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A unique insight into the state of Australian general practice

The General Practice: Health of the Nation report gives a unique overview of Australian general practice. It reflects the experience of more than 1700 RACGP Fellows from across Australia, and incorporates information from the Medicine in Australia: Balancing Employment and Life (MABEL) survey and various government publications.

The report provides information at a specific point in time and highlights longer-term trends across the general practice sector from the point of view of both patients and GPs.

The 2020 Health of the Nation report also addresses the impact of COVID-19 on general practice and patients, including:

  • changing patient presentations (mental health, preventive health, patients avoiding or delaying seeing their GP)
  • new delivery models (telehealth)
  • impacts on general practices as businesses
  • consequences for GPs in training and the future health workforce
  • experiences of GPs working in rural areas and Aboriginal and Torres Strait Islander health.

This year, we’ve developed a fully interactive digital version of the report that you can read online.

Downloads

Download the PDF General Practice Health of The Nation 2020

General Practice Health of the Nation 2020

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Download the PDF General Practice Health of The Nation 2020

Infographic summary of the 2020 report

 

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Download the PDF General Practice Health of The Nation 2019

General Practice Health of the Nation 2019

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Download the PDF General Practice Health of The Nation 2018

General Practice Health of the Nation 2018

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Download the PDF General Practice Health of The Nation 2017

General Practice Health of the Nation 2017

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Videos

Good morning.
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.

Acknowledgments

I acknowledge the traditional owners of the land from which I’m joining you, the Ngunnawal people, and pay my respects to elders around Australia.

We need to match those words with deeds, and I want to congratulate the College and its members for your ongoing focus on Closing the Gap.

In particular, I want to welcome this report’s focus on educating and training more First Nations GPs. As the report notes, “Aboriginal and Torres Strait Islander people remain significantly under‑represented in the health workforce”, which “contributes to reduced access to health services for the broader Aboriginal and Torres Strait Islander population.”

In that context, it’s good news that First Nations medical graduates are more likely to choose general practice than any other specialty – but of course we have much work to do, on workforce issues and more broadly.

I also acknowledge your Acting President and President-Elect
And of course, I particularly want to pay tribute to your late President Dr Harry Nespolon.

As I said in the Parliament in August, Harry was my first call as Shadow Health Minister, and we stayed in close contact until just days before his death.

He was great company – smart and funny. But he was also a relentless advocate for GPs and their patients.

That passion and determination should remain an example for all of us who care about general practice.
 
Report

I’m honoured to help launch the fourth ‘Health of the Nation’ report
It’s a very good report in a very bad year!

When we launched the last edition in Parliament last September, none of us could have imagined the Black Summer of bushfires, or of course the COVID-19 pandemic.

I thank you for your tireless efforts throughout this annus horribilis
and I acknowledge the impact that’s had on you and your practices.

71% of GPs say their income is lower or much lower than the same time last year, 33% say their work-life balance has suffered
and most concerningly, 41% say their health, and particularly their mental health, has deteriorated.

Of course, every day you see the same impacts among your patients
This report highlights the sharp increase in mental health concerns, particularly for young people and women, that’s one reason why I continue to encourage the Minister to release and respond to the Productivity Commission’s report on mental health, which has been on his desk since June
 
COVID-19

I think governments – and indeed alternative governments – should draw two broad lessons from this report.

The first is that we need to better support you during COVID-19
Because even on the most optimistic vaccine timeline, the pandemic will be with us throughout 2021.

Of course, there have been important changes this year.

I joined the College in calling for Medicare telehealth items early this year, and for their extension when it seemed they might expire in September.

This report makes clear how transformative that’s been – with 15% of GPs providing telehealth care before the pandemic, and 97% doing so now, but of course, we need to see Medicare telehealth items extended beyond March, both for COVID and more broadly and there are a range of other challenges.

According to this report, less than half of GPs feel the federal Government has done enough to ensure their safety during the pandemic
 
Broader reform

But I think the second lesson from this report is this: the challenges that general practice faces didn’t begin, and won’t end, with the pandemic.

