Dr Stephen Duckett( PhD)

But it will be a wasted opportunity if the extra money going to GP clinics as a result of the thaw is not used to buy better general practice.

The main primary care reform on the table now is the Health Care Homes scheme, designed to improve the way GPs manage chronic disease patients. It’ s a valuable government initiative, but more needs to be done.

A Grattan Institute report, released last week, describes primary care as a renovator’ s opportunity.

It says the funding GPs will receive as a result of the lifting of the freeze should be used to buy better data so future reform can be based on sound evidence about what works— and what doesn’ t. 1

The eminent physicist Lord Kelvin once said:“ When you can measure what you are speaking about and express it in numbers, you know something about it; but when you cannot measure it, when you cannot express it in numbers, your knowledge is of a meagre and unsatisfactory kind.”

And so it is with general practice policy in Australia today.

Unfortunately, government and taxpayers know little of what goes

on in general practice. We know what was billed for— essentially how long the consultation was.

But there is no knowledge outside the practice about why the patient presented, what the GP did or whether best-practice guidelines were followed.

By contrast, much more detailed information is available— in a way that protects the privacy of patients— about hospital care, both public and private.

The absence of data about general practice has real consequences for patients. Without practice information about the complexity of

patients’ problems, the government cannot make appropriate payments via Health Care Homes.

And without better data on whether practices are properly monitoring patients who have chronic conditions, the government cannot properly reward practices that get the best results for their patients.

The time is ripe for change on this.

Our report argues an additional payment should be made to practices that provide extra data and that automated extraction from practice

computer systems can provide that data. So it would mean no more work for GPs but more money.

The government can provide payment for this data based on the number of patients being looked after, rather than adding yet more clutter to Medicare’ s list of fees for individual services.

At present, the primary care system is not so much a system as an uncoordinated rabble.

Just as the government is flying in the dark about how it manages primary care, GPs are, to some extent, flying in the dark about managing their patients.

THE PRIMARY CARE SYSTEM IS NOT SO MUCH A SYSTEM AS AN UNCOORDINATED RABBLE.

Each individual practice works in its own way, with hit-and-miss referral arrangements and no guarantee of good feedback about what happened to patients admitted to hospital.

This lack of insight means that money is being wasted because people are being admitted to hospital for conditions that good primary care could have prevented.

Both the patient and taxpayers are losers here.

However, current attempts to overcome the problem are bedevilled

by petty bureaucratic jealousies and bickering between the Commonwealth and the states.

Primary health networks are micromanaged by the Commonwealth, and the states regard them as creatures of the Commonwealth and view them with suspicion. Victoria refuses to embrace them and maintains its own local primary care co-ordinating bodies.

The Commonwealth, states and primary health networks need to work together to build referral paths, close gaps in services and reduce the number of unnecessary hospital admissions.

This would best be achieved by a formal agreement between all three— setting priorities for what the networks will do in their regions and committing both the Commonwealth and the states to invest in them.

Data, bought with funds released by lifting the Medicare rebate freeze, provides the opportunity to establish these priorities.

Better GP data will provide the solid foundation necessary for more effective local systems and so allow for a more effective primary care system.

Practitioners, patients and taxpayers will be the winners.

Dr Duckett( PhD) is director of the health program at the Grattan Institute. 1. Duckett S, Swerissen H. Building better foundations for primary care. Grattan Institute, April 2017: bit. ly / 2pvUGqH