Staying true to old-fashioned general practice

Dr Naomi Gleadow did much of her training in Melbourne.
 
Since qualifying in 2003 from Monash University, however, she has worked along Australia’s east coast, as well as in Africa and Ireland, before settling back in Townsville, where her husband Michael lived. Her experience includes specific women’s health practice, along with Aboriginal and Torres Strait Islander health.
 
In 2018 she joined Cranbrook Medical, a general practice that has been in the same Townsville location since 1995. It has had just one GP owner, with Dr Gleadow taking over this ‘unique, very loyal practice’ in early 2020.
 
Pandemic brings constant change
Since Dr Gleadow began her career in general practice, GPs have experienced faster change than previous generations. But the pandemic has forced day-to-day, even hour-to-hour change, with GPs pivoting between physical and online consultations.
 
The standard response to patients’ requests for advice seems to have become, ‘This may change tomorrow, but here’s my advice today.’
 
Thanks to technology, patients sometimes even know about changes before GPs, much to Dr Gleadow’s chagrin.
 
‘We like to be the bearer of important health news that impacts patients, so we’ve had to change our mentality there,’ she said.
 
While Dr Gleadow uses social media more than she previously had, she rates daily staff huddles and face-to-face patient communication as the best way to manage operational change and patient expectations.
 
‘As long as we keep communicating with patients about what we do know as information changes, patients respect that,’ she said.
 
Despite the rapidly changing environment and government health advice during the pandemic, CommBank’s latest GP Insights report reveals that almost all Australian patients are satisfied with the way GPs are adapting. A very high proportion of patients who had used the service are specifically satisfied with major changes, including telehealth and the way GPs are handling vaccinations.
 
Technology improves patient satisfaction
In an industry that still uses faxes, General practice has seen a dramatic technological change since the pandemic’s onset. With some of Cranbrook Medical’s patients living up to 500 km away, telehealth has been transformational.
 
Dr Gleadow can now speak to a farmer, who is working in a paddock, to check his latest blood pressure reading and make decisions based on the information he gives her over the phone or by video. The adoption of telehealth extends across Australia, with the GP Insights Report showing that almost one in four consultations are now conducted via telehealth.
 
According to Dr Gleadow confidentiality used to be a barrier to new digital services. However, she says patients are now very accepting of receiving scripts over the phone and medical certificates via email.
 
‘What patients want and how we provided services before wasn’t congruent,’ she said. ‘Technology is changing that.’
 
Mounting pressures
For practices like Dr Gleadow’s, the temporary inclusion of telehealth as a Medicare item is a major improvement to practice economics. She hopes it becomes permanent.
 
The GP Insights report confirmed that telehealth was having a mixed impact on practices’ profitability, and the rising cost of consumables and increased bulk-billing were adding to the financial pressure.
 
Dr Gleadow says that in the early days of the pandemic, it was often up to practices to buy the necessary masks and gloves to protect staff and patients. She offers this as an example of how ‘practices, pivoted so well’.
 
Additionally, general practices are central to the vaccination rollout, with the general public being urged to consult their GP if they want to discuss the situation. Research also revealed that 56% of people would prefer to have their vaccination at their GP.
 
‘Those aren’t 30-second conversations, but 15-minute conversations,’ Dr Gleadow said.
 
‘The vaccination process itself further adds to practices’ time constraints. Longer-term, the pandemic will have a flow-on effect.
 
‘This could include a higher incidence of mental health issues, or misdiagnosis where GPs are overwhelmed by patient demand.’
 
Addressing staff shortages
General practice has been challenged by shortages of GPs and support staff for years, and practices rated it as the top challenge in the GP Insights Report. Dr Gleadow says GPs are leaving the profession as the growing pressures lead to burnout.
 
Around 14 years ago, when Dr Gleadow was working with an Aboriginal health worker in Townsville that particularly impressed her, she said to her husband, who was a teacher, ‘wouldn’t it be great if we could train local staff?’ From that conversation, Michael later started Connect ‘n’ Grow.  
 
Offered from Year 11, the program initially focused on providing healthcare training to Aboriginal and Torres Strait Islander students from rural and remote schools. The program has since expanded to support students from any background to pursue a career in healthcare.
 
Now a registered training organisation, the program is running in multiple schools around Australia, and for Dr Gleadow ‘the most enjoyable thing about Connect ‘n’ Grow is that if we can keep encouraging good people into healthcare, we will improve the whole workforce shortage.’
 
The best, not the biggest
Dr Gleadow bought Cranbrook Medical because she wanted a family-run practice with old-fashioned qualities, where the staff know patients, and a multi-generational approach to family care.
 
‘I feel a sense of responsibility that I want our general practice to continue the way it’s going,’ she said.
 
‘That is, a practice where patients want to come, staff want to work, and GPs can get joy from general practice.’
 
Dr Gleadow wants to provide good training for staff and be a strong safety net for patients.
 
‘I want to be a practice that I’d be proud to recommend to my own family,’ she said.

RACGP Victoria Women in General Practice Committee is hosting the ‘Brainy Women: A Healthy Mind and Body’ conference in May 2022, with support from CommBank Health. Registration is available on the RACGP website.

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