AGED CARE – a vital service needing vital improvements

Managing older patients is something all doctors have to do, but aged care is a specialty where general practice is heavily involved – in our practices, and particularly for patients in residential aged-care facilities (RACFs). These are some of the most frail, complex and vulnerable patients we care for.

However, despite a Royal Commission, many recommendations and a few improvements, much remains to be done in this area; and GPs attending RACFs are not valued by our healthcare system or our government. I find this astounding, given the complexity of care required and the high load these patients can impose upon our hospital system.

As most GPs attending RACFs are aware, the fundamental problem is a lack of adequate remuneration, combined with poor integration of medical care into the RACF model. Increasing red tape and poor IT systems in RACFs exacerbate the situation.

Unfortunately, the new aged-care incentive payments (ACIP) system has been a debacle and made things worse rather than better. About three years ago when ACIP was being planned, I met with the then Commonwealth head of Primary Care. During what was quite a long and somewhat tense meeting, I told him that his proposed new system would not work. Some changes were made (it could have been even worse!) but he was determined to push ahead regardless, and then “re-evaluate”. That time has certainly now come.

What can be done to improve aged care and encourage GPs to continue providing care?

Fortunately, this is fixable, and there are solutions if government chooses to implement them. Some effort has been made on improving nursing, allied healthcare, and even RACF food; and now we need improvements to the medical care that is so essential.

The most obvious change would be to improve the MBS rebates for RACF visits. They are unique RACF items, and it would be very easy to raise them to reflect the complex care required. And a simple budgeting model. It should also be possible to arrange the 12.5% bulk-billing incentive so that it can be applied to RACF visits as a separate practice.

The second thing would be to reformulate the ACIP to actually provide an incentive. This would mean making MyMedicare enrolment simpler for RACF residents and reducing the care-planning requirements, which are hard to achieve in the current system and also not of benefit to every patient. It would also involve a stepped payment structure so that GPs with fewer patients are not disadvantaged, as is the case currently. As the budget for ACIP was increased, this should be entirely possible within the current budget.

Thirdly, we need integration of GP medical care with the rest of the RACF care, which involves a change of mindset from many RACF providers. It also requires a lot of work on the RACF IT systems – these are not only poorly designed, but do not incorporate the requirements for proper medical record-keeping and do not integrate with any of our medical software. And don’t even get me started on electronic medication charts! I am sticking with the paper ones until the electronic version is usable.

There are plenty of other issues – such as needing dedicated phone consult items both within and after hours; utilisation of in-house pharmacists; family conferencing MBS items; GPs paid to sit on clinical governance committees; good State Health support for both physical and mental health; and more.

This is all actually doable and affordable. Imagine working in an aged-care system where you are well paid, well supported, a valued and integral part of the team, where the IT systems make good care easy. This is my vision. And our elderly frail patients and those dedicated to caring for them deserve no less. The patients, the RACF providers and our health system will all be winners. I will continue to advocate for aged care, and your input is welcome.