The cracks have been exposed – here’s how we can mend them

Karen Price

30/11/2020 3:58:01 PM

New RACGP President Dr Karen Price writes exclusively for newsGP on the future of general practice and how everyone has a role to play in creating a stronger primary care system.

Dr Karen Price
RACGP President Dr Karen Price says areas of jurisdictional blindness when it comes to primary care are holding back the health of the entire nation.

Healthcare costs in Australia have more than doubled since the turn of the century, with total spending now reaching almost $200 billion each year.
We have invested massively in healthcare as a nation, but I would argue we have not always done it in the most intelligent way.
For too long primary care has been pushed aside in favour of flashy announcements and commercial interests at the expense of holistic care, patient outcomes and value for money.
The metaphor is build your health system on a solid foundation like general practice, otherwise everything else becomes structurally unsound. Fragmentation, commercialisation and increasing costs result from poor investment in the foundational elements of a house or, in this case, a health system.
While we know these structural funding inequities have been widening for some time, COVID and the preceding Black Summer bushfire crisis mean they are now exposed for all to see. Too many times GPs have been left out of the loop, when the reality on the ground has seen people crying out for primary care.  
And we all have been feeling the strain – not just of 2020, but of decades of structural neglect and a lack of courage with health system reform.
In that time, major shifts in our society have not been met with innovative policies and approaches to match; we need a more modern workplace and, crucially, we need it to be funded properly.   
Child care, rural infrastructure investment, climate impacts, clusters of inequality, the levers of intersectional inequity and socio-economic determinants of health are all under political influence and need collective physician advocacy to progress our nation’s health.
Every dollar invested in primary care not only produces tangible health benefits for our patients, but reduces the costs of other more expensive services. For example, better utilised primary care could help prevent $3 billion of avoidable hospital admissions, while $1.5 billion in emergency presentations could be managed better in general practice
Australian GPs are highly trained medical professionals. We possess one of the best and most comprehensive educations in general practice across the entire planet, but without more support we won’t be able to fully return the benefits of that investment to the Australian people.
The evidence is on our side, and as President of Australia’s largest medical college I am going to prosecute that argument forcefully.
We need to encourage a new generation of medical students to choose general practice for all the right reasons, because it is a thriving sector of challenge and reward. It must have the resources to match.
Another area of reform that cannot be ignored is the dysfunction that exists between state/territory and federal governments. There are jurisdictional areas of blindness when it comes to primary care and it is holding back the health of the entire nation.
Bridging that divide will be one of my top priorities. Because as any good GPs knows, fragmentation – at any level – is anathema to high-quality clinical care.
Australia as a country is essentially its own complex care patient; there are multiple interventions and specialties required to keep it healthy but, as with any complex care patient, GPs must be central.
As such, we must also recognise the need to work collaboratively in an interdependent system. And just as we advocate for collaboration between specialties during patient care, we must take the same approach when arguing for systemic change.
It is my firm belief that teamwork and coordination drive outcomes. Expertise lies within the community and not with any individual ‘superheroes’.
No single profession or discipline is better than the other, they are complimentary. And to work together better, we have to have a view of a holistic system, rather than just the four walls of our own paradigms behind which we sit and argue.
The art of dialogue in this instance is a rare skill that needs continuing development.

Dr Price believes that, as in the the Japanese art of kintsugi or kintsukuroi, it is not only possible to repair the cracks in general practice, but to make it stronger for the future.

