Embracing reform

BY DR SANDRA HIROWATARI, CHAIR, AMA COUNCIL OF RURAL DOCTORS

I love the word reform. Form it again. Redo.

A simple concept. Kids do it. Their hunk of play dough gets smashed back together if they do not like the shape that came out. What forms at the second try may be a very different animal than the first start.

Potters at wheels who cannot quickly remould, will lump the clay back in a ball and re-form the vessel.

The process requires:

insight to see a different view, what I call “putting on a different pair of glasses”; and
the action of destruction as part of creation.

The adjectives ‘courageous’ and ‘inspired’ often describe ideas of reform.

Notice this is not tinkering at the corners, fussing with little wins and making small changes. This is thinking outside the box. Maybe even crushing the box with an elephant foot. It is the antithesis of expecting different results by doing things the old way.

Reforms and reformers are not popular. The status quo, no matter how dysfunctional, is known, comfortable, predictable. Change causes stress. I believe reforms occur when the pain of the old is greater than the discomforts of making the change.

So in our rural medical life, we need reform. You and I know it because it’s just not working. Rural health has so many gaps. The statistics are there: insufficient manpower, longer hours, less downtime, more mental illness. I am talking about us.

We struggle to gain a sense of self-actualisation. There is the black cloud of uncertainty associated with working with limited resources such as diagnostic imaging and tests. One word of criticism from our non-collegial colleagues diminishes us. The frustrations of slow or non-existent internet, the cost of living, the distance to families, our loves. Our networks can be paper thin. The comfort of a nearby specialist is on our wish list.

No wonder the IMG who has completed their 19A/B moratorium heads straight for the comforts of urban life. Rural locum coverage are the norm, patients are weary, yet accepting, of yet another new (transient) doctor. We know there is inequity in health care delivery. And in our tired minds we know there is a better way.

So, some needed reforms include:

Medicare indexation. To quote the previous Chair of this Council, David Rivett: “I think it’s time for a harder-nosed approach. In future, I’d love to see the AMA get a fighting fund established on behalf of GPs to try to get both (political) parties to index (rebates) fully.” A fighting fund may mean altruistic dips into your pocket to fund a strong pre-election campaign to revamp the rebates to the patients. The picture is bigger than indexing our MBS payments, it is about how it effects patient life – in either dollars or access to care.

Medicare MBS and incentive restructuring to reward quality care. To quote a Federal Councillor: “Support quality care, get money back to the practices that are providing quality (and not high through-put corporate style clinics).” And another councilor: “Focus on the attendance items which are quite separate from rooms based items” and “articulate a vision for the future of high quality, cost effective Primary Care that will save money in the long run. Our practices should become the ‘hospitals of the future’. Community care should revolve around general practice.” And: “Go big, or go home”.

The Rural Generalist. The Collingrove agreement between Professor Paul Worley, the rural health commissioner, ACRRM and RACGP defines a generalist as “medical practitioner who is trained to meet the specific current and future health care needs of Australian rural and remote communities, in a sustainable and cost-effective way, by providing both comprehensive general practice and emergency care, and required components of other medical specialist care in hospital and community settings as part of a rural healthcare team”.

Head up, Rural doctors. Reform is on your doorstep. You may not like it. There will be discomfort in the process of change, maybe loud voices, bewilderment and naysayers. Too much, too fast, too slow, too little, too late.

But kids can reform their clay. We can too.

AMA ramps up its aged care advocacy

BY DR ANDREW MULCAHY, CHAIR, AMA’S MEDICAL PRACTICE COMMITTEE

It only takes a skim of the media headlines to know that the aged care system is failing older people. Many reported cases of poor quality care are a result of delayed medical care and neglect, and AMA members are deeply concerned for their older patients. There have been multiple inquiries and reviews into the system in the past couple of years. Government are well aware of the issues and, while there was a $5 billion funding increase in the aged care 2018-19 budget, more urgently needs to be done.

The AMA is responding to its members’ concerns by ramping up its aged care advocacy. In November 2017, the Medical Practice Committee (MPC) conducted a survey on AMA member experiences and perceptions of aged care to inform future AMA policy. In April 2018, a new Position Statement, Resourcing aged care was released. This Position Statement focuses on workforce and funding measures required for a good quality aged care system, and draws from the learnings of the aged care survey.

