Fragmentation of care will cost every Australian dearly

Fragmentation of care will cost every Australian dearly

Dr Sean Stevens

Friday 30 August 2019


The Australian healthcare system consistently rates in the world’s top 10 in Organisation for Economic Co-operation and Development (OECD) health outcomes. A major reason for this is the strong, high quality, primary healthcare system lead by General Practice. Ninety per cent of Australians see their GP every year, and GPs are the experts in holistic, undifferentiated care and preventative health.


It is disappointing then to see multiple organisations and levels of government seek to dismantle this holistic care in favour of profits, short-term political gain and ‘patient convenience’.


The existing siloed primary care includes pharmacy vaccinations, ambulance organisations running urgent care clinics, nurse practitioners in pharmacies and palliative care organisations running chronic disease clinics. All of these services can and should be provided within General Practice.


Unfortunately, this trend shows no sign of abating with pharmacists now pushing to prescribe, manage mental health and manage chronic disease. There is a tsunami of multiple morbidity coming our way that can only be addressed with a coordinated, holistic program of prevention and management of multiple conditions.


One in every three Australians has a chronic disease – 83 per cent of Australians over 75 years of age with two or more chronic diseases; and two in three Australians have three or more risk factors for chronic disease.


As an example, my patient Jim came in the other day “for a repeat on my blood pressure tablets”.


I knew Jim’s wife had been admitted to a nursing home recently, so I asked how she was.


Jim, a normally stoic bloke, burst in tears, saying, “Doc it’s so hard”.


After a long chat, it was clear he needed to start antidepressants. He also hadn’t had his shingles or flu vaccination, hadn’t done his faecal occult blood test and was due for a urine ACR and spirometry for COPD screening.


Now a pharmacist may have been able to manage the “repeat on my blood pressure tablets” in a hypertension clinic. But Jim is a person not a systolic blood pressure to be managed. This fragmentation of care does not serve Jim, or the millions of Australians like him, at all well and it needs to be fought.


I hope that all levels of Australian Government realise the benefits of our excellent health system before it is too late. The benefits of General Practice lie in its diversity, its ability to manage multiple issues under one roof and the more conditions that are hived off to other silos, the weaker the benefits become.


The sum of the whole is indeed greater than the sum of its parts. We are and remain the experts in holistic, undifferentiated care and preventative health and we need to ensure that our politicians know that.

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