How Primary Health Care could take a lesson from the disruption we’ve seen in the travel and hotel industries.
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Ok, that title was designed to get your attention, but I will admit have just spent the last few weeks pondering where market disruption could come into its own when it comes to primary health care. Believe me, there is no place like a holiday with the kids to get the creative imagination flowing and this thought piece kind of wrote itself.
But stay with me here, as I really think there are some lessons we can learn from disruption and how it could make primary health care more accessible and better for patients.
In the last 3 weeks I have spent time away, both with work and for a holiday. I have organised cabs, Ubers, Air BnBs and hotels and this is where I started thinking: ‘Why can’t primary health care be as easy as this?’
Let’s take last week for example.
Both my wife and I took a week off from work to take the kids away. We booked an Air BnB at small beach side town on the north coast. Given we have 3 quite young children, I could not have imagined the chaos or potentially afforded this holiday if I was only able to book in at one of the local hotels in the bigger towns nearby. Thus, the use of Air BnB allows me the ability to take my children to a beach side holiday for a week and spend money in the local community. It also enabled me to have the space needed for 3 young kids to create noise that would not have been tolerated (by me or the other guests) in a smaller hotel suite.
The week before this I travelled for work down to Melbourne. I caught a taxi to the airport, but this time I stayed in a comfortable hotel room, used room service, and had the convenience of staying mid-city, close to all my meetings, because this was infinitely more appropriate to my needs for my work trip. I also didn’t need the additional space that is provided by an Air BnB.
However, upon my leaving for the airport and my return leg, I had miscalculated timings and when I looked on my booking app, I realised it was quicker and easier to grab an Uber than wait for a taxi as it was peak hour and I had left my run a little late. So, jumping on the Uber app, I had an Uber outside and ready to go within about 3 minutes and made my flight with a few minutes to spare. A few years ago, I have no doubt I would have missed my flight searching for a taxi and then had to explain to my employer why I had additional charges for rebooking a flight.
So where am I going with this? In a perfect world this is how our primary health care could be and should be.
Now before I get anyone offside, I want to make it completely clear, there will always be the need for GP’s, and we need more, not less. But we should be empowering them to work to their full scope and they should be remunerated appropriately for this work. But there is a need for other options and solutions to the ever-growing problems in primary health care. This is also a way we can improve the crisis we currently face across our tertiary care sector and reduce the strain it feels as well. These are, as we know, problems of supply and demand.
We currently have a crippling shortage of supply of GPs. This shortage cannot be fixed overnight and there is a need for our healthcare practitioners to get “down and dirty”. We need health practitioners to do some heavy lifting to address our skyrocketing chronic disease challenges, our ever-growing mental health problems and the gaps in the market that GPs* (*not all but many) no longer want to support, such as aged care, and rural and remote communities.
There is also an excess of demand for primary health care. Some of that demand could be better addressed by nurse-led models of care (virtual and face to face) and Nurse Practitioners. There is no shortage of demand, so it seems folly to worry about competition straight away: there is more than enough work to go around. Doctors can still earn significant income working to their full scope and would probably enjoy the work more if they were empowered and enabled to do so. Nurses working independently would also enjoy their work more. Imagine, if we could set up systems where they too were remunerated appropriately for the value, skill and outcomes they could bring to the system as well. This would enable a win-win for both parties. This isn’t an either/or conversation, it’s an and/both.
For argument’s sake, let’s just fast forward 40 years and think about what might be: Let’s just say I’m in my mid 80s and things have started crumble a little and I need more support. I, like many Australians of this age, have one or more chronic diseases, but am keen to age in place. Happily, I am empowered to make decisions so that I get the right care in the right place at the right time.
Now wouldn’t it be great if, when I needed something quick and easy for my chronic disease management, I could reach out on the day and get what I needed through a virtual nurse-led model of care or by seeing a Nurse Practitioner without the need for waiting weeks for a GP appointment, which wasn’t really required. This might be my routine vaccinations, some repeat prescriptions, some health education, and/or other support and enablement for my chronic disease.
If I needed more complex support or investigations and care, then maybe my GP would be a more appropriate route for meeting my needs. In this multidisciplinary environment given they are no longer inundated with minor non-GP required services, I could get an appropriate appointment quickly and have more time with them to discuss my complex care needs as they weren’t in a rush to deliver 7 minute medicine as they were being paid appropriately for the skills, value and outcomes they were now delivering.
Or come to think of it, even better still they would both work independently (as could my allied health team) but integrated at the core (an improved My Health Record maybe?) to meet my needs and demands. Meeting my needs and demands means that my chronic disease management and my aging in place occur in a timely, cost effective and appropriate manner. This in turn means I am less likely to need to head to Emergency, as my needs are being met in the community primary health care setting by a team of skilled and valued practitioners.
This modern multi-faceted system is right at our fingertips. We already have virtual nurse-led solutions that deliver hospital reduction, cost savings and better patient outcomes ready to go, if the funding models were there. We already have Nurse Practitioners desperate for a Medicare system that acknowledges, empowers and supports the value, skills and abilities they possess and could bring to the table immediately.
The ease, choice, value, and sustainability of our system to deliver integrated care could be as easy as requesting an Uber, yet Australians are still waiting for a taxi when none are available and they’ve missed their flight or, like many Australians, they’ve ended up in Emergency with a potentially preventable admission.
These problems were avoidable if they could just have accessed the right care at the right time in the right place by an integrated empowered team which includes GP’s, Nurse Led Models of Care (Nurse Practitioners) and our allied health counterparts.
Ben Chiarella
Director of Clinical Innovation
Ramsay Connect
