Prevention: The heart of general practice, not an optional extra

In 2025, the RACGP Health of the Nation report highlights, once again, preventive care as a cornerstone of Australian general practice.
 
Yet earlier this year, a BMJ paper argued the opposite: that given the current demands on our profession, GPs shouldn’t be ‘tied up’ doing prevention, including prescribing statins, but rather should focus our limited time and resources on seeing only those who are acutely unwell.
 
With a catchy title and flashy diagram, this article gained considerable traction and reactions among the usually measured GP public health community.
 
As our RACGP Specific Interests Public Health channels asked, were the authors really arguing that as our health system strains under immense growth of chronic disease, we should stop trying to prevent illness and its complications, and instead park our GP ambulances on the growing ramp at the bottom of the cliff?
 
To us, as public health-oriented GPs, the answer is an unequivocal no.
 
It’s not breaking news that GPs are under immense time and resource pressure.
 
The solution is not to do less prevention – suggesting otherwise is a substantial misunderstanding of both the value of prevention, and the value of general practice. 
 
Not only do GPs deliver preventive care activities, evidence demonstrates that we are extremely good at them.
 
Having an established relationship with a primary care provider is associated with increased uptake of preventive health measures.
 
The vast majority of childhood vaccinations in Australia are delivered via general practice, as is cervical screening and cardiovascular risk assessment. 
 
We know that behavioural interventions in primary care settings lead to, among other things, reductions in smoking and improvements in physical activity.
 
Working effectively with our patients to keep them well is a true test of the strength of a longitudinal relationship with a trusted GP.
 
Rarely do people book in to discuss staying well, but we must seize opportunistic windows alongside acute care delivery in order to treat the whole person in front of us. 
 
That is the crux of the matter.
 
How can you treat a patient’s acute gastroesophageal reflux without counselling them on weight reduction and alcohol intake, both of which will reduce their overall risk of future cardiovascular disease?
 
How can you not recommend appropriate travel vaccines when a patient presents for their repeat antidepressant script and casually mentions they’re heading to Tanzania for the next three months?
 
Trusting long-term clinical relationships are the foundation of difficult conversations about behaviour change, risk management and wellbeing.
 
The question therefore is not whether we should integrate prevention into general practice, but how to do this most effectively. 
 
There is a body of literature on how to integrate preventive health more systematically in general practice, but acknowledgement of the time and skill required and access to enabling allied health services would all be a good starting point.
 
It is no surprise that the Health of the Nation report found 99% of GPs offered preventive services, and 84% of respondents wanted to offer more.
 
This reflects our belief that prevention is not only impossible to separate from general practice, but our expertise in this should be a source of pride and professional satisfaction.
 
After all, it’s generally more effective, both from a cost and a human suffering point of view, to put a fence at the edge of the cliff than to keep adding ambulances to the bottom.
 
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general practice care health of the nation preventive care public health