‘Absolute failure’: Emergency doctors back radical healthcare reform

Emergency department doctors contending with rising numbers of deteriorating patients are backing GPs calling for a radical overhaul of Australia’s healthcare system, warning that it is no longer fit for purpose.

President of the Australasian College of Emergency Medicine Dr Clare Skinner is urging the federal government to seize the chance to fundamentally transform primary care and redress the current healthcare funding model, in which acute hospital beds were clogged with patients who should have received the care they needed in the community.

Emergency departments are contending with rising numbers of patients with chronic conditions.Credit: Steven Siewert

“We are seeing the absolute failure of the acute health system around Australia,” Skinner said. “What could be a more dire signal that now is the time for major reform.”

NSW emergency departments have recorded increasing presentations in the highest triage categories for more than a decade, with the number of people with potentially life-threatening conditions more than doubling since 2012. There were 50,195 presentations in January to March 2012 compared to 101,929 presentations over the same quarter in 2022.

Skinner’s call for action is a clear signal to the federal government that doctors on the frontlines of Australia’s overwhelmed hospital systems are backing GPs’ call for urgent reforms in primary care, amid reports of declining bulk-billing rates.

Her comments come as the government’s Strengthening Medicare Taskforce prepares to meet on Friday. The taskforce is charged with ending Australia’s primary care crisis, with a budget of almost $1 billion over four years.

“I think healthcare workers of Australia would stand behind a government that had the courage to make the big decisions to reform this broken system,” Skinner said.

“The workforce is totally broken. We have squeezed every last drop we can out of this current model that was devised in the 1980s that is no longer fit for purpose as the population ages, and we’re needing to manage complex chronic disease,” she said.

A 2020-2021 productivity commission report on government-funded health services showed that more than a third of all emergency department patients last year had conditions that could have been treated outside hospital.

In a communique following the Strengthening Medicare Taskforce’s first meeting last month, Health Minister Mark Butler said: “There is no doubt that primary care around the country is in a parlous state.”

The communique outlined the taskforce’s five focus areas: building the healthcare workforce, multidisciplinary care that used the full skills of nurses, pharmacists and allied health professionals, new care models that fostered stronger relationships between patients and practices, harnessing technology, and universal access to inclusive and patient-centred care.

Australia Medical Association vice-president and taskforce member Dr Danielle McMullen said the taskforce wouldn’t need to start from scratch. The former federal government’s 10-year plan for primary care, released on budget night in March, is the product of “unprecedented cooperation” between peak medical and healthcare groups, McMullen said.

The plan sketches out major reform, including a shift from an illness-centric and fragmented system towards a prevention and wellbeing model that is integrated, multidisciplinary, and focused on “what matters to patients”, rather than “what is the matter with patients”.

One key pillar of the plan is a scheme known as voluntary patient enrolment (VPE), whereby a patient would enrol with a general practice, and the practice would get an annual payment for that enrolment or other benefits.

Implementing that patient enrolment plan is the AMA’s top priority going into Friday’s meeting, AMA President Steve Robson said last week.

Skinner said it was a mistake to characterise the crisis facing emergency departments as simply a lack of available bulk-billing GP appointments on a given day.

“This is the result of decades of underfunding and under-resourcing primary care,” she said. “We’re seeing people with chronic and complex illnesses who have deteriorated to the point where they need a hospital admission because they haven’t been able, or can’t afford, to access that care in the community.

“Then there are no hospital beds available for them because there are other people occupying those beds who can’t be discharged for the same reasons,” she said.

CEO of Australian College of Nursing Adjunct Professor Kylie Ward said the healthcare system could not afford to continue on its trajectory where emergency departments were overwhelmed by patients with conditions that should have been avoidable.

“We need to think about how we can build a fairer health system that acknowledges what is causing some of these chronic health problems in the first place,” Ward said.

The Labor government has not endorsed the unfunded plan, but McMullen said “Minister Butler has shown through the establishment of the taskforce, and the $750 million downpayment, that he is committed to significant primary care reform”.

The taskforce is scheduled to report to the federal government at the end of 2022.

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