This report again highlights the funding pressure that general practice faces – and the burdens that imposes on both GPs and patients, who face record out-of-pocket costs, yet as this report highlights, on a per capita basis, funding for general practice is falling.
 

It’s in that context that I’ve been critical of the Government’s recent changes to Medicare rebates for ECGs.

Now, there’s been some debate over why and how those changes were made, but the practical impact is clear: less support for GPs to perform life-saving heart tests.

Those changes should never have been made, and it shouldn’t take six months to review them.

I’ll continue to call on the Minister to reverse them,
 
But supporting general practice isn’t just a matter of investment – it’s also a matter of reform.
 
I was struck that the leading priority in this report was Medicare rebates – and the second-leading priority was creating new funding models for primary health care.

The message is clear: you want greater investment in general practice, but you don’t necessarily want that investment in episodic care
Fee-for-service will always be part of Medicare.

But adding new funding models would reward those of you who are already providing comprehensive, preventive care – and allow others of you to do the same.

To be fair, the Government announced some funding for this purpose in the 2019 Budget, particularly for older Australians.

But we’ve seen that program stall during the pandemic
We have been talking about this change for decades. The time for talk is over.

And so I urge the Government to make good on that promise as a matter of urgency and I can assure you that Labor will be focussed on these issues in the lead up to the next election

Well welcome everybody to the launch of the RACGP’s Health of the Nation report.

I particularly want to start by acknowledging Dr Ayman Shenouda and Dr Karen Price as the current and future Presidents of the RACGP, Dr Matthew Miles as the CEO, all of our incredible RACGP members in what has been perhaps the most significant and the most difficult year for Australia's medical workforce since the Second World War.

I especially want to acknowledge the passing of Harry Nespolon.

Harry has been such an important figure in medicine and general practice in Australia, and none more so than this year where throughout his illness he worked on telehealth, on primary care, on the 10-year primary care vision, and he kept doing that right up to his very last days, and it was an immense loss for his family first and foremost, his friends, but for the whole profession.

It has been an honor to have worked with Harry through this time but all of our health professionals have been extraordinary. Our doctors, our nurses, our pathologists, our pharmacists, everybody associated with general practice.

But today I particularly want to acknowledge our GPs.

It hasn't been an easy year. We know from the report itself that mental health remains the number one issue and source of presentation for patients. We also know that 27% of our doctors in general practice have had some self-identified decrease in the quality of their mental health through this, which has been the hardest and most difficult of years, and so I want to acknowledge that and I want to recognize that as part of that we've been providing support and funding for the health of our doctors across Australia, the mental health of our doctors across Australia.

But we want to work with the RACGP going forwards on strengthening that role more broadly. We've added an extra 500 million dollars to mental health in recent months through the course of the pandemic, and in particular as part of that we've doubled the MBS psychological services available under Better Access. Many of you have made the case and argued for that, you recognize the importance.

Whilst there's a significant monetary investment, it's much more important that it's the access to services that are being expanded and improved for our patients, and that in turn supports our general practitioners more broadly.

Again there's a 5.7 billion dollar investment in this year alone in mental health, and that's supporting the work of our general practitioners, our doctors who are involved, as well of course our psychologists and our psychiatrists, our support services.

Central to that has been telehealth, and this brings me to my second area beyond mental health, and that's COVID-19, your work and what we've been able to do together.

The most fundamental reform that we've seen in Australia I believe this year has been telehealth, and we all saw the tragedies and the agony that were coming out of Italy and Spain and France and the UK and New York during March and April. The extraordinary scenes and the immense pain and the risk to health care workers. In that environment we made the decision, after consulting with the RACGP and ACRRM and the AMA, and doctors across Australia, to bring forward telehealth.
It was fundamental to protect our doctors and nurses and to protect our patients.

It allowed those early difficult lockdowns at the commencement of the first wave to proceed, whilst providing care to our patients and support for our doctors. Now over 40 million telehealth services across Australia.

What we see as part of that is that this has become an ordinary accepted transition, a 10-year plan brought forward in 10 hectic days at the end of March.

