‘Devalued’ GPs rail against task substitution in Scope review

Michelle Wisbey

22/03/2024 4:50:29 PM

The role of general practice is oversimplified and the profession misunderstood, according to a scathing RACGP Scope of Practice submission.

Bandaid stuck onto cracked concrete.
The RACGP has warned a lack of focus on continuity of care will only weaken Australia’s healthcare foundations.

The RACGP has unleashed a long list of fears, frustrations, and fury about the future direction of Australian healthcare, warning there will be ‘costly outcomes’ for patients, budgets, and the health system if continuity of care is not prioritised.
In response to the second round of consultation for the Commonwealth’s Scope of Practice Review, the college voiced strong objections to the shape the report is taking, saying its purpose must go beyond simple task substitution.
It also reiterated that primary care is much more than an initial entry point, and said the current review places a disproportionate emphasis on first contact access and an oversimplification of general practice.
‘There is a serious likelihood of wasted financial resources and recommendations that will have very costly outcomes for patients, the health system and the health budget,’ the submission states.
‘More specifically for GPs, the perceived devaluing of the specialised training required for general practice will impact on morale and GP workforce attraction and retention.’
According to the college, the review has likewise overlooked evidence related to the benefits of continuous and coordinated care, raising significant concerns that general practice is being viewed as a barrier rather than a solution.
RACGP President Dr Nicole Higgins said the submission reflects a feeling of anger among many of the college’s 40,000 GPs over the current state of healthcare and the reputation of the profession.
‘The work and the role of GPs has been devalued down to tasks, and it feels like everyone wants to become a doctor without going through the rigours of medical school,’ she told newsGP.
‘GPs’ medical training differs from nursing and pharmacy training, so we’re trained to work differently and while sometimes we might have shared tasks, we approach them differently.
‘GPs have been taught clinical reasoning and critical thinking and, yes, we have some shared tasks, but whole people don’t come in bits that can be picked off as a task.’
With all areas of the healthcare workforce struggling for numbers, the review was a priority recommendation of the Strengthening Medicare Taskforce Report, aimed at allowing health professionals to work to their full potential, while emphasising the need for multidisciplinary teams.
Its initial Issues Paper, released earlier this year, also clearly expressed the need for a different funding model and better coordination between specialties.
But Dr Higgins said the current societal views of GPs are ‘devaluing who we are and what we do’, and it is having detrimental impacts on professional morale.
‘We’re fighting for the future of general practice,’ she said.
‘When we’re trying to encourage medical students to become GPs, the message that’s being sent by governments to our young doctors is working against us.
‘I want to assure members that there is a lot of work happening in the background to make sure that general practice and our profession is valued.’
While acknowledging that Australia already has one of the top health systems in the world, the RACGP submission outlines several reform priority areas which would allow GPs and practice teams to work to the top of their scope.
First, it says pharmacy location and ownership rules must be reviewed to allow dispensaries within general practice, and that GPs should be allowed to dispense medication.
Second, it recommends that ‘artificial restrictions’ placed on MBS item descriptors and PBS restrictions must be removed, as they ‘unnecessarily curtail’ GPs.
Its other key reform recommendations include:

  • harmonising legislation across jurisdictions to reduce administrative burden and streamline processes
  • recognising GPs as specialists with agencies such as Centrelink, workers compensation bodies, the Department of Veterans’ Affairs, and the National Disability Insurance Agency
  • enabling broader general practice teams to deliver more independent practice
  • recognising GPs’ advanced skills through structured training
  • exploring innovative models of employment to increase the GP workforce
  • increasing funding to support interdisciplinary and multidisciplinary care
  • improving the user experience of current ‘clunky’ electronic medical record software.
The consultation paper also warns about the Review’s current investigation into health systems in the UK and Canada, saying they could be a ‘cautionary tale’.
It warns they are all facing their own GP workforce crises, despite a decade of attempting role or task substitution through nurse and pharmacist prescribing.
Last year, a UK Pulse survey revealed 45% of full-time GPs aged 30–50 years old were considering reducing their hours.
A second survey found that 21% of UK doctors who had indicated they were likely to leave the profession had contacted a recruiter, while 14% had applied for a role abroad – with Australia being the preferred destination.
‘Our health system is in the top three in the world, and we will not let this become a basket case,’ Dr Higgins said.
‘The NHS has not only created GP refugees, but also now health refugees as people from the UK flee their health system.’
The review’s final report and implementation plan is due to be handed to the Department of Health and Aged Care in October.
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Dr Gal Strasberg   23/03/2024 7:13:29 AM

