Over-regulation in general practice is emblematic of a system in need of a serious overhaul.
I count many General Practitioners as my friends and acquaintances. I know how hard they work, and I am aware of the oft unreasonable demands that their patients place on them. Australian GPs are rightfully seen as some of the best trained family physicians in the world. However, I also know that GPs are just like any group in our community. They carry their share of members whose motives are confused, and not what we would want to see in a group in which we need to have the utmost trust.
Throughout my career in health I have witnessed first-hand the serious tensions that exist between government and GPs, between hospitals and local GPs, also with professional groups such as Pharmacists, and on rare occasion public feuds between individuals. It is clear that sections of the Australian community have a troubled relationship with our General Practitioners. This is something that we need to acknowledge if we want to make things better. We do need to make this relationship better because high quality general practice is the bedrock of a high quality healthcare system.
The recent experience with the flawed roll-out of the COVID-19 vaccination program, illustrates the problem. General Practices are highly individualistic with many resistant to joint working to meet whole of community outcomes. We also need to acknowledge that the Commonwealth’s supply chain arrangements were unduly optimistic with the COVID-19 vaccine and this ‘burned’ the many practices that invested in the vaccination roll-out. There is ample blame to be shared and it is perfectly understandable and appropriate therefore for States to step in with their mass vaccination hubs. This will deliver the scale and distribution of vaccinations that already busy General Practices cannot offer.
In truth, and in the broad, we cannot rely upon General Practices across the nation to universally deliver our priority primary health outcomes. I appreciate that this is a controversial statement but my experience over the last 20 years gives certainty to my view. Somethings need to change, and I believe this is as much in the interest of GPs as the communities they serve.
The operating and revenue arrangements of General Practices incentivise patient throughput over the quality of the services that patients receive. As a community, we currently get what we pay for- services over patient outcomes! As such, we cannot criticise GPs for doing what the Medicare system requires of them. It is the Medicare system that needs to change, and the Commonwealth has the power in this regard. Many of the GPs I know lament the poor continuity of care that the system allows them to offer their most vulnerable patients.
In the meantime we will see GPs subject to the administrative scrutiny from the Commonwealth that is intended to curb the worst of the ‘gaming’ that sees practices optimise revenues by claiming MBS items that are technically non-compliant with the definitions in the MBS schedule. While the regulatory ‘microscope’ is applied we miss the larger issue that patients are going without the care that General Practices might otherwise provide. Over-regulation in general practice is emblematic of a system in need of a serious overhaul.
We need to step back, engage with the profession, and look at what is in the national interest. I know of too many good GPs that lie awake at night worried that they will be audited by the Commonwealth, instead of thinking how best to care for their most vulnerable patients. This is just so unnecessary.
Perhaps something of the order of a commission of inquiry is needed so that we can get a good line of sight on the true status of the primary health sector more broadly, but with a focus on General Practice as the universal linchpin for lifelong whole person care. Insights are required to inform the changes to better align the Medicare system with the needs of an ageing community living longer, but under the burden of multiple chronic illnesses.
The scope of any such national review or inquiry could include:
- General Practice
- Community Pharmacy
- Allied Health
- Community Mental Health
- Aged Care ( Residential and In-home)
- Palliative Care (Hostel and In-home)
Many GPs want to recall the reasons that they first embarked on a medical career. Yes, they want a good livelihood but they also want to help their patients. A better balance needs to be struck!
Thought starters for PHNs
- How would you rate the quality of the relationship that your PHN has with it’s local GPs? What evidence do you have for this rating?
- How might you go about improving the relationships that General Practices have with counterpart primary health providers such as Pharmacists, Allied Health professionals, etc.?
- What are you doing to optimise the relationship that GPs have with their colleagues working in the hospital sector?