This piece was originally featured by Croakey Health, here.
Introduction by Croakey: At a post-Budget breakfast last week, hosted by the Australian Institute of Policy and Science, Health Minister Mark Butler told the audience that health professional rivalries had “dogged” the health system for years.
Meanwhile, consumer advocate Harry Iles-Mann writes below that ongoing feuding between peak bodies representing general practice and pharmacists is damaging public confidence and trust.
He calls for an end to “unhelpful and unacceptable” discourse involving name-calling and alarmism, and for the needs and values of consumers and the community to be centred in health reform efforts.
Harry Iles-Mann writes:
Being spoken for, or over, as a patient is an experience that is regrettably still common. It’s dehumanising, objectifying, and only serves to reinforce a sense of isolation and disconnectedness from the points of care that we rely on.
It doesn’t matter what’s being said, or how big or small a decision is being weighed up. The tone of conversation, and our exclusion from it in principle is enough to damage any hard-earned trust we have in medical professionals, peak bodies, and the system more broadly.
Imagine sitting in a room as a patient, faced with a difficult decision about what treatment path to follow, only to have two medical professionals of different disciplines argue over your head with one another about the merit of treatment options as if you’re invisible.
You feel you might as well be.
You have no voice, no agency, and the tone of disagreement quickly begins to shift as if there are other scores trying to be settled at your expense.
Suddenly your feeling of isolation turns to suspicion. This doesn’t seem to be about trying to secure the best outcome for you anymore – one that balances what matters to you as a patient with a pathway that aims to achieve safe, high quality clinical improvements to your health and wellbeing.
This same dynamic is now dominating the debate at a broader level as the medical and pharmacy professions trade blows, at the expense of consumers.
Eroding public confidence
The feud between peak bodies representing general practice and pharmacists over the NSW Government trial to allow pharmacists to administer vaccinations and prescribe some treatments is a real-time case study on damaging public trust and eroding patient confidence in the health sector.
It comes at a time of complex proposed reforms, ahead of an inevitable jostling by big players in the health sector for more resourcing.
Pharmacy prescribing is intended to improve equity of access and reduce unsustainable primary care workloads by allowing pharmacists (who have been trained and accredited) to administer a conservative range of medicines for some common health needs including vaccinations, UTI’s, ear infections and birth control.
Queensland has moved to make pharmacy prescribing permanent, with Victoria and New South Wales in the process of developing pilots for the same scheme.
The recent escalation of Australian Medical Association messaging as part of the You Deserve More campaign – which makes the claim that the pharmacy-prescribing trials are an experiment– is the latest in a series of what seems to be warning shots being levelled in a debate between communities of practice.
Over the past months of following reporting, the release of press release after press release on the NSW Pharmacy prescribing trial, and the now alarmist “You Deserve More” campaign, I have observed the public and those within communities that I advocate for follow that similar trajectory of a harmful patient experience discussed above.
Arguing over patients’ heads
It will come as no shock to most that there are cultural and professional disagreements in the health sector. Disciplines don’t always get along. That’s not a bad thing.
What is unhelpful at best, and nearly irreparably damages public trust and confidence in health systems and professionals at worst, is when those systems and their custodians start to argue over the heads of patients and the public.
With Australia in the midst of a primary care crisis, reform that decreases the already crushing workload experienced by GPs and improves access to timely care holds merit enough on face value to explore. To the Australian public, this concept is simple.
Peak medical bodies publicly resisting a reform (one of the objectives of which is to alleviate pressure on primary care) only further compounds public suspicion about what is really being debated. Regardless of the conclusions drawn, the growing sentiment that the public interest and what matters to patients has been lost along the way foreshadows a predictable and disappointing damage to consumer trust in, and between peak bodies and clinical disciplines.
It also threatens the prospect of building the inter-disciplinary relationships that will underpin patient-centred models of care and creates a feeling of isolation, disconnectedness, and distrust.
There are better ways to have difficult and sensitive discussions about novel ideas and innovations to models of care, or ways of potentially improving the accessibility of care.
An ideal path
The ideal path is one that all stakeholders walk along together – including health consumers – and which holds our voice and values at its core as discussion evolves.
It’s one that supports challenging discussions but tethers every perspective to core principles of respect for the values and perspectives of people with a lived and living-experience of engaging with and relying on a spectrum of points of care. And it recognises the professional experience and expertise of clinical disciplines also sitting at that table.
There is still time to change the tone of this discussion, to base our willingness as a sector and peak bodies to engage on discussion, implementation, and evaluating of pharmacy prescribing based on how closely it aligns with what matters to the public and not the ramifications it has for who acts as gatekeeper to certain types of care.
Based on available evidence, there is a reasonable view that this reform could be a positive one if implemented effectively and does not result in merely shifting pressures from one point of care to another without appropriate support, resourcing, education, regulatory safeguards, and a significant strengthening of connections and information sharing between existing sector silos.
It also aligns with a national focus on reducing primary care workloads and improving patients’ access to care when appointments with GPs are becoming increasingly cost prohibitive and difficult to access.
Meaningful broad reform
Designing for genuine and meaningful impact is hard to do when patients and consumers aren’t part of the conversation, or even in the room.
The National Press Club panel on the Medicare Taskforce findings was notably absent of any consumer input – made bitterly ironic considering the emphatic agreement between panelists of the need to create patient-centred systems and services.
This only compounded the perception that government, health peaks, and media consider consumer contributions and partnerships as secondary, further feeding into that damaging perception that decisions are being made paternalistically.
The way discussion evolves, and the effect it has on public and consumer trust and confidence is an experiential one – something far more volatile and challenging to remedy when sentiment sours.
The last three years provides ample evidence (see here and here for examples) of the damage inconsistent messaging and a lack of public trust in government and the health sector can perpetuate.
An antidote
How we create meaningful broad reform that centres on the needs and values of consumers and the community has an obvious answer: you design, implement, and evaluate in partnership with us, the consumer.
Tethering the ongoing (likely uncomfortable) conversation about the path ahead for substantive reform firmly to what matters most to, and impacts consumers is the only antidote to the divisions between and indecision by stakeholders that is consuming the space.
Name calling, alarmism, and discourse that actively alienates the communities we serve and are accountable to is unhelpful and unacceptable.
Building trust through meaningful dialogue about what matters to us is the single most powerful mechanism for positive system reform available, but is currently under-utilised.
Without a shift in tone, pharmacy prescribing will make for another unfortunate and avoidable case study on how to damage trust and alienate the public regardless of clinical impact – to add to the pile of lessons arguably not learned over the course of the COVID-19 pandemic.