Organisation: Heart Foundation ACT
Date: 31 th July 2009
Contact person: Tony Stubbs, CEO
Email: Tony.Stubbs@heartfoundation.org.au
The Heart Foundation ACT Division acknowledges the vital work of general practice and the broader primary care sector in the maintaining and improving the health of the
ACT community. We are pleased to have the opportunity to contribute to the deliberations of the GP Taskforce and would be more than happy to meet with the taskforce to elaborate on our submission if required. Please note we have only responded to chapters/questions relevant to the Heart Foundation ACT.
In 2006, heart, stroke and blood vessel disease accounted for 34% of all deaths in
Australia with cardiovascular disease being responsible for one in three deaths each year (ABS 2008). Primary care has a vital role to play in addressing this issue given that CVD accounts for 12% of all problems commonly treated by GPs in 2006-2007
( Britt et al). High blood pressure accounts for 18.5 % of all chronic problems managed in general practice, lipid disorders 6.7% and coronary heart disease 2.5%.
All told, GPs managed cardiovascular problems at a rate of 17 per 100 encounters with their patients (AIHW 2008).
The Heart Foundation ACT believes that the Canberra needs a strong and vital primary care system that is designed and resourced to deal with the increasing burden of chronic diseases in our community. It is well established that significant management gaps exist in general practice for people with, or at risk of, CVD. This is particularly true for people from lower socioeconomic backgrounds and Aboriginal and Torres Strait Islander peoples.
The Heart Foundation acknowledges the complexities the taskforce faces in addressing issues such as GP waiting times and understands that the community want some short term answers, however, we strongly believe that the formation of the taskforce provides an important opportunity to rethink our approach to general practice and primary care. This is the ACTs opportunity to make structural changes that will make a real difference in the long term.
We believe that concentrated action with regards to how chronic disease is managed and the development of better systems to underpin this care is vital if we are to see a reduction in the current burden, both clinical and administrative, that GPs carry.
1

Do you have any ideas about ways to reduce waiting times for appointments for see a GP?
It is essential that the way patients are managed in primary care supports the general practitioners primary role as a clinical leader and coordinators of care, removing unnecessary burdens. General Practitioners in the ACT need to be better supported to deliver evidence based and evidence driven services for their patients. They need better access to a multidisciplinary team including nurses and allied health professionals with good access and support from medical specialists to support their work and they need adequate and skilled administrative staff.
While most of the suggestions following are longer term in nature, there are already many support systems in place via the ACT Division of General Practice to provide resourcing in the short term to start addressing many of the structural issues at a system level. Current work by the ACTDGP in areas such as e health, primary care collaborative program support, risk factor management support and practice nurse support should attract increased resourcing to enable more practices to access this current level of support, more often.
How do you think this can be addressed in the short and long term?
ACT is well placed to progress innovative models of care for people with chronic diseases. Expansion of appropriately resourced systems-based chronic disease management models of care will improve the quality of care, will address management gaps and will support GPs to refocus their roles back to clinical leader and coordinator of patient care.
The Australian Primary Care Collaborative program with its systematic approach to patient care has clearly demonstrated it can achieve improvements in clinical management and indicators and is well supported by participating practices. The
‘collaborative model’ has proven to be effective but the current funding model is limited, short term and ad hoc. This model works and needs to be expanded and should become usual care in the ACT.
Having access to a range of services to support patient management is an essential part of any new approach to primary care. GPs need easy and ready access to the full range of health professionals and related services to help their patients achieve their management goals.
There are opportunities within the existing ACT Diabetes Services Plan, with its planned community diabetes service, to expand this concept to a community ‘chronic disease’ service which addresses prevention and management issues for people with chronic diseases such as diabetes, CVD and renal disease.
The Heart Foundation ACT believes that a coordinated, community based, multidisciplinary service, with good links to medical specialists and other supports, would be a big step in supporting GPs in the management of the large number of their
2

patients with chronic disease. The allied health and nursing workforce required for a diabetes services would be very similar to that required for a broader chronic disease service, making for a more sustainable and flexible workforce structure.
The potential for this service to become a ‘hub’ for the full range of risk factor prevention and management services is also clear. Smoking cessation programs, weight management groups, walking programs, gentle exercise programs and nutrition programs could also be delivered or coordinated from this service.
The importance of comprehensive, coordinated, multidisciplinary primary care has been recognised by the National Hospital and Health Reform Commission providing possible opportunities to seek support from the Australian government for blended funding models to enable adequate resourcing of this new service.
3

