Tuesday, March 2, 2010

Are GP Super Clinics the answer to the access problems?

The Federal Government is building 31 GP Super clinics to be set up over the next four years. There will not be one in the ACT. The Commonwealth Government wants to ensure that all Australians have access to affordable, high quality, comprehensive and integrated primary care services which are convenient and accessible and the Super Clinic is seen by many, including the Federal government, as one way to provide this.

On Wednesday (24 Feb 2010) in the National Health Forum Series presented by the Australian Primary Health Care Research Institute at the ANU a panel discussed the Question “Are GP Super clinics the answer to the access problem?”

An overview of the session is available on the APHCRI site. A podcast the second forum in The Australian University's National Health Reform Series, 'Are GP Super Clinics the answer to the access problems?' is available online.

Julie Derrett, HCCA Policy Officer, listened to the podcast and has written this post, sharing some of the points raised by each of the four speakers.
Professor Mark Harris, Executive Director , Centre for Primary Health Care and Equity at the University of NSW and a member of the External Reference Group, National Primary health Care Strategy.

When we look at the big picture of access to GP’s in Australia it doesn’t look too bad particularly when we are talking about episodic care; 80% of Australians see a GP each year and the average number of consultations each year is at least five, and around 80% of those visits are reimbursed totally through Medicare. The situation in rural Australia can be quite different.

After hours availability is very poor when compared to other countries like Australia. The big problems around access are in primary allied health.

Medicare funding is very restricted and about half of the care that people need from allied health providers is not funded at all. This just makes access to allied care unaffordable for many. Co-payments are a big problem with both doctor and allied health care and while state allied health services are free there can be very long waiting times for access.

Will Super Clinics solve this problem of access to allied health services? If they provide access to multi disciplinary care in the one location at an affordable cost, yes they will improve outcomes for many consumers.

The research shows that where multidisciplinary care providers are co-located the quality of care improves, however, size matters. When clinics grow larger than 20 full time equivalent staff the quality of care is more likely to suffer in terms of continuity of care and patient centred care.

Dr Steve Hambleton, Federal Vice president of the Australian Medical Association.

Steve Habmleton believes there has been a significant under investment in both health facilities and doctor training in Australia for decades and that this is why we are talking about an access problem today. He also pointed out that Super Clinics are not a new idea. He went on to list the kinds of services that will be available at the Super Clinics: GP, after hours, dieticians, podiatrists, psychology, visiting specialists, practice nurses, chronic disease management, pharmacy, computerized and provide teaching. This is what Steve’ Hambleton’s Brisbane city practice provides and has done for 21 years. It is a good model and it is good for our patients.

Welcome the investment in the super clinic model, but invite the government to talk to people already on the front line to see where the pressure points. The AMA is very concerned to that super clinics should not be set up in opposition to existing practices.

At public consultation meetings on Super Clinics which Steve Hambleton attended, it was clear that the services were already in place. Are Super Clinics g in the places of most need is the question.

Dr Rashmi Sharma, President of the ACT Division of General Practitice

Dr Sharma pointed out the even though the ACT has a significant GP shortage it did not receive Federal Government funding for a Super Clinic. She was concerned that the clinics could create another tier of primary health care delivery and could further fragment care.

Physical access to clinics was another concern. Concentrating health care facilities in town centres will create barriers for many, especially in Canberra where public transport is very poor.

Dr Sharma was not confident that the bulk billing model of the Super Clinic would be sustainable. In her own quite large practice it certainly isn’t possible, even though they have allied health practitioners and practice nurses providing an income stream.

In a recent survey of Canberra GP’s it was revealed that many consumers were not being referred appropriately because GP’s are often not aware of what services are available. Dr Sharma would expect co-location to overcome some of this awareness problem.

Dr Sharma was not convinced that the new model is any better than what we already have in many existing middle size practices and that it may be better to invest in what we have.

Russell McGowan, Health Care Consumers’ Association of the ACT.

Russell McGowan said, “Super Clinics are no more the answer to our health care needs than supermarkets are to our food needs. They play a role, where they can be useful is where they are physically accessible and where they are open all hours, but they won’t be of value if they crowd out all the alternatives.”

Russell reminded the audience and panel that what consumers are looking for in health care is the triple bottom line – safe, high quality and cost effective health care.

Super clinics can provide a different model and this comprehensive mix of medical and allied health services could be an advantage to some groups who have complex chronic conditions and need the interaction of many health providers to keep them well. Many consumers will still want to see local suburban GP’s because we value some of the things that they do above other considerations. But increasingly consumers will want more from their GPs regardless of location or size. Things like: practice nurses, e records, integration with allied health and after hours access. This will be hard for really small clinics to deliver without additional assistance.

A lot of money will be spent setting up these clinics and we will have to carefully monitor and evaluate to see whether we are getting the best bang for our buck.

The co-op model, like the West Belconnen health Co-op, should be considered seriously. It has the potential to deliver the integrated, accessible and cost effective outcomes that we are seeking from the Government’s expenditure on super clinics, but at a fraction of the cost.

There is more information about the Federal Government Super Clinic program at Super Clinics

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