You understand better than anybody the transformation. Whilst it was intended to be temporary with 270 interim items, our plan and our commitment is to make this transition permanent. We've already made iterative changes in particular on the advice of the RACGP, but now we're working on the final long term form of guaranteed universal whole of population telehealth for Australia.

The fact that we've done that in this year of all years in the midst of COVID 19 is an extraordinary testament to the flexibility and the innovation of our general practitioners around the country.
Thank you

At the same time that's been coupled with what we've done in the prescription side. Electronic prescriptions, home delivery of medicines, in particular for our elderly or those who for whatever reason are finding it difficult to leave home. That's been transformative.
So the nature of medicine in many ways has changed. Still, two-thirds of consultations continue to be face to face, which is such an important thing. We've made sure that that's been a critical part of our plan for a 10-year primary health care plan with the RACGP and the medical community across Australia.

I want to acknowledge and thank you for everything that you have done to protect Australians to save lives and to keep Australians safe during the course of COVID- 19.

But then as we look forward there's still a great deal of work to be done to make sure that the general practice pathway is more attractive than ever and to make sure that the distribution between rural and regional is fairer than ever.

We are working very closely on our national health and medical workforce strategy, in particular that's focused on making sure that we have strong pathways into rural generalism. At different stages of their careers, whether it's to do their medical degrees whether it's to do their specialist training as general practitioners or whether once you have Fellowed GPs, the ability to either attract or retain them in rural Australia.

Simplifying what is a very complex arrangement, as so many of you have said to me, is a fundamental part, and then reinvesting any of the efficiencies into incentives for people to practice and study in the bush, and to stay in the regional areas for their career, is at the heart of what we're doing.

I'm really heartened though. What we've seen is a 40% increase in interest in rural general practice from our medical students. We've seen a 55% increase in indigenous enrolments in medical school, and above all else what we're also seeing is the transformation of the structures.
We're putting in place integrated primary care models. We're working with the ACCHOs, with the aboriginal community controlled health organizations, and we are working together on our long-term national rural health strategy which is about 3 000 new doctors and 3 000 new nurses in rural and regional Australia.

A simple easy to understand system for people to enter as students to do their training or to come as Fellowed doctors, that's the vision and the goal going forwards.

It's an exciting time. General practice is being transformed literally before our eyes this year and you're the ones that have made that happen.

It's been a challenge they've been more precious than ever before and we are here to provide that support and assistance but you're the ones that have helped protect and save the lives of what the Medical Journal of Australia says is over 16 000 Australians.

There couldn't have been a greater contribution to the very work and mission of our medical profession and the very reason you all sought to be general practitioners to help save lives and protect lives.
And for that I thank you and I am delighted to officially launch the RACGP’s General Practice: Health of the Nation report for 2020.

Acknowledge the traditional owners of the land on which we meet, wherever we are around the country today. I’m coming to you from Wurundjeri land in Melbourne. 

I want to acknowledge all those people working in First Nations’ health, particularly the growing number of First Nations GPs that the 2020 Health of the Nation report brings to our attention. We have so much work to do to close the gap and your contribution is so important and so desperately needed. 

We must address the legacy of our settler history, which is the shameful health circumstances of First Nations people.
We must put treaty, truth, justice and self-determination at the heart of all policy, including health policy.

Greens want to see more resources and workers in First Nations community controlled health services and communities at the centre of decision-making about the structural disadvantages they face. We also want to see health practitioners in the mainstream able to offer cultural safety to First Nations people. 

As we launch the 2020 Health of the Nation report today, I also want to acknowledge and thank all GPs for your work in supporting the health of our communities, but in particular for your vital work over so many months on the frontline of the COVID response this year. When you compare our situation here to that of countries around the world, we know that we have a lot to be grateful for in the work of you and your colleagues in practices across the country, our first responders.
When I became leader of the Australian Greens, the first thing I wanted to put my stamp on was to elevate the three challenges of the jobs crisis, economic inequality and the climate emergency and how they can be solved through a Green New Deal.

And then the waves of COVID-19 overtook the globe.

But when you think about it, what COVID has done is to expose many of the underlying problems that are the legacy of decades of failed economic and social policy.

