One size does not fit all
BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE
The profession-led system of standards for general practice in Australia has served GPs and our patients very well. They are uniquely tailored to the needs of general practice and our patients and while, from time to time there has been disagreement over some aspects of these standards, they are generally well accepted.
That’s why the AMA continues to watch with real concern the Australian Commission of Safety and Quality in Health Care’s increasing interference in this space.
Spurred on by a recommendation from the 2010/11 Australian National Audit Office (ANAO) review of the Practice Incentives Program, which said that the Department of Health needed a means to better inform itself about the quality of general practice accreditation, the Commission appears to have decided to use this as an opportunity to expand its influence and control.
During earlier consultations the AMA raised concerns with the direction the Commission was taking. There remains deep concern that the Commission is trying to deliver a ‘one-size-fits-all’ solution, particularly as it is now moving to take the standards it has developed for hospitals and day surgery and try and adapt these to primary health care. There is no long-term guarantee that the Commission will not try and wrap general practice up within these arrangements as well.
General practice has led the way in developing an appropriate accreditation model, with assessment against standards undertaken by accrediting agencies who know and understand general practice. The standards are informed by an expert committee and general practice stakeholders.
They are regularly reviewed to reflect contemporary practice and designed to focus on continuous improvement and delivery of safe and high quality care. One can’t help but come to the conclusion that the ACSQHC is trying to empire build, at the expense of many years of good work.
If other sectors need the ACSQHC’s assistance in progressing accreditation, I don’t have any argument with their involvement. However, general practice does not need to be included in the Commission’s inevitable one-size-fits-all approach.
Without some clarity on the Commission’s intentions we are standing on the edge of a very slippery slope. Are we going to end up with multiple sets of standards applicable across a sector? Are general practices going to be able to choose whether to be assessed against the NSQHS Standards or the RACGP’s Standards? Will they have to comply with both?
Will standards be weakened so as to encompass other health services within the primary care sector? Or will the Standards applicable to hospital care be transposed on to general practice and primary sector health care services? Can you imagine how much trust you would engender in your patient if you were required to wash your hands with alcohol up to five times in a consultation?
Are we going to see a shift from our system of voluntary accreditation to one forced upon us by the Commission? What impact will that have on schemes that provide vital additional funding for general practice and support for infrastructure and quality improvement, such as the PIP, PNIP and the GPRIP. Will the Commission ignore the diversity of general practice and play into the hands of larger players? Will the focus of health care become more about ticking a box then the actual provision of quality of care?
We know that, for now, current accreditation arrangements for general practice remain largely intact, although the Commission has succeeded in having them modified and brought within its own frameworks. We are one step away from the ACQSHC trying to take total control, which is something that all GP organisations need to worry about and protect against.
One size does not fit all, yet despite this we know that it is the way that bureaucracies tend to try and work.
Published: 08 May 2017