View profile for Dr Gal Strasberg
Dr Gal Strasberg
Rural General Practitioner FRACGP MBBS BAppSc. Passionate about point-of-care technologies and improving the patient experience. Undertaking further training in Point-of-Care Ultrasound (POCUS) and use of AI in health.

12h Edited

GP colleagues, it's time for a change. Our profession has been decimated while our paper tiger representative bodies do little to improve the situation. Many of us clearly recognise the lamentable quisling figures sabotaging the future of healthcare delivery in Australia.

Understanding how we got here is necessary in order to effect real change (a brief synopsis of our profession's demise is summarised in Steps 1-3). Will you support me in making a change? It is imperative that we fight for this, lest we find ourselves in a situation from which there is no escape - a fractured, dysfunctional healthcare system that produces mediocre patient outcomes without generating the expected savings.

Step 1: Vilify
- Undermine public trust in the medical profession by creating a false narrative in the media through coordinated and persistent attention to stories like "Cosmetic Cowboys," "Billions in Medicare Rorting," and other sensational, inaccurate headlines
- Discredit and scandalize specific medical professionals in an effort to further the previously stated objective and create a false, misplaced moral panic

Step 2: Divide (and conquer)
- Use lobby groups and stakeholder organisations as weapons to sow division among medical and allied health professionals
- Encourage allied health professionals, such as pharmacists and nurses, to assume the role of GPs in the absence of the requisite training or experience (emboldened by professional organisations and lobby groups)
- Exploit compromised cognitive firewalls to advance a story about "increased scope of practice" and "better access," at the expense of the safe, high-quality care that GPs provide

Step 3: Nullify (and $ave)
- Normalise a culture in which non-medical personnel provide medical care to the general public
- Sustain the funding allocation for non-GP services as a top priority, discouraging medical graduates from pursuing general practice (which exacerbates the problem and appears to defend healthcare rendered by non-medically trained individuals)
- Save billions of dollars while persuading the public that better access is being provided at a lesser expense
- Observe the decline in GP numbers, which reinforces Steps 2 and 3
- Ignore the fact that these weekly articles do not translate to any meaningful action by GPs or their representative bodies (the most important piece of the puzzle)
- RACGP, AMA: Where are you? Who do you represent?

Dr Helena Andrea Smetana   23/03/2024 7:26:07 AM

I am from Canada and still have parents living there. My husband is from the UK with extended family living there. All of our overseas relatives marvel at how great our health system is compared to theirs. The stories are endless of people they know with delayed diagnoses resulting in late stage disease across breast . Colon cancers, and many others. Having to wait months and months to get worked up for a breast lump or rectal bleeding and then months and months to get seen by the surgeons is a common story. GPs are forced to watch system neglect. I would strongly caution against trying to emulate anything from either countries’ health system and would actually say we need to everything in our power avoid following their system and instead learn what NOT to do.

Dr Gideon Johannes Gouws   23/03/2024 7:43:41 AM

I'm surprised it has taken the profession so long to appreciate the significance of this review. Was it not the College who was bragging only a few weeks ago about "how well the GP submissions around the country were received"? Surely you must get where this is heading, and why.

