Answer:
Comprehensive, integrated primary health care underpins cost-effective national health systems.1,2 In Australia, general practice is the foundation of primary care, providing continuing, comprehensive, and coordinated primary health care to the vast majority of Australians.
Explanation:
The fragmentation of care can result in inefficiencies and higher costs and can pose other risks.2 Task substitution in Australian general practice needs to be discussed in the context of supporting the core attributes of general practice, including its continuity, comprehensiveness, and its role in coordination. Otherwise, change might diminish the valuable contribution general practice makes. However, general practice in Australia is in the midst of a workforce crisis, with a shortage of general practitioners3 and other professionals integral to general practice, such as nurses.4 This crisis provides an impetus and opportunity for innovation in general practice, despite posing a serious challenge for both general practice and the broader health care system.
Defining new roles in general practice may help maintain and enhance the quality of patient care in the face of workforce shortages, but we need to move the discussion beyond task substitution alone. We need to consider:
whether we need enhancement, substitution, delegation or innovation;5
whether current approaches to task substitution achieve this, or whether they result, for example, in supplementing patient care;6
the technical aspects of the skill-mix and its impact at practice-level, as well as the broad issues of organisational change and health policy that will form part of any change strategy;7
the acceptability to GPs of task transfer; and
GPs’ ability to delegate effectively.
Most importantly, we need to assess new approaches to task substitution in terms of benefits and risks to patient care. To do this, we advance the six principles discussed below.
Principles for assessing task substitution
Roles within general practice teams should support the GP–patient relationship
All roles within the general practice team need to respect and support the GP–patient relationship. Many patients want to be able to identify the GP with whom they have an ongoing and trusted relationship, and many consider their GP as key in linking them with other members of the general practice team.8 Patient acceptance of others within the team performing different tasks thus hinges significantly on an effective GP–patient relationship.
In the increasingly complex Australian health system, it is important to support the GP’s role as patient advocate. Patient safety and the cost-effectiveness of care require that patients’ confidence is maintained and that appropriate investigation and treatment occur. In our health system, GPs provide this vital role.
