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Chapter 1: Current and emerging issues

1.1 Common health presentations in general practice

As in previous years, RACGP Fellows participating in the 2021 Health of the Nation survey were asked to nominate the three most common presentations they see.

Psychological conditions (including sleep disturbance and depression) were the most commonly reported reasons for patient presentations for the fifth consecutive year, and the overall number of GPs who selected mental health in their top three reasons for patient presentations has risen steadily since the survey was first launched, from 61% in 2017 to over 70% in 2021. This increase is statistically and clinically significant and reflects findings from multiple sources that mental health presentations in general practice are increasing (Figure 1, Figure 3).

The 2020 survey showed a large spike in preventive care (particularly immunisation) during the early days of the COVID-19 pandemic and a drop in management of physical health conditions. The 2021 survey results, however, showed a return to previous rates of care for musculoskeletal, endocrine and metabolic, women’s health, and circulatory presentations2 (Figure 1).

Musculoskeletal conditions (back or neck pain, arthritis) have returned to the second-most commonly reported reason for patient presentation (according to 39% of GPs). Respiratory presentations (cough, asthma, sinusitis and suspected COVID-19) remain the third-most commonly reported reason by GPs (31% of GPs), falling from 45% at the start of the COVID-19 pandemic. Preventive care (immunisation, diet) has returned to similar rates reported in pre-COVID years (21% of GPs) (Figure 1).

Figure 1. Mental health is the most commonly reported reason for patient presentations in general practice

Mental health is the most commonly reported reason for patient presentations in general practice

*Showing top 10 of 18 response options.
**Descriptor amended in 2020 to include ‘suspected COVID-19’.
***New response options added in 2020. Caution should be used on the magnitude of differences from 2019 and 2020, as two new codes – ‘undifferentiated illness’ and ‘effects of non-medical issues’ – were added in 2020. Note: ‘Men’s health’ code label changed in 2019 (from male genital system); ‘Women’s health’ code label changed in 2019 (from female genital system).
Measure: GP responses to the question, ‘What are the three most common reasons for patient presentations?’
Base: Total survey respondents, n = 1309 (2017); n = 1537 (2018); n = 1174 (2019); n = 1782 (2020); n = 1386 (2021).
Source: EY Sweeney, RACGP GP Fellow Survey, May 2021.
 

Figure 2 shows variation in reported health presentations according to the GP’s age, gender and practice location. GPs aged 44 years and younger are more likely to report a higher proportion of patients presenting for psychological, respiratory, women’s health, and pregnancy and family planning reasons, whereas GPs aged 45 years and older are more likely to report musculoskeletal, endocrine and metabolic, and circulatory issues as reasons for patient presentations (Figure 2).

Female GPs are more likely to report psychological, women’s health, and pregnancy and family planning as reasons for patient presentations, whereas male GPs are more likely to report musculoskeletal, respiratory, circulatory and skin presentations (Figure 2).

GPs in rural and regional areas more commonly see endocrine and metabolic, circulatory and skin issues compared to their colleagues in metropolitan areas. GPs in areas of greatest socioeconomic disadvantage reported seeing a higher proportion of musculoskeletal, endocrine and metabolic issues, as well as the effects of non-medical issues on health (such as domestic violence, inadequate housing) (Figure 2).

These gender- and age-related differences in presentations, along with the differences related to practice location, have been consistently reported through the five years of the Health of the Nation survey.3

GPs working in Aboriginal medical services (AMSs) are more likely to report endocrine and metabolic issues (66%) and the effects of non-medical issues on health (38%), and are less likely to report psychological (53%), musculoskeletal (25%), women’s health (9%), and preventive care (9%) than GPs working in all practice types.[3] GPs in AMSs are more likely to work in areas of socioeconomic disadvantage.3

As with previous years, the 2021 findings may reflect an overall higher disease burden in areas of socioeconomic disadvantage and a need to prioritise acute physical health issues. Lower rates of health literacy among patients in these areas may also affect when and how they seek help.2

Figure 2. Commonly managed health issues vary according to a practitioner’s personal characteristics

Commonly managed health issues vary according to a practitioner’s personal characteristics

Showing top 10–12 of 18 response options.
Measure: GP responses to the question, ‘What are the three most common reasons for patient presentations?’, split by GP characteristics.
Base: Total survey respondents, n = 1386.
Source: EY Sweeney, RACGP GP Fellow Survey, May 2021.

