Supporting Tasmanian GPs to keep all Tasmanians healthy (and out of hospitals)

Transcription

1 Supporting Tasmanian GPs to keep all Tasmanians healthy (and out of hospitals) Introduction General practice is the foundation of Australia s healthcare system. General practitioners (GPs) and their teams are the most accessed part of the Australian healthcare service, providing more than 2.8 million Medicare Benefits Schedule (MBS) subsidised services to just over half a million patients each year in Tasmania. 1 Given the clear impact general practice has on health and with Tasmania having some of the worst indices for chronic disease and aging population in the country 2, the support of general practice and primary care in delivering care and moderating the workload in the acute care sector is vital. The failure of successive state and federal governments to invest adequately in general practice has resulted in continued increases to the overall cost of healthcare delivery. GP led community care offers the Tasmania health sector the best option for easing the weight on our public hospitals, and anything that supports our ailing hospital system offers support to our patients in general practice. This submission This pre-election proposal has been developed based on the principle that supporting the identified aspects of general practice will bring benefits to patients, the Tasmanian government, the profession and the wider community. The following four strategies are presented for investing in the health of Tasmanians: 1. Increasing funding to smoking and gambling cessation programs including free nicotine replacement to disadvantaged areas and a transparent commitment to cease acceptance political donations from the tobacco or gambling industry. 2. Setting a 72 hour target for all THS hospitals for the delivery or provision of Discharge Summaries to general practice, with a firm commitment to full interoperability with general practice systems by Supporting healthy communities by providing free influenza vaccinations to those visiting their GP to be vaccinated and free fruit to public schools. 4. Implementing general practice internships for postgraduate year 1 and 2 medical practitioners as a state sponsored program to keep our best graduates in Tasmania. The RACGP is committed to working with the Tasmanian government to ensure the proposals within this submission are achieved.

2 1. Increasing funding to smoking and gambling cessation programs Smoking kills an estimated 19,000 Australians every year and is the risk factor responsible for the greatest burden of disease in the country (9.7%). 3 Smoking is estimated to kill approximately half of all long-term users 4, causing 40% of deaths in men and 20% of deaths in women before the age of 65 years. In 2015, the RACGP, along with other specialist medical colleges and stakeholders, strongly encouraged the Tasmanian government to adopt the proposed Tobacco Free Generation legislation,. Australian studies suggest a link between gambling and domestic violence with over half the people presenting at gambling counselling services in Victoria, South Australia and Tasmania reporting family violence in the previous 12 months. 5 The majority of patients treated for the effects of smoking or the flow on effects of problem gambling are treated first in general practice. System wide resourcing for cessation activities, coupled with divestment of political support for industries that contribute to these health issues, is a vital part of any evidence-based approach to their management. The Tasmanian Government cannot continue to support the tobacco and gambling industries while funding public awareness programs that do not meet our patient s needs. That the Tasmanian Government removes these evidenced causes of morbidity and mortality in Tasmania people by a 3-step approach: Step 1- Government subsidised free smoking cessation support for all Tasmanians, facilitated through Tasmanian general practices Step 2- Reopen discussions with GPs and other stakeholders to explore changes to tobacco and gambling legislation to protect Tasmanians from the demonstrated harms associated with these activities Step 3- A commitment to cease acceptance of political donations from the tobacco and gambling industries in the first year of the parliamentary term 2. Setting a 72-hour target in all THS hospitals for the delivery or provision of Discharge Summaries to general practice, with a firm commitment to full interoperability with general practice systems by RACGP Tasmania estimates that unexpected or unnecessary re-admission to hospital of patients following discharge costs the Tasmanian health system up to $1.5 million per year. The minimum cost to the public purse for a hospital outpatient consultation is around $150, compared to $37 for a general practice consultation. Keeping patients in general practice, and out of hospital, postdischarge represents a clear saving to the health system..

3 The costs incurred in unnecessary readmission are the result of: poor hospital discharge processes internal systems that conspire against timely provision of discharge information a lack of commitment from the THS in remediating the problem and proactively moving toward IT systems that are more interoperable with general practices. The RACGP has been highlighting these issues in meetings with the THS and the Minister for Health since While there has been some minor improvement in the time taken to provide discharge information to the patient s GP, not enough has been done and the problem still affects the health budget. Additionally there is compelling evidence that a follow up consultation to the patient s GP within seven days of discharge is associated with a much lower risk of readmission 6,7, but this must be supported by timely provision of discharge information. RACGP Tasmania calls for an immediate commitment by the Tasmanian government that all THS sites will be fully interoperable with the most common general practice software packages by RACGP Tasmania also calls for the addition of a 72-hour provision of discharge summary to a patient s usual general practice or GP target for all THS sites from the start of the financial year. We propose that General Practice Liaison Officers in each region generate a report annually report outlining successful adherence levels to this target and that that report be provided to the RACGP for communication to its members. 3. Supporting healthy communities by providing free influenza vaccinations to those visiting their GP for the vaccine and free fruit to public schools while stopping funding of ineffective health promotion materials The annual influenza season places the already stressed THS under significant additional strain. RACGP Tasmania members report communication from the Royal Hobart Hospital effectively putting its services on bypass during peak flu season. The most recent influenza season saw approximately 3000 deaths, almost 18,000 hospitalisations and over 350,000 individual cases across Australia. This was consistent with influenza-related mortality and morbidity over the previous five years 8. A government-subsidised influenza vaccination program would cost far less than the economic losses from the 3000 deaths a year, mounting hospital and health bills, and productivity.

