What are the benefits for the patient?
What is Enhanced Primary Care?
On 21 May 1999 the Commonwealth Government's Budget introduced
the Enhanced Primary Care (EPC) Package. A GP MoU in August
1999 included the new MBS items for EPC with the new items coming
into effect on 1 November 1999.
The 21 new MBS items for EPC address:
- Health assessment of the elderly;
- Care plans for chronic conditions, as well as
- Case conferencing.
How is EPC a shift in focus?
Enhanced Primary Care is a shift in focus towards primary health
care.
The following working definition of primary health care has
been put forward by The Centre for Primary Health Care, University
of Queensland.
"Primary health care is a health systems policy model
adopted by the World Health Organisation and the United Nations.
The policy model identifies structures that support health principles
for advancing health and a set of claims about the effectiveness
of the policy model to improve health.
The structures are the primary health care sector which
includes practitioners such as general practitioners, community
nurses, pharmacists, social workers and other health providers.
It includes the agencies in which they work and extends well
beyond these to include local government, the non-government
sector and the other public and private sector organisations
whose policies and activities influence health and well being
yet may not be recognised as health promoting organisations.
Citizens are seen as important contributors to the development
of health services.
The principles applied to advance health in these structures
include collaborative networking, partnerships between sectors
and intersectoral co-operation. The principles require the search
for a balance between macro and local needs and between short
and longer-term gains in health, recognition of the inequalities
in health between groups and in access to the policy and resources
allocation process. Advocating for social equity and affirmative
action that reduces these inequities in health is pivotal to
the policy model. In this respect health systems that are based
upon local needs of communities are pivotal to the advancement
of people's health and well being.
The effectiveness of this approach to health advancement
is open to critical examination and empirical testing".
Purpose of the items
All of the items must involve a GP and if possible, this GP
should be the patient's usual GP.
The scope of this new approach
The Commonwealth government has supported this approach through:
- New MBS items for EPC
- Practice incentives program
- Commonwealth Carelink Centres
- Coordinated Care Trials
- Sharing Health Care (chronic disease self-management)
- Preventing falls in older people
- IT initiatives to keep health providers in touch
What does EPC comprise?
Health assessments
These are available for Indigenous people 55 years
or more and for people aged 75 years or over. The assessments
embrace an analysis of the patient's whole life, not just the
physical condition. In a structured way, the patient will be
assessed in many areas of life. For example, a physical check
may identify a previously undetected condition and information
concerning the patient's surroundings may identify that the
patient is at risk of falling or the patient may not be receiving
adequate social support. An examination of medications includes
over the counter purchases as well as doctor's prescriptions.
The assessment may be conducted in the patient's home,
the doctor's surgery or a combination of both. The assessment
may take between 60 and 90 minutes to complete and is able to
be done annually.
The patient must consent to the health assessment
receive a copy of the written report with its recommendations.
Care Plans
The patient's usual GP is able to develop a plan for
the care of the patient with other health providers. This plan
provides a documented process for long term care for a patient
with a chronic illness or with multidisciplinary needs. A plan
can also be developed for a patient being discharged from hospital.
The care plan team must include a GP and at least
2 other health providers who contribute a different service.
A chronic illness is one that is likely to be present
for 6 months or more or a terminal illness.
The GP is able to initiate the plan and include other
appropriate health providers. Or, another health provider is
able to initiate the plan where the GP contributes.
The patient must consent to the care plan and receive
a copy.
Case Conferencing
The patient's usual GP, by communicating with other
health providers at the same time, is able to develop a plan
for a patient with a chronic illness or with multidisciplinary
needs or who has a terminal illness. The case conference can
be conducted face to face, by telephone, videoconference link
or a combination of these.
A case conference is appropriate when there is a need
to respond to an urgent need.
The care plan team must include a GP and at least
2 other health providers who contribute a different service.
The GP is able to initiate the plan and include other
appropriate health providers. Or, another health provider is
able to initiate the plan where the GP contributes.
The patient receives a copy of the care plan.
What is ADGP's role in the implementation
of the new EPC items?
The EPC Co-ordinator at ADGP is responsible for:
- Co-ordination of the implementation process
- A national voice for GPs in implementation issues
- Liaison at a national level with key stakeholders
- Identification of relevant issues
- Identification of models for implementation
The EPC Co-ordinator at ADGP is Maxine Clark mclark@adgp.com.au
What is the State Based Organisation's role
in the implementation process?
- Conduit between Divisions and ADGP on progress and issues
related to program roll-out
- Liaison with key stakeholders
- Develop and deliver education, training and support for
GPs
- Co-ordinate and support Divisional activity
- Foster community linkages
- Promotion of the new MBS items
Each state has an EPC Co-ordinator
The co-ordinator in your state is:
Why are the Divisions important in the EPC
implementation?
- Support and education to GPs
- Identification of local needs
- Development of a local strategy
- Able to collaborate and consult at a grass roots level
- Identification of links to health providers and community
groups
- Identification of barriers
- Ability to build on existing relationships and programs
For information on Divisions in your area:
http://health.gov.au/hsdd/gp/
http://gpnetwork.net.au/cc/divsearch.asp
What are the benefits for the GP?
- Matching patient needs to services
- Utilization of IT
- Allows for emotional and social well being to be included
in patient care
- Patient 'commitment' with a copy of the plan
- Opportunity to develop community capacity
- Establishment of relationships throughout the community
- Opportunity to formalise pre-existing and new relationships
with other health providers
- Opportunity for better co-ordination of care
What are the benefits for other health providers?
- A formalised link with a GP
- Opportunity to formally contribute specialised care or services
- Participation in co-ordination of patient care
- Patient 'commitment' with a copy of the plan
- Opportunity to establish relationships throughout the community
- Contributing to a plan which matches patient needs to services
- Opportunity to build a relationship with a GP and a Division
of General Practice
What are the benefits for the patient?
- If eligible, entitlement to a comprehensive health assessment
which extends beyond a physical examination. The approach
to this care is preventive in nature with a focus on health
promotion.
- If suffering from a chronic condition, a terminal illness
or where multidisciplinary care is required, the patient is
entitled to a care plan or case conference
- Care plans and case conferencing allow the carer to take
part although the carer cannot be counted as a 'health provider'
according to the government's rules
- The patient receives a copy of the report for a health assessment,
care plan or case conference
