I enjoy being a GP. The breadth of skills and knowledge, the close and long-term relationships, and the opportunity to make a huge difference to so many people’s lives. I suspect most GPs enjoy these aspects of their work as well. And our patients appreciate it.
The problem?
This enjoyment is increasingly being undermined by a government that does not recognise or appreciate the value of general practice or preventative healthcare, with a resultant lack of investment and chronic underfunding. There seems to be an assumption that we can just keep doing more and more for less and less. The government contribution? Incentives to force bulk billing for everyone.
Add to this the various groups chipping away from the sidelines, fragmenting care and trying to remove any perceived “straightforward” consults (which are usually not that straightforward in reality) – and we have the recipe for declining morale, declining workforce, and non-viable practices.
These are issues that can be fixed, resulting in general practices being the “health hubs” of the future where most care is delivered and hospital presentations are minimised. Of course, this requires additional funding and some redesigning, but the cost would actually be low compared to the additional funding being directed to hospital care. If you have time, look at the outcomes achieved in Denmark with this approach – it was so effective they actually closed about half their hospitals.
The alternative is a decline in primary healthcare, increased costs, and the development of a two-tier health system where those who can afford it can access the longer consultations and complex care that is required nowadays; but those who can’t (often those who need it most) get the short consults that are all the bulk-billed funding will allow. They will then have to rely on the urgent care centre at $290 per visit, or the even more expensive hospital system, to pick up the pieces. More cost for worse outcomes.
This kind of inequity runs against what I see as the Government’s own Labor principles, and is more expensive for worse outcomes.
The solution?
Fundamentally, it has to involve a revamp of the MBS to properly value long consults, and not penalise those who need them, or the doctors providing this complex care. And funding more nursing and allied health within general practices to deliver true team-based, effective primary healthcare. Our practices should be the “hospitals of the future” where the vast bulk of healthcare is delivered.
