This last year has again shown how resourceful, determined and capable general practices are in times of crisis
The COVID-19 pandemic lingers and many communities, including my own in Melbourne, have been plunged into lockdown again and again.
The vaccine rollout has encountered many challenges, yet our GPs, practice managers, nurses, receptionists and administrative staff have not only persevered, but performed tremendously. Practices have delivered more than 12 million COVID-19 vaccine doses (more than half the national total), and by the time you read this it will be many more.
The General Practice: Health of the Nation 2021 report underscores that GPs are more important than ever, and we need greater support to help communities manage the fallout from the pandemic.
General practice is a ready-made mass-vaccination service
Our survey found that almost three out of five GPs reported ‘managing patient expectations about vaccinations’ as one of the most challenging issues arising from the pandemic. Multiple changes to vaccine eligibility requirements left many people confused and overwhelmed and, unfortunately, some of these patients took their frustrations out on general practice staff.
Differing eligibility requirements across jurisdictions added to the strain. Government can alleviate this additional pressure by ensuring practices are kept in the loop on public health decisions. General practice must be involved in public health decisions, including changes to the vaccine rollout.
This rollout will no doubt have more twists and turns ahead, and it is vital that GPs are properly consulted to ensure we can best perform our critical role as the backbone of the vaccine rollout.
We must look ahead and be clear-eyed about the future of our profession
Not enough junior doctors are choosing a career in general practice. It is that simple.
The general practice workforce is ageing – the proportion of GPs over the age of 65 increased from 11.6% in 2015 to 13.3% in 2019.
At the same time, not enough medical graduates want to be GPs. The proportion of final-year students listing general practice as their first preference specialty has fallen to just 15.2% – the lowest since 2012.
International medical graduates will continue to play a crucial role in bolstering the general practice workforce, but we must also grow our locally trained workforce. We also need more GPs to practise outside major cities. The RACGP is Australia’s largest representative body of rural GPs, so that will always be a high priority.
I believe that by highlighting how diverse and rewarding this career path can be, we can encourage more doctors to opt for general practice. But it is also important to address what is holding more doctors back from a career as a GP. Piece-by-piece repair is not sufficient – genuine reform in the sector is required.
A great place to start would be putting general practice on a more sustainable, long-term financial footing. At a time when we are needed by our communities more than ever, the share of total government healthcare spend for primary care is in decline. Funding for GPs and general practice services is less than 8% of total health expenditure, yet we provide more than twice the number of episodes of care a year than hospitals, and all at one-sixth of the cost.
As we revealed last year, economic analysis by PricewaterhouseCoopers estimates that implementing the RACGP’s Vision for general practice and a sustainable healthcare system and boosting primary care funding could provide benefits of $5.6 billion over the next five years.
This issue is front of mind for many of our members. This year’s survey found that 26% of respondents ranked Medicare rebates as their highest priority. More than half of GPs surveyed said they would recommend general practice as a career to their junior colleagues, but 48% indicated they are less likely to do so now compared to a decade ago. Those who would not recommend general practice as a career have concerns around their remuneration, recognition and Medicare billing requirements.
So, if the Federal Government is serious about boosting the general practice workforce of the future so all patients can continue to access high‑quality primary care regardless of where they live, it is vital this is reflected in long-term funding arrangements. The task of attracting more junior doctors to general practice would be made that much easier and the savings for the entire health system would be immense.
We need to set a target and stick with it. Anything less could be detrimental to the entire health system and, indeed, the health of the nation.
Managing the fallout from the pandemic in the years ahead will be crucial
Ask any GP and they will likely report more and more patients presenting with mental health concerns. This is part of a longer-term trend. For the fifth consecutive year, psychological conditions, including sleep disturbance and depression, were the most reported reasons for patient presentations. Over 70% of GPs selected ‘psychological’ in their top three reasons for patient presentations, a number that has risen steadily from 61% in 2017.
As the first port of call for many patients with mental health issues, GPs play a vital ongoing role over many months or even years. Four out of five GPs report they have patients with mental health conditions that are mostly managed within general practice. This aligns with data showing that GPs provide the majority of Medicare-subsidised mental health services.
The scale of the task has only grown over the last 12 months. To help these patients, we need new Medicare items for longer mental health consultations so we can really get to the bottom of what is going on.
The true measure of any society is how it treats its most vulnerable
The last year has seen an increased focus on aged care, a shift that could not have come soon enough. GPs play a vital and often unrecognised role in caring for older people in residential aged care facilities and in the community. People aged 65 and over account for 16% of the Australian population but represent nearly 30% of all general practice consultations.
Ensuring adequate access to primary care can make an enormous difference. We know people with dementia entering the aged care system are less likely to experience an increase in prescriptions for medications like antipsychotics if they retain a relationship with their usual GP.
When asked what would make them more likely to work in aged care, two-thirds of GP respondents said better remuneration via Medicare items, while more than half selected fewer administrative burdens and more clinical staff in aged care settings as key drivers. Helping GPs get on with the job of helping older people in aged care is essential.
It is also important to remember that GPs are the only medical practitioners that specialise in managing patients with multiple health conditions. Almost three‑quarters of GPs surveyed reported that most of their patients have multiple medical conditions.
This challenge looms large on the horizon for general practice. To better help patients with multiple conditions who are at heightened risk of ending up in hospital, we must change how we structure general practice funding. As things currently stand, Medicare discourages GPs from treating more than one condition in the same consultation. It is vital that we remove this barrier and incentivise longer consultations to support comprehensive care by GPs.
The solutions are in plain sight –we just need the political will
The RACGP will continue fighting for practices and their patients across Australia.
Only when the fundamental role of general practice is properly recognised and greater support and resources are given to our hardworking GPs can government honestly say it is committed to improving the health of the nation.
To all practices, I say keep up the great work. Your communities need you now more than ever before.
Dr Karen Price
17 September 2021