The sustainability of general practice must be reframed in a more ‘positive’ light to bolster the workforce, the parliamentary inquiry into diabetes has heard.
According to the RACGP’s diabetes special interest group chair, funding needs a rejig to facilitate team-based care, prevention-based consults and general practice research to tackle the growing health burden of diabetes.
“As a highly trained specialist, generalist GPs play a fundamental role in the prevention, diagnosis and management of diabetes across the lifespan of this disease, working with patients at every stage of their health care,” the RACGP’s specific interest diabetes network chair Dr Gary Deed told the standing committee at today’s public hearing into diabetes.
According to Dr Deed, the importance of a sustainable workforce has not been “adequately addressed” in previous national strategies.
While the current strategy – published in November 2021 – does make moves to right this wrong, he stressed the need for “whole of health systems changes” that include primary care, to encourage positive patient outcomes.
Australia must reframe the dialogue around the sustainability of general practice, added Dr Deed, to avoid scaring off GPs in training.
“We need the talk to become a little bit more positive,” he noted, “through enhancing the experience for younger doctors coming through the training system.”
Dr Deed added that while he didn’t want to encourage a “conscription-like” program, he mentioned that a method of encouraging all GP trainees to spend time working in rural and remote areas may enhance cultural understanding and renew appreciation for the “wonderful craft” of general practice.
According to the RACGP’s recent Health of the Nation report, “doctors working in [rural and remote] areas actually had an enhanced concept and enjoyment of being a GP, versus their metropolitan colleagues,” noted Dr Deed.
However, it’s not just the primary care workforce that’s central to diabetes care.
Diabetes prevention needed the support of allied health professionals, added Dr Deed, noting that the currently subsidised five allied health referrals allowed as part of a chronic disease management plan is inadequate both for people with diabetes and for those at risk looking to prevent onset.
“It’s the sustainability of interventions”, which may take many years to achieve, that delivers “true health outcomes” said Dr Deed, adding that while five allied health sessions may “lay the foundations”, there is a need for longer-term funded programs.
“With diabetes being this fast-growing chronic disease, it’s critical that general practice is sustained with appropriate investment to allow us to facilitate care for people with living with diabetes, let alone any chronic disease,” added Dr Deed.
According to Dr Deed, this includes expanding the capacity for prevention-focused GP consultations and better funded long consults to deal with complex patients.
Currently, the health care system focuses on “opportunistic care”, responding to immediate health needs, with little space for prevention, added Dr Deed.
While chronic disease management plans are available for patients with diabetes, Medicare does little to cater for those at risk of development, like those with gestational diabetes, prediabetes or intermittent hyperglycemia.
“We need to be a little bit more lateral thinking about how we facilitate access for people who are at grave risk of developing the disease by statistical chance.
“There’s evidence that lifestyle prevention does work, but it’s not easily available under the current funding models in general practice.”
According to Dr Deed, a focus on early detection and prevention is paramount to successful care.
But while there was plenty of evidence and tools to support prevention and early intervention, “we lack the implementation science and research to embed them in clinical workflows such as general practice, and also incentives to encourage the uptake”, Dr Deed told the committee.
Dr Deed called for investment into the RACGP’s guidelines on management of type 2 diabetes in general practices, one of the few “harmonised” practical guidelines across all specialities.
“Other colleges get funding to produce guidelines, we get nothing,” added Dr Deed.
Dr Deed added that a “wonderful outcome” from the inquiry would be to reinstate the BEACH study – a “granular analysis of diabetes in general practice” that facilitated “quality assurance”.