What we heard and what we shared: cohealth’s contribution to the Independent Review into GP services

Many people who access care at cohealth experience higher rates of chronic disease, multiple health conditions and mental health challenges.

These health needs are often shaped by broader life circumstances, including unstable housing, insecure employment, past trauma and other social factors. As a result, many clients require more coordinated and sustained care than standard bulk-billing general practice models typically allow.

To navigate a complex health system and access the right care, many clients require additional support through:

Longer appointments and coordinated care

Longer consultations allow clinicians to safely monitor chronic conditions, respond to changes in health, adjust treatment plans and support clients to stay engaged with their care. This helps reduce the likelihood of avoidable emergency department presentations.

Access to multiple services in one place

Clients benefit from access to a range of services within a single location, including medical care as well as mental health, housing and social supports.

Culturally safe and trauma-informed care

Many clients require care that is trauma-informed, culturally safe, bilingual where needed, and delivered with compassion and understanding.

Through our engagement with clients and the community, several themes emerged about what people value most in their care.

Clients told us they value:

• access to a team of different professionals working together to support their care
• not having to repeat their story, and knowing their care team understands their history
• trust that their care team communicates and works together to support them
• being able to access care in their language, and in a culturally safe and respectful environment
• not feeling rushed during appointments, and having time to discuss their background and health needs.

These insights have informed the submissions cohealth provided to the Review and reflect the experiences and priorities of the communities we serve.

• The way care is currently funded for clients with more complex health and social needs doesn’t reflect the true cost of that care.
• The way Medicare funding works is that it pays per appointment, which doesn’t work well for people with complex needs who need extra time, social support and care coordination.
• There have been many reviews about our primary care system. Evidence supports cohealth’s experience that caring for clients with complex social needs, in a safe and effective way, requires longer consultations and substantial work. This is work that can’t be billed under the current Medicare funding arrangements.
• Funding also doesn’t support team-based care effectively – where nurses, allied health professionals, social workers and others work together with GPS to care for complex needs clients.

These have shaped our 8 recommendations to the Independent Review:

Target funding under Medicare for people with high health and social need

Using MyMedicare to register ‘high needs’ clients, introduce a package of extra funding for them to cover longer consultations and more proactive follow up and care coordination.

Blended funding for more comprehensive community primary care

Create the opportunity for community care that caters for high health and social needs to combine flexible grant funding to sit alongside their Medicare revenue.

Pool together State and Commonwealth funding to prevent avoidable hospital admission for high-risk cohorts

Create joint-funding arrangements for community-based alternatives like rapid access appointments, assertive outreach, post discharge follow up and integrated care pathways with hospitals

Fund social work and care coordination

Fund care coordination, client outreach and social work roles in a consistent way.  These are essential in caring for disadvantaged populations, and keep medical professionals work focused on health and care quality.

Better support the funding of team-based care
Move ahead with known solutions to fund integrated care across different professionals in the client’s team. National reform work suggests blended payment approaches, refining incentive programs and assigning more team based care in high needs areas.

Create incentives to support GPs to work where demand is most intense AND help them work to the full extent of their skills and authority.

Allocate incentives based on the client complexity, rather than geography to support these clinics to attract and keep general practice services..

Remove the arrangements under Medicare that constrain the contribution of other members of the team (nurses, allied health) and create reliance on GP authorisation, so they can focus on complex care rather than routine tasks.

Better utilise the full range of roles in a team to reduce the bottlenecks on GPS and improve wait times.

Help clinicians to work to the fullest extent of their skill and training by having Medicare (MBS item) and blended funding recognise the contribution of nurses/practitioners and allied health clinicians in chronic disease management, preventative care and care coordination.

Invest in community health infrastructure
Implement the Infrastructure Victoria recommendations to audit and assess current facilities, plan for the long term and invest in local high quality local community health facilities.

A long history of advocating for clients

For many years, cohealth has engaged with key decision makers in government and provided submissions to reviews and policy reform processes that shape the health and wellbeing of the clients we care for.  You can see much of our work to push for change in Medicare investment for vulnerable cohorts, on our website.

cohealth remains committed to advocating for a health system that supports the health care needs of our clients  – many of whom have complex health and social needs.