Integrated care: The GP is central

Australian Medicine August 17 2009

A question increasingly being asked is: in an integrated model of care, where do GPs fit and what is their role? It is a mystery to me why this question even arises. After all, the GP already plays the central role in patient care.

We deal with 90% of problems that we see and then refer patients when more specialised care is required. We provide ongoing care after an acute care episode and we are the bridge that helps patients move safely between one sector of care and another.

Integrated care is fundamental to whole patient care. One of the AMA’s greatest concerns regarding health care in recent times has been the fragmentation of care within the system, mostly in the pursuit of trying to save or make a dollar We help our patients on a daily basis to navigate their way through a complex health system and to ensure that care does not become fragmented.

The potential for patients to fall through the gaps is immense and we are there to make sure that this does not eventuate. We know that the fragmentation of care diminishes cost effectiveness and endangers patients, more tests are ordered and repeated and multi-morbidity diagnosis is lost causing delays in treatment and disease management.The consequences of fragmentation and the outcomes of much research in this area across the globe have perhaps brought the focus so intently back to the concept of integrated care where care is patient-centred, comprehensive and coordinated.

One of the core recommendations of the National Health and Hospitals Reform Commission is for the strengthening and multidisciplinary integration of primary health care services, building on the vital role of general practice.It recognises and restates the important role of general practice in the delivery and coordination of comprehensive care. The next six months will see the Government consulting directly with the health professions and other stakeholders about the recommendations of the NHHRC on enhancing primary care. In addition, the Government has committed to engaging with the AMA for advice on how to deliver the best outcomes for patients.

This also is a recognition that general practice has been responding to the changing health care needs of the community by embracing team-based care. More than 60% of general practices have a practice nurse and GPs regularly refer patients to other primary health care providers such as psychologists, physiotherapists, podiatrists, dietitians, etc. Increasingly, practices employ or co-locate with these and other health care providers to improve patient access to care.

GPs consider the needs of the whole patient and through the GP-led team give patients better access to other primary health care services within a framework that enshrines medical diagnosis, assessment and the consideration of an appropriate management plan. Integrated care involves cooperation and collaboration within the system.

The modern GP facilitates integrated care by acting as the patient’s guide through the health system, ensuring that the right doors are opened at the right time. This movement back to best-practice GP-led teams is also recognition of the best way to provide health care for the increasing number of patients with multiple morbidities.

To answer the question about where the GP fits in an integrated model of care, I can only say where we have always been – front and centre.

Dr Rod Pearce is Chair of the AMA Council of General Practice