through funding of the important role general practice has in delivering both aims.
While preventative health requires a whole of community focus and an effort from each and every one of us, much of the service responsibility again falls to general practice. The GP has the lead role in ensuring their patients remain healthy over a lifetime and preventing illness, identifying risk and offering early intervention is already a large part of what we do.
I know firsthand that our patients most certainly value general practice and understand well the need for prevention and for real investments around that beyond just a health message. Research Australia’s annual Health and Medical Research public opinion poll ranked preventative health as one of the nation’s key health priorities. More than 75 per cent of Australians ranked preventative health as a key priority in 2016.
In determining health priorities, that role now falls to the Primary Health Networks and their focus in six priority areas: Aboriginal health, aged care, e-health, mental health, population health and health workforce.[vi] However, we know that issues around equity and social determinants of health is key to shifting entrenched disadvantage. The much broader set of objectives in our National Primary Care Framework (April 2013) should be revisited. Clear aims to drive our funding decisions which included a focus on addressing inequity in keeping all Australians healthy, preventing illness as well as reduce unnecessary hospital presentations and making improvements in the management of complex and chronic conditions.[vii]
To drive the level of change general practice needs to be better resourced. Investment needs to prioritise general practice and build upon existing services and arrangements. An investment which will lead to improved health outcomes, better management of chronic disease, a stronger focus on prevention and lower rates of unnecessary hospital admissions. A strong investment in general practice is what is needed to secure a healthier future for all Australians. The lift of the freeze, albeit slowly, is welcomed, but this only puts us back where we were at in 2013 before it was introduced. Let’s get the full discussion back on track. Let’s pick up where we were at nearly a decade ago when we were on the cusp of significant reform in Australia. A reform which saw a priority on general practice and its role in prevention and primary care.
[i] Britt H, Miller GC, Henderson J, et al. General practice activity in Australia 2014–15. General practice series no. 38. Sydney: Sydney University Press, 2015. Available at http://hdl.handle.net/2123/13765
[ii] AIHW 2017. Australia's hospitals at a glance 2015–16. Health services series no 77. Cat. no. HSE 189. Canberra: AIHW.
[iii] Starfield, B., Shi, L. and Macinko, J. (2005), Contribution of Primary Care to Health Systems and Health. Milbank Quarterly, 83: 457–502. doi: 10.1111/j.1468-0009.2005.00409.x
[iv] Harris MF, Harris E. Facing the challenges: general practice in 2020. Med J Aust 2006; 185: 122-124.
[v] Australian Institute of Health and Welfare. 2014. Access to primary health care relative to need for Indigenous Australians. Cat. no. IHW 128. Canberra: AIHW.http://www.aihw.gov.au/publication-detail/?id=60129547987
[vi] The Department of Health. Primary Health Networks (PHNs). Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/PHN-Background
[vii]Commonwealth ofAustralia.NationalPrimaryHealthCareStrategicFramework.2013.Availableat: http://www.health.gov.au/internet/main/publishing.nsf/Content/6084A04118674329CA257BF0001A349E/$File/NPHCframe.pdf
Dr Ayman Shenouda