The up-skilling of general practitioners (GPs) will assist in controlling healthcare costs and improve the quality of care provided to patients, says Dr Bobby Ramasia, principal officer of Bonitas Medical Fund.
The report shows that payments for hospital services accounted for 36.7% of the total benefits paid to healthcare providers during 2012 while specialist fees accounted for a further 23.3%. Together, payments to hospitals and specialists accounted for 60% of the total paid to healthcare providers and these costs are escalating at a rate of between 11 and 12% annually.
Ramasia says that a review of Bonitas’ claims data has shown that a large proportion of Bonitas’ hospital costs result from overnight admissions. Admissions for pneumonia and gastroenteritis in particular feature in the scheme’s top five admission categories and represent the top cost drivers.
“These admissions could be avoided by educating GPs on clinical guidelines and care pathways for the management of these conditions as an outpatient.
“The upskilling of general practitioners, such that they are equipped to perform relatively minor procedures in their rooms rather than referring these cares to specialists and hospitals, will have a significant impact on reducing health costs,” he explains.
In this context, the need for additional clinical skills to deliver cost savings and improvements in the quality of care being provided by GPs has been highlighted by independent practitioner associations and healthcare professionals.
Bonitas has responded by establishing a programme that is designed to enhance surgical and medical skills likely to be carried out by GPs.
“Our ultimate objective is to increase the GP’s ability to manage patients more professionally and clinically appropriately at primary care level, and decrease the unnecessary referral to secondary care and hospital care,” explains Ramasia.
Candidates who attend course are awarded a certificate of attendance of a GP skills enhancement programme. Following formal accreditation of their facilities, GPs who attend the programme are rewarded for managing clinical and surgical conditions that contribute to the escalating downstream costs. Continuing Professional Certificates obtained from the University of Pretoria are also offered to GPs who attend the entire course.
“The initiative is essentially a relearning programme and it is hoped that during the course, GPs will develop progressively in all clinical areas,” he says.
Ramasia believes that this strategy must be underpinned by an effective peer review process. “Bonitas has a well-established GP profiling and peer management processes in place, which is constantly developing and evolving. We have set up a series of peer review master classes during which the candidates are formally trained and accredited.
“The programme covers an overview of profiling tools, the peer review process, quality indicators and clinical guidelines. This will ensure a consistent and credible peer management process, which we believe will raise both the profile and status of peer managers,” he explains.
Learning opportunities will also be offered to the National Health insurance pilot site doctors. This will enhance their skills and promote holistic and complete area at the primary care centre as far as it is clinical appropriate, and without compromising the patient’s or doctors’ safety.
Ramasia says that by creating a constructive and transparent partnership between the general practitioner, patient and medical scheme we will be able to monitor healthcare delivery collectively.
Sustainable healthcare system
This will encourage behaviour change will that will result in improved cost effectiveness, quality and clinical outcomes. “The general practitioner holds the key to the success of this strategy and we are therefore committed to fostering closer relationships with them and to provide support through relevant information sharing and effective peer management,” he concludes.
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