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    Andrew Taylor

    As a trained rural GP, with about 30 years experience, and having just returned from a short time in King Island (like all of Tas is ” too few GPs”) I have some very strong opinions on this work force shortage.
    The raw numbers indicate we have plenty of docs for the whole population. We may well have a significant distribution problem but the solution doesn’t require the use of relatively untrained untrained people.
    GPs do a lot of lesser skilled work as is stated by Mr Duckett. But Mr Duckett I see Chronic Disease Management as an example of the easy stuff as it is algorithmic. It can be done by anyone, although this will cost the public purse a lot- as all algorithmic care does. But no decisions need be made in delivering such care so financial rewards need not be paid to doctor for his/her efforts. Nurses have proven in other fields such as psychiatry that they are easily capable of following procedures and protocols.
    Similarly specialist referral, as an outcome, often implies no management decision has been made, or that “the case” is beyond the capability of the treating practitioner. Thus the consultation was not onerous in terms of responsibility taken and could have been provided by anybody with a similar lack of ability.
    The most difficult work we GPs do is in seeing the acute (initial) presentation of any illness- especially in an unknown patient. Unfortunately this is rarely recognised by health administrators as our greatest challenge.( It is hard to measure and very hard to cost.) It does involve traditional diagnosis by history taking and examination. Sometimes it then requires advice, or reassurance, or a treatment or it may demand some array of tests to confirm and exclude differentials. This is difficult, onerous in terms of time taken, financially under rewarded and yet incurs great responsibility. Rural practice requires this be done many many times each day as there are few Emergency Departments, more trauma, and less diagnostic supports available. Certainly there are no specialists if it all seems a bit difficult!
    So GPs instead take the easy city jobs with the very very high paying rewards that chronic disease care pays, where little responsibility is taken, and after hours care is provided through a Goverment agency. And rural areas go without services.
    But Mr Duckett what you propose must just make things worse! The easy high paying stuff already goes to the richest man in every country town – the pharmacist- and you now suggest that we take more from the few GPs that are out there and hand this over to the pharmacist too. Huh??
    Maybe it might be better to reverse the situation and allow all rural GPs to to run a pharmacy- perhaps through an intermediary such as the local supermarket- and do their own dispensing? The financial rewards would easily provide returns that would likely encourage doctors to go bush.

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    Reading the Grattan Institute’s report, it was clear that the writers lacked understanding about what a general practitioner truly does. The report quotes data from the BEACH study as evidence that GPs handle substantial numbers of “simple” consultations that involve only a single diagnosis and/or a prescription without any recognition of the diagnostic process. As Andrew Taylor has pointed out, one of the key roles of the GP is to diagnose the condition; whether or not the problem is a simple one is unknown when the patient first walks through the door.

    If better access to GPs is needed, then improve access for to GP training for junior doctors. We have had big increases in medical school graduates, but vocational GP training has not kept pace. The latest round of training position was over subscribed, meaning that many doctors interested in being GPs have missed out.

    If you have a bonded rural scholarship program, then run it well enough so that students are held to the agreement after they graduate. After all, they know the terms and conditions when they sign on.

    There is no real advantage to pharmacist vaccinators, as most of the general practices I am familiar with have vaccinations done by nurses in collaboration with the GP, and it is not an onerous burden on GP time. There is no need to further fragment care by introducing yet more task substitution into the mix.


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