GP at the heart of Medical Home model

GP at the heart of Medical Home model

Dr Simon Torvaldsen
AMA (WA) Council of General Practice

Thursday 29 August 2019


Behind the debacle that was the Health Care Homes program, there was a grain of truth. The concept of the patient-centred medical home was initially developed and promoted in the US, as an attempt to reform its fragmented and hugely expensive healthcare system. It is now recognised worldwide as the best model for delivering comprehensive, cost-effective patient-centred healthcare.


In Australia, our GPs are the centre of the healthcare system and we have elements of the ideal medical home model already in place. It is no accident that the Australian health system was recently found to have the world’s best outcomes and cost-effectiveness.


It is important not to confuse this with the unloved Health Care Homes program, which borrowed the terminology but was really just a poorly remunerated, poorly thought-out funding model.


Prior to its launch, I met with then Federal Health Minister Sussan Ley and told her in no uncertain terms that the model was poorly designed, underfunded and risked failure, but she thought otherwise and went ahead anyway. The program was a dismal failure and she is no longer Health Minister.


The medical home model emphasises a patient having an ongoing relationship with a particular doctor (who leads a multidisciplinary practice team) and primary care that is comprehensive, coordinated and accessible, with a focus on safety and quality. The definition is explicitly doctor-centric in that it nominates the physician as team leader and as the main focus of relationship-based continuity of care.


There is now a large body of evidence to prove that providing more healthcare in a primary care setting results in better outcomes and lower costs, and that the medical home model is the ideal way to do this. This concept is strongly supported by both the AMA and the RACGP, and both organisations have policies advocating it.


Why is all this important to us as GPs? It emphasises our value and the central role we play in providing the best health outcomes for the lowest cost. It also provides a very good evidence-based argument for further investment in General Practice. 


At the last AMA National Conference, I successfully sponsored a motion that 16 per cent of the Federal Health Budget be allocated to General Practice. This would not only provide a funding boost, but would allow for long-term health planning.


Federal Health Minister Greg Hunt says he wants a 10-year plan for General Practice. The AMA has the answer for him with both a detailed model and a funding plan. His challenge now is following through on this. There has been some commitment already, to the tune of about $500 million, but a much more comprehensive response is required.


So, it is not all doom and gloom for us as GPs. The Medicare freeze has been lifted. AMA action has prevented the proposed cuts to the PIP and indeed, secured some increase. There is increasing recognition of the central role of General Practice and the importance of holistic, continuing care.


I have also been working very hard with WA Health Minister Roger Cook on these issues, and he does understand and support our view. I have also been working directly with the WA Department of Health and am gradually making progress.


The MBS Review may have some faults, but there is strong recognition from the Taskforce about the importance of promoting General Practice and increasing our funding. I have had ongoing dialogue with Chair, Prof Bruce Robinson and other key Taskforce members regarding this.


Challenges remain. Talk is cheap, getting the funding necessary to make it work properly won’t be easy, and implementation will be incremental. There are numerous other groups such as pharmacists and nurse practitioners who see business models for themselves and have little interest in the bigger picture such as continuity of care or optimal outcomes. Your AMA is aware of this and is standing up on behalf of you and your patients.


It may not feel like it right now but with some hard work, we can make this an exciting and rewarding time to be a GP. I along with the rest of the AMA are working hard to make it happen for you.

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