Deadlines are looming for consultations/feedback on a range of Taskforce reports issued as part of the Medicare Benefits Schedule (MBS) Review.
The review is considering how the more than 5,700 MBS items can be better aligned with clinical evidence and practice, and improve health outcomes for patients, and also identifying whether there are any services that are obsolete, outdated or potentially unsafe.
In this post below, one in a mini-series on MBS Review reports, GP and health academic Dr Penny Abbott draws on the evidence and compelling personal insights to back the Review’s current recommendation for better GP supports for people when they leave prison. She urges others to respond on the issue by 1 March 2019.
Penny Abbott writes:
The MBS Review Taskforce has recommended that people leaving prison be eligible for GP health assessments, and is currently open for feedback: http://www.health.gov.au/internet/main/publishing.nsf/Content/MBSR-open-consult
This is a very welcome acknowledgement that release from prison is a crucial health transition time, when people are highly vulnerable to poor continuity of care and deterioration in their health and wellbeing.
General practice is at the coal face here. Most people leaving prison have substantial health and social needs and will seek care from a GP within the first month after release.
It is an ethical and societal health imperative to make the most of this opportunity. Good health care can support the wellbeing of people as they seek to re-integrate into the community and break the cycle of repeated incarcerations for people who mainly need social support and health care.
I have worked as a GP in the community and the prison health sector for many years. I know how important it is to engage people in skilled GP care on leaving prison, and also how this engagement commonly fails. Time pressure is an important contributor to a lack of relationship-building and holistic GP care during critical post release consultations.
“She preferred not to tell her GP she’d been in prison”
I think of one young woman, Nicki, who I saw ahead of her release regarding the health care she would need on release.
She would have benefited from a post-release health assessment after her three months in custody.
We had investigated some of her health issues, commenced treatment of her depression and had done the work-up so she was ready to start Hepatitis C treatment.
She expressed concerns about how she could maintain her health after release and was worried particularly about her mental health.
However, she told me there was no point in writing a medical summary to give to a GP when she left prison, even though she was going to a new town and didn’t know anyone there. She explained a GP wouldn’t believe anything on it because “it had to do with crims”.
In fact she preferred not to mention she had even been in prison, because it would start her relationship with a GP off on the wrong foot. She intended all the investigations we had done to be repeated in the community.
Unfortunately, her previous experience with community GPs after leaving prison had been poor. She felt she had been brushed off and that there was an assumption she was drug seeking rather than a person with legitimate health concerns.
I asked her how things could be different and she told me GPs should be paid more to provide longer consultations for people leaving prison – pre-empting the MBS review by a couple of years!
She explained that she always felt like she was taking too much time:
“Maybe if they can talk to you, maybe the things that they say to you can help you… you might be thinking you – you don’t feel good, you feel down. Maybe if they had a talk to you, and then told you to leave, or whatever, maybe that could stop you from hurting yourself.”
Currently the connection between people leaving prison and GPs is suboptimal.
Experiencing ‘medical homelessness’
GPs can feel overwhelmed by the many health and social needs of people seeking to re-establish their lives and their health care on leaving prison.
Health linkage programs at prison health services can find it hard to engage GPs when trying to organise seamless post release care for their patients.
Health assessments have been used with effect in the Aboriginal and Torres Strait Islander communities, and allow GPs to engage with people with multiple risk factors and health needs in a proactive, preventative approach.
The assessments also facilitate whole practice care, actively encouraging practice nurses and Aboriginal health workers to contribute to the assessment.
Most people in prison in Australia do not access the health care they need in prison or in the community. This is despite their poor health, related as it is to the social determinants of health. Through cycles of imprisonment, stigma, broken linkages with healthcare providers, siloing of health care within the prison and community health systems and lack of supportive systems in general practice to manage addictions, there is poor access to health care for people who become involved in the justice system.
In this era of patient-centred medical homes they experience medical homelessness.
I am greatly encouraged by the MBS Review’s recommendation to engage people leaving prison in GP Health Assessments after release. If you also support this I encourage you to make a submission to the consultation call so this becomes a reality.
The MBS Review open consultation will close on 1 March 2019.
Dr Penny Abbott is a GP who works as a Senior Lecturer at the Department of General Practice, Western Sydney University, and as a clinician with the Justice Health & Forensic Mental Health Network. She has also worked within the Aboriginal community-controlled health sector for over 20 years.