All the signs suggest that general practice in Australia is about to undergo a major upheaval.
And it’s no great surprise. It’s a worldwide trend in response to the rise of chronic disease and the cost blowouts that inevitably follow. Health funders everywhere are taking note and demanding efficiency and better health outcomes.
I’ve been speaking to Dr Chris Bollen, an Adelaide general practitioner who also has a foot firmly planted in the world of modern business. With extensive experience consulting on health practice improvement and an MBA under his belt, he’s a great person to talk to about the future of general practice.
In his view, the current rebate system is broken. “It rewards traditional behaviours,” he tells me. “We typically treat self-presenting patients who turn up with single, acute problems. Therefore, there’s currently no great incentive in Medicare to manage chronic complex conditions.
Yet a 2016 Australian government commissioned report shows that care and money are not distributed appropriately. 25% of GP patients won’t get the care they require because they simply don’t present. The other 75% are often over-treated. And yet we know that 5% of the population accounts for 50% of health costs, and most of those are precisely in this chronic complex condition cohort.
“Chronic care requires higher thinking - a new way of practice. And more than that, it needs a whole new healthcare delivery model supported by highly skilled, multidisciplinary teams using modern technology,” Chris says
“Patients need health and wellness education and encouragement to change their behaviour too - to take ownership of their care plan, and doctors may not be the most appropriate team members to deliver that.”
In other words, a complete shakeup in the way community medicine is practiced, funded, structured, run and delivered is required. “These changes may threaten some doctors who see their power base eroded”, Chris warns. “And others may struggle to change the way they practice.”
“Chronic care requires higher thinking - a new way of practice. And more than that, it needs a whole new healthcare delivery model supported by highly skilled, multidisciplinary teams using modern technology” - Dr Chris Bollen.
What’s being done?
Fortunately, there’s political support at the federal level. The health minister recently announced the launch of Healthcare Homes, a two-year trial focusing on patients with chronic care issues.
A step in the right direction, Chris calls it, but he knows it will be at the practice level where the real challenge lies. “Chronic care requires teams made up of members that coordinate and communicate effectively, and that is going to require significant leadership from owners and managers.”
Doctors rarely receive formal training in leadership but Chris predicts that they will have to upskill quickly to meet the challenge. They will have to learn to delegate, and cede some traditional territory to other team members who can better manage complex care plans.
And when will all this change take place?
If the government trial is a success, then there will likely be a major shake-up in Medicare to ensure that money goes where it is needed. That may be just two years away. Not much time for a revolution.
It will be a busy time for Chris, I suspect. His change management skills and his subject matter expertise are likely to be in high demand. He’s already working with many practices across Australia as well as benchmarking successful models around the world.
What he knows so far gives him cause to be cautiously optimistic. He tells me that there are good reasons for doctors to embrace the future. In overseas case studies, doctors have seen increased financial reward, greater job satisfaction and recognition, both from within the medical profession and from the community.
Adapt or risk failure
He does warn that doctors and practices that cannot adapt will likely fail. Change will come.
“The evidence is growing for the need to measure outcomes, involve patients in the design of healthcare delivery and focus on improvement. All this has been shown to save money and improve patient and doctor satisfaction. Health funders are very interested in these issues.”
And despite some resistance to change he notes that there is a generational shift taking place. “Younger doctors crave more multi-faceted and rewarding careers that also allow for a better lifestyle,” he notes. “With up to 50% of doctors considering a career outside of medicine due to work-related stress, it’s clear that job satisfaction is a key driver for employment.”
I ask Chris which practices will have a competitive advantage when it comes to hiring doctors. He offers his own recent career move as an example. “I drew up a list of 20 requirements that I needed to be fulfilled in order to be effective as a clinician. I then approached 10 practices and chose the one that best fit my criteria.”
This turns the traditional recruitment model of practice chooses doctor on its head.
“Practices must adopt people-centric strategies if they wish to attract the best staff,” he suggests. “Increasingly good doctors will vote with their feet when it comes to choosing where they want to work and under what conditions.”
Whilst leadership and communication skills will be essential he finally stresses the important role technology will play in the future.
“The technology tools currently available allow much greater access to accurate real-time patient data,’ he says. “And teams will, more than ever, be able to manage care plans based on evidence.”
So plenty to think about for the Australian general practice community, it seems. And probably not too much time to think about it. Exciting times ahead for the well prepared - but scary for those that can’t adapt.
“The evidence is growing for the need to measure outcomes, involve patients in the design of healthcare delivery and focus on improvement. All this has been shown to save money and improve patient and doctor satisfaction.” Dr Chris Bollen