Building a 21st Century Primary Health Care System: A Draft of Australia's First National Primary Health Care Strategy
Key Priority Areas
Key Priority Area 1: Improving access and reducing inequity
Key Directions for change
Primary health care is delivered through an integrated service system which provides more uniform quality care across the country, actively addressing service gaps and the needs of specific population subgroups.
For patients this means: Australians will have access to well integrated primary health care services that are more available, matched to meet peoples’ needs, and provide continuity of care including safe handovers between care providers. For those Australians who have specific needs or difficulties in accessing care, service delivery will be responsive to their individual needs and circumstances.
What the Future Looks Like
- Access to core services supported by universal access to a Medicare rebate will be retained but will be supplemented by targeted local programs and collaborations across the service system.
- Through this combination of core services and targeted programs, accompanied by new funding and governance structures, primary health care services will be better integrated, will take responsibility for individual and population needs, and will address current variability in access and outcomes, including for after-hours access, traditionally under-serviced groups, and for patients in transition across the service system.
- Service delivery will proactively respond to the needs of those Australians who find it difficult to access mainstream services, or who have specific health care needs whether because of their location or demographic characteristics or health status or because of the circumstances under which they need to access care. At the same time, mainstream services will be more responsive to the needs of different groups.
- Service delivery and funding arrangements will support flexible service delivery models, promote effective and cost-effective use of technology and drive innovation by supporting information flows and workforce education and training.
What Changes are Needed to Get There?
- Primary health care services/organisations actively monitor and implement programs to address service gaps and inequities in local communities.
- Funding arrangements support programs designed in local communities to address areas of market failure and promote connections across sectors. While design features will fit local needs, examples could include:
- Outreach programs to under-serviced populations such as people living in aged care facilities, people with physical and intellectual disabilities, and people in under-serviced regions;
- Transition services that support patients on discharge from hospital or who need to navigate across the system;
- Building team-based interventions focussed on providing joined-up and flexible services to the homeless or those with mental health needs;
- Arrangements to provide better access to primary health care after hours; and
- Building on ‘Closing The Gap’ initiatives, improve health outcomes for Aboriginal and Torres Strait Islander peoples.
- New infrastructure supports patient access, team work and integrated care solutions, and better uses technology and outreach services.
- Support for primary health care workforce in under-supplied areas.
- Regional organisations and service providers have the information and tools to monitor access gaps in their areas of responsibility and to respond where improvements are needed.
- Professional organisations actively encourage improved cultural awareness in service delivery.
Measurable Change would be: closing the gap in health outcomes across the population with special attention to vulnerable communities.
Key Priority Area 2: Better management of chronic conditions
Key Directions for Change
A new approach to improve continuity and coordination of care particularly for those with chronic disease, including through a comprehensive national approach to chronic disease management, tailored and delivered locally.
For patients this means: Wherever they live, eligible individuals with chronic conditions can enrol with a practice or provider who becomes responsible for managing their care, monitoring progress and supporting self-management. While tailored to local service systems and needs, services could include comprehensive multi-disciplinary team care, ‘as needed’ care coordination, sharing of information within and across providers, and self-management support including through diagnostic support tools.
What the Future Looks Like
- A new comprehensive approach to chronic disease management which recognises that individual consultations with a GP or specialist cannot alone provide the range of integrated services needed to achieve long term management of an individual patient.
- The new approach will provide improved health care for patients with chronic disease through flexible, tailored management of an individual’s health care needs with clear responsibility by their practice or provider for their management and follow-up. Arrangements would include:
- voluntary enrolment with a health provider based on clinical need;
- evidence-based and standardised assessment processes that identify eligible patients at various points in the service system (hospital, specialist, community health);
- access to chronic disease management interventions, based on assessed clinical need, and delivered in line with best practice;
- flexible service responses tailored to the mix and level of services an individual needs;
- supported self-management using available electronic and communication tools; and
- where appropriate, a personalised shared care plan linked to an individual’s electronic health record.
What Changes are Needed to Get There?
- Over time, realign chronic disease funding with individual and community need.
- New chronic disease management approach is collaborative and patient-focussed with consistent identification and assessment of patients and delivery of joined-up interventions.
- In consultation with professional groups improve assessment tools and protocols and incorporate available evidence to ensure effective targeting of services and cost-effective use of system resources to achieve long term health gains.
