General Practice Crisis Summit: Key outcomes

Morgan Liotta

6/10/2022 4:29:51 PM

High-level solutions were discussed in working groups and summarised into recommendations to inform the RACGP White Paper.

Photos from the General Practice Crisis Summit
The RACGP held a full-day General Practice Crisis Summit at Old Parliament House on 5 October. (Image: Oneill Photographics)

Around 120 GPs and other healthcare representatives attended the RACGP’s General Practice Crisis Summit at Old Parliament House in Canberra on 5 October, to pool expertise and establish solutions to the myriad of problems facing general practice in Australia.
The day’s program included three working group discussions around solutions to the key issues facing GPs, including funding, workforce and data governance.
Attendees were presented with three questions by subject matter experts to engage in roundtable working group discussions, which were then summarised and presented to the room.
Professor Price said that the differing views among each group is ‘what will make the session so successful’; however, overall, significant themes were identified across all discussion groups.
‘We have every recommendation proposed today captured, which will all inform the White Paper … [and] be presented to [the Federal] Government in coming weeks,’ Professor Price said.
Session 1: What funding model is required to support general practice’s leading role in providing patient-centred, continuous and coordinated care, and to ensure equitable access to this care?

Subject matter experts Dr Michael Wright, Chair of the RACGP Expert Committee – Funding and Health System Reform and Chief Medical Officer at Avant Mutual, and Professor Claire Jackson from the University of Queensland’s Faculty of Medicine Primary Care Reform conducted the introductory briefing.
Dr Wright began by presenting an outline of the advantages and disadvantages of each of the current main funding models, highlighting how general practice insights can inform the development of effective funding models needed for a sustainable healthcare system.
The RACGP is calling for flexible and blended payment models, with payments appropriately indexed and set using a ‘proper pricing process’ and for the modernising and simplifying of Medicare.
‘Blending is a combination of models and is increasingly used to balance the pros and cons of any particular model,’ Dr Wright said.
‘We need to ensure any applied models align with the business model of general practice …
[and] push for a balance of funding between the practitioner and the practice.’
Professor Jackson then expanded on feasible funding models, showing comparisons with international models of care and funding.
‘One possibility for scalable funding solutions is the return to the original Medicare intent and return the patient rebate to its original value over time, starting with the standard consultation,’ she said.
‘The time [for funding reform] is now. Our sector is fading away, or becoming unreachable for thousands of Australian families, especially the most vulnerable.
‘We care, we know, and we must act swiftly and decisively to rescue the holistic, comprehensive, relationship-based general practice model of care for all Australians.’
Summary of roundtable discussion outcomes for session 1:

  • Significant and urgent investment in general practice
  • Simplify and modernise the MBS
  • Appropriate indexation for general practice items using a proper pricing process
  • Flexible and blended payment models
  • All health funders to start contributing to general practice, including private health insurers (with oversite) and more from state/territory governments
  • Increasing patient Medicare rebates to reduce out-of-pocket costs, particularly for vulnerable patients
Session 2: How can we address and reverse the erosion of the general practice workforce, ensuring general practice is an attractive career path with long-term career sustainability?
The introductory briefing was conducted by subject matter experts RACGP Rural Chair Dr Michael Clements and Professor Jenny May, Director of the University of Newcastle Department of Rural Health.
Professor May spoke about the diversity of the general practice workforce and the significance of balancing medical workforce graduates.
Dr Clements then outlined the challenges around distribution of the medical workforce, in which both demand and supply need to be considered, saying targeted measures are needed to maintain and grow the general practice workforce.
‘Demand is rising on the back of an ageing/natural population increase and complexity of care, and supply has been declining for over 20 years,’ he said.
‘It is imperative that workforce interventions are multiple and longitudinal and look at scope of practice and distribution … Improving recruitment and increasing retention need to go hand in hand.
‘We need to focus on building general practice as an attractive career for medical students, not one that is associated with poor remuneration and significant red tape.’
Summary of roundtable discussion outcomes from session 2:
  • Improve recruitment and retention for both incoming doctors and those already in the profession
  • Exposure to general practice earlier, eg pre-specialist training
  • Shift the culture and the narrative around general practice to highlight its value as a career choice
  • Better support for international medical graduates by reducing training costs and red tape, as well as streamlining Fellowship pathways
  • Building stronger/more flexible infrastructure in rural areas
Improving the general practice workforce is only possible through funding and health system reform, the subject matter experts concluded, as increased investment in general practice underpins all other activities in this area.