Aged care calls for adequate resourcing to ensure doctors are supported to deliver medical care to their older patients. One such measure includes appropriate remuneration to cover the opportunity cost of leaving a surgery to visit patients in Residential Aged Care Facilities (RACFs). The AMA also advocated for this policy change at the MBS Reviews’ General Practice and Primary Care Clinical Committee (GPPCCC). Dr Richard Kidd (Chair, Council of General Practice) and AMA Federal Secretariat called for increased MBS rebates for GP RACF attendances, telehealth consultation items for GPs, and for the Practice Incentive Program (PIP) Aged Care Access Incentive (ACAI) to remain.

MPC, with input from the Council of General Practice, has lodged six aged care submissions this year alone. These include:

Aged Care Workforce Strategy Taskforce – The Aged Care Workforce Strategy;
Australian Aged Care Quality Agency – Draft Standards Guidance (for the new Aged Care Quality Standards);
House of Representatives Committee on Health, Aged Care and Sport – Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia;
Medical Services Advisory Committee – New mobile imaging services for residential aged care facilities;
Aged Care Financing Authority – Respite Care; and
Department of Health – Specialist Dementia Care Units.

In addition to the House of Representatives Committee on Health, Aged Care and Sport for the Inquiry into the Quality of Care in Residential Aged Care Facilities in Australia submission, Dr Tony Bartone and Dr Kidd gave evidence at a public hearing in May. Dr Bartone and Dr Kidd highlighted that AMA members have major concerns that the current aged care system is failing older people, and called for more appropriately trained aged care staff, especially registered nurses, in RACFs. Dr Bartone and Dr Kidd also highlighted that doctors need to be recognised and supported as a crucial part of the aged care workforce to improve medical access, care and outcomes for residents.

In addition to the Aged Care Workforce Strategy Taskforce submission, Dr Bartone recently attended both Aged Care Workforce Taskforce Summits. The summits are aimed at engaging stakeholders in developing a strategy for ensuring aged care workforce growth to meet older people’s needs. Dr Bartone highlighted that the current aged care workforce does not have the capacity, capability and connectedness to adequately meet the needs of older people.

MPC aged care advocacy efforts were also reflected in several Budget announcements, including:

the establishment of an Aged Care Quality and Safety Commission ($nil);
investment in rural aged care ($40million);
improvements to My Aged Care website access ($61.7million) and faster Aged Care Assessment Team (ACAT) assessments ($14.8million);
improved access to specialist palliative care services in RACFs ($32.8million);
a new mental health service for older people living in RACFs ($82.5million); and
14,000 additional home care packages (plus 6000 additional packages as announced in the Mid-Year Economic and Fiscal Outlook) ($1.6billion).

However, more needs to be done to ensure older people receive quality care. 20,000 additional home care packages makes a small dent in the 104,602 people currently on the waiting list. The Productivity Commission stated in 2011 that the aged care workforce must quadruple by 2050 to meet demand, but there was no mention of a workforce strategy in the budget. MPC is waiting with bated breath for the Aged Care Workforce Strategy to complete its work (by the end of June 2018).

MPC will continue advocating for a better quality aged care system. 2018 will see the introduction of four additional aged care Position Statements, covering topics such as the health of older people, palliative care, clinical care, and innovation in aged care. So watch this space.

AMA aged care Position Statements and submissions can be accessed through: advocacy/aged-care.

Federal Council communiqué

BY DR BEVERLEY ROWBOTHAM, CHAIR, AMA FEDERAL COUNCIL

The May meeting of Federal Council is condensed to one day immediately before the start of National Conference. While shorter in length, the breadth of matters brought to the Council remains significant. The meeting was the last for outgoing President, Dr Michael Gannon, and several other members – Drs Susan Neuhaus, Gary Geelhoed, Robyn Langham, Lorraine Baker, Stuart Day, Andrew Mulcahy, and John Zorbas. As a result of the election of incoming President, Dr Tony Bartone, and Vice President, Dr Chris Zappala, Drs Brad Frankum and Gino Pecoraro also completed their terms. All have been substantial contributors to the work of Federal Council, in some cases over many years.

Dr Gannon provided an overview of his last weeks in office with highlights including a tour of remote Indigenous communities with the Hon Warren Snowdon, the Federal Budget with its wins for workforce, and attendance at the Council meeting of the World Medical Association in Riga.

