RACGP elections: all eyes on the future

THE year 2020 has been one of upheaval and change for life in general, and general practice has not been spared. Despite being members of the largest medical specialty in Australia, GPs work under considerable strain, a topic that others and I have addressed in the past.

Nominations are now open for the Royal Australian College of GPs’ (RACGP) elections of President and Censor-in-Chief. Nominations close on Thursday 30 July 2020, nominations will be announced on Tuesday 4 August. Voting for President will be held between 12 noon on Thursday 20 August, and 12 noon on Monday 31 August. The winner will be announced on Wednesday 2 September.

Whoever becomes the next RACGP President will shoulder much responsibility in navigating the changes to general practice that may in fact radically change the way medicine is practised in Australia for many years to come.

I see six domains being of critical importance for the next presidential term:

1. governance;
2. philosophy;
3. training and assessment;
4. rural generalism;
5. remuneration; and
6. big data – My Health Record, e-prescribing, data sharing etc.

Governance

It is hard to be effective if one’s house is not in order.

While I do not play any part in RACGP governance, last year’s resignation of a long-standing CEO and the appointment of a Chair who is not a doctor raised some eyebrows and posed a number of questions about the internal machinations of the College.

In recent months, we witnessed further controversy when an extension to the sitting President’s term was sought on account of the COVID-19 pandemic, yet was subsequently decided against by the RACGP Board.

We know full well from mainstream politics that when parties get caught up in their own internal affairs, it can be to the detriment of broader policy setting and functions. The RACGP needs to learn from this.

Philosophy

This is a huge challenge for the next President: just what is a GP?

Volumes could be written about such a question. Demographics, exponentially expanding medical knowledge, and changing social expectations have resulted in GPs playing very different roles from those at the inception of the RACGP in 1958.

The College has spent a lot of money in promoting the GP as a “specialist in life”. Is this really general practice?

GPs not only perform many cognitive and practical tasks for their patients. Increasingly, GPs also need to be advocates and care coordinators. Some of the most effective GPs I know are those who can make things happen in timely and effective ways for their patients.

Training and assessment

Training and assessment are core roles of the College. Even though we have a record number of medical graduates, general practice training is proving unpopular.

Clearly, lifestyle and income play roles when graduates select a specialty, but so too does the reputation and experience of the training and assessment. Registrars want to feel supported, well taught and to be given a case load and casemix that lead to confidence and independence in practice.

The assessment processes adopted by the RACGP (and this applies to all medical colleges) need to reflect the work of GPs in all its complexity.

It remains a great irony that while quality is viewed in terms of time spent with patients and the ability to tackle complex reasoning and tasks, the College examinations test via multiple choice questions and objective structured clinical examinations (OSCEs), which are all about haste and reflex decisions.

All eyes will be on the transition away from the RACGP’s OSCE and what replaces it in 2021.

Rural generalism

Rural generalism is an evolving discipline that encompasses traditional general practice, hospital medicine and pre- and post-hospital care.

Australia’s vast geography demands that doctors who practise outside of urban and regional centres be equipped with broad skillsets.

The Australian College of Rural and Remote Medicine has always sought to promote rural generalism. The RACGP has now also become involved in this domain and its sheer weight of numbers and political clout mean that it shall also play a significant role in how rural generalism evolves in our country.

Having been a rural generalist for 23 years, my take on this is that rural generalists must not only be rural hospitalists and nor must we be only rural GPs.

To be true to rural generalism, those of us who practise it must remain actively involved in both hospital and general practice settings.

The next RACGP President will have a delicate political and philosophical role in appeasing both urban and rural factions within the College.

Remuneration

The elephant in the room!

For many reasons – including patient demand, government pressure, commercial competition and GP altruism – most GP consultations are bulk billed.

More and more is expected of GPs, yet the Medicare rebate remains way behind that of other specialties.

The COVID-19 pandemic has accelerated the adoption of telephone and video consultations as well as debate regarding how to remunerate doctors for such work.

Over time, the income of most GPs has become a blend of fee-for-service and government payments based on performance and quality, the most important of which are the Practice Incentive Program (PIP) payments. The PIP can be substantial income for practices but it requires accreditation and considerable administrative input.

These financial and administrative burdens, as well as other industrial issues, have become a greater focus for the RACGP.

The new President has to decide whether to take the College more and more down this political role, or to swing back more towards standards and education.

Big data

Practice software, My Health Record, the Australian Immunisation Register, the Australian Health Practitioner Regulation Agency and College registrations, among other things, are now done via the internet. GPs who fail to engage with the online world will find their work impossible to do well, and their incomes will suffer too.

Over the next few years, the RACGP and other medical organisations need to be vigilant that the privacy and trust of patients and doctors are not undermined during this paradigm shift. This is especially pertinent in the health sphere, as patient data are not only of great commercial value but also coveted by academics and researchers.

When it comes to big data, the new RACGP will need to be a great defender. Good luck to all the candidates and to the eventual winner.

Dr Aniello Iannuzzi is a Visiting Medical Officer at Coonabarabran District Hospital, a GP, and a Clinical Associate Professor at the University of Sydney and University of New England. He is Chair of the Australian Doctors’ Federation. He is not nominating for the RACGP elections.

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless so stated.