Work begins to address ‘terrifying’ general practice trend

Jolyon Attwooll

1/08/2022 6:53:04 PM

RACGP Vice President Dr Bruce Willett outlines the discussions that took place at the first Strengthening Medicare Taskforce meeting.

Medicare card
The first meeting of the Strengthening Medicare Taskforce took place last Friday.

‘Primary care is in worse shape than it’s been in the entire Medicare era.’
These were the blunt words of the Minister for Health and Aged Care Mark Butler this weekend in a speech at the Australian Medical Association (AMA) annual conference in Adelaide.
The minister declared primary care as one of two priorities under his tenure, with the other being aged care.
‘It’s hard enough to get a GP right now and we know that the current generation of older GPs are pretty exhausted, particularly over the last two and a half years, and we just do not have the pipeline coming through,’ he said in a question-and-answer session following the speech.
‘It is probably the most terrifying trend that I see in primary care.’
The remarks, reported in Nine Newspapers, came shortly after the first meeting of the Strengthening Medicare Taskforce, which Minister Butler chairs. With representatives from the RACGP and a range of other peak bodies and advocacy groups, the group is due to present recommendations for fixing Medicare by the end of the year.
At that inaugural gathering, RACGP Vice President and Queensland Chair Dr Bruce Willett represented the college in the place of President Adjunct Professor Karen Price, who was unable to attend.
Dr Willett said he was encouraged by the tone of Minister Butler’s remarks.
‘It’s a wonderful thing to see a health minister acknowledge the parlous state of general practice,’ Dr Willett told newsGP.
‘This is a result of decades of literally decades of neglect of general practice, and it’s now time to fix it.’
Minister Butler also referenced discussions surrounding voluntary patient enrolment in the inaugural taskforce gathering.
‘I’ve posed the question to members… “how do you describe the value proposition for patients?”’ he said.
‘I really think that is a crucial challenge for us.’
Dr Willett said that when the issue was discussed, he expressed the college’s support for voluntary patient enrolment with clear caveats.
‘The RACGP accepted that there is a place for voluntary patient registration, particularly for those vulnerable patients with chronic complex diseases, where fee-for-service will struggle to provide adequate compensation and adequate care,’ he said.
‘It needs to be voluntary for both patients and practices and that’s essential,’ he said.
‘And it should not be tied to a requirement to bulk bill, nor [should it] replace fee-for-service. Fee-for-service needs to remain the mainstay of our healthcare system.’
He said he also reiterated the need for Medicare Benefits Schedule (MBS) to have ‘significant uplift’ to help address the challenges facing general practice.
Among other priority areas for the taskforce to consider, Minister Butler listed multidisciplinary care, the use technology in healthcare and business models for general practice.
In its report, Nine Newspapers referenced the low level of medical graduate interest for going into general practice.
In 2022, this has reportedly risen marginally to 16%, up from the 15.2% proportion of final-year students who listed general practice as their first preference specialty last year according to the college’s most recent Health of the Nation Report.
The AMA conference, in which Professor Steve Robson was confirmed as the new AMA President, while GP Dr Danielle McMullen was elected vice-president, also included a contribution from Department of Health secretary Professor Brendan Murphy.
Professor Murphy again alluded to an undersupply of early career GPs.
‘Far too many of our young doctors are not choosing to go into general practice, which is the area we have the greatest predictive need in the future,’ he said.
Dr Willett believes the work of the taskforce will be fundamental to reversing what he calls ‘an enormous amount of inertia’ about medicine workforce choices and says it will involve both financial investment and bolstering the status of general practice.
‘It’s going to take years,’ he said.
‘I would say that this taskforce is extremely important. The plans that have been discussed to restructure Medicare represent a potentially generational change.
‘It’s really important that we get them right and the governments listen.’
Noting that the taskforce is carrying out its work at a time of significant financial constraints, Dr Willett stresses that a well-resourced and highly functioning general practice sector underpins the world’s best performing health systems.
‘General practice is the most cost-effective part of the healthcare system,’ he said.
‘If the Government does not grasp the nettle here, the downstream costs are going to be enormous.’
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Dr Suresh Gareth Khirwadkar   2/08/2022 7:00:26 AM

It’s easy. Roll out the DVA CVC program to everyone and we have the solution in 1 simple easy immediate fix. However We all know the amounts on offer and the KPIs that will come with it will never come close to the CVC program. They will never commit another ~ 75bn (the rough cost of 25m more CVC programs) that they probably need to. In fact it’s likely to be a zero sum game which will just hurt patients and hurt medical professionals.