The Secretary General’s report highlighted several wins in the Federal Budget which were the result of AMA advocacy. Most important among these was the introduction of a comprehensive medical workforce package. This included the establishment of the Murray Darling Medical School Network with a number of participating medical schools offering end-to-end rural medical school programs; an expansion of prevocational GP places for doctors in training; additional GP training places earmarked for rural generalists; and an emphasis on supporting doctors undertaking training in rural areas.

A major win in the Budget was the overhaul of bonded medical places which will apply to all new participants from January 2020. Existing BMP and MRBS participants have the choice to opt in. The changes offer more certainty and flexibility in how return of service obligations can be satisfied. Federal Council heard that the Secretariat is receiving calls from members expressing their delight in the life-changing outcomes from these announcements.

The AMA’s sustained advocacy for workforce reform included a medical workforce and training summit held in March 2018. An important theme from the summit was the need for a whole of government approach to planning the future delivery of health care and for all governments to collaborate more effectively on workforce planning, training and coordination.

Federal Council noted AMA activity on issues impacting on practice including medical indemnity reforms, private health insurance reforms, the ongoing MBS review, and reports on the significant engagement with aged care policy reform.

The AMA’s public health advocacy remains a consistently strong area of activity. Federal Council received an advanced draft of the Position Statement on social determinants of health, and received updates from the working groups on child abuse and neglect, and health literacy.

The Ethics and Medico-Legal Committee continues its revision of the AMA’s Position Statement on Medical Practitioners’ Relationships with Industry. It has commenced a review of the Position Statement on Conscientious Objection.

Federal Council agreed with a recommendation from the AMA’s Taskforce on Indigenous Health that the AMA sign on to the joint statement by non-Indigenous Australians in support of the Uluru Statement from the Heart.

Federal Council adopted the AMA Anti-Racism Statement which addresses racism in the medical workforce, and expresses support for good medical practice that reflects the cultural needs and contexts of patients.

The Council of Doctors in Training is working on the development of standardised questions to support State and Territory AMAs to run hospital health checks which measure and report on how well health services are meeting State-based industrial agreements and/or accreditation standards for doctors in training.

The Council of Private Specialist Practice has been considering a proposed website to support transparency of doctors’ fees. The Council noted the complexities of such a site and expressed its view that the site must be government-controlled. The Council also noted its concerns that such a website would be unmanageable if its aim is to capture every fee charged by a privately-billing doctor. Council acknowledged that there is a strong desire in government, and from consumers, to improve fees transparency and support patient awareness.

The Council of General Practice reported on the success of AMA advocacy in the Government deferring the introduction of the Practice Incentives Program Quality Improvement Incentive, which would have left many practices financially worse off. Five incentives scheduled to cease on 1 May 2018 will now continue until 30 April 2019.

The MBS Review, through its general practice and primary clinical care committee, is examining funding for GP visits to residential aged care facilities, including funding for telehealth consultation items. AMA advocacy has resulted in the referral to the MBS Review of consideration of funding for wound care items in general practice.

The Council of Public Hospital Doctors reported on its consideration of the impact of technology on workplaces, and the future of work and workers. Further analysis will be undertaken to look at potential industrial implications including task substitution, medico-legal issues, obsolescence, and outsourcing.

The Council of Rural Doctors outlined additional work that the AMA should undertake in considering rural doctor health. including longer working hours, lack of access to resources and professional support, professional and geographical isolation, and limited team support. The Council noted the work underway by the AMA subsidiary, Doctors’ Health Services Pty Limited, in sponsoring a trial of telemedicine consultations for rural doctors.

At the Annual General Meeting of members held on the day following the meeting of Federal Council, members voted unanimously to create a new position on Federal Council for a representative of Australia’s Indigenous doctors, nominated by the Australian Indigenous Doctors’ Association, and who is a member of the AMA.

The flu vaccine is being oversold – it’s not that effective

Winter has started, and with it, flu season. Inevitably, all of us (young, old and sick) have been implored to be immunised against influenza, with some eligible for a subsidised vaccine. And people are heeding the message, to the point that there is now a shortage of available vaccines.

At the same time, findings from three important Cochrane reviews on the effectiveness of the influenza vaccination aren’t consistent with the advice we’re been given.

Cochrane reviews are independent systematic reviews, which are comprehensive analyses of most of the literature relevant to a research topic. Cochrane reviews summarise the results in a multitude of studies, and are regularly updated to absorb new research.

These three Cochrane reviews have been recently updated, as well as stabilised, which is what happens when it looks as if it seems unlikely new research would be published that would change the conclusions.