Canberra-summit-Article.jpgRoundtable discussion groups workshopped solutions to key issues facing general practice. (Image: Oneill Photographics)

Session 3: How can we improve the capture, linkage and meaningful use of data (including patient experience, clinician experience and quality patient outcomes) to support equitable general practice-based care?
Australian Digital Health Agency Chief Clinical Advisor Dr Steve Hambleton and ANU Medical School Clinical Associate Professor Louise Stone conducted the introductory briefing.
Dr Hambleton spoke about how data can improve quality care and population health, while Associate Professor Stone spoke about the validity and meaning of data, and measuring outcomes in general practice.
They highlighted the many ‘lost opportunities’ due to a lack of infrastructure, funding, and digital literacy to make use of the valuable data general practice has.
‘Data needs to lead to equitable investment according to patient and community need – supporting service planning, resource allocation and continuous improvement,’ Dr Hambleton said.
Summary of roundtable discussion outcomes from session 3:
  • Ensure ethical and meaningful use of data, including identifying for what purpose the data is being collected, ie funding, planning, quality improvement
  • Better support for data linkage across education, health, social and justice
  • Interoperability between systems
  • Establish a framework of data governance
Professor Price concluded that a ‘huge range’ of topics, challenges and recommendations were covered in the day’s discussions, which will be put to good use. 
‘This has been a landmark event for general practice and the first step on the long path to reform,’ she said at the end of the event.
‘We will be taking your insights and developing a White Paper on general practice reform with the intention of presenting this to the [Federal] Minister for Health and Aged Care, with the expectation that we see serious and immediate action by government to address the challenges facing general practice.
‘It is critical we continue to show solidarity in calling for essential reforms to general practice, collaborative action and advocacy are key to achieving the necessary reforms to guarantee the sustainability of our health systems.’ 
The summit’s Master of Ceremonies, GP Dr Mukesh Haikerwal agreed, adding that ‘now is time to push for reform’.
‘The system is crumbling,’ he said. ‘We urgently need short-term solutions for the long-term solutions to happen.’
In another press statement at the end of the day, Professor Price highlighted the key funding recommendations from the summit.
‘We are calling for an immediate and substantial increase in Medicare patient rebates, and an increase to the bulk-billing incentive by at least 2–3 times,’ she said.
‘This is particularly important for our rural and remote communities, which we know have poorer health outcomes and life expectancy, as well as those who are vulnerable and disadvantaged.
‘We are also calling for appropriate and ongoing indexation for MBS items, so that it is in line with the real-world costs of providing high-quality care in communities across the country.’
Final outcomes from the summit will be collated into a White Paper sent to attendees for consultation before being presented to government in coming weeks. It will include including short- medium- and long-term recommendations for reform.
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Dr Benjamin Weiss   7/10/2022 6:00:16 AM

You are all missing the point into why GPs are retiring in droves especially experienced GPs with over 30 yrs experience in General Practice,Get rid of this ridiculous time wasting annual CPD proposed from next year and just let GPs get on with what they do best i.e treating patients.

Dr Rebecca Monahan   7/10/2022 3:39:11 PM

I'm surprised that CPD isn't mentioned. The new annual requirements are over the top and unfairly disadvantage those who work part time.

