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What future for general practice – the cry from a rural GP

The current focus on primary health care reform has left GPs feeling confused, nervous and anxious, if this piece from rural GP David Monash is anything to go by. He writes:

“The elephant in the room that is not being spoken of or referred to in the current plethora of reports and indicated reforms in the area of Primary Health Care is: What do our General Practitioners actually do? And what is to become of them?

According to the reports released in the last six weeks, general practitioners appear to be ineffective, inefficient, have no professional identity, minimal skills, easily reproducible clinical skills and are at least obstructionist to team care if not entirely unnecessary in their current role. Reading this literature I’m not sure what they are doing or why they are doing it so badly.

Surely some of the 22 000 GP’s this country funds are doing something effective? Apparently not if you believe the literature we are being fed.

Besides this we don’t have enough of them.

Or do we in fact have too many given their total ineffectiveness? If this is the case why are we increasing their numbers? The department has believed for years that we have too many GPs per capita and the answer is apparently to reduce the numbers and replace them with allied health personnel. Is that what we are doing? The recent increase in training numbers will replace the retiring GP work force but not increase it. Have we been manoeuvred into this position where the GP shortage can be used as a reason and lever for this level of reform?

Reading the multiple submissions made in the consultation process it is apparent that general practitioners can be replaced easily by allied health personnel. This includes nursing staff that merely need to be given prescribing, pathology and referral rights to match GP skills.

The DoHA website is running a survey: “Would you be willing to see a nurse practitioner for some types of care and not a GP if it was quicker and if your quality of care was unaffected?”

Is this a reflection of their attitude to general practice?

According to this survey, which is “Yes Ministerish” in its directional questioning, the implication is that treatment from nurses will not affect the quality of medical care and will be quicker in delivery. It probably will be quicker until they too are buried in the bureaucratic red tape that has killed the ability of general practitioners to utilize their clinical skills or they meet their first serious problem masquerading as a simple issue. Assuming this situation is recognized as such. If it is not recognised them it will take no extra time at all.

In relation to the independent nurses working alone or in pharmacies: Will they need to work from accredited premises? Will they need to keep accurate and defensible clinical notes? Will they be able to complete Centrelink forms, disability parking permits, taxi subsidy applications, death certificates, sick certificates for 2 year olds who can’t attend their day care, obtain authority prescriptions, and complete the myriad of paperwork that surrounds work place injury? Work place injuries that they may be the first to see and treat. Or are all these bureaucratic issues solely the province of general practitioners?

This attitude of omnipotent competence not only applies to nurses but appears to include psychologists, physiotherapists, pharmacists, podiatrists and other allied health personnel all of whom are seeking direct patient access with MBS funding. Will patients or the tax payer pay for patients who see a psychologist for a year while their hypothyroidism progresses? What about the patient with the tumour receiving six months of physiotherapy with only temporary improvement.

“The need to improve the level of teamwork in primary health care, encourage greater integration and improve affordable access to a range of non-medical services is well accepted, although there is debate around where the GP sits in the team.”

Further to this debate, general practitioners apparently do their tasks so poorly that it will be necessary to develop specific and directive funding formulas to drive them to work in a manner and direction the bureaucrats, the ivory tower specialists and the authors of the multiple submissions, believe they should be working in.

Perhaps there should be some concern in relation to these developments as clinical skills applied carefully to individual illness and circumstances is replaced by pre-determined protocol applied universally to all according to a set funding formula.

So where will general practitioners go? Is there a role for them at all? Should they all specialise? Or is the development of an allied health tier in the primary health area pushing them into the realm of general practitioner specialists? If this is the case you can guarantee they won’t receive funding appropriate for this role!”

Comments 2

  1. Frank Campbell says:

    Sounds like a combination of rampant specialisation and corporatism is bedevilling GPs. Out here in the boondocks there’s no doubt about the value of GPs. The leading question cited re “nurse practitioners” shows why surveys need rigorous critical scrutiny. Bureaucracy never asks a question unless it knows it’ll get the answer it wants. The essence of corporate government is to damage you, then tell you it was your decision. Transparency, consultation, “independent” review…there’s an armada of spinnakers at the command of every suit…cutting through the tendentious verbiage is a full-time job in itself.

    The whole point of general practice is to see people in context over time. Most people do not need to see a specialist. The GP knows which “patients” to handball to specialists. The GP is a filter. Without that filter, health costs will sharply increase, unnecessary specialism will proliferate…it makes me sick.

  2. Jon Hunt says:

    It would be nice if he actually stated which reports, and which parts of these reports he had problems with, rather than an unsubstantiated summary. At least then we would know exactly what he was on about.

    Rural doctors in particular are generally quite touchy about their position in the scheme of things. They’re not the same as city GPs because you can’t just refer people to the local hospital when things get difficult, because you are the local hospital. But in the city I think there is the tendency for those so inclined to do not much and get away with it because, let’s face it, you get paid the same.

    Part of the allied health, nurse practitioner push I am sure is because of the lack of GPs, particularly in the country where you can’t get them for love or money. Anything would be better than nothing.

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#IHMayDay18
#LoveRural 2014
Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
#AusCanIndigenousWellness
#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016