Dr Brendan Sean Chaston   23/03/2024 8:18:31 AM

Although I appreciate the attempts of Dr Higgins to defend general practice I believe it’s all too late. The “nurse practitioner workforce plan” was published by the federal government on the 15/5/23. RACGP were obviously aware of its content and yet are reacting now when the legislation is tabled. The Assistant Health minister “Ged Kearney” who appears to be championing the legislation was previously a nurse, then nursing union official then trade unionist. It was obvious where this was headed in the context of ‘scope of practice review’.

Motherhood statements and fluffy rhetoric mean nothing to a trade unionist. Industrial action is their language.

Dr RS   23/03/2024 8:46:47 PM

All I have to say to my Fellow GPs who are outraged at the devaluation of GPs( by the way - this task substitution is not unique to GPs- the powers behind this are trying to do the same to specialists as well)- It’s the Law of the Jungle You have no Friends or anyone remotely interested in the political and government circles looking to preserve or promote good general practice and supporting appropriate remuneration for that task. My advice- provide the best care to patients, get them on side and private fees, stay away from the traps like my medicare/ capitation etc( except when you are happy to live off and be controlled by Government payments) With a dwindling GP base and an increase in “other” medical practitioners, patients will go to whoever provides the best care and is most qualified.

Dr Peter James Strickland   24/03/2024 7:51:49 PM

I know of specialists (now) who started out as GPs, and found it too demanding physically and mentally thinking over a broad range of medical practice. I can remember a 10 yr old very short child with obvious signs of cretinism, and who had been missed for years by paediatricians --she was placed on a restricted diet to lose weight, but fortunately was not badly affected intellectually. I diagnosed her, placed her on thyroxine, and she grew inches in months. The mother insisted on seeing a paed. endocrinologist, and who congratulated me, wrote her up, and charged 3 times the amount I had done on the consultations! GPs are undervalued, and everyone in life has their genius, and remember different things well --I remember the picture in my 3rd medicine textbooks! We have to avoid weak representation, and that necessitates direct statements and decisions with governments about the importance of GPs for the community ---and their political survival if they fail to listen!

Dr Abdul Ahad Khan   24/03/2024 9:03:14 PM

Unlike the AMA, the RACGP is funded by the Govt.
Dr. Higgins & her Team are very Handsomely Paid by the Govt.

So, the RACGP is a Toothless Tiger - they are all Talk - they love their Talkfests.

A fresh MBBS Graduate is made to go through Hurdles after Hurdles, before he / she is deemed by the RACGP to be Safe enough to let loose on the Populace unsupervised.
On the other hand, NON-MBBSs are encouraged to function as a Defacto GPs & the RACGP keeps SILENT.

The RACGP will be like the AMA , an Organisation not hesitant to stand up to the Govt., only when it cuts free from their Paymaster - only then will they be able to stand up for GPs.


Dr Dannielle Maria Kolos   25/03/2024 10:16:10 AM

If an organisation has to fight so hard,for jts existence, then it is not appreciated by the public. Time to create an alternative?

Dr Abdul Ahad Khan   25/03/2024 7:44:30 PM

Dr. Strasberg, you state this :
" GP colleagues, it's time for a change. Our profession has been decimated while our paper tiger representative bodies do little to improve the situation. "

I totally agree that a CHANGE is needed.
I believe that so long as the Paymaster of the RACGP is the Govt. no CHANGE is possible.
Kindly illuminate us, on the CHANGE that you have in your mind.


Dr Tieu Minh Tat   30/03/2024 12:37:44 PM

Dr Gal Strasberg, thank you for your comments.
I can't agree more about your comments.
We need someone to represent for the GP benefit, just purely the GP well being, not about their level of qualifications or how they run their practice or how they manage their patients.
If any chemists or Mr Jo Blo in the chemist can treat patients, why do we still need the RACGP sky high standard, we should all disband the RACGP because the government can do anything they want, at least it looks like that anyway.
Someone needs to organize a strike for the sake of the GP, the new medical graduate future and the health of the patients/ nation.
For now we can forget about the RACGP & AMA, they are only worry about their organization benefit. They are giving more work/ requirements to the GP than benefit.