AUSTRALIAN PRIMARY HEALTH CARE INSIGHTS AND INNOVATION SERIES
Leanne Wells and Paresh Dawda
Healthcare systems are challenged to better cater for contemporary demands at the same time as recovering from the aftershocks of COVID-19. The need to disrupt healthcare and put it on a sustainable footing is the subject of intense policy discourse and never far from the headlines.
No country is doing well
Several new reports paint a sobering picture about what’s ailing health care and of societies in distress. They reinforce that accessible primary care is the backbone of high-performing health systems, yet all point to a crisis in primary care.
In the UK, Lord Darzi’s review of the NHS and the IPPR Commission on Health and Prosperity report that health challenges have reached “historic proportions” helping to trigger Change NHS “the biggest ever conversation about the future of the NHS”.
Australia’s high-profile Strengthening Medicare Taskforce has laid out the most pressing investments needed in primary care. A series of subsequent reviews propose an ambitious new funding architecture for primary care practices, among other areas of policy shift.
In Canada, the public has been their guide using strategies such as citizen panels to develop an Our Care Standard to assess the adequacy of primary care.
Mirror, Mirror 2024, the Commonwealth Fund’s comparisons of health systems in selected countries, found that even as the top-ranked country, Australia does not do well on measures of access and care process (a domain that includes prevention, safety, coordination, patient engagement and preferences).
Common themes, common conclusions
No matter whether government, clinical, researcher or community-driven, there are common themes across these reports. All describe the impact of the social determinants of health and surges in long-term conditions and mental health needs, particularly among children and young people. All describe systemic failures.
All convey a mixed picture of the quality and experience of care and variations in equity of access to care. All refer to the need to adjust where health budgets are spent.
All conclude that if we don’t remedy and transform primary care, not only will the sustainability of our health systems suffer so, too, will the productivity, prosperity and wellbeing of nations.
Seven prescriptions for impact
In this vodcast, three global experts discuss their ‘top pick’ prescriptions for change.
The power of data
"Data is something we really need to get in order ….Data is our guide for equity and quality care. When we don’t have that, we lose out on the opportunity to lean into what our patients and communities really need for their health."
Dr Kirsten Meisinger, Director of Leadership and System Transformation, Harvard Medical School Centre for Primary Care
Data supports population health management by tracking and analysing health outcomes, identifying gaps in care, and developing targeted interventions. Predictive analytics assists in decision-making, identifies patients at high risk of readmission or complications, allows providers to intervene early, and prevents adverse outcomes. If we are to harness the power of data, this needs to happen at the national, regional and service level through infrastructure that can share data across different platforms and settings, investments in the necessary technology, and education to ensure that staff are trained to use it effectively.
From analogue to digital
Care closer to home: neighbourhood approaches
Rethink health care destinations
Real teams activated around a common purpose
Leadership and distributed ‘new’ power
Health creation
Outside the walls
“Tomorrow belongs to those who can hear it coming”.
David Bowie
When you can forecast the future, you can do something about it. In imagining a better health care future, there are aspects we shouldn’t change: relational compassionate care must remain the constant, but everything else is up for disruption.
Think tanks have long described the over-reliance on hospital care and the political reluctance to challenge this as a barrier to change in health systems.
Policymakers acknowledge system interdependencies, particularly that hospitals will only be able to manage demand by working in different ways, including delivering more care beyond hospital walls.
It’s time to start taking primary care outside of its traditional walls too. It’s time to conceive of primary care as something wider and more community connected.
“It’s about co-production and working together with people to meet them where they are in order to deliver their care. It’s about not being bound by boundaries. Health care doesn’t necessarily happen in general practices, clinics and hospitals, it happens in communities neighbourhoods and where people go”
Dr Paresh Dawda, Founder and Director, Prestantia Health
Just as the system is complex, so are the solutions. But just as general practices can embrace improvement and innovation by breaking down the steps for change and taking a ‘plan, do, study, act’ mindset, so too can the system.
Primary care is where we most need transformation and investment, and we have the knowledge and levers to accelerate change.
Accelerating action on these seven prescriptions would start to shift the dial toward ideal health care.
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