Good primary care is vital for good health. But Australian primary care is failing in one crucial area: the prevention and management of chronic disease.

Australia’s health system was designed to deal with infectious disease, wars and accidents. But the most significant burden on the health system today is chronic disease. Three quarters of Australians over the age of 65 have at least one chronic condition that puts them at risk of serious complications and premature death.

Each year the government spends at least $1 billion on planning, coordinating and reviewing chronic disease management and encouraging good practice in primary care. Yet each year there are more than a quarter of a million hospital admissions for health problems that potentially could have been prevented by better primary care for chronic disease.

Primary care services are not working anywhere near as well as they should because the way we pay for and organise them through Medicare goes against what we know works.

At best our primary care system only provides half the recommended care it should for chronic conditions. Often it is much less. For example, nearly a million Australians have been diagnosed with diabetes, but only about a quarter get the care that is recommended each year.

Ineffective management of chronic conditions in primary care leads to worse health outcomes and higher costs.

Grattan Institute 2016

Some estimates suggest the cost of potentially preventable hospital admissions from chronic disease is $2 billion each year. Even if we use the more realistic estimates developed for this report, the costs are $322 million per year. And of course, Australians would be in better health.

Social, economic and environmental changes are the best way to prevent chronic conditions. But where good quality primary care services are in place, the outcomes are much better.

Prevention and management of chronic disease in primary care is not easy. It requires sustained effort by people with chronic conditions working in partnership with a team of health professionals. The role of GPs is vital. Care must be planned rather than reactive; it must focus on the patient, rather than on health professionals, and it must focus on outcomes.

We need more effective regional management of primary care services by Primary Health Networks. We need clear targets and financial incentives for the prevention and management of chronic disease in regional areas. The focus of chronic disease funding needs to move away from a patient-related payment to a general practice and towards a broader payment for integrated care.

The evidence shows that a consistent approach to clinical care pathways for specific chronic diseases can make a real difference to outcomes. And for that, we need much greater investment in supporting service development and innovation in primary care. Read the full report