‘Like a conductor’: The unseen craft of general practice

This week, RACGP President Dr Nicole Higgins attended the 2023 Primary Care Conference, which was organised by the Federal Government and held in Canberra.
 
She made the following speech at the event, touching on the value of general practice, and highlighting the vital importance of bringing more medical graduates into the profession, and making it a career of choice.   
 
Dr Nicole Higgins’ speech in full:
Today we are meeting on Ngunnawal Country and we acknowledge and pay our respects to their Elders.
 
I also recognise that, in Aboriginal culture, ‘health’ does not just mean the absence of disease but the social, emotional, and cultural wellbeing of the whole community. 
 
I am Dr Nicole Higgins, a GP from Yuwi Country.
 
I am a clinician and supervisor from Mackay in North Queensland and President of the Royal Australia College of General Practitioners – an organisation that represents 43,000 members, GPs and GPs in training.  
 
A country kid from a public school in a system that didn’t make it easy. The system still doesn’t make it easy: three out of five GPs describe the health system as their biggest concern.  
 
But I was lucky because growing up I had a wonderful family GP who took me under their wing. 
 
And so it happens, that I called Dr David Tynan last night to say thank him and his team for looking after my grandma who died last night at the big age of 95. 
 
Dr Tynan and his team still care for my mum, my sister who has an intellectual disability and the rest of my extended family.  
 
From the front desk to the nurses to the registrars and allied health professionals, they know my family and the team keeps them well. 
 
The evidence says that having a family doctor is better than any wonder drug. As Elizabeth Deveny [CEO of the Consumers Health Forum] said: ‘Prevention is cheaper than Medicare’.
 
I want you to pause for a moment and close your eyes. 
 
There is an orchestra is warming up in the background. Dedicated musicians warming up, all absorbed in their own space:
 
Strings. 
Woodwind.  
Percussion. 
Brass – don’t let me forget the brass.  
 
There are talented and skilled musicians, valued members of the orchestral team.
 
And then there’s the conductor. 
 
Often unseen in the pit, the conductor creates a conversation between the musicians. 
 
The conductor doesn’t have to know how to play the violin or the flute. But they need to make sure the notes are played at the right time, in the right place, with the right musician and instrument.
  
But the most important part of the orchestra is the note. That note is the patient. 
 
Like a conductor who takes years to learn their craft, it takes a minimum of 11 years of study to become a specialist general practitioner.   
 
Much of what we do is unseen, and I have found that most people do not understand what we do or how we do it. 
 
Nine out of 10 Australians see their GP every year.
Two out of three of our GPs in training are women.
Four out of five rural and regional doctors are RACGP members.

Dr Nicole Higgins speaking at the Primary Care Conference in Canberra this week.
 
Mental health is the most common presentation we see in general practice.  
 
Patients report that they are more likely to see a GP for their mental health concerns than any other healthcare professional. 
 
We do most of the same training as a cardiologist, a paediatrician or a psychiatrist but we leave the hospital system to work and train in the community.
 
We are generalists. We are trained in undifferentiated, whole person and complex medicine. We have a depth and breadth of scope that that varies depending on where you live and the needs of the community. Our scope is often limited by legislative, regulatory and administrative burdens. 
 
GPs can. 
 
Too often as GPs, we hear that someone else can do what you do. 
 
Too often we hear that there are not enough of you so we will get someone else to do your job.
This is not the message our medical students need to hear. 
 
But you can’t be what you can’t see. We need our medical students to be exposed to general practice at every step of the way.
 
We need general practice to be valued so that it once again becomes the career of choice for our young doctors. 
 
GPs are the cost-efficient engine room of the healthcare system.
 
We keep people out of expensive hospitals. We give you pretty good bang for your buck. 
 
It costs the taxpayer $40 to see the GP for an earache, for example. If the same person presents to the ED – it is $600 for an episode of care.
 
Lumos data showed that a relationship with a GP practice reduced risk of ED presentations and unplanned hospital admissions.  
 
A visit to the GP within two days of a hospital admission was followed by 32% fewer readmissions within the first week. 
 
A cost benefit analysis indicated that there was $1.60 in healthcare system benefits estimated for every $1 spent in the primary care system. 
 
We must never trade off quality, safety and evidence for access. The biggest risk is fragmentation of care, duplication of services and cost blow outs.
 
We have seen what happens when GP and primary care is underfunded and undervalued. Ten years of neglect has led to overflowing hospitals, ramping, and young doctors not wanting to become GPs. 
 
But times have changed. 
 
This government has recognised that it must invest in general practice and primary care.
 
As I said before – it is the cost-efficient engine room of the health system.
 
All of us in this room are leaders.  
 
We have the opportunity to grow the whole primary healthcare sector and value the skills that we all bring, including general practice. 
 
We must increase capacity through collaboration and with respect.
 
On behalf of Australian GPs, I look forward to working with you all over the next few days and into the future. Thank you.
 
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Dr Nicole Higgins general practice