Stalwart of ‘powerful specialty’ rewarded with professorship

When Charlotte Hespe interviewed to obtain her university professorship, the setting may not have been ideal for a formal and focused discussion, but it did provide a clear platform to represent her passion for strengthening general practice.
 
‘[The university] changed my time and it just happened to coincide with when we were doing two solid days of advocacy for general practice in Parliament House,’ Professor Hespe told newsGP.
 
‘I naively thought that you could get a private room in Parliament House where I could sit and do the interview, but there’s nowhere security-wise once you’re in … so I had to do it in the public lounge area on my computer with headphones on, which was not so conducive to feeling relaxed.
 
‘But it did prove that I was actually advocating for general practice.’
 
That interview sealed the deal and she became a professor at Sydney’s University of Notre Dame, the culmination of a journey that began in 2008 and also saw her take on the role of Head of General Practice and Primary Care Research since 2016.
 
Professor Hespe applied for her latest position after completing a PhD focused on the implementation of best practice guidelines using cardiovascular disease preventive care as a model, and the theoretical framework of quality improvement collaborative.
 
‘These academic journeys can be hard, but for me, it’s been a nice progression,’ she said.
 
‘My PhD was all done from a viewpoint of how do we improve what we do, and what are the barriers to it? And there’s no doubt that there are barriers to the work that we do in general practice.
 
‘You could call it incentivisation – so what incentives do we get to provide high-quality best care?’
 
‘As we all know … just the payment to do that basic service has been starved for the last 20 years. But alongside of that, there’s been nothing to actually address what I think is a key issue for us as GPs.
 
‘Although we love providing the service … if you just pay a GP fee-for-service, then you’re not actually incentivising high-quality care, you’re incentivising volume. And it’s always distressed me that quality improvement has never really been a focus of an incentive for us as GPs, because we do need to be incentivised for the activities that we do.
 
‘We also need to be incentivised to be accountable to provide high-quality care and work to improve what we’re doing.’
 
The solution to that could in part lie in Professor Hespe’s longstanding advocacy role with the RACGP, as the NSW&ACT Chair of the Board for the past six years.
 
Since becoming a Fellow of the RACGP at the end of the 1990s, she has been involved with the college and was ‘immediately happy’ when tapped on the shoulder to assist with the exams, having served as an examiner over the years.
 
‘I’ve really appreciated what I’ve been involved in, in advocating and being involved in general practice,’ she said.
 
‘My mantra has always been that there is no point in me complaining if I’m not willing to be in there providing solutions.’
 
Having been already elected to three consecutive two-year terms, Professor Hespe’s tenure will come to an end in November. She says it has been an ‘absolute honour’ to have been given an opportunity to ‘hopefully make a difference’.
 
‘That’s what drove me in the first place,’ she said.
 
‘I went in there with the absolute goal to assist the college in becoming the organisation that I personally felt it needed to be, which was about being with all the members and advocating for us on the things that really mattered in order for us to actually be able to deliver what I see as being the most important part of healthcare in Australia – and that is primary healthcare.’
 
Despite her upcoming departure from the Board, Professor Hespe says her commitment to securing a better future for general practice remains strong.
 
‘You’ve got to be at the table and you’ve got to be communicating better,’ she said.
 
‘Over the six years [of being on the Board] I feel that the “ship has turned” somewhat and we are very much more an organisation now that understands it’s a membership-based one that needs to both be accountable for education standards, etcetera, but also accountable to be advocating for general practice, so that it can deliver the things that we’re setting standards about.

‘There’s no point in having excellent education and fantastic standards if you’ve got no GPs to deliver it and the practices collapsing because they’re no longer financially sustainable.’
 
Professor Hespe, who is also an inner-city practice owner, has a clear vision for the future of the profession through her academic work and supervising and teaching the next generation.
 
‘What I really want is for enthusiastic, bright-eyed, bushy-tailed medical students to really want to be in general practice,’ she said. ‘And to see what a powerful specialty it is with respect to really delivering improved health.
 
‘The students I talk to come into medicine because they want to make a difference.’
 
However, that can often get lost in translation, according to Professor Hespe, who says when students get taught in the hospital system they may only be exposed to a small percentage of work that might be ‘exciting and adrenaline-rush creating’.
 
‘We need to go out there and sell what an amazing difference that we make to health outcomes and what a vital role general practice is … and the whole community benefit from having a good general practice specialty,’ she said.
 
‘I don’t think I can talk to a GP who doesn’t know the impact that they have on families and individuals.
 
‘So I want to see that the students are getting that, and seeing general practice as such a rewarding career and feeling like it is viable and sustainable.
 
‘And that people can access appropriate care and the appropriate place at the appropriate time, which is my forever goal.’
 
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advocacy future of general practice professorship RACGP Board strengthening primary care