Reshaping primary care


building blocks

Location rules, ownership rules and funding model changes should be considered in the post-pandemic landscape, expert says 

Sweeping changes should be considered to the way primary care operates and is funded, a health economics expert says.  

In an article published this week, Stephen Duckett, head of the Grattan Institute health program, says the “response to COVID-19 transformed primary care” with new ways of working that were embraced by patients.

Mr Duckett, a long-term advocate for pharmacy regulatory reform, called for the post-pandemic health system to learn from the COVID-19 changes and “create a new normal”.

Among the changes he recommends as part of this ‘new normal’ are sweeping alterations to the community pharmacy landscape, in particular, moves to further integrate the pharmacy sector into the broader primary care structure.

“Pharmacy location and ownership rules should be changed to facilitate incorporating pharmacies into these one-stop shops [for co-located services],” he said.

“Grants (or loans) to encourage co-location or consolidation should be part of a post-pandemic economic stimulus package”.

Changes to consumer behaviour and supply difficulties had emphasised the need for a restructure of the system, he said.

“With the drop in face-to-face consultations, and an apparent drop in preventive visits, many general
practices and pharmacies are struggling to survive financially. They are also still finding it difficult to get reliable information, and many are desperate for supplies of personal protective equipment, testing kits and influenza vaccines.”

“The current challenges have highlighted the importance of regional planning, coordination
and communication. Primary Health Networks have played a central role in delivering the Commonwealth’s pandemic measures at the local level, but until now their importance has not been recognised,” he said.

“In future they will need to be strengthened, more closely integrated with state public health and acute services and freed from some of the bureaucratic shackles that applied to them before the pandemic.”

Australia had commenced the “first, hesitant steps” towards new primary medical care funding arrangements, with an enrolment fee for people aged 70 years announced in the 2019 Budget, Mr Duckett said. 

Examples from similar countries, like the Alberta, Canada, primary care networks, offer a solution where networks of practices (medical and other) would be eligible for additional funding to employ pharmacists,
physiotherapists, nurses and other health professionals. 

Mr Duckett also highlighted the growth of telehealth in the wake of the pandemic, and the introduction of new medication services on 31 March, “including the electronic delivery of prescriptions from the practice to the pharmacy and expanded home delivery of medications,” as important pandemic-derived developments that needed to be continued and built upon.

The article was published online first in the Australian Journal of Public Health

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