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Health of the Nation: Urgent need to bolster workforce


Michelle Wisbey


15/11/2023 12:01:00 AM

Chronic underfunding, burnout, fragmentation, and increased consultation complexity were among the annual insight into general practice’s ‘troubling’ findings.

Health of the Nation reports spread out of table.
The 2023 RACGP Health of the Nation report makes clear that more GPs are needed to meet ever-increasing demand. (Image: Lily Edwards)

It is a paradox testing the health of all Australians – patient presentations going up while GP numbers are going down.
 
And without urgent interventions, a workforce boost, and a funding overhaul, this gap will continue to widen.
 
That is one of the key messages stemming from the RACGP’s 2023 Health of the Nation report, released on Wednesday, which offers the seventh annual insight into the life of a GP.
 
This year, the report centres around ‘attraction and retention of the general practice workforce’, with its headline message pleading for more to be done to grow the GP pipeline and improve sustainability.
 
RACGP President Dr Nicole Higgins told newsGP that despite the report making for ‘sobering reading’, there are still reasons for GPs to be proud of the care they offer every day and of the difference they make to patients’ lives.
 
‘Patients are continuing to tell us that they feel heard, respected, and that GPs are spending more time with them,’ she said.
 
‘We’ve also enabled better access to care through telehealth and the evidence says most people’s turnaround time to go and see their regular GP is a short amount.
 
‘The narrative around GPs being difficult to get into isn’t reflected in the Health of the Nation report.’
 
But the report reveals far greater support is needed to allow general practice to run at its highest potential.
 
According to the 2048 practising GPs and 183 GPs in training surveyed for the report, 71% said they had experienced feelings of burnout, while overall job satisfaction has plummeted to 66%.
 
The report highlights the looming workforce crisis, with only 20% of practising GPs indicating they would recommend their profession to junior colleagues and 29% intending to retire in the next five years.
 
In 2021–22 there were 39,259 GPs in the primary care workforce, and while that number continues to increase, the pace of growth is not sufficient to meet greater demand.
 
This year, 13.1% of medical students reported general practice as their preferred specialty of future practice, a decrease from 13.8% in 2021.
 
Dr Higgins said the retirement figures are ‘deeply concerning’.
 
‘We need to very closely look at attraction, retention of GPs, and looking across the pipeline at how we can support those who are coming into medicine, junior doctors, to ensure that we get people coming into general practice,’ she said.
 
‘It’s about making sure they have quality exposure.’
 
Work-life balance also continues to test GPs, with just 29% of respondents agreeing that balance will improve, down from 33% last year.
 
Workload, stress, and time pressure are the top health system issues causing the most concern for GPs in 2023, followed by access to healthcare and patient financial issues.
 
Comments from GPs in the report shed a light on the impact these pressures are having on Australia’s frontline workers.
 
‘As a GP, we are stretching our limits to look after patients in the community,’ one GP said.
 
‘The complexity and expectations of patients are wildly out of kilter with the amount of time we are remunerated to spend with them via Medicare,’ said a second GP.
 
‘I love my job, but the current climate makes it feel increasingly hard to provide quality care to my patients,’ a third respondent said.
 
Positively, less than 1% of people reported being unable to see a GP when they needed to, while GPs are spending an average of 18.6 minutes with each patient, rising from 17.7 minutes in 2022.
 
But more patients than ever before are seeking GPs’ help, with 90% of Australians seeing a GP last year, receiving an average of 7.9 episodes of care throughout the year.
 
Mental health continues to be one of the fastest growing issues in general practice, with 38% of general practice consultations in a typical week including a mental health component.
 
The proportion of GPs reporting psychological factors as the main reason for patient presentation also continues to grow, up from 61% in 2017 to 72% in 2023.
 
‘Mental health is the most common presentation and that load is especially being taken by women,’ Dr Higgins said.
 
‘We know that mental health consultations take longer, and that Medicare doesn’t recognise or reflect the time that we spend with our patients adequately.
 
‘This is important because it contributes to the gender pay gap, and when just over 60% of our GPs in training are women, we need to make sure we have a system that supports the care that’s been delivered.’
 
This year has also brought with it additional challenges for practice owners, with changes to payroll tax leaving clinics hundreds of thousands of dollars in debt and on the brink of collapse, and bulk billing rates on the decline as a cost-saving measure.
 
These fears were evident in the Health of the Nation report, with 80% of owners concerned about the viability of their practice.
 
The proportion of GPs bulk billing all patients halved from 24% in 2022 to just 12% in 2023.
 
GPs also reported charging an average of $74.66 for a Level B consultation, including the $39.75 rebate, up from $64.02 last year.
 
The cost-related concerns coincide with a 6.5% drop in government spending on general practice.
 
Moving forward, Dr Higgins said adequate funding for GPs and their clinics needs to be a priority.
 
‘We are the engine house. We keep people out of hospital, we keep people out of the emergency room and ambulances – it makes sense to invest in us,’ she said.
 
After 10 years, we’ve got the first real funding injection into general practice, but we need more to make sure we are sustainable and thriving.
 
‘We need to address funding issues immediately, such as payroll tax which is having significant impacts on the ability of practices to stay open, we then need to look at how general practices are funded and ensure that those longer consultations are adequately remunerated to reflect the type of care being delivered.’
 
The 2023 General Practice: Health of the Nation report will be officially launched in Canberra this morning.
 
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Dr Thomas Rolley   15/11/2023 5:43:57 AM

One consideration could bed "concerige" level GP.

Taking on fewer high paying patients at substationally higher fees.

Like offering a business class flight on long haul if we were an airline.

This solves a couple of problems - more money for the GP.
Less burnout as they are seeing a reduced number of patients.

2 days concierge, 2 days standard GP could be very sustainable and much more attractive to medical students.

The downside is that a lot less patients can be seen on the concierge days potentially execerbating access problems.


Dr Vito Gaetano Spina   15/11/2023 8:13:07 AM

The issue is the need to make it more attractive for medical students to enter into GP training. Providing a hecs fee rebate of 50-70% to graduates who choose to enter into GP training after they complete the training, increasing the remuneration the graduates receive during the training and increasing the mentalhealth skills component of the training would go a long way. In additon for existing practice that continue to Bulk Bill, the increased rebate does not address the 30% of patients that are not eligible and genuinely cannot afford to pay $85 each time they visit a doctor so allowing practices to charge a administration/membership fee yearly and call it the MyMedicare Fee should be introduced.


Dr Megan Elisabeth Barrett   15/11/2023 9:05:35 AM

Especially with the finding presented at Wonca that patients with a regular GP for 10 years have a 30% reduction in hospitalization! Let's do the maths on the savings for that one!


Dr Geoffrey Ronald Greig   15/11/2023 6:49:01 PM

Totally disillusioned with all levels of government. None give a damn and pretend to support us while continuing to destroy General Practice as part of universal healthcare. From pitiful rebates , to never ending increased red tape, to increased taxes.
Why would any current hospital doctor become a gap. Practices have no value as there are no buyers unless sold to a corporate.
General practice as we know it is in its irreversible death throes with severe consequences for the whole health system.
No wonder a 1/3 of us want to quit asap


Dr Christine Colson   15/11/2023 8:49:16 PM

'...GPs are spending an average of 18.6 minutes with each patient, rising from 17.7 minutes in 2022...' Clearly medicare regards this as standard. How can any self-respecting GP feel that $41 is an appropriate rebate for that level of care? The fact that it is reported without mention of the exploitation it represents says it all.