Health of the Nation 2021: The current shape of general practice

Jolyon Attwooll

21/10/2021 3:05:46 PM

The RACGP’s annual report taking the pulse of general practice around the country has been released. Here are the key themes and reactions to this year’s findings.

Health of the Nation report cover.
The 2021 Health of the Nation report draws on the responses of 1386 GPs.

The latest annual General Practice: Health of the Nation report has landed, taking the temperature of general practices across Australia and highlighting the challenges they face.
The ongoing burden of the pandemic, mental health concerns, pressures on recruitment – particularly in rural and regional areas – and telehealth are among the prominent themes of this year’s report, which draws on the responses of 1386 GPs to a survey carried out this April and May.
The appeal and job satisfaction of working as a GP is also laid out in detail, with the career largely viewed as highly rewarding, despite the recent difficulties. While an increasing number of GPs say they are less likely to recommend a career in general practice compared to 10 years ago, almost three-quarters of those surveyed (73%) say they are satisfied with being a GP overall.
Parliamentarians of all sides also contributed pre-recorded messages for the report’s launch, which took place on Thursday.
Federal Health Minister Greg Hunt paid tribute to the ‘extraordinary work’ carried out by GPs under the leadership of RACGP President Dr Karen Price in the face of what he called ‘the greatest health challenge we’ve seen since the Second World War’.
Minister Hunt also cited telehealth as a ‘structural change’ and said future planning will include a focus on three elements: voluntary patient enrolment, the transfer of training responsibilities for GPs to the RACGP and the Australian College of Rural and Remote Medicine, and recruitment in rural areas.
Shadow Minister for Health Mark Butler called the report ‘an incredibly important source document for policy makers and for the general community to understand the work of general practice in keeping our community safe’. He also commended the ‘extraordinary contribution’ of general practice during the pandemic, and highlighted ‘the frank and honest engagement’ he has had with the RACGP since returning to the health portfolio earlier this year.
Adam Bandt, the leader of the Australian Greens, thanked the RACGP for its policy engagement.
‘As a begrudging member of the least trusted profession speaking to the most trusted, can I just say how grateful I am for your contributions to the big issues in public debate,’ he said, while also welcoming the RACGP’s position on climate change.
‘Your efforts in speaking out around the health impacts of the climate emergency have been powerful.’

Watch the introductory message from RACGP President Dr Karen Price


Key themes: Managing COVID
The management of the COVID-19 response is covered in the report, with the biggest issue by some margin being cited by GPs as ‘managing patient expectations about vaccinations’.
It is among the main concerns of 59% of GPs who took part in the survey. More than a third (37%) also reported finding a financially viable way to provide COVID-19 vaccinations as one of the big challenges.
‘Repeated changes to vaccine eligibility requirements left many patients confused and frustrated and unfortunately some took this out on general practice staff,’ Dr Price said following the report’s launch.
‘Governments at every level must have nimble communication channels into every general practice to manage the changes required to allow for small business planning and adaption. 
‘We can’t be put in the position where our patients are informing our staff of the latest changes or even worse, arguing with us over new guidelines and recommendations.’
Dr Price also made an urgent call for Federal Government support in tackling a looming health crisis, with a spike in COVID-19 cases ahead.
‘General practice could alleviate pressure on emergency departments and hospitals,’ she said. ‘But currently, it is in the same position, only we will [also] be managing COVID-positive patients or “long-COVID” patients in the community and without the backing of hospital infrastructure.
‘Government must act now to ensure GPs are funded to do this essential in-community, and in some cases, in-home care.’
Mental health
This continues to be the most significant health issue encountered day to day by general practices around the country.
More than 10% of the population received specific MBS-supported mental health care in 2019–20, almost twice the rate of the previous decade. Most of the services (82%) were provided by a GP.
The report also notes these figures are likely ‘an under-representation of the true magnitude of mental health presentations to GPs, as the longer consultations required for these presentations are often billed as a general consultation rather than under a specific mental health MBS item number.’
The mental health impact on GPs themselves is also flagged, with more than one in every two of those surveyed reporting their wellbeing had at least one negative impact due to the pandemic.
An increasing number (38%) said their work/life balance deteriorated in the past year, a pattern that is even more acute in rural and regional areas, where 44% of GPs reported the trend.
Aged care
The report underlines GPs’ important role in providing aged care services, with those over 65 years representing almost 30% of consultations despite only accounting for 16% of the population.
However, the report also identifies ‘significant barriers’ to GPs’ work, including in residential aged care facilities (RACFs). GPs said support – including better MBS remuneration, fewer administrative burdens, more clinical staff in aged care settings and improved IT infrastructure – would help enable greater involvement.
Aboriginal and Torres Strait Island health
The report reflected growing interest among GPs to work in Aboriginal and Torres Strait Islander health, with 56% of respondents saying they had a particular interest in the space. That compares to 44% among other specialty trainees.
RACGP Aboriginal and Torres Strait Islander Health Chair, Professor Peter O’Mara, said the report ‘offers us hope for the future’ but also highlighted significant access challenges.
‘Aboriginal and Torres Strait Islander people tend to have more complex medical needs and need culturally safe care for this to be successful,’ he said. ‘However, Medicare doesn’t adequately fund the longer consultations, non-face-to-face care, co-ordination and flexibility required.
‘Adequate resourcing is crucial in order for general practices and Aboriginal Community Controlled Health Services to continue to provide high quality care to Aboriginal and Torres Strait Islander people’.

There is growing interest among GPs to work in Aboriginal and Torres Strait Islander health. (ImageMenzies School of Health Research)

He also said it was ‘critical’ to ensure higher rates of COVID-19 vaccination among Aboriginal and Torres Strait Islanders, following devastating recent outbreaks.
Rural general practice
One positive message from the report is that interest in working in rural general practice is strong in the next generation of GPs, despite the well documented recruitment challenges for the area. A total of 59% of GPs in training said they were interested in rural practice, which is more than other specialists in training (40%).
The report also found more GPs in rural and regional areas manage patients with several health conditions – or multimorbidities.
RACGP Rural Chair Dr Michael Clements said there is a lot of work ahead to ensure rural Australians have the healthcare they need.
‘While we are making gains, we have a long way to go,’ he said.
‘It should be a priority for government because we are talking about people’s lives – access to high-quality healthcare is essential to living a healthy, happy life.
‘Clearly, we need to do more to incentivise and adequately renumerate GPs to train and live in rural and remote Australia.’
One of the ongoing success stories emerging from the pandemic, telehealth has become an area of healthcare with ‘high rates of satisfaction’ among GPs and patients alike, the report notes.
Some changes are reported from the 2020 survey. Phone consultations made up 17.1% of all GP attendances in May 2021, down from a one-third in April last year, the report states. There has also been a fall in GP attendances using video, from 1.3% of all telehealth consultations in April 2020 to 0.29% by May 2021.
More than one in every two GPs (53%) said they have spent more than they first budgeted on technology for telehealth consultations.
Funding future general practice
The biggest policy priority found in the report is the issue of funding, with 49% of GPs surveyed citing Medicare rebates among their top three priorities.
‘Genuine reform in the sector is required,’ writes Dr Price in an introductory message to the report.
‘A great place to start would be putting general practice on a more sustainable, long-term financial footing.’
The decreasing proportion of healthcare funding going to general practice is another cause for concern, Dr Price believes.
‘At a time when we are needed by our communities more than ever, the share of total government healthcare spend for primary care is in decline,’ Dr Price said.
‘Funding for GPs and general practice services is less than 8% of total health expenditure, yet we provide more than twice the number of episodes of care a year than hospitals, and all at one-sixth of the cost.’
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