3 February 2023

The Royal Australasian College of Physicians welcomes the report of the Strengthening Medicare Taskforce, but patients need more access to specialist care than is foreshadowed by the report. Specialist care of physicians and paediatricians plays an essential role in delivering high quality healthcare for patients, especially the increasing number with chronic diseases.

One of the recommendations of the report is to “support local health system integration and person-centred care through Primary Health Networks (PHNs) working with Local Hospital Networks, local practices, ACCHOs, pharmacies and other partners to facilitate integration of specialist and hospital services with primary care, and integrate primary care with mental health, aged care, community and disability service.” The RACP supports this recommendation but knows more need to be done.

RACP President Dr Jacqueline Small says “The RACP welcomes new thinking and innovative approaches to health system reform, but these reforms will be both ineffective and costly if they do not include specialists, and will impact negatively on patients.

“Every day, physicians and paediatricians play a critical role in delivering quality community care to patients with chronic or complex illnesses. We do so in collaboration with General Practitioners, allied health professionals and other support staff.

“Including medical specialists in integrated and team-based models of care will deliver better outcomes for patients, provide support and capability development for GPs and other health professionals, and address problems with accessing specialist medical care.

“Supporting medical specialists to work more closely with GP practices is one model that could improve patient satisfaction and health outcomes, reduce fragmentation of care and reduce hospitalisations from chronic and complex conditions.

“We already have examples of effective team-based care models in action. The Strengthening Care for Children Project has shown promising outcomes from integrating paediatric and GP care, while the Geriatrician in the Practice Program in rural NSW has provided regional patients with easier and better coordinated access to geriatric care managed through their regular GP clinics.

“Our own Model of Chronic Care Management sets out a path to make multidisciplinary team care more accessible and patient-centred, while avoiding unnecessary hospital visits to people with intermediate level of chronic conditions. We’re eager to share our model with all stakeholders and encourage all sectors of the healthcare profession to engage with it,” Dr Small said.

“It’s a better way of working, but there need to be changes in the way the system operates to make team-based care more widely available.

“The RACP wants to work with the Minister for Health, Mark Butler MP, to deliver the optimum healthcare system that works for all Australians – a system that doesn’t leave patients waiting, but delivers the quality level of care they need when they need it.

The RACP is calling on the Federal Government to:

• Involve medical specialists in primary care reform, and implement the RACP Model of Chronic Care Management  to integrate and streamline patient-centred GP, medical specialist and allied care for patients with chronic comorbid conditions and disabilities
• Involve medical specialists (physicians and paediatricians) in the design and operation of Urgent Care Clinics to expand their outreach into community-based care services
• Integrate medical specialists into innovative blended funding models to be implemented as part of the announced reforms, including
  • provide funding support for GPs to seek advice from medical specialists in difficult cases
  • break down the place of service delivery (public hospital versus private practice) funding barrier for patients with chronic conditions to ensure GPs and physicians can work collaboratively from the same care plan
  • Include medical specialists in the voluntary patient registration scheme to support team-based routine care for chronic patients
  • appropriately index Medicare rebates so they are sustainably aligned with inflation.