In Praise of General Practice
One of the greatest assets – if not the greatest asset – that Australia has in health care is the general practice workforce. General practice is arguably the most cost effective segment of our whole health system. This once cottage industry is changing and growing and you would think that the Government would be striving to fertilise it and nurture it and help it grow. But no, we continue to get negative signals that frustrate and demoralise GPs.
One of the greatest assets – if not the greatest asset – that Australia has in health care is the general practice workforce.
General practice is arguably the most cost effective segment of our whole health system. This once cottage industry is changing and growing and you would think that the Government would be striving to fertilise it and nurture it and help it grow. But no, we continue to get negative signals that frustrate and demoralise GPs.
Sure, we hear the occasional word of reassurance and support in a speech from the PM or the Health Minister, but all the actions are going the other way. The policies and the politics and the language are coming across as less than supportive of general practice. Worse, the calls for proper meaningful consultation on the way ahead for primary care remain unheeded.
The Government must learn to take general practice seriously and seriously support it and build primary health care reform around it – in partnership.
Why? Let me tell you why …
Family doctors train for 10 years before we can claim the title of specialist General Practitioner.
The work we do is very personalised, very private and longitudinal. By the very nature of our work, general practitioners build strong patient loyalty and we put that to good use.
Study after study has shown that a few simple words from the family doctor can profoundly influence behavioural change. A few words that cost nothing at the end of consultations that result in more people kicking the habit potentially save millions of dollars. The inevitable lung diseases and cancers do not occur. The real savings multipliers occur, however, when those patients become role models. The result is fewer smokers to pass on the killer habit. We then have more healthy individuals who can influence virtuous cycles of healthy behaviour and good living, not vicious cycles of illness and premature death.
We general practitioners encourage quarterly visits for our patients with complex care needs. We provide them with personalised health advice, which is enormously motivating to encourage individuals to actively participate in their health care. All my patients know what the ELF diet means - Eat Less Food!
This important health relationship works both ways – and often to the financial detriment of the GP.
How many of us stay back to sign off the paper work? How many of us see that extra patient when it’s time to go home because they are ‘my’ patients? How many of us should charge a ‘C’ instead of a ‘B’ but don’t because of compassion for our patients. The majority of ‘down scheduling’ has nothing to do with Medicare audits or PSR processes. It’s all about the special doctor-patient relationship.
We do not do home visits and aged care visits because they are financially viable. They aren’t. We do them out of loyalty to our patients.
I was woken up on a recent Monday morning by a patient’s daughter who had my personal mobile phone number. She told me her father had just passed away in the nursing home and she did not know what to do.
I told her to meet me at the nursing home where together we walked in to pay our last respects to her ‘Dad’, my patient. He was finally at peace and more relaxed than he had ever been in the past four months since his wife's death. We sat by his bed for 30 minutes swapping stories about his life and times. There are no rebates for that. My patients back at the surgery waited a little longer that day - but they all understood.
An 80 per cent bulk billing rate does not confirm that the rebates are appropriate. It confirms GP compassion. It confirms the willingness of GPs to teach and pass on their ‘profession’. It has nothing to do with token preceptor fees. It has everything to do with our duty of care to our future colleagues and their patients.
Survey after survey shows that people want to see a doctor when they are sick or injured or want health advice.
General practice is the health system to many people. The first step in any health reform process should be to appreciate general practice, support general practice, and build on general practice. We are not seeing that at the moment.
If governments want health reform, if governments want to make things better, if governments want to improve efficiency in the health system, you do not demoralise GPs. But this is what is happening right now.
To borrow from a recent former Prime Minister, the greatest moral challenge of our time in health is the assault by stealth on family doctors.
Here is the assault on family doctors in 10 simple steps:
- Allow rebates to fall to pitiful levels, cancel any after-hours loadings, and ensure that home visits and nursing home visits are non-viable.
- Push GPs out of hospitals and allow their skill sets to contract.
- Squeeze GPs into larger practices, making individual continuity of care more difficult.
- Refuse GPs access to modern technology like MRI, and claim it is beyond their capacity.
- Seek out outlier GPs and publicly castigate them in a public report for their aberrant behaviour.
- Build a GP Super Clinics down the road from established practices and subsidise competitors to further reduce private investment in General Practices.
- Berate GPs for not making themselves available after hours.
- Task substitute with Nurse Practitioners and then grant them higher rebates than Medical Practitioners with decades of experience. For example, $120 per presentation in the Nurse Walk-In Clinic in Canberra.
- Take away ‘for and behalf of’ rebates for practice nurses from GPs and hand it to a third party employer, guaranteeing everyone is worse off except the shareholders.
- Set up a primary health care organisation to look after all of primary care. Unwind the structural drivers for centralised communication (100 per cent of primary care funding is no longer from one level of government) and then squeeze GPs out of the governance structures and attempt to insert bureaucrats between doctors and their patients.
Does all this sound familiar? This is all fact, not fiction. This is the brave new world for General Practitioners in 2011.
We at the AMA say we have had enough of this assault on GPs.
The AMA will not tolerate any further interference in the primary tenet of our members’ professionalism – that personal doctor-patient relationship. That is what drives us, that is what leads to job satisfaction, that is what leads to excellence, and that is what delivers cost effectiveness.
GPs are the engine room of quality, efficient, longitudinal health care. All our governments need to work this out and support it. Now. Immediately.
Turning the heat up on the frog feels good for a while, but eventually it will surely kill it.
Published: 17 Apr 2011