Big picture critical in general practice reform: RACGP President

Imagine, for a moment, what general practice could be. If you are reading these words, the chances are you already have some idea of its current situation.
 
It is the heart of our healthcare system, its cost-efficient engine room, with nine in 10 Australians putting their trust in a GP every year – some of them many times over.
 
In 2021–22 that trend grew even stronger. More people than ever saw their GP, while general practices continued to do much of the heavy lifting against COVID-19 and its chronic aftermath, as well as deal with business as usual.
 
We also know that 2022 has been a year in which many general practices have struggled, both financially and on a deeper level. The toll, not just of the pandemic but of years of neglect, is surfacing more than ever before – so much so that the strain is repeatedly acknowledged at the highest level.
 
The work of GPs is extraordinary, but general practice needs help.
 
This is a time of year when many of us reflect as well as look ahead. It is also a moment when a grasp of the bigger picture in healthcare and the potential for meaningful reform has never been more important.
 
The change of government in May led to the Strengthening Medicare Taskforce to look at solutions to the chronic challenges facing primary care. We must do everything in our power to take this opportunity with both hands.
 
I have taken the college’s seat at the table in its most recent meetings, and soon the Taskforce will make its recommendations public. From there, cabinet will decide the way forward, with its direction likely to be reflected in the Budget next May.
 
Policymakers need to listen carefully to those of us who are in consulting rooms every day, hearing from patients first hand, as well as managing practices.
 
After all, imagine a system where holistic, patient-centred care is valued more than six-minute medicine; where preventive healthcare is seen as an investment, not a cost, and GPs are empowered to lead the treatment of the growing number of people with chronic diseases and mental health issues.
 
Imagine a general practice where the most critical relationship in healthcare, between a patient and their GP, is nurtured and encouraged by the system.
 
Imagine a world in which general practice is the aspiration of more and more of our brightest medical school graduates.
 
Imagine a country where access to excellent general practice healthcare is not dictated by postcode, but available equitably to every resident, whether in the inner suburbs of our cities, in regional towns or in Aboriginal communities in our remotest corners.
 
And imagine a society where the work of GPs is valued just as highly as other specialists, and the invisible power of primary care, which keeps so many people out of our over-stretched hospitals every year, is understood, recognised and encouraged by policymakers and politicians.
 
If I did not believe all of this was possible, I would not have put my hand up to be RACGP President.
 
But, as I said during my campaign, it is time for a reset.
 
GPs are tired of being undervalued, of being scapegoats – and, in some of the most distressing and inaccurate media coverage I have seen this year, even falsely accused of widespread dishonesty.
 
In the short time since I had the extraordinary honour and responsibility of becoming the RACGP President, I have realised misconceptions about general practice are more common than I realised – even in Parliament House.
 
Many in the corridors of power do not understand the fundamentals of what we do, and the challenges of managing a small business while looking after the health of the community.
 
We are working tirelessly to change that, and I promise to be in Canberra, adding my voice as a fierce supporter of the power of general practice, whenever I can – just like my predecessor, Adjunct Professor Karen Price, in whose fearless footsteps I follow.
 
Every journey must start somewhere, and an important step this year was the formation of the Parliamentary Friends of General Practice. It is co-chaired by GP-turned independent MP Dr Sophie Scamps, former emergency room doctor and Labor MP Dr Gordon Reid, and National Party Senator Susan McDonald in a refreshing show of non-partisanship.
 
Its first meeting was followed by an extraordinary awareness campaign, with GPs and RACGP advocates speaking to more than a third of Parliamentarians about the role of general practice.
 
Already I have seen the power of carefully directed advocacy, and welcome AHPRA’s recent decision to reduce red tape for international medical graduates (IMGs). We hope that will smooth the way for more IMGs to work here, and we will continue to lobby for more support on the ground once they arrive.
 
If there is one certainty for next year, it is that 2023 will be full of change. Within the RACGP, we are returning to profession-led training from February, and I am excited to be involved in this transition. It is a massive undertaking and there will be inevitable bumps in the road, but together I am sure we will make it work.
 
There are also significant policy debates ahead.
 
While I agree with parts of the recent Grattan Report, I am deeply concerned about its support for capitation and its naïve assessment of the general practice workforce situation. It looks to the NHS/UK model and would risk bringing a system to Australia that trades off continuity for access. A recent House of Commons report showed only too well the state of crisis that can cause.
 
As a Mackay-based GP, I have also had deep concerns about the power and influence of the pharmacy lobby for some time, with vested commercial interests competing against clinical common sense. Now it is not just in Queensland but also spreading to other states.
 
We will continue our careful scrutiny of these programs, and I urge all members to express their concerns to their local MP and make our voices heard.
 
Even with these challenges, I am optimistic about what lies ahead.
 
It is a feeling boosted by an incredibly positive and unified GP22 conference in November, as well as the inspiring work of GPs around the country, which the college’s recent annual awards acknowledged. Their stories are worth reading.
 
It was also a reminder that the college has 40,000 members and our voice is loud.
 
Thank you for your efforts in 2022 – they have not gone unnoticed.
 
Together, we will fight for general practice to be everything we know it can be.
 
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Dr Nicole Higgins Medicare RACGP President