- Supported self-management, using modern tools for patients with chronic conditions that enable monitoring of health status and alerts where appropriate.
- Effective multi-disciplinary teams including appropriate use of the specialist workforce, supported by training, funding, infrastructure and technology.
Measurable Change would be: for patients with chronic disease, reduction in avoidable hospital admissions and other key evidence-based clinical indicators of quality chronic disease management.
Key Priority Area 3: Increasing the focus on prevention
Key Directions for Change
Strengthen the existing framework for promotion, prevention and early intervention in primary health care, to encourage more systematic approaches, with regular recall and follow-up, coordinated and integrated with other preventive activities, including a focus on improving health literacy, within local communities.
For patients this means: Individuals receive regular risk assessments appropriate for their age and conditions available at multiple points of the service system (not just GPs), and are actively linked with other community-based supports and activities.
Higher levels of health literacy, starting at schools and building across the community to ensure individuals have the skills and knowledge to manage their own health and are supported in doing so. Individuals are supported to more clearly recognise their responsibilities and take positive actions to maintain their own health and well-being.
What the Future Looks Like
- Primary health care services provide a range of preventive services to their local communities. All health providers, where they can, use evidence to promote healthy behaviours. Service delivery is supported by data and information systems, including recall and reminders, and risk assessment tools. These services are coordinated across providers in a local community to eliminate duplication and overlap, and make best use of available workforce and provider networks, including nurses, allied health and pharmacists.
- Targeted prevention activity focuses on hard to reach populations, who may not otherwise access services, and for whom investment in prevention will mean much improved downstream outcomes.
- Primary health care services are well integrated with broader prevention activities at the local level, to actively link patients with community-based supports and activities, and receive feedback on patient progress from other services as appropriate.
What Changes are Needed to Get there?
- Health care professional organisations focus on education and training on effective preventive activities, communication of broader preventive health initiatives, uptake of tools and information systems to support preventive care.
- Changed service delivery and funding arrangements support best use of the available workforce, including for nurses, allied health, and pharmacists and responding to local needs.
- New arrangements support supplementary prevention services for individuals and practitioners, focussed on high-risk populations and those conditions and behaviours where prevention and early intervention can result in significantly improved outcomes and system wide effectiveness and cost-effectiveness.
- A focus on improving community and individual health knowledge and providing education and support to individuals to manage and improve their own health.
Measurable change would be: further reduction in lifestyle risk factors for chronic disease such as smoking and obesity, especially for vulnerable populations.
Key Priority Area 4: Improving quality, safety, performance and accountability
Key Directions for Change
Establish a strong framework for quality and safety in primary health care based on improved information and quality assurance systems to support measurement, feedback and quality improvement for providers and greater transparency for consumers and funders.
For patients this means: Individuals will have enough information about health providers, facilities and services to enable them to make informed choices about their care. Patient care is based on the best available evidence. Safety and quality is not compromised through poor information at patient handover, or a lack of information on performance and quality of services across different parts of the system.
What the Future Looks Like
- Access to information on safety, quality and performance will drive continuous improvements in primary health care services and improved health outcomes for patients.
- Service providers and regional primary health care organisations have the tools to reflect on the effectiveness and cost-effectiveness of their services and to adapt to emerging challenges and population needs.
- Primary health care professionals will work within a performance framework that meets their needs, supports peer feedback and comparison as part of continuous quality improvement, and recognises the challenges of measuring performance across all aspects of primary health care.
- The providers of publicly subsidised primary health care services across the workforce will be accredited against comprehensive standards for primary health care services.
- Primary health care will be supported by research that is timely, accessible and readily applicable to policy and service delivery.
What Changes are Needed to Get There
- An engagement with the community and with health providers about how the effectiveness of the primary health care service system should be measured and monitored over time.
- eHealth records are able to track care and treatment of individual patients.
- Knowledge support systems and information are developed to provide practitioners with information about their own performance and the capacity to compare themselves with their peers or against best practice.
- Care delivery ensures appropriate use of the workforce – matching roles and responsibilities with ‘scope of practice’.
- Agreed performance indicators are implemented across primary health care settings to drive improvements in practice and to inform consumers and policy makers.
Measurable Change would be: reduction in avoidable errors attributed to safety and quality issues.