How to fund and plan GP care vs QAS/Hospital?

A standard or extended GP visit (MBS item 23 or 36) is funded at a fraction of the cost of an ED, OPD or QAS attendance. There is no margin for consumables, PoC pathology, PoC imaging, and so on.

Additionally, GPs (especially the 'good' ones) are booked up in the same way that consultants in hospital OPD are booked up (but usually by days; not weeks or months in advance).

So, the community may benefit from a network of GP clinics funded like ED or OPD: fixed hourly rates, provided PoC pathology (eg iSTAT), PoC imaging (eg US), consumables (eg IV access, fluids, dressings, medications). Need not be 'whole' clinics eg one GP + one RN + one EN per session and the 'rest' of the clinic can carry on normal business like the rest of the hospital does regardless of ED activity.

 

Why the contribution is important

You're telling us that patients are preferring to attend ED for services that could be provided in the community, and you're right. The reasons people go to ED eather than the GP ought to be explored. You are likely to find that they are seeking prompt one-stop-shop access to diagnosis and management and the reason they get that at ED is because the facilities are set up (with stafs, infrastructure and funding) to provide what patients seek.

If you want those needs to be met in other settings which currently have the skills but not other resources, you need to invest appropriately.

by mcrice on August 12, 2019 at 03:32PM

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Comments

  • Posted by RodW August 14, 2019 at 08:48

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    That’s the key.
    Invest in primary care appropriately.
    Keep soft referrals in the community.
    Keep complex care in the community affordable.
    Then we can offer those complex dressings, that iv fluid for gastro, that fracture management, even perhaps minor monitoring and telemetry, point of care testing etc.
    GPs are progressively being forced to ditch their skills for economic reasons.
    make primary care viable It’s still the cheapest way to deliver health care and prevention.
  • Posted by ALE August 20, 2019 at 14:37

    Agree. Funding for on the day/more acute care within general practice is key. This requires additional funding within general practice
  • Posted by Caz August 22, 2019 at 14:06

    Agree. The main issue with this whole process is that the state is looking for ways to shift cost out of the public hospitals. But it is the federal system that funds primary care - poorly.
    Medicare values GP time at $37 for up to 20 minutes of care, there is no extra funding for consumables so the sutures or plasters etc at $100 a box would have to come out of that. The only way GPs can make their business viable is to charge a private fee or see people fast and not use much resources.
    GPs are already a resource that are trained to manage subacute and chronic conditions (and plenty of acute ones as well) instead of reinventing the wheel Qld health needs to provide funding to primary care directly if it wants to divert patients from tertiary centres . I reckon it would get great value for its money, I work in GP and in ED and speak from experience!
  • Posted by mcrice August 22, 2019 at 15:32

    Hitting the nail on the head, Caz.
    QH values even the simplest ED visit at around $300
    So the workload just follows the money (which leads the resource allocation)

    Te get patients out of ED and into the community will require a disruptive change in funding for their care; disruptive at ED and GP ends.

    Is MSHHS willing to let go of budget allocation, or just patients?
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