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Chapter 1: Current and emerging issues

1.1 Common health presentations in general practice

The physical health impact of the 2019–20 bushfires and the COVID-19 pandemic on the community is immediately apparent in the survey results from GPs.

Psychological issues, including depression, anxiety and sleep disturbance, remain the most commonly seen presentations in general practice, with 64% of GPs reporting it in their three most common reasons for patient presentations (Figure 1).

However, 2020 sees a significant shift in the second most commonly reported presentation, with preventive healthcare increasing to 56% (from 18% in 2019)2 (Figure 1). This is due to the greater number of flu vaccinations provided in 2020 compared to other years. The Australian Government secured 18 million doses of the flu vaccination in 2020, significantly more than in 2019, and encouraged all Australians to get vaccinated early to avoid extra stress on the health system during the COVID-19 pandemic.3

The preventive healthcare category includes health screening as well as vaccination. While there was an increase in vaccination, it is likely health screening decreased as patients avoided presenting for usual care. There was a corresponding decrease in other health presentations, including musculoskeletal (from 40% to 25%), circulatory (from 26% to 17%) and endocrine and metabolic (from 34% to 17%) (Figure 1).2 This change in patient presentations is concerning, as the longer term impacts of patients delaying health screening and chronic disease care could be significant. Refer to section 1.4.2 for further discussion of this topic.

There was an increase in respiratory presentations, including cases of suspected COVID-19 (Figure 1).* This may also reflect increased presentations related to smoke inhalation as a result of the 2019–20 bushfires. Exposure to bushfire smoke can have significant short- and long-term health impacts, especially for the most vulnerable members of the community. This puts increasing pressure on general practices with more attendances. A national survey found more than half of Australians were affected in some way by the 2019–20 bushfires, with an estimated 5.1 million people experiencing adverse health impacts from smoke inhalation alone.4

Figure 1. COVID-19 changed the patient presentations seen in general practice*

COVID-19 changed the patient presentations seen in general practice

*Showing top 10 of 18 response options
Descriptor amended in 2020 to include ‘suspected COVID-19’
New response option added in 2020. The unique nature of general practice is to manage presentations of undifferentiated illness, and to work in partnership with the patient to undertake health assessments and use clinical judgement to determine the most appropriate course of treatment or therapy
Measure: GP responses to the question ‘During the COVID-19 pandemic, what are the three most common reasons for patient presentations?’
Base: Responses to survey question, n = 1309 (2017); n = 1537 (2018); n = 1174 (2019); n = 1782 (2020)
Source: EY Sweeney, RACGP GP Survey, May 2020.

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 of 18 response options
Measure: GP responses to the question ‘During the COVID-19 pandemic, what are the three most common reasons for patient presentations?’, split by GP characteristics
Base: Responses to survey question, n = 1782
Source: EY Sweeney, RACGP GP Survey, May 2020.

As seen in previous years, women’s health issues and pregnancy and family planning presentations are more likely to be reported by younger GPs, female GPs and metropolitan GPs (Figure 2).

Psychological presentations are less commonly reported by GPs in areas of socioeconomic disadvantage and regional/rural areas in 2020. This may reflect the increased presentations for physical (such as endocrine and metabolic) health conditions, rather than a direct decrease in presentations for mental health (Figure 2).

Younger GPs and female GPs are more likely to report that psychological issues are the most common reason for patient presentations (Figure 2).

The RACGP survey also found that GPs located in areas of differing socioeconomic advantage1 reported some variance in common patient presentations.

Areas of lower socioeconomic advantage see more patients with endocrine and metabolic issues as well as the effects of non-medical issues on health (such as domestic violence, housing, income and racism). GPs in the most advantaged areas are more likely to see psychological issues and women’s health presentations (Figure 2).

GPs working in Aboriginal Medical Services more commonly report seeing patients about the effects of non-medical issues on health (18%) than GPs working in all types of practices (5%).5 GPs working in Aboriginal Medical Services are also more likely to be located in areas of socioeconomic disadvantage, with 50% of respondents located in SEIFA 1–3, compared to 16% of all GPs in SEIFA 1–3.,5

As with other findings, the lower reported rates of psychological presentations in areas of socioeconomic disadvantage may reflect the need to prioritise concurrent physical health issues (endocrine and metabolic, circulatory) rather than actual lower rates of mental health presentations.

  • According to the Australian Bureau of Statistics’ Socio-Economic Indexes for Areas (SEIFA) ranking 1 (most disadvantaged) versus 10 (least disadvantaged).
  • The higher rate of respiratory presentations in 2017 is attributable to the timing of the survey, which occurred in July (rather than May) and so coincided with the flu season.
  • 2. EY Sweeney. RACGP GP Survey, May 2019. Melbourne: EY Sweeney, 2019.
  • 3. The Hon Greg Hunt MP, Minister for Health, media release: Record flu vaccines in 2020 to protect Australians, 27 May 2020 [Accessed 15 August 2020].
  • 4. The Australia Institute. Polling: Bushfire crisis and concern about climate change. Canberra: TAI, 2020.
  • 5. EY Sweeney. RACGP GP Survey, May 2020. Melbourne: EY Sweeney, 2020.
  • 6. Isaacs AN, Enticott J, Meadows G, Inder B. Lower income levels in Australia are strongly associated with elevated psychological distress: Implications for healthcare and other policy areas. Front Psychiatry 2018;9:536. doi:10.3389/fpsyt.2018.00536.
  • 7. Kutcher S, Wei Y, Coniglio C. Mental health literacy: Past, present and future. Can J Psychiat 2016; 61(3):154–58.
  • 8. Public Health England. Local action on health inequalities: Improving health literacy to reduce health inequalities. London: PHE, 2015.

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