4 The RACGP SNAP (Smoking, Nutrition, Alcohol and Physical Activity) Guide notes that: Diet is a key contributor to optimum health throughout every stage of the lifespan. Exclusive breastfeeding for at least the first six months of life offers considerable health benefits to infants and, in the long term, to children and adults. Diets low in fruit and vegetables have been causally linked to cancer and CVD, accounting for 2.1% of the total burden of disease and injury in Australia in Most Australians (91%) do not eat enough vegetables and only half eat enough fruit. Tasmanian governments have tended to focus on supporting Tasmanian communities to be healthy by providing written materials (ie pamphlets). RACGP Tasmania considers this to be a less effective approach to health promotion than investing in programs which have been shown to be effective at reducing risk of developing acute or chronic health issues. RACGP Tasmania calls on the Tasmanian government to fund a free influenza vaccination to all Tasmanians where the service is delivered by the patient s GP. This will protect those who are vulnerable to influenza, like children and the elderly, increase herd immunity and allow for a check-up consultation to alert the GP and their patient to other potentially preventable health issues. This is a value added, preventive activity. The RACGP also calls on the Tasmanian government to provide access to fresh fruit in or through all public schools to combat the rising incidence of obesity and other growing chronic disease risk factors. Such a commitment would show the Tasmanian government supporting local growers and leading by example in seeking to change the dietary habits of young Tasmanians. Prevention through evidence based activities rather than funding more pamphlets. 4. GP internships as a state sponsored program- keep our best in Tasmania, for Tasmanians General practice is a major medical specialty; GPs make up over 30% of the medical workforce across Australia, and an even higher proportion of the medical workforce in rural and remote areas. 10 It is therefore essential that all medical practitioners have experience in, and understanding of, general practice. While some medical students gain general practice exposure in medical school, this is both minimal and rare. Increasing junior doctor exposure to general practice will align medical training to real-world care. It is well recognised that patients receive most of their healthcare in general practice as opposed to the hospital system. Yet, the medical intern program in Australia is almost exclusively hospitalbased. Exposure to, and experience in, general practice early in medical training is key to a better performing health system and efficient use of health resources. General practice is the most

5 accessed health service in Australia and therefore all medical professionals should have an understanding of the specialty. RACGP Tasmania calls on the Tasmanian Government to resource a program of state-funded internships in general practice, allowing those who wish to specialise in general practice the option to start their vocational training in postgraduate year 1 or 2 in a funded position. This will add to the allure of practicing in Tasmania, keeping our best and brightest medical graduates in the state, to the benefit of all Tasmanians. Exposure to general practice in early years of training for Tasmanian medical graduates who proceed to specialise in another speciality will also benefit Tasmanians as their clinicians will have a greater understanding of the setting where patients most often access care. References 1. Department of Health. Annual Medicare Statistics [ to ]. Canberra: DoH, Available at [Accessed 16 October 2017] ey_ Peto R, Lopez PR, Boreham J, Thun M, Heath C. Morbidity from smoking in developed countries Oxford: Oxford University Press; Search PubMed 4. English DR, Holman CD, Milne E, et al. The quantification of drug caused morbidity and mortality in Australia. Canberra: Commonwealth Department of Health and Human Services; Search PubMed 5. Problem gambling and family violence: family member reports of prevalence, family impacts and family coping. Suomi, A., Jackson, A., Lavis, T., Patford, J., Thomas, S., Harvey, P., Abbott, M., Bellringer, M.E., Koziol- McLain, J. and Cockman, S. in Asian Journal of Gambling Issues and Public Health 6. Dusheiko M, Gravelle H, Martin S, Rice N, Smith PC. Does better disease management in primary care reduce hospital costs? Evidence from English primary care. Journal of Health Economics,. 2011;30(5): Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. Journal of hospital medicine. 2010;5(7): Australian Influenza Surveillance Report No October to 27 October [accessed online, 11 December 2017]

6 9. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD. The burden of disease and injury in Australia 2003, PHE 82. Canberra: AIHW; Search PubMed 10. Australian Institute of Health and Welfare. Medical practitioners workforce Canberra: AIHW, Available at [Accessed 21 August 2017].