Investing more in general practice to improve Australia’s healthcare

Bruce Willett

24/04/2018 11:31:22 AM

Relying on high volumes of patients has created a vulnerability in general practice, says RACGP Queensland Chair Dr Bruce Willett.

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Dr Bruce Willett believes general practice has been overlooked for significant investment in the three decades since the introduction of Medicare.

General practice is at the heart of Australia’s very successful healthcare system.
Australia is consistently in the top three of health and disease outcomes within the Organisation for Economic Cooperation and Development (OECD) across almost all healthcare indices, with our effective and cost-effective primary care system the engine behind these great outcomes.
However, one area in which we don’t perform particularly well is that of out-of-pocket expenses for patients. While we mostly blame the tertiary sector for this situation, it is also true that out-of-pocket expenses for general practice are growing in the face of continuous underinvestment by governments to support patient access to primary care over the past several decades.
Governments have not invested in patient rebates to support access to general practice despite the efficient delivery of healthcare in Australia. Not only are we in the middle of the pack for cost per gross domestic product (GDP), we fare even better in terms of what we spend in general practice. 
General practice has continually been overlooked for significant investment over the last three decades since the introduction of Medicare, with more funding spent on hospitals. The response to the lack of support – made worse by the increased number of general practice graduates (and, therefore, greater competition) – has been to focus on increasing the volume of patients.
Although a reasonably successful strategy to date, focusing on volume and charging consultation fees, which reflect the value of the care we provide, has unfortunately created a vulnerability in general practice that has been eagerly exploited by pharmacists, online medical certificate and prescription providers (also often pharmacists), nurses and others.
GPs should be working cooperatively with other healthcare providers, not competitively. The challenge for general practice and the RACGP is to make sure that we can add and demonstrate value to what we do. GPs have amazing skills, but we need to maintain and extend those skills in order to give value to patients.
Hospitals are overcrowded, overextended and have run-away budgetary problems. The tertiary health sector should be referring patients back into primary care, where they can receive the most appropriate care more conveniently.
However, RACGP Queensland has been made aware of recent efforts that indicate little understanding of how we work and how we maintain viable businesses.
In the case of RACGP Queensland, the challenge is to convince Queensland Health and the Hospital and Health Services that there is a mutual benefit to patients, general practice and the hospitals if they invest in upskilling GPs.
Greater investment could be in extra training and upskilling for the GPs, but it could also mean improved access to specialist assistance, more streamlined referral processes or help with bulk purchasing of equipment used to treat fractures in general practice, rather than a fracture clinic. It might even mean some extra money for a patient presenting at a general practice, rather than at hospital; it is not good enough to just send patients away and tell them to go and see the GP – there needs to be a benefit to general practice as well.
In the current climate, extending the scope of general practice is the only way we can escape the spiral of inadequate rebates and perceived simplification of what we do.

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