As COVID took over our lives we saw the impact on the most vulnerable. Older Australians living in a poorly resourced and regulated aged care sector. A  growing workforce of part-timers, casuals and gig economy workers, whose low wages and precarious circumstances meant that they had little choice but to keep turning up for work even at the risk of their health, and those around them. A let-it-rip housing market with costs ballooning beyond many people’s reach and governments’ reluctance to properly fund public housing so people had stable, affordable and healthy housing options. Trade and industry policies that have seen Australia lose its manufacturing base and run short of local provision of essential items like PPE for the health workforce and essential medicines. 
 
All of this culminated at the same time as the visceral manifestation of the climate crisis with a summer of horror, people displaced, homes burnt to the ground, cities and towns blanketed in smoke for weeks, and essential habitat for our precious wildlife destroyed. 

We know the health impacts of global heating will present themselves to GPs who will be some of the first responders to heat distress, poor air quality from smoke and dust, injury from extreme weather events and more novel diseases. 

We also know that psychological distress from the social, economic and environmental conditions that we are living with is a rapidly growing problem. The Health of the Nation report again confirms the growth of psychological presentations to GPs, and that it is the largest group of presentations that you are seeing. While other health issues vary across age, gender and region, psychological issues remain consistently high across all these demographics.

I met a 17 year old student a little while ago who said she can’t think more than a year ahead, because when she tries to think what the climate crisis will do to her in 5 to 10 years time, it all gets too much.
We are robbing children not just of their future, but also their present. Scott Morrison calls this ‘needless anxiety’, but it is actually a very normal reaction to some very worrying science.

They are watching the climate crisis unfold before their very eyes and they know they are going to suffer the consequences of a collapsing civilisation if our generation fails to rise to the challenge.

They also know that targets in 2050 are next to meaningless unless there is strong action in the next 10 years. As we speak, parts of Antarctica are melting so quickly that if they pass tipping points, we lock in 3-4m searises this century. That’s during my young daughter’s lifetime. If we don’t act by 2030 and have strong 2030 targets, and stop opening up new coal mines and gas fields, it will be too late.
The Green New Deal is about converting that anxiety and anger into action and ambition - a tangible plan of how we can build a future that they can prosper in. 

A key to that prosperous future is being able to offer the best healthcare in the world to all our citizens.

Our Greens vision is for universal access to health care so that there is no gap and no out-of-pocket costs. We’ve got a plan for chronic disease, to place an increased focus on preventive health and to bring dental healthcare in the Medicare system.

Health care funding is a choice for Government. At the moment the government can find $7.8 billion per year to subsidise the fuel costs of the mining industry, another $6.6  billion per year for rebates on private health insurance and a massive $43 billion per year on defence contracts that could be directed into the public health system. At the same time, some of the biggest mining companies are paying no tax at all.

GPs remain the most common first port of call for people, and the most regular contact point in the health system. The viability of practices and the health of GPs is a concern for the Greens.  We still haven’t got the funding for primary care and general practice right. We still haven’t  matched the funding for patient need and care with general practice viability. The Health of the Nation Report again sets this out as a key challenge. In 2019 we committed to invest $4.7 billion over this decade to lift the Medicare freeze in full and protect bulk billing, including investing in life saving diagnostic tests like X-rays and MRI scans. 

We are concerned that the growing size of practices creates access issues for some patients who may have to travel further. But we also see technologically enabled practice as a real opportunity for improving access as well as viability. Telehealth must be here to say and must evolve to help us manage the complex interplay between parts of the system.

But the key to all this is getting the budget measures in place to fund the system that Australians deserve.
So thank you for inviting me to speak to you all today. 
My goal now is to fight for the future. Core to that is a  health system that is world class, has universal access and where our health outcomes aren’t based on how much we can pay. And in order to deliver on that, we need a world class health workforce with GPs and nurses at the forefront. The Greens will always be fighting for affordable, accessible and high quality health care. That’s why we need a Green New Deal for Australia where we can deliver a future for all of us.

Thank you.
 

Podcast

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