I acknowledge the traditional owners of the land in which I record this message, the Wiradjuri people (WEIR-AJ-ARI). I pay my respects to their elders past, present and future.
I welcome you to the launch of Health of the Nation. We would normally be together, welcoming our nation’s politicians to talk to GPs in Parliament House. In a pandemic, like us all, Health of the Nation has adapted. I encourage you to take the time to listen to our speakers today who have recorded messages for you.
The General Practice: Health of the Nation 2020 report provides findings from a survey of almost 1,800 GPs across Australia. This is our fourth annual report and it could not come at a more important time.
The last 12 months have tested our health system like no other time in living memory.
We had the devastating summer bushfires and then, before we could draw breath, the emergence of a once in a lifetime pandemic. These twin health crises have made clear how vital primary care is when disaster strikes.
When the bushfires hit, our GPs stood tall in communities across the south and east of Australia. Take Bega’s Dr Duncan MacKinnon, an RACGP award winner, who worked long hours to help co-ordinate the local health response to the bushfires so that patients always had access to a GP. He also fought strongly for increased funding and support for counselling services post-bushfires and I thank him for all of his great work.
Then when the pandemic gripped the nation our GPs were up to the task once more.
Almost overnight, they changed the way they treated patients and ran their practices, implemented infection controls, embraced telehealth services, reassured anxious patients, persevered and thought outside of the box.
GPs on the frontline of these health crises worked tirelessly to help their communities. It is in the DNA of general practice to do so. Tasmanian GP of the Year Dr John Ballantyne in Launceston co-founded the Tassie Face Mask Project to make and distribute cloth masks to vulnerable people. Bendigo’s Dr Katie Snow worked with a Refugee Health team to create COVID-19 videos and flyers.
GPs have been central in running COVID-19 respiratory clinics, which have kept people safe by testing anyone with flu-like symptoms.
I volunteered to establish a testing clinic in Wagga Wagga because I knew it would make a difference. When the news came through to my practice that we had been selected - all the members of the team including nurses, receptionists, administrative staff and GPs put their hand up and said they wanted to be involved. We were set up to see 60 patients a day if needed.
It showed just how responsive and willing general practice is when health crises emerge and I was proud to be a part of it.
But, as our report highlights, to make sure that GPs can continue helping their communities they need more support.
The role of GPs must be formally recognised in disaster and health crisis preparation, mitigation, response and recovery, at both state and national levels. We know our communities and will be there for patients during and after this pandemic so we should be front and centre. We are also the ones helping communities hit by bushfires to heal.
General practice also needs better access to personal protective equipment. Almost half of the GPs we surveyed cited difficulty accessing adequate PPE as one of their biggest challenges. General practice relies on PPE for the protection of GPs, practice teams and patients.
So it is not surprising that eight out of 10 GPs think both the federal and state governments needed to do more to provide practices with PPE. The Federal Budget last month did include funding greater supply and we will be keeping a close eye on whether the situation improves.
The long-term health consequence of the COVID-19 pandemic are unknown but likely to be severe. That includes the effects of patients delaying or avoiding care and the impacts of the virus itself on long-term physical and mental wellbeing.
There will also be an increase in mental health concerns. The report tells us that mental health is already the most common presentation reported by GPs and RACGP member feedback highlights that a higher percentage of patients experience mental health issues following disasters.
So what can government do to lend GPs a helping hand? The solutions are right in front of us.
The extension of Medicare subsidies for telehealth services to the end of March next year is welcome, but a longer term plan is needed. We look forward to working with the Government on this plan because telehealth has been a game changer for general practice and patients.
More than two in three GPs report a positive change in attitude toward using telehealth as the result of the pandemic, and seven in ten GPs think that continuing telehealth after the pandemic would support patient access to high-quality care in general practice.
When we look at the patients hardest hit by the pandemic, such as those with multiple chronic conditions who have delayed or avoided care, people from culturally and linguistically diverse backgrounds , older people and COVID-19 positive patients with long-term health effects, it becomes clear once again how vital continuity of care is.
It improves patient health outcomes and reduce hospitalisations.
A voluntary patient enrolment model will facilitate greater continuity of care for many patients and support GPs and practice teams to manage chronic disease and mental health issues. We urge the government to prioritise introducing the promised model.
Mental health must be a priority. If Medicare subsidies were available for longer mental health consultations, you could take more time to get to know what your patients are experiencing and how you can help.
