93205 Health and Society: Primary Health Care Report.

Primary Health Care Service: General Practice - The Mosman Practice.

Criteria 1: Service Profile

The Mosman Practice is a local GP clinic in which individuals receive initial healthcare in the
form of treatment, prevention, or intervention. With 83% of individuals having consulted
with a GP at least once in the past 12 months (ABS, 2016), GPs have the important role of
providing holistic care encompassing all aspects of health to treat and discuss personal health
issues and if needed, be able to refer individuals to medical specialists for further treatment
(NHS 2020).

Within this service, a multidisciplinary team (MDT) of healthcare professionals work

together to provide holistic care. This includes:
 The GP: doctor qualified in general medical practice.
 Nurses
 Midwives
 Pharmacists
 Physician associates
 Health visitors
 Elderly specialists

The Mosman Practice is a general practice located at the address; 393 Military Rd, Mosman
NSW 2088. Its location is central to the suburb of Mosman, and easily accessible to
surrounding local areas. In this way, it attracts a wide audience and demographic, however,
mostly accounts for families and the elderly, seen in the practitioners and treatments
provided, along with location as 20 schools are in the surrounding area.

Criteria 2: Accessibility:
GP services are provided through small practices in which remuneration comes from fees-for-
service, consisting of Commonwealth rebates and patient co-payments. Remuneration also
comes from Practice Incentive Payments (PIP) for GPs who succeed in the management of
asthma, diabetes, cervical screening, and indigenous health. Most funding for GPs comes

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93205 Health and Society: Primary Health Care Report.

from the federal government.

Through the Commonwealth
Medicare Benefits Schedule, patients
are eligible for a rebate. The
Mosman Practice, however, operates
on Private Billing, in which patients
pay at their own expense. As such,
the affordability of the service is a potential limitation to access as patients need to be able to
pay upfront for the consultation. As seen in the figure 1, the out-of-pocket expense is greater
than the Medicare rebate, and as such, could hinder those of a lower socioeconomic
background from utilising this service with around 4 per cent of Australians delay visiting a
GP because of cost (Sweriseen & Duckett, 2018). Further, private health insurance is
prohibited by law from funding any primary medical care, which includes GPs. So, any gap
fee if Medicare doesn’t cover the service cost in full is required to be paid by the patient.

This service is available to anyone, regardless of social or economic status. The Mosman
Practice “caters to the needs of all your family” (The Mosman Practice, n.d., para. 1), with
the main services being listed below.
 Adult and child immunisations
 Aged care and senior health
 Antenatal care
 Chronic Disease Management
 Mental health
 Skin cancer
 Travel medicine
 Weight management
 Women’s health

These services can be accessed in person at the practice. The website is user-friendly and
easily accessible with concise and categorised information, showing phone number and a link
to book online on each page, along with opening times. Bookings are available and
encouraged and can be accessed through the website or made by phone. During the week,

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93205 Health and Society: Primary Health Care Report.

walk ins are discouraged, however no appointments are necessary on Saturday afternoons,
Sunday, or public holidays.

This service does provide support to those living in challenged circumstances providing
translators, ways to reach care after hours, and the option for home visits at the discretion of
the GP. The clinic itself caters for patients with physical impairments through ramps and lifts.
Despite the set fees, the practice encourages discussion of financial situation with the GP as
reduced fees are available to regular patients in financial need.

Criteria 3: Health Promotion:

Health promotion is about equipping patients with the knowledge and resources to stay
healthy. As such, GPs have a vital role in nursing health promotion, with the potential to
improve health outcomes for the community, in turn, reducing health expenditure. The
Mosman Practice enables individuals to gain autonomy over their personal health. Improved
investment in general practice will aid in keeping the community safe and healthy, keep
healthcare costs low, and ensure sustainable, effective, efficient and equitable distribution of
resources (RACGP, 2021).

A general practitioner has the scope to drastically improve and impact a patient’s life and
wellbeing. Their nature of work encompasses looking after the physical, emotional, social,
spiritual, cultural, and economic aspects of the patient’s life to improve physical and mental
health. GPs must be a tune to all health issues, with the knowledge of when to refer patients if
needed.

In considering the overall disease burden in Australia, priority areas are identified in which
general practices can target resources in the prevention and intervention. With 38% of disease
burden in 2018 being preventable and due to modifiable risk factors, GPs – as the first point
of contact with the health system – have an important role in educating patients about risks
and changes needed to reverse impacts (AIHW, 2019). Risk factors contributing the most
burden was tobacco use and obesity, both of which are modifiable. This is where GPs come
in, advocating for change in the patients’ behaviours, enabling this change to occur through
advice, assistance and support, and mediating between sectors to reach a lower rate of

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93205 Health and Society: Primary Health Care Report.

preventable health issues (Saan & Wise, 2011). The Mosman Practice identifies obesity and
chronic illnesses as an area of concern. In their advocation for chronic disease management,
they are improving the health outcomes of patients and aiding the reduction of total burden
rates, through the strategies of health promotion as determined by the Ottawa Charter.

North Sydney was the first Sydney council to ban smoking (both cigarettes and vaping) in
2019. This demonstrates strategies for health promotion as advocating and enabling the need
for change from health professionals such as GPs, prompted mediation across sectors in
which government and council intervened. With health professionals publicly supporting the
proposal, it is clear how health practitioners impact the community in a positive way,
improving the environment of patients. GPs understand the priority areas and through
understanding Ottawa Charter framework, are able to ensure beneficial health outcomes.

