Medicus April 2016

O P I N I O N

GOVERNMENT FAILING TO MOVE INTO 21 ST CENTURY

Dr Steve Wilson Chair, AMA (WA) Council of General Practice

W hen government decides to build and deliver ‘big bang’ projects, the result is usually in both finance and product terms an absolute disaster.” That was a statement made by this column back in 2015 in a piece about My Health Record. You will not be surprised to learn that in 2016 nothing has changed in the healthcare space, particularly for GPs and their patients. The problem, and the pain, are real and neither the Federal nor State Governments – Liberal or Labor – seem to be capable of grasping the fact that continuously changing policy decisions of the previous government for political or ideological fads contributes nothing other than financial waste, more lost opportunities and patients are definitely no better off. Even as funding levels fall, General Practice finds itself being asked to do more and more with dwindling resources as the demand for consultations rises. Central to this problem is the government’s poorly thought out health policy development and worse still is its implementation. Aged Care is a good example. Given that rising numbers of frail older people are one of the most pressing needs facing our healthcare system (alongside increasing demand for access to primary care advice and assessment), it is surely time for government and General Practice, to think boldly about how to redesign services, maximise the

use of technology, and change the organisation of care. The Department of Health decided, in its wisdom, to invest in a portal to streamline access to needed services for elderly patients. The idea had merit – in principle. Did the project begin with consulting GPs, who after all would be the ones managing and coordinating the care of the patients? Apparently not. What the Department produced has complicated access by requiring all patients to undergo either a RAS or ACAT assessment in order to access support services. An assessment bottleneck was created causing delays to the elderly accessing support and medical care. Worse still, direct referrals to service providers for required services were blocked by the bureaucratic requirement for an assessment. While the rationale for all users to undergo an assessment is to collect data on the services provided to the elderly, these are very expensive; they need to be weighed against the cost of the services that are needed by the patients. What is the priority here? The collection of mountains of data or patients having ready access to necessary medical care? If the project’s service priorities weren’t bad enough, the icing on the cake was the online referral form, which is central to accessing services. The form is difficult to find and inadequate in its structure, not save-able to the GP’s clinical system

and only available as a PDF! This is 2016 – the 21 st century no less and the Federal Health Department is asking GPs to revert to using 20 th century processes to enable their elderly patients the right to access necessary medical services. Does government and the Department deserve to be savaged by GPs and their patients for this? Definitely yes. This is inexcusable and demonstrates government has yet to learn that top-down approaches to policy implementation and ‘big bang’ projects don’t work and the community suffers. The Department’s presentation to the Federal AMACGP was, to put it mildly, not well received and the Department was told to go back to the drawing board and provide a 21 st century product that was fit for purpose and which would benefit GPs’ elderly patients, not hinder them. My Health Record is another classic case study in what happens to government big bang projects which use a top-down approach. When the project appears to be stalling, hold an inquiry make some recommendations and either shut the project down or put someone else in charge and spend millions more on trying to make a dead cat bounce. This is precisely what the government has done. Both state and federal governments are guilty of the same offence. General Practice and the wider profession want 21 st century healthcare solutions for their patients. Continued on page 41

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