Sometimes it takes a crisis to take stock of what is working and what needs improvement.
The last 12 months have shown us that primary care is fundamental to the health of our community and must be properly resourced.
Nearly 90% of Australians visit their GP each year – yet general practice only receives 7.5% of all government health expenditure. Most countries invest about 10 to 13% of their health spending in primary care.
Given the workload general practice is shouldering in the wake of the twin health crises, it is clear that change is needed. The need to better fund primary healthcare is strongly reflected in this year’s survey responses, with “Medicare rebates”, and “Creating new funding models for primary healthcare” the top priorities identified by GPs.
If we do not change course the health consequences arising from the pandemic will become even more difficult to manage. Patient out-of-pocket contributions are increasing year on year. Given that some patients have already been delaying or avoiding care in 2020, we must be doing all we can to enhance accessibility to quality general practice care.
GPs are seeking sector recognition and support and, as this report shows, are integral to the primary health care system across the entire country. The Health of the Nation report outlines some of the issues the Federal Government’s 10 Year Primary Healthcare Plan needs to address to bolster the sector and ensure it can deliver on its preventive, early intervention potential.
I want to turn to rural health.
I am a Wagga Wagga-based GP, a former head of RACGP Rural and passionate about fighting for healthcare in rural and remote Australia. I am the Acting President of the largest representative body of rural and remote GPs in Australia.
We all know the challenges facing rural healthcare, including workforce issues.
In major cities there are more than 121 GPs per 100,000 people and this falls to just over 100 in outer-regional areas.
This can cause problems for patients, with some patients in outer-regional and remote areas waiting longer than people in major cities to get urgent care. So we know what the problems are. However, I also see immense opportunity for rural general practice.
If we can show future doctors just how rewarding practicing in rural areas can be, we can tackle workforce issues head on. Working as a rural or remote GP you see the positive impact of your work in your community every day. Your skill set advances rapidly and you develop a broader range of skills too.
Don’t just take my word for it, you only need to listen to this year’s RACGP Rural Award winners.
This year’s Brian Williams Award winner, Dr Lorri Hopkins in Albany, is adamant that with the right approach we can give junior doctors the confidence to train in the country and enjoy a long, rewarding career in a rural community.
GPs in rural areas report greater ease in building a patient base and often have longer relationships with their patients, which improves continuity of care. I highly recommend future doctors consider “going rural”.
I am pleased we are making progress.
The RACGP worked closely with the Department of Health to change the Australian General Practice Training Rural Generalist policy, giving registrars more flexibility to choose the right training pathway. As a result we saw a 40% increase in junior doctors choosing the Rural Generalism pathway for our 2021 training, compared to applications for 2020.
That shows that with the right policy settings we can encourage more future doctors to opt for a career in these communities.
When it comes to Aboriginal and Torres Strait Islander health we are also making positive in-roads.
In 2020, there are 404 Aboriginal and Torres Strait Islander medical students - this has increased from 265 in 2014. This year, 121 Aboriginal and Torres Strait Islander students started studying medicine, which is a 55% increase over the past three years.
Still, we need to do more to boost the Aboriginal and Torres Strait Islander workforce. Inspiration can be drawn from GP in Training Dr Josie Guyer. Half a century ago Josie’s mother was told there was no place for her to work in a hospital because she was Aboriginal. Her daughter is now a doctor and RACGP award winner.Upon receiving the award, Josie’s message to any Aboriginal and Torres Strait Islander person considering becoming a doctor was straightforward – “you can do it, because I have done it and we need more Aboriginal and Torres Strait Islander people working as health professions - including in general practice.”
These are words that can inspire us to aim for so much more.
Finally, I would like to once again honour the legacy of our late President Dr Harry Nespolon.
Harry was a giant of general practice. I have the highest respect for him and everything he was able to achieve for the general practice community.
He rose to the occasion during the summer’s bushfires and the pandemic and provided exemplary leadership. Right to the very
end he worked as hard as he could. Harry fought for what he believed in and never looked back.
Thank you Harry and thank you everyone for listening to me today.
Thank you to the RACGP Fellows who completed the Health of the Nation survey, which helps the RACGP to present this picture of the sector each year.
I urge you all to visit our website, read the report and view speeches from the Minister for Health Greg Hunt, the Shadow Health Minister Chris Bowen and the Australian Greens leader Adam Bandt.