What do you think about new roles for practice nurses in General Practice?
The Heart Foundation ACT is very supportive of the role of practice nurses play in general practice. Practice nurses are a key component of capacity in general practice to prevent, and support management of chronic disease.
Currently while practice nurses provide a diverse range of services that are valuable to general practice there isn’t adequate funding to support these activities, particularly in relation to supporting GPs in their coordination of care for patients with chronic disease.
Practice nurses have significant expectations on them and ongoing training to enhance and develop their skills is essential. The Heart Foundation, on behalf of the AGPN, has developed a CHD module which sits as part of a chronic disease e- learning program for Practice Nurses and we are currently developing an electronic ‘toolkit’ for Practice Nurses and General Practitioners to support a systematic approach to their care of patients at risk of, or with existing, CVD. Creating incentives for general practice to make it viable for practices to have their Practice Nurses accessing this type of training and support is also important.
There are some significant issues to consider when looking at an enhanced role for practice nurses in primary care. Currently practice nurses do not have a common level of education or skill base in the primary care setting. While the existing
Competency Standards for Nurses in General Practice provide a framework for the roles and responsibilities of both registered and enrolled nurses in general practice, until a credentialing system is established to ensure that these competencies are being met by ENs and RNs working in the sector it is difficult to generalise their roles and functions and ensure quality service provision in all practices.
While the Heart Foundation ACT strongly supports the evolving role of practice nurses, we also support a multidisciplinary approach to primary care and thus we believe it is vital that the taskforce consider the roles and capacities of the entire multidisciplinary team when considering workforce issues in the primary care setting.
The range of allied health professionals, nurse practitioners and medical specialists all have an important role to play in the management of patient care, particularly for those with chronic disease. It is this multidisciplinary team working together with general practitioners that will ensure the ACT community gets best practice, evidence based care and will support GPs in their role as clinical leaders and coordinators of care.
4

Should there be a public upto date list of private health providers, including allied health professionals, including their area of speciality
Investigations into the development of a provider list should commence with a review of the already well developed web based databases that most allied health professional associations have, eg. ‘Find an APD’ ( www.daa.asn.au
). These systems have been developed over a number of years, are maintained by the credentialed professionals and their professional associations and are thus most likely to remain upto date. Most of these databases allow easy searching by location (including by division), area of interest/expertise, DVA and MBS provider status and special issues such as languages spoken. It is likely that development of an interface with these existing databases could be the most effective approach to this perennial issue.
Should there be an upto date provider directory for health workers that includes public and private practitioner across all specialities available for use by health workers.
Heart Foundation ACT believes that the same system developed for general public use could be used for referring health professionals. The health professional association databases noted above contain a range of information relevant to consumers but also to referrers. It may be that addition links would be required for a referrer interface (eg. to specialists) but having ‘one system’ would greatly reduce duplication in development and maintenance.
Should GPs in conjunction with ACT Health look into e-health systems for GP patient consultations to increase efficiency and free up time for more face to face consultations.
Heart Foundation ACT strongly supports e-health initiatives that allow the use of electronic client records and improved data linkages. These innovations, which are essential for an effective multidisciplinary approach to primary care, will streamline data collection processes, reduce time consuming paper based communication and will improve coordination of patient care amongst multiple providers. The size of
Canberra makes it ideal for trialling shared e-records and this initiative would be consistent with the aims of various ACT plans/strategies such as the Chronic Disease
Strategy and the ACT Diabetes Services Plan.
Additional to electronic patient records, another important information technology issue is the development of patient registers and recall systems. General Practice in the ACT needs an increased capacity in areas such as IT infrastructure, IT training and increased incentives to support general practice to develop and maintain patient registers and establish guideline driven recall systems. The very successful Australian
Primary Care Collaborative program which uses a systems based approach to care uses patient registers , for example for patients with CVD, as a fundamental component of patient management. The collaborative model supports best practice, guidelines driven care and thus increased resources and incentives should be made available to allow more practices to work in this way.
5

Do you have some special knowledge or interest in vulnerable populations including groups of children, the aged, people with a mental illness and the isolated.
Australians in the most disadvantaged groups compared with those in the most advantaged groups are more likely to die from heart, stroke and vascular disease and are more likely to smoke daily, be obese and have diabetes. It is thus essential that any reforms to the primary care sector in the ACT ensure improved access to services for these groups and in no way create additional barriers to improving their health.
Primary care services that are ‘connected up’ and offer a range of services via a streamlined and coordinated processes, provide the best opportunity to support these groups.
Cardiovascular disease is the leading cause of death for Indigenous Australians. In
2002-2005 Indigenous Australians were three times as likely to die from CVD as the non-Indigenous population. Increased support for both the Aboriginal Community
Controlled Health sector and mainstream primary care sector to support Aboriginal and Torres Strait islander peoples to have annual health checks with systematic recall and follow up services is essential. In 2005-2006 less that 4% of the target groups between 15-54 years and just 7% of the target group over 55 years received their annual health check (AIHW 2007).
.
Are there additional supports which would assist such people to improve their access to primary care?
Initiatives to improve self management skills and health literacy are very important in supporting patients to be more able to work with their GP in addressing their health issues, in particular for chronic and complex conditions. The more skilled and informed with regards to their condition and how to address it the patient is, the more likely they are to undertake positive health behaviours and access a range of service providers who can work with them to achieve better health outcomes. While once again this is not a short term strategy, overtime a population who is skilled in self management will work with their general practitioner in a more effective way.
6

Australian Bureau of Statistics (ABS), Causes of Death 2006 (2008)
Britt H, Miller GC, Charles J, Bayram C, Pan Y, Henderson J, et al. General practice activity in Australia 2006–07, General Practice Series No 21, Australian Institute of
Health and Welfare (2008)
Australian Institute of Health and Welfare (AIHW), Australia’s Health 2008 (2008)
Australian Institute of Health and Welfare AIHW), Aboriginal and Torres Strait
Islander Health Performance Framework Report 2006 (2007)
7