Dr Anjum Ahmed Shaikh   2/08/2022 7:02:59 AM

I wonder why the younger GPs would take up General Practice, when any disgruntled patient can openly write negative reviews abusing their doctor and complain to HCCC at the drop of a hat. It is the most abused profession by the patients, by the public, by the regulatory authorities, by Medicare and by the government. There is no system in place to protect and look after the health and mental well-being of the GPs. The patient should be made to pay, the same amount of money as they pay when they make a claim in the small claims court, before registering a complaint to the HCCC.

Dr Bradley Arthur Olsen   2/08/2022 10:00:50 AM

Who could blame the young doctors ,as a GP in Bundaberg QLD you have no respect from QLD health ,referrals made under their guidelines are rejected by them regardless, I am at the receiving end of medicolegal action due to Qld health's attitude and refusal to do their part. I encourage young doctors to stay away from GP and Bundaberg

Dr Ian   2/08/2022 12:00:06 PM

When to to get into medicine you need a VCE score of 99.75 the reason for the desire to specialise to teach the Top is easy to see .
Yet General Practice is incredibly challenging when done well with the huge medical knowledge advances in diagnosis and treatment .
The easiest way is to dramatically increase the intake of people able to study and practice medicine .
Many more are very keen to help society in this way .
By 2035 you could have many more the number of General Practitioners in areas of need and all superbly trained .
Remuneration is vital but so also satisfaction which derives from competency from achieving great saves steady well being and avoiding catastrophic error .

Dr Richard Mark Smith   2/08/2022 9:23:37 PM

I have been waiting for this moment since bulk billing backfired at the starting gate. It seemed so socialistic, to bill the Government at amount which partially covered the amount of monies foregone when patients were unable to pay for a consultation.
My colleague in rural Victoria was , in his words, a refugee from the NHS. His dire warning foretold the current situation just as his presence stamped the truth upon his disappointment.
1) Reinstate the relative value of a GP consultation when Medicare (Medibank) was introduced
2) Remove, reduce, simplify and streamline business processes
3) Develop an independent and objective career advice system alongside medical education
4) Provide strategic HECS and Tuition fee remissions and incentives to increase the match with evolving workforce requirements
5) Invest in a Government backed program to modernise the primary cafe infrastructure, technology and support services skills
6) Establish interoperative standards

Dr Christopher Francis Boyle   3/08/2022 6:24:45 PM

The biggest turn off for young Doctors is that they lose money by leaving the hospital system, joining GP training and becoming a GP. If you have a HECS debt, a mortgage etc you would not want to be GP and earn 1/3 to 1/2 of what you can earn as a Specialist. It is a no brainer. The gap in income between GPs and Specialists is huge and needs to be addressed.
I am not a Neurosurgeon and could not do what they do. But I challenge them to do what I do. They could not cope with the Mental Health patients, the diabetes etc that we deal with. We are every bit as Specialised as they are and should be remunearted as such.
Add to this the abuse from patients, Medicare and politicians so why do it? Younger Drs choose to do easier roles in Medicine.
The shortage of GPs needs to be fixed ASAP. The cost of inaction and failure to sort it out will mean that cost of care will rise enormously into the future and the Health outcomes will be worse.

Dr MT   6/08/2022 7:57:10 AM

I totally agree with Dr Anjum Ahmed Shaikh. GPs are treated like SLAVEs by patients and by Department of Health. GPs have to meet all patients’ demands, otherwise they sue us, they lodge complaint to HCCC. On the other hand, GPs will be punished by Department of Health if we serve more patients, if we do more investigations such as pathology and imaging, if we prescribed PBS items etc. DoH keep introducing new rules to depress GPs more and GPs are not consulted, and we can not oppose these rules. They decided to publish every complaints from patients even before they conduct investigation. GPs are now facing Cyber Bullying as well.
GPs are under enormous pressure from both patients and Government. GPs have to pay huge amount on staff, overhead, tax etc, but if we work hard and earn more, we will be ‘reviewed’ and punished by DoH!
I would not encourage the younger generation to pursue General Practice, a career which is undervalued and under extreme stress.

Dr Abdul Ahad Khan   6/08/2022 1:10:31 PM

Taking a totally different tangent :
If Pharmacists are being permitted to DIAGNOSE & PRESCRIBE Anti-biotics, then walk the same Talk & allow Allow Doctors to Prescribe & Dispense Medications - it will be much more Convenient for the Patients & new Graduates will take up Financially lucrative General Practice - workforce shortage Issue solved !