Dr Syed Naqvi   7/10/2022 11:43:16 PM

*GP is an "orphan specialty". No one cares about GP.
*General perception is that GP is a lazy doctor who could not get specialization.
*GPs are most hard working doctors, yet poorly paid for their time and poorly appreciated.
*GPs are perceived as gatekeepers and trash bin of hospitals.
*GP often finds them in front firing line of complaints form multiple agencies.
*No organization is friend of GPs (e.g AHPRA, College, PSR, DDU, NPS, ATO, Lawyers, Court of law ,Coroner's inquiry, abusive patients,death certs) deal with them good luck
*This & that guideline, webinars,conferences, CPD, urgent/emergency care . Everyone loves to teach & punish us for our human errors.
*Put it this way I will educate my kids to join general practice in future. It is better for them to be a tradie in Australia because they get better wage than us.
*$39 level for level B consult and paying cuts ,taxes and feeding organizations out of this is a joke.
*No unity (stop work till no abuse) but we are cowards.

Dr Nicholas Kunzer   8/10/2022 4:11:47 AM

As a young GP working in rural NSW I find there is a lot of positive aspects to working in general practice that are especially attractive to new graduates with young families. I think that for my generation, who tend to value flexible working hours and work life balance, a career in general practice is becoming more and more attractive. I think the colleges are doing a good job of creating a high benchmark for fellowship and ongoing education that sets a good precedent for new graduates to value their service and charge appropriately in mixed models of billing. If there is a critical mass of new GPs that set this benchmark for quality, accessible, and personalised care with an affordable out of pocket cost, patient perception will change. Keep working hard, providing high level care, and keep learning. Thank you to everyone helping to reshape our specialty for the future.

Dr Stewart James Jackson   8/10/2022 9:27:12 AM

Most of the outcomes were just motherhood statements!
1. Reform CPD now. Next triennium demands on us outrageous.
2. Allow practices to directly recruit and train GP’s bypassing failing training .
3. Stop complaining when others takeover our roles. Instead step up and work a few more hours so people can access us for emergency care.

Dr Robert James Tuffley   9/10/2022 10:31:25 AM

I have been a GP for 40years.
The college is more concerned with mindless CPD programs and mindless statements like " We need more funding for general practice".
The public needs to understand that if a GP bulk bills a patient they are effectively giving a 50% discount. Universal bulk billing and bulk billing clinics have had a major deleterious effect on general practice.
1. CPD is a burden on GPs and there is no evidence base to indicate that it improves general practice.
2. We need main stream media information explaining to the public why universal bulk billing is not good for medicine and general practice in the future. GPs will always consider patients financial position when billing.
3. Allow practices to recruit and train GPs directly.
4. Reskill general practice. GPs should be encouraged to do minor surgery, # management, joint injections, IUD insertions, ear toilets, home and NH visits etc
5. To GPs- work hard, upskill, charge appropriatley, and regain respect.

Dr Susan Margaret McDonald   9/10/2022 4:22:30 PM

It all boils down to: MORE MONEY

Dr Mileham Geoffrey Hayes   15/10/2022 7:56:34 AM

RE: The Crisis Summit
"Myself when young, did eagerly frequent,
Doctor and Saint and heard great argument,
About it and about,
But evermore came out,
By that same door wherein I went".
Rubaīyāt of Omar Khayyām

Dr Ian   15/10/2022 11:49:20 AM

Over the Decade there will need to be more health care devotees admitted to medical schools as people live longer and the demands for excellent care increase .
Some patients are so complex with co-morbidities mental health challenges substance abuse interpersonal violence and disaster medicine that we will need one medically trained doctor for 300 people rather than the in the 1970s aimed for one in a thousand .
And the training ought be fundamental critical for four years and then life long so complaints about CPD are hard to justify .
In the USA doctors from primary care to emergency care to all specialists there is re- certification after ten years .
Most Australian Doctors are highly competent and devoted but general practitioners deserve more remuneration relative to the current system in what is great speciality that requires immense knowledge and ability .

Dr Abdul Ahad Khan   15/10/2022 4:34:55 PM

The CPD requirements from 2023 onwards, is UNREAL & should be SCRAPPED.
Otherwise, it will result in many Senior GPs who have performed at the Highest Standards, to PREMATURELY RETIRE.
Please show the EVIDENCE that the Current CPD Requirements are INADEQUATE.
If there is no Justification for changing the Current CPD Requirements ( which is already very Time-consuming & Arduous ) , then DO NOT CHANGE ANYTHING - if it ain't Broken why Mend it .