In addition to an increase in psychological presentations, more patients are accessing mental health Medicare Benefits Schedule (MBS) items.

This trend of increasing use of mental health services has been exacerbated by the COVID-19 pandemic.5

It is important to note that these figures are likely an under-representation of the true magnitude of mental health presentations to GPs, as the longer consultations required for these presentations are often billed as a general consultation rather than under a specific mental health MBS item number.


More than 10% of the population received specific MBS-supported mental health care in 2019–20, almost doubling the rate from the previous 10 years.4
The majority of these services (82%) were provided by a GP (Figure 3).

 

Figure 3. GPs provide the majority of MBS-subsidised mental health services, and attendances are rapidly increasing

GPs provide the majority of MBS-subsidised mental health services, and attendances are rapidly increasing

Source: Australian Institute of Health and Welfare 2021. Mental health services in Australia. Canberra: AIHW. Viewed 27 May 2021

In addition, it is important to recognise that GPs have also been affected by COVID-19, with more than half (53%) reporting at least one negative impact to their wellbeing because of the pandemic (Figure 4). These rates have remained steady since the 2020 survey and suggest ongoing effects on GPs and their practices.

Increased reporting of a deterioration in work–life balance, from 33% in 2020 to 38% in 2021,3 may be due to the increased burden of providing COVID-19 vaccines and related counselling in 2021.

Male GPs are more likely to report no change to their wellbeing as a result of COVID-19 (50%) compared to female GPs (35%).3 This is consistent with GP survey findings in 2020,6 and aligns with findings from surveys of the wider population, with women often disproportionately affected by unpaid caregiving duties.7

GPs in rural and regional areas are more likely to report a deterioration in their work–life balance (44%) compared to GPs in metropolitan areas (37%). GPs in Victoria are the most likely to report a negative effect to their wellbeing (58%), with more reporting effects on their work–life balance (44%) and physical health (20%) compared to GPs in other states.3 This likely reflects the impact of Victoria’s prolonged COVID-19 lockdown in 2020.

Figure 4. One in two GPs reported the COVID-19 pandemic had a negative effect on their wellbeing

One in two GPs reported the COVID-19 pandemic had a negative effect on their wellbeing

Measure: GP responses to the question, ‘Have you experienced any negative impact on your own wellbeing as a result of COVID-19?’ (select all that apply).
Base: Total survey responses, n = 1386.
Source: EY Sweeney, RACGP GP Fellow Survey, May 2021.
 

During the COVID-19 pandemic, GPs’ need to manage more stringent infection-control measures and concerns for their own wellbeing, as well as those of their patients, has affected them and their practice staff. GPs also reported increased stress from constantly changing clinical advice, Medicare rule changes, financial and business pressures, and managing a larger volume of patient enquiries. See Figure 7 for more information.

  • According to the Australian Bureau of Statistics remoteness areas.
  • According to the Australian Bureau of Statistics’ Socio-Economic Indexes for Areas ranking 1 (most disadvantaged) versus 10 (least disadvantaged).
  • 1. Department of Health. Annual Medicare statistics: Financial year 1984–85 to 2020–21. Canberra: DoH, 2021.
  • 2. RACGP. General Practice: Health of the Nation 2020. East Melbourne: RACGP, 2020.
  • 3. EY Sweeney. RACGP GP Fellow Survey. Melbourne: EY Sweeney, 2021.
  • 4. Australian Institute of Health and Welfare. Mental health services in Australia. Canberra: AIHW, 2021.
  • 5. Black Dog Institute. Mental health ramifications of COVID-19: The Australian context. Sydney: Black Dog Institute, 2020.
  • 6. RACGP. General Practice: Health of the Nation 2020. East Melbourne: RACGP, 2020.
  • 7. Hammarberg K, Tran T, Kirkman M, et al. Sex and age differences in clinically significant symptoms of depression and anxiety among people in Australia in the first month of COVID-19 restrictions: A national survey. BMJ Open 2020;10(11):e042696.