Recently, a lovely middle-aged lady sat in front of me. We dealt with her difficult skin lesions and a chronic cough, but it turns out the real reason she was there was to share a story with me – that she had recently discovered her next-door neighbour, and best friend of the last 40 years, was actually her sister. That was a very interesting story and there was quite a bit involved in this consultation.
With such consultations, we are rightly expected to keep comprehensive records. When I graduated, not so long ago, a few lines on a 4 x 6-inch card represented most consultations. Now, we are all expected to:
- take part in shared decision-making
- meet minimum referral criteria for public hospitals (which are sometimes a little arbitrary)
- deal with complex chronic diseases (seems we are the new general physicians)
- deal with multiple comorbidities as our patients are getting older and sicker
- meet ever-increasing legislative and other compliance standards, and
- be aware of and consult with ever more clinical guidelines.
While most of these things are improvements in the way we do things, GPs are constantly being expected to do more and more with less. Medicare freezes are stark, but the real threat has been from decades of no indexation.
The argument from the government is clear: if the majority of GPs are willing to accept the bulk-bill rebate, then clearly it is adequate. The truth is that most GPs feel for their patients and want them to have the best healthcare regardless of their ability to pay.
Ten years ago, there was quite a marked GP shortage yet bulk-billing rates remained persistently high, mostly because GPs care about patients who cannot afford it. GPs cannot be expected to continue to underwrite the system.
General practice must value what it does to have others value what we do. Asking those who are in a position to contribute to their healthcare to do so is becoming essential for the continuation of quality primary care in this country; however, there are those who are not in a position to contribute and for them, it is clear we need to be thinking of other ways of funding their healthcare.
Many of us have long resisted blended payments with some form of voluntary registration; however, it is becoming increasingly apparent as countries across the world struggle with paying for their healthcare that new forms of funding for the whole community now need to be considered.
The patient I mentioned above had difficult problems and she expected that I could help her in a general practice setting, close to home and community, and with someone she knew and trusted with this delicate information. We need to be properly resourced to continue to help these kinds of patients in our communities.
Dr Bruce Willett
Chair, RACGP Queensland