Taking a collaborative approach and bringing everyone along for the ride will be vital if we want to continue to see meaningful change in the healthcare space. That is how we are going to be able to voice our strength, as a community working to deliver outcomes over time – just as general practice has always done.
But this means we must also recognise that perfect is the enemy of good, because in a world of vested interests, competing priorities and limited resources, Australian general practice is still doing an incredible job under significant pressure. We must therefore concentrate on targeted advocacy and be careful to avoid change for change’s sake.
Teamwork will lead us forward. I do not pretend to have all the answers, but I am sure to know a GP who does.
I already have a great network and team coming along this next two years with me. I know there are times when compromise will be necessary; however, I vow to always have your best interests at heart.
I am first and foremost a GP. A GP first, with a community-first approach, has always been my mantra.
I strongly believe that we must also accept the lessons and mistakes of the past, and use them to inform and strengthen our future rather than sweep them under the rug.
One of our colleagues, Associate Professor Janice Bell, often talks about kintsugi or kintsukuroi, the Japanese art of repairing broken pottery by mending the areas of breakage with lacquer dusted or mixed with powdered gold, silver, or platinum.
As a philosophy, it treats breakage and repair as part of the history of an object, rather than something to disguise, and the use of powdered gold means once repaired it is stronger than ever.
Acknowledging our flaws and transforming current vulnerabilities into new areas of strength is the way we will move forward together. 
The RACGP is our medical college and like all other medical colleges our history is long and important to remember. Our best times are when we act together with common purpose for the common good, knowing everything is ultimately for our patients’ care.  
We must recognise that our differences – like all diversity, including that of country of origin, geography, ideas, gender or practice style – is a strength. Professional values can hold us through the rough times, and clinical leadership and GP leadership is vital to our college.
In the meantime, I have extraordinary faith in the RACGP’s community of members, and our ability to rise above the difficulties of this year and continue to deliver a high level of care, regardless of what more may come. 
Next year will be a great time to rebuild our communities and to declare that general practice is here for the long haul. Now is the time to confidently demand on behalf of our patients the resources to do that properly and fully commensurate with our world-class training.
‘Ring the bells that can still ring. Forget your perfect offering. There is a crack in everything. That is how the light gets in.’
          – Leonard Cohen, Anthem
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Dr Magdalena Simonis   1/12/2020 8:15:26 AM

Beautifully said Karen. We look forward to working with you and the college and to bringing the government’s attention to the strength and efficacy of GPs, who are at the centre and heart of the primary care system.

Dr Elysia Thornton-Benko   1/12/2020 8:46:32 AM

Great article Dr Karen Price.
Looking forward to your leadership.

Dr Irandani Anandi Ranasinghe-Markus   1/12/2020 10:19:13 AM

Congratulations Karen Price on your appointment to the role of presidency of our college. Look forward to working with you to make Primary Care the core of our nation’s health. Applaude your philosophy and vision! Wishing you the best as you step in to the role!

Dr Kodikkakathu Saratchandran   1/12/2020 11:39:08 AM

We can trumpet ourselves to be important and indispensable but the public attitude and the Governments' attitude do not concur with it! We are seen as and treated as 'just GPs' and perhaps many GPs feel the same way. Hope that my colleagues don’t take offense of me saying so! The College can do a lot in up-skilling GPs in different areas of medicine and certify them as Specially trained GPs in the areas they have taken the training. Then in a GP collective the patients can be cross referred to those GPs , A higher reward needs to be sought from the Government for those GPS. This will improve the patient perception of GPs and many cases, now referred to specialists, can be managed in house by the GPs. The self-perception of the GPs will alter as well. You can see such sub specialization with Specialists and Nurses and we have to take the clue from there.

Dr John North, OAM   1/12/2020 4:21:23 PM

Like your determination, congratulations and good luck.

Dr Christo Karuna   1/12/2020 5:27:12 PM

Your article is inspiring, Karen. General practice is the bedrock of the health care system and needs to be strengthened, especially post-covid-19, to improve our health.

Dr Raymond Yeow   1/12/2020 11:31:21 PM

Dear Karen,
I would pose the question that if were to design Australia's health system today from a Blank sheet of paper ....that the system would look very different from what it looks like today. Roles and tasks may very well be bundled into different role packages. GPs as they exist today may not even exist as a role in this new health system.
Hence any changes made now would merely be making running repairs to a faulty/flawed system.
".....need to encourage a new generation of medical students to choose general practice for all the right reasons,..."
I saw a comment by Dr Kamerman on FB saying that only 18pc of Australian Med Grads are going into GP there is a lot of work to do on this front.
Best of luck to all of us ...

Dr Arnold Dela Cruz   2/12/2020 1:05:43 PM

Great that the problems confronting general practice are being looked at and that with your leadership and your team as well as the rest of us, the members of the RACGP, we shall be able to get on top of these - one by one , step by step. Assertive yet cautious and patient, standing our ground yet tactful enough, up to date yet know our limitations. We all should work together as one. We may not all agree on certain stuff but things can be done. We need to remember that the strength of a team is only as strong as its weakest link.