GP Services to Residential Aged Care Facilities
Residents of aged care facilities are amongst the sickest and frailest of Australians, and have higher needs for general practice than their counterparts of the same age and sex living in the community.
There are numerous barriers faced by General Practitioners (GPs) who care for patients in residential aged care facilities (RACFs). These barriers have led to a situation where fewer GPs are prepared to visit facilities, causing a critical shortage of GP services within some facilities.
MBS items for attendance of patients in RACFs do not reflect innovations that exist in other areas of the MBS that have been demonstrated to contribute to high quality team based care. These include the capacity of general practitioners to delegate some tasks to their general practice nurses and other clinical staff; and the ability for patients to claim a rebate for a range of clinically relevant services, some of which are done by the GP in the absence of the patient.
The AMA and the RACGP strongly encourage the federal government to begin modelling Medical Benefit Schedule (MBS) item numbers to improve access to medical services in aged care facilities by extending the improvements in the MBS into residential aged care.
Both AMA and RACGP are of the view that proposals on the attendance items outlined in this paper, particularly the capacity to delegate clinical tasks to a general practice nurse, are applicable to the whole of the MBS. However, given the significant profile of aged care and the opportunity this model provides to increase the level of medical services and quality of care to residents in residential aged care, it offers a real opportunity for the Government to implement an innovative proposal.
The proposed model of care outlined in this document seeks to address the major challenges faced by GPs who care for residents of aged care facilities:
- The disjointed nature of care for patients, created by workforce and infrastructure issues in RACFs;
- The necessity to undertake clinically relevant tasks for patients (e.g. discuss falls, writing prescriptions, discuss issues with relatives and RACF staff and hospital staff), while not in attendance at the RACF. (Most GPs receive a list of prescriptions needed by the pharmacist for packing every fortnight as well as requests from nursing staff.);
The opportunity cost of attending a RACF, compared with caring for patients at the general practice.