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‘A time of opportunity’: College publishes its advocacy priorities
With Medicare confronting its biggest challenges yet, the RACGP President is determined to reset general practice as ‘a career of choice’.
RACGP President Adjunct Professor Karen Price believes change for the better is possible.
‘We have a time of crisis, which gives us a time of opportunity.’
That is the message RACGP President Adjunct Professor Karen Price wants to convey to colleagues following the publication of the college’s advocacy priorities.
Released during the first sitting period for the new Federal Government, they come at a time when momentum is gathering for reform within the Strengthening Medicare Taskforce that Professor Price is also part of.
Fiercely passionate about the ‘highly rewarding’ career of general practice, the RACGP President is adamant that advocacy and reform must elevate the profession.
‘Why would I want to do anything else?’ Professor Price told newsGP. ‘It is a highly rewarding job. It would bore me doing the same thing over and over again.
‘This is the most intellectually challenging discipline because you can see anything and everything, and you need to diagnose across a broad categorisation of disease.’
However, she is also clear about the substantial challenges facing the work she loves.
‘We have now a situation in which general practice is becoming unsustainable,’ the RACGP President said.
‘We have a failing pipeline, we have a failing business model and we have a challenge in how we’re delivering expert care, in that Medicare fails to appreciate the complexity of general practice work.’
She warns that continuing down the same path could see Australia’s healthcare costs soar towards the notably higher healthcare costs per GDP seen in the US.
‘This is now recognised,’ Professor Price said. ‘We can’t go on or we risk really having a huge challenge in Australia – one which it’s never faced before – where the primary care sector falls over and the rest of the health system will seriously suffer.’
Among the college’s advocacy priorities are enhancing care for older patients, as well as those with disabilities and mental health conditions. Long consultations and improving telehealth and rural health access are also very much on the agenda.
For Professor Price, the key is clinical space and infrastructure to carry out appropriate care, as well as recognition that the work of general practice will not be clear from a simplistic numerical analysis of Medicare item numbers.
Ensuring the reward for cognitive medicine is ‘at least the same’ as procedural medicine and that GPs are supported to provide longer consultations so they can appropriately care for patients are other priorities.
‘A big error I see policymakers and people who think in more actuarial terms make is they try to apply a Medicare item number as if that can audit what general practice is doing,’ she said.
‘We are doing care coordination at a very high level, and we are experts in that complexity. Big datasets cannot tell the full story of systemic failings where a mixed methods or qualitative analysis in research terms can.
‘I am concerned some are interpreting large datasets inappropriately. My research training suggests this is resulting in misinterpretation and over-claiming of simple quantitative data.
‘It’s a total lack of understanding of the discipline of generalism, and it needs to stop.’
Highlighting good role models, as well as valuing diversity by giving GPs the tools, time and resourcing to expand their skillset are other priorities Professor Price raises.
‘When we’re trained to a high degree, we should be able to practice what we’ve been trained in,’ she said.
The RACGP President also talks frankly about both the emotional reward and burden of the role.
‘From a purely human point of view, I’m not a robot and I want to have rewarding and meaningful, caring relationships with my patients over time, to see them develop and be able to keep them healthy,’ Professor Price said.
‘I have third generation children who call out “Dr Price” in the waiting room and run to me, and it’s just the most wonderful thing.
‘To have that trust, it’s sometimes a bit scary but … it keeps you humble, because it’s always keeping you on your toes.
‘I always say my patients are wonderful teachers. I am always learning; I like continually learning and being challenged by that.’
With those emotional, intellectual and clinical rigours, Professor Price speaks of the need to protect the GP workforce.
‘We need to be able to recognise that GPs need time off to rest, but they also need time off to debrief, to upskill and relearn their craft,’ she said
‘That’s all packaged in for our hospital-based colleagues, but we need to package it into general practice as well.’
As for the Medicare taskforce, Professor Price is prepared for significant reform to emerge.
‘My focus will be to make sure that the big structural changes are implemented, and in particular, looking at one whole health system so states can recognise that contributing to general practice helps their hospital systems,’ she said.
‘That’s a really important part and we have to get that right.’
Professor Price also recognises that the approach to data is likely to form an important part of any change – but stresses general practice must maintain governance in this area.
‘Let’s look at what’s worked and what hasn’t worked overseas,’ she said.
‘What has not worked is targets for general practice; what has worked are quality improvement projects which are clinically driven by the GP themselves, like in Sweden where they can look up and benchmark their own practice against local practices.’
But as much as anything, Professor Price wants advocacy and reform to set up the right pathways for doctors coming through the system so they can gain as much from the work as she has.
‘We need to make general practice a career of choice,’ she said.
RACGP advocacy priorities
Compiled following consultation with members, the college priorities are listed as follows, with more information in each area included in the full document:
- Enhanced primary care services for people over the age of 65, people with mental health conditions and people with disability
- Longer general practice consultations to support patients with complex needs
- Improved access to telehealth, so patients can talk to their GP on the phone about complex issues such as chronic illness and mental health
- Support for patients to see their GP within seven days of an unplanned hospital admission, to help prevent the risk of patients going back to hospital
- Improved access to care in rural communities, by encouraging and supporting rural doctors to upskill in other areas such as internal medicine, mental health, paediatrics, palliative care, and emergency
The college also confirms its support for the implementation of the
Uluru Statement from the Heart and Closing the Gap, as well as action to provide a voice for Aboriginal and Torres Strait Islander people in Parliament and to invest ‘in equality in health and life expectancy for Aboriginal and Torres Strait Islander peoples’.
More details on the college’s advocacy priorities can be found on the RACGP website.
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