General practice wait times ‘longer than acceptable’ for almost one in five Australians

Anastasia Tsirtsakis

12/11/2020 4:23:53 PM

While most people rate their health and GP experiences positively, accessibility continues to vary depending on where they live, according to a new report.

Doctor marking his calendar.
Almost one in five survey respondents felt they waited longer than acceptable to get an appointment with a GP.

The findings are from the Australian Institute of Health and Welfare’s latest report on patient experiences in 2018–19, based on different Primary Health Network (PHN) areas.
The report found that 83.2% of Australians had seen a GP and overwhelmingly reported positive experiences, with more than nine in 10 patients stating their GP always or often listened carefully, showed respect and spent enough time with them.
Accessibility, however, did not rate as well.
More than one in 10 (12.3%) adults who needed to see a GP did not do so, most commonly in Western Sydney (21.7%), the Nepean Blue Mountains (20.6%), Tasmania (18.5%), South Western Sydney (16.5%) and South Eastern NSW (16.3%).
Less than one in 20 (3.5%) adults delayed or did not seen their doctor due to cost, ranging from 2% in Central and Eastern Sydney to 8.7% in Tasmania.
Almost one in five (18.8%) felt they waited longer than acceptable to get an appointment with a GP, and was often the case in PHNs in NSW, with 31.3% in the Nepean Blue Mountains, 27.6% in Western Sydney, Murrumbidgee (25.8%) and South Western Sydney (24.5%).
Accessibility, in most cases, proved to have a direct correlation with PHN areas that have a higher prevalence of chronic disease, such as the Nepean Blue Mountains (60%), Tasmania (61%), and South Eastern NSW (62%).
Chair of RACGP NSW&ACT Associate Professor Charlotte Hespe, a GP and Head of General Practice and General Practice Research at the University of Notre Dame, told newsGP that data is not surprising.
‘It is across those areas we know we have issues that need to be addressed in general practice, which is one of the things that I’ve been concerned with for a long time,’ she said.
‘The Nepean Blue Mountains, for instance, it’s not that far from Sydney, but there’s not very many GPs there.
‘I know from patients of mine who’ve moved to the Blue Mountains that most of the GPs’ books are closed. So a lot of my patients continue to come back into Sydney to see me in the inner city.
‘So the demand out there is a lot more than your number of GPs, and that’s the same with Western New South Wales and Murrumbidgee.’
Associate Professor Hespe believes the data is reflective of the core issues faced by general practice regarding lack of funding and incentives.
The latest AIHW report on national health expenditure showed Federal Government funding dropped from $10.7 billion in 2017–18, to $10 billion in 2018–19.
‘It’s very telling that the funding to general practice has been dropping and continues to drop, despite the fact that we continue to be told the healthcare system is financially unsustainable going forward,’ she said.
‘And what are we doing? We’re not only underfunding primary care, we’re undermining its reputation – and we have to turn it around.
‘I’m so proud to be a GP, I’m so proud of the role that we play in the healthcare system. But I’m so not proud of the way in which politicians and financial policy people don’t actually get the need to fund it, rather than to continue to play this really weird game of continuing to pour funds into the hospitals.
‘If we can really improve and build up primary care, we won’t need to be funding hospitals to the extent we’re doing.’

Chair of RACGP NSW&ACT Associate Professor Charlotte Hespe says the data reflects the lack of funding and incentives given to general practice.

With data collected prior to the onset of the COVID-19 pandemic, Associate Professor Hespe says she is interested to see the influence telehealth has had on general practice accessibility and health outcomes.  
The new report certainly indicates the importance of continuity of care.
It found that 75.8% of Australians had a preferred GP and, similar to previous years, 87% of adults rated their health from ‘good’ to ‘excellent’.
Associate Professor Hespe says this is evident in her day to day practice, particularly for patients with chronic disease.
‘The people I see who have a regular GP, things are much more kept in line versus people who are erratic and don’t follow through with things. You just see a much bigger gap,’ she said.
So how to tackle the issue of accessibility?
In addition to further incentivising work in rural and remote areas, Associate Professor Hespe believes Australia needs to look to more innovative models.
‘We know … the patients with the most complications are in those areas that say they don’t have access to regular care,’ she said.
‘That goes back to the need to look at more innovative models, and where we use the GP very much to the top of their skill set. Don’t waste their time doing admin duties, don’t waste their time doing dressings … when I can get someone else to do that and I use the GP much more in a consultancy specialist referral mode.
‘You can actually run a really good healthcare service when you do that and then that would improve your appointment accessibility.
‘But you can’t do that under the current model, unless the GP sees the patient every single time. That really clogs up our system.’
Associate Professor Hespe is also an advocate for voluntary patient enrolment.
Due to rollout earlier this year on 1 July – for patients aged 70 and older with chronic and complex conditions – it was put on hold by the Department of Health in light of the pandemic.
If such a system where to be applied to the whole population, Associate Professor Hespe says, practices could better aware of their patient population and organise their services accordingly.
‘One of the disadvantages of the Australian general practice system at the moment is that for me, as a GP, I don’t really know who my patient population is,’ she said.
‘Although I can say I’ve got, say, 8000 patients who fulfil the RACGP definition of a regular patient, I don’t really know if they are mine. They may still have gone to another GP the same number of times – might have gone to another two or three GPs.
‘So who takes responsibility for them?’
Voluntary patient enrolment means practices will be able to ‘pre-empt’ problems and could partner with PHN areas that have enough GPs to do clinics around the state, according to Associate Professor Hespe.
‘It’s like specialists. A lot of the specialists go and do clinics around the state on a regular basis, as well as running their city clinic,’ she said.
‘Why can’t GPs do that too in a well-oiled primary care service?’
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Dr Patricia Montanaro   13/11/2020 7:58:54 AM

Can the sentiment “patients felt they waited too long for an appointment” please have quantifiers. Does this mean 1 hour or 6 weeks and does it denote patient preference including possible time of consultation and day- or reasonable health need ( especially for the type of presentation) ? Does it denote realistic business issues. So what I believe is missing is more discussion on the patient wish doctor appointment reality gap . If it is health need I would change my practice. If it is selfish , entitled unrealistic unreasonable wish from patient I would expect RACGP , AMA other medical bodies , government to strongly advocate and educate to stop a misperception of need that breeds dissatisfaction and scope creep by non doctor other health professionals. I would also like a positive spin on which areas do better and how they succeeded eg I have x3 book on day appt per session to allow for urgent health needs not patient whom or disorganisation wishes PM

Dr Oliver Frank   13/11/2020 8:37:45 AM

Dr. Chris Bollen and I proposed at the RACGP Convocation in 2016 that the RACGP should lobby government to require all citizens who want their health care funded or susbisided by government (e.g. via Medicare) to be enrolled in only one general practice at a time. After that proposal was defeated by 100 votes to nil (my estimate of the number of members who were present and who voted), I expected that it might take three or four years for GPs and our professional organisations to start supporting this concept. Earlier this year, the AMA which had staunchly opposed patient enrolment, came out in support and now an increasing number of others are doing the same.