Although GPs have the scope to refer patients to other professionals, it has been found that
providing effective counselling to patients for issues such as smoking cessation, has higher
rates of quitting, compared to when a patient is referred to community resources (Tremblay et
al., 2001). Thus, the success of GPs is indefinite and irreplaceable, showing significant
positive outcomes on the community, ultimately impacting greater populations.

The Mosman Practice further promotes health outcomes through the use of technology, as the
practice has a social media presence on Facebook. On this page, they promote various issues
affecting the community and health alerts, such as need and availability of COVID-19
vaccinations. Visuals aid this communication, catering for all groups, including those
impaired in sight, speech and literacy levels. Direct interaction between community and
practice promotes a positive response in which values will align to unanimously support
health improvements.

Criteria 4: Service Collaboration:

As stated previously, GPs work in correspondence with a large MDT, consisting of many
health professionals. However, external to this, GPs often work with other healthcare
professionals such as midwives or mental health professionals.

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93205 Health and Society: Primary Health Care Report.

Mental health illnesses are on the rise in the younger age groups in Mosman, with the age in
which mental health issues are first reported getting younger in addition to the severity. 15.5
in 100 people aged 15 and older report mental and behavioural problems, while 7.5 in 100
people aged 18 years and older report very high psychological distress in the Mosman local
government area (SNHN, 2020). The collaboration of GPs at the Mosman Practice with
specialised mental health professionals aims to decrease this ever-rising statistic. The lack of
communication between GPs and mental health professionals creates additional problems and
psychological stress for the patient (Friedman et al., 2011). The Mosman Practice is
incorporating mental health professionals into care when required to address patients’ needs
more appropriately. Further, the promotion of youth mental health speciality services such as
Headspace and the Butterfly foundation equips adolescents with more resources to combat
the issue. By promoting these platforms on social media used by the demographic targeted,
further ensures the efficacy of collaboration.

Criteria 5: Social Determinants of Health (SDH):

In relation to this service, the social determinants of health are extremely relevant as GPs
have the opportunity to better support patients faced with social challenges. This can be done
through simply asking about their circumstance and looking through patient history. In
acknowledging factors of health inequity, access to and quality of healthcare services can be
improved to better accommodate vulnerable populations in Australia.

With low socioeconomic position linked to higher GP utilisation than those of high
socioeconomic position who favour health care specialists (Fjær, 2017), it becomes evident
that the social gradient in society results in high expenditure of GP use in those with a low
socioeconomic background, due to the financial aid given through schemes such as Medicare.
As such, services covered by Medicare – including GPs – must increase services provided to
ensure equity of access to resources for those facing challenges in circumstance.

While there is no single definition of the SDH, the WHO suggested that SDH includes
socioeconomic position, early life, social exclusion, work, unemployment, social support,
addiction, education, disability, living environment, food, and transportation (AIHW, 2020).
Social exclusion is forefront in Australia, as a continuous and ongoing repercussion from

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93205 Health and Society: Primary Health Care Report.

intergenerational trauma of systemic racism from colonisation, which now impacts

Indigenous Australians. The gap between non-Indigenous and indigenous Australians is clear
in health outcomes, with 28% of Indigenous adults being in good health, compared to that of
54% of non-Indigenous adults (AIHW, 2020). In considering GP service, the physicians at
the Mosman Practice offer culturally safe services using patient navigators (which help
patients overcome potential barriers to treatment) and ensure that care is accessible. While
only 0.3% of the population in Mosman LGA identifies as Aboriginal and Torres Strait
Islander, the practice promotes inclusivity and ensures upholds equity of access by providing
this service. (SNHN, 2020).

Furthermore, this service lacks in some sectors of SDH, not catering for those affected by
addiction as well as it does for those in need of social support or early life. With 13 out of the
16 doctors at the Mosman Practice focusing on at least one of the following: family medicine,
Antenatal care or children’s health, it is evident that an importance is placed on early life in
comparison to that of addiction, with no professional specifically catering for that SDH area.
So, while this service has clearly impacted the SDH of early life, social exclusion, social
support, and socio-economic position through ability of financial aid (as stated in Criteria 2),
where it lacks becomes prominent in remaining aspects of SDH.

In addition, to help further the positive impact, practices need to become effective health
resources at a community level. This means not confining services to patients at the clinic,
but seeking out through the community, ways to reach more vulnerable individuals and
groups. Partnerships with community groups and leaders is a way to achieve this as engaging
other sectors (such as education) can create opportune healthier environments. For example,
introducing mental health prevention programs in schools provides students with the
resources to seek help themselves, and grows awareness of the issue among teachers and
parents. Focusing on ways the at-risk groups in this community can access help increases a
focus on social support and thus the health outcomes for said SDH.

References:

Student Number: 14267710 Name: Elizabeth McGrory

93205 Health and Society: Primary Health Care Report.

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93205 Health and Society: Primary Health Care Report.

Fredheim, T., Danbolt, L., Haavet, O., Kjønsberg, K., & Lien, L. (2011). Collaboration
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Student Number: 14267710 Name: Elizabeth McGrory