Mad as hell, GPs won’t take it anymore

GPs have reached their Peter Finch moment – they’re mad as hell and they’re not going to take this anymore, according to attendees at last Wednesday’s crisis summit in Canberra.

“We’ve always had this social contract,” said Associate Professor Louise Stone, speaking with InSight+.

“We’ve always said, we’ll do whatever we can to help, we’ll work as hard as we can, we’ll do whatever we can for our patients. In exchange, we need the resources to do so.

“And we’ve been thrown under the bus.”

The crisis summit was called by the President of the Royal Australian College of General Practitioners, Adjunct Professor Karen Price, and included “leaders from the general practice sector, consumer groups, government, and academia to develop solutions to secure the future of general practice care in Australia and improve patient health outcomes”.

A/Professor Stone said a strong emerging theme from the summit was “a sense that the time has come for GPs to be relentless and vocal about the nature of general practice”.

“We are not going to be silent anymore,” she said.

It had come as a bit of a shock, she said, to collectively realise how undervalued and disrespected general practitioners have been, not just by governments and other external entities, but from within the medical profession itself.

“There is systemic GPism – like racism and ageism,” she said.

“On the one hand, people overtly say, ‘oh yes general practice is the core of health care’.

“But on the other hand, there is systemic discrimination against and disrespect towards GPs. We saw it with the shortages of personal protective equipment. We saw it with the lack of consultation about the COVID-19 vaccination rollout and caring for COVID patients in the community.

“We’re not even included in the Crimes Legislation Amendment (Assaults on Frontline Emergency and Health Workers) Bill 2022 … apparently it’s not okay to assault pharmacists and nurses, but it is okay to assault GPs.”

A/Professor Stone said there was a strong feeling at the Summit that it was time to start calling out disrespectful and devaluing behaviour whenever it was seen.

“We are sick of being expendable,” she said.

“Trying to explain the complexity of general practice is hard. You can’t do it in a soundbite, and as a result people who believe they can do our jobs like to tell us what it is we do.”

Professor Grant Russell, Professor of Primary Care Research at Monash University and a GP, agreed.

“It’s clear that GPs are not going to stay quiet,” he told InSight+.

“Systemic discrimination was a strong theme that came through [at the summit]. It’s easy to adopt a victim mentality, but there are plenty of examples of far-thinking people in other parts of medicine who can see the value in general practice [and give it due respect].

“But that is not as widespread as it should be, and of course that gets noticed more when the system is under strain.

“It’s a system that is not fit for purpose. There isn’t a quick fix and there have been many bandaid solutions by governments over the years.

“I’m cautiously optimistic. The summit was a brave and public attempt to do something meaningful. There were a lot of views shared but the challenge is in pulling them together into reforms that can make a difference.

“It was a good beginning of an attempt at consensus building.”

Adj Professor Price said the short-term consequence of the Summit was a call for “an immediate and substantial increase in Medicare patient rebates and the bulk-billing incentive”.

“The time for talk is over, we need immediate action to ensure the future of patient care in Australia,” she said.

“We are calling for an immediate and substantial increase in Medicare patient rebates, and an increase to the bulk-billing incentive by at least two to three times. This is particularly important for our rural and remote communities, which we know have poorer health outcomes and life expectancy, as well as those who are vulnerable and disadvantaged.

“We are also calling for appropriate and ongoing indexation for MBS items, so that it is in line with the real-world costs of providing high-quality care in communities across the country.

“The evidence has been mounting for some time now that general practice is on the brink. And our latest Health of the Nation report made it clear, with just 3% of GPs surveyed saying current Medicare rebates are sufficient to cover the cost of providing high-quality care, and almost three in four reporting feelings of burnout over the past year.

“We are in this crisis because Australia’s general practice patients have been stripped of funding via falling Medicare rebates, which don't cover the cost of providing health services. This erosion of healthcare funding for patients has occurred over decades, today’s government can and must change this.

“We need to ensure equitable access to care, with enough GPs to care for people in every community, because everyone needs access to high-quality care no matter their income or postcode.”

Adj Professor Price said the summit was about “giving hope to the community”.

“[The summit] was about developing policy ideas,” she told InSight+.

“The politicians may well say there isn’t any money but they cannot ignore this. They can’t just kick it down the road or it’s going to cost them and we will end up with a US-like system that is fragmented and expensive.

Adj Professor Price said the RACGP would now release a White Paper in the next few weeks that would include “short, medium, and long-term reforms”.

“It will include recommendations to pivot the health system to preventing illness and keeping people well in the community, rather than the current hospital-centric disease-specific model, which will lead to overall savings for the health budget.”

Jasmine Davis, President of the Australian Medical Students’ Association, who was also invited to the summit, said it had been encouraging to see so many experts in one room, “determined to make general practice work”.

“I’m aiming to be a rural generalist, and it’s been a little scary,” she told InSight+.

“Is my career going to look the same as I thought it would? Is it going to look a lot different? Those are big, scary questions.

“I have loved my placements in general practice, however, many students only have short rotations in the community and spend most of their time in the hospital setting, and therefore don’t get the opportunity to see the true scope and possibility a career in general practice could be.

“AMSA is looking forward to working with stakeholders like the RACGP to ensure students are part of the discussion in working towards policy solutions.”

AMSA will be holding a roundtable with medical education and general practice experts about how to increase medical student interest in general practice on Tuesday 11 October, in Canberra.