Making allies in health

By Eric Martin

The Strengthening Medicare Taskforce Report and this year’s Federal Budget spelt out the need for improving primary care and reviving Australia’s general practice services using allied health professionals. Yet while funding has been allocated and the various doctor and allied health groups have been brought onboard, little has been revealed about the practical realities of how a more integrated general practice should operate, let alone the benefits for GPs.

Medical Forum caught up with paramedic and health care expert Professor David Reid , Associate Dean of Allied Health at ECU’s School of Medical and Health Sciences, to discuss the advantages and challenges facing GP clinics adopting the new model, as well as its impact on patients.

“The National Safety and Quality Standards put the patient at the centre of everything, but if it's going to benefit practitioners, it’s going to benefit the patient,” Professor Reid said.

“Ideally you have an integrated system that may be co-located in one building, or in buildings next door to each other, which is, for example, what ECU has done at Yanchep and Wanneroo, where we have a GP service with external allied health who come in and provide clinics.

“ECU is developing a health centre in Yanchep where there is not a huge amount of health services and the nearest hospital, Joondalup, is miles away. The GP clinic will be followed by a second building for the health hub containing allied health services such as exercise physiology, with sonography potentially coming in one day a week to do scans.

“Imagine being able to say, ‘you actually don't have to go all the way to Joondalup, they're going to be here next Wednesday, and I'll get I'll get them to book you in for an assessment’.

“There is a clear benefit to GPs if you've got an integrated service and you can immediately refer somebody to a dietician, to the physio, to the speech pathologist, to the psychologist, or to the community paramedic based in the GP surgery, who does the home visits and the follow ups.”

Professor Reid explained that the other big factor for GPs was having confidence in knowing which practitioner to refer to.

“One of the biggest issues for many doctors is trusting the clinicians that you are referring your patients to – it is a double-edged sword. But if you have that close relationship with them, you can be confident when saying, ‘Yes, I trust this person, I know what they're doing, and I know they provide good service’,” he said.

“Allied health is becoming more specialised as well. Physios, for example, also differ in their areas of expertise – all of them can deal with anything essentially – but if you need a highly specialised one, it helps if you can ask other physios who to approach.”

Professor Reid highlighted that one of the first questions to ask when examining the new model was ‘what is good health care?’

“Is it the fact that you go into hospital and get discharged without an adverse event? Or is it the fact that you did not need to go to hospital in the first place, because you have some good preventative care that meant you could stay at home? Which is the better metric?” he asked.

“They are hard to measure, and they are hard to define, but I think that having these wraparound services will be good for patients in the long run and probably take pressure off GPs as well. The model is moving into preventative medicine and will stop people from needing to see their GP in the first place.

“We all have different needs at different times: an individual is not going to need a GP all the time, it might be that they need to see a physio for a few months and can complete this aspect of their treatment before moving on to the dietician or the specialist.”

The second question was, ‘how many people want to stay in their own home and get the care they need there?’

“It is a big focus in nursing homes, but with an ageing population, what does it mean for people staying at home? Is there going to be an increased use of allied health? I think allied health can play a big part in continued on Page 12