The healthcare revolution we all need: a one-stop shop, from GP to specialist
Imagine having a local healthcare centre where you can see your GP, take your child to the paediatrician, see your dietician or psychologist, and know that your on-site general physician and GP are working together to help you manage your diabetes problems, all supported by a strong Medicare system.
While our health system over many years has been able to provide excellent care for people with acute illnesses, increasingly our community needs a new model to help patients with more complex health needs, especially people suffering from chronic diseases, disability and economic deprivation.
People are confronting increasing waiting times to see GPs and specialists, and there is disturbing evidence that out-of-pocket costs lead many to defer medical review or treatment, and as a result they suffer preventable complications, hospital admissions, and even death.
The pandemic has lifted the lid on what many health experts and advocacy groups have been concerned about for years – our public health system is struggling to keep up with the growing population’s needs and the increasing requirement to expand clinical services and improve the way that we deliver care.
It also has highlighted inequity in healthcare, with much greater mortality from COVID being evident in deprived socioeconomic regions and communities. We are also dealing with a mass staffing crisis across healthcare – with demand overtaking supply – particularly in regional communities, which are crying out for help.
Ambulances are ramping at hospitals across the country because there are too few beds. There is disturbing evidence of clinicians suffering from strain and burnout, which will lead to many leaving healthcare.
Some short-term solutions are clear: increase public health funding, boost the healthcare workforce to meet demand, especially in communities with higher need, and manage staff shortages caused by COVID, boost GP numbers, expand training places for specialists and bolster telehealth. But these measures will only alleviate some of the immediate pressures and will be expensive. We now have an opportunity to drastically reform healthcare long term, and we don’t want to miss it.
People with multiple or complex chronic conditions require a collaborative care team that involves GPs, medical specialists, nurses and allied health professionals working together to provide comprehensive, patient-centred health services. We must transform where and how we deliver care, so that people with chronic conditions can receive integrated care instead of spending time making appointments with different health providers and jumping around the system.
Various iterations of this have been trialled in the past. We’ve had Medicare locals and GP super clinics, but all have lacked integration with medical specialists. To succeed, the model needs to be truly multi-disciplinary and to have funding and governance mechanisms across state and federal boundaries.
This is the type of care that will make healthcare more accessible, catch health problems early and ensure chronic health concerns are followed up before they become an acute problem. It would result in a significant easing of the pressures on the national healthcare system and local emergency departments.
Our college sees the new government’s focus on strengthening Medicare as a great opportunity to deliver this transformation, but strongly encourages inclusion of medical specialists in these discussions. We hope we can start taking the necessary steps to get there.
Dr Jacqueline Small is president of the Royal Australasian College of Physicians and a Sydney-based paediatrician; Associate Professor Nick Buckmaster is chair of the RACP College Council.
‘Healthcare: The healthcare revolution we all need: a one-stop shop, from GP to specialist’, Sydney Morning Herald (smh.com.au), 18 August 2022.