Communication Breakdown
Doctors and nursing homes both want to improve medical care for residents, but there’s just one sticking point.
Above: Dr Steve Hambleton, president of the Australian Medical Association.
By Stephen Easton
Doctors and aged care providers must communicate better and work together to improve residents’ access to medical care, according to the heads of the Australian Medical Association (AMA) and Aged Care Association Australia (ACAA).
Since taking over the AMA presidency this month, Dr Steve Hambleton has made it a key priority to improve the relationship between doctors and aged care providers to get better outcomes for residents.
“I’m certainly keen to prioritise engagement in the aged care area,” he said, “because I think we’ve got to get better solutions to make life better for the residents, and the care practitioners.”
In a statement last week, Dr Hambleton argued that better medical care in aged care facilities would help free up hospital beds, and reinforced several reforms he had previously suggested during a speech at the ACAA NSW State Congress in May.
These included a call for a new accreditation standard to be introduced that would guarantee ongoing medical care for residents, an idea that was rejected completely by ACAA’s Chief Executive, Rod Young.
“Basically you’re asking aged care providers to be held accountable to accreditation, for something over which they have no control,” Mr Young said. “[Providers] don’t even contract GPs to provide services; the contract arrangement is between the resident and GP.”
“How the dickens can you say we should be held accountable for that?”
Above: Rod Young, CEO of ACAA.
But the two associations broadly agree on what is needed most of all – more communication between GPs and aged care providers – and Dr Hambleton said he was keen to start talks with Mr Young and other aged care stakeholders in order to present a more united voice to government.
“I’m very happy to disagree, and happy to discuss it further with providers and their representatives; I think there’s a huge opportunity for constructive dialogue,” he said, adding that he had already planned to arrange a meeting with Mr Young in person, rather than “communicating via press release”.
“We believe that [the proposed accreditation standard] would actually create a situation where you have to improve communications between GPs and residential aged care providers.
“It would certainly be a performance measure that could be externally monitored and it would precipitate what we both need to do – and that is to engage [with each other] better and develop opportunities and solutions. It would also reinforce the point that both Rod and I are making now [that residents must have better access].”
In his response to the AMA last week, Mr Young included ACAA’s own six-point position on the issue, and acknowledged that while both peak bodies “want the same thing”, their methods of achieving it differed.
Broadly, the two associations want government support to go to what they see as the right areas, like building dedicated rooms in facilities for consultations, and supporting contractual agreements between aged care providers and GPs.
There is also loose agreement that government ought to allocate funding for implementing telehealth, electronic prescriptions and electronic medical records, and to increase current Medicare rebates for consultations in residential care, which both argue are not enough to pay for the actual costs in time and travel, and the complexity of the healthcare required by many residents.
“I think we have more aligned goals than unaligned goals,” Dr Hambleton said.
“We all care about the quality of medical care for the patients and I think [doctors] have to work with the providers using different solutions in different areas. There are things we can all do better, and I agree; aged care is one of the most challenging areas of health care.”
There are a number of issues that are also related to this poorly supported collaboration between medical and nursing and the service provider. Best practice implementation would recommend the multidisciplinary approach and case conferencing. This method of care management and focus on the individual plan is an excellent example when in practice and well supported by the GP’s. The medicare benifits available are well worth the effort for a service contract between a provider and a GP…..the problem is we dont have enough GP’s that either understand the incentive scheme and or wish to spend significant time in practice in a nursing home. It is time that we outlined a structured pathway and career role for the Greiatric Nurse Practitioner.
Good point Drew it is interesting the AMA will not support this role. I hope Dr Steve Hambleton is bringing more to the table than a new accreditation standard to be introduced that would guarantee ongoing medical care for residents. I Have personally had to beg to get GPs to come to ACFs and had them refuse when medical intervention was required. I am not sure how accreditation standards foistered on ACFs would improve this situation. Maybe the AMA could support greater stipulation on the requirements of GPs availability to residents and to have them scrutinised for failure to deliver service to ACF clients. Certainly it would have better effect.