What the reviews found

The first Cochrane review looked at the effects of the influenza vaccine in healthy adults from 25 studies conducted over single influenza seasons in North America, South America, and Europe between 1969 and 2009. It found the vaccine reduced the chance of getting laboratory confirmed influenza from 23 cases out of 1,000 to 9 cases out of 1,000.

While this seems to be a reduction of more than 50%, that seems less optimistic expressed in absolute terms.

The infection rate in adults drops from 2% per year to 1%. You could say that’s halved, but it effectively only drops by 1%. So this means that out of every 100 healthy adults vaccinated, 99 get no benefit against laboratory confirmed influenza.

The second Cochrane review – which looked at trials in children over single influenza seasons in the US, Western Europe, Russia, and Bangladesh between 1984 and 2013 – found similar results.

The third Cochrane review looked at vaccines for the elderly in nursing homes. It found much less good evidence, with only one randomised trial – considered the gold standard in clinical trials as it establishes causation rather than correlation.

While observational studies (that draw inferences from a population to establish associations) have been done to show benefits of the vaccines, bias means we cannot rely on their results.

There are also potential harms from influenza vaccines noted in the reviews. They range from serious (a neurological disease called Guillain Barre) through to moderate (fevers, in children especially – some of which will cause febrile convulsions), and trivial (a sore arm for a couple of days).

Why are we so scared of the flu?

There is a special concern about influenza from a public health point of view. This comes about from its potential to cause pandemics. The first in modern history was the Spanish influenza pandemic of 1918-19, when tens of millions of people died worldwide.

There’s good evidence to show face masks protect against influenza.
from shutterstock.com

There have also been been several, less severe pandemics. These include the most recent swine flu that, although while affecting some (unexpected) groups of people (including pregnant women, those who were obese, and had asthma), caused little more effect on the overall population than the usual seasonal influenza.

Public health experts worry about another pandemic that can be more harmful and contagious, which could be devastating. But it’s important to note the vast majority of deaths from Spanish influenza were from secondary bacterial infections and predated the antibiotic era.

The reasons influenza virus has this ability to cause new pandemics comes from its instability – it changes genetically easily, making it more difficult for our immune systems to recognise newer strains. The effect is that new vaccines must be prepared every year for a best-guess at next year’s virus, and we need vaccination every year.

Influenza can also undergo a more radical change, such as when a new form of the virus emerges from an animal host (wild or domesticated birds or pigs, for example). This moving target makes it more difficult to vaccinate against – especially with the genetic shifts of pandemics. Just when we need protection most, vaccines can provide it least.

So what, if not the vaccine?

There are physical barriers that can prevent the spread of influenza. These are the masks (to reduce the spread of aerosol-borne virus particles), hand washing (to reduce the spread if virus from hands onto shared surfaces), and quarantine measures (isolating infected people to reduce their infectivity).

There is now reasonable evidence such measures reduce infections considerably. It might take a bit of effort to change the psyche of Australians to make wearing a facemask acceptable if you have an acute respiratory infection. Even the heroic “soldiering on to work” (or school) with your virus needs to be reversed as a public health act.

Chris Del Mar, Professor of Public Health and Peter Collignon, Professor, infectious diseases and microbiology, Australian National University

This article was originally published on The Conversation. Read the original article.

New kit to help with the management of bedwetting children

A new report from the NSW Agency for Clinical Innovation (ACI) has highlighted the need for improved management and healthcare of bedwetting children.

Titled, Young People with Urinary Incontinence, the report was released ahead of World Bedwetting Day, which is May 29.

In partnership with the Sydney Children’s Hospital Network and the Continence Foundation of Australia, ACI took part in a project known as PISCES, which stands for paediatric information, schema, continence, education, support.

The project was designed to better understand the experiences of children with urinary incontinence, their parents, and the health practitioners who support them.

The report of the project details difficulties in obtaining timely diagnosis and support for the problem, with parents being routinely told “the child will grow out of it”, and limited information about it being available.

The release of the report also coincided with the second edition of the Australian Nocturnal Enuresis Resource Kit, developed by the partnership and focussing on the issues surrounding lack of information and delayed access to specialist care post-diagnosis.

Designed to help fill this void, the kit serves as a resource for Australian healthcare professionals, patients and carers.

Nocturnal enuresis, or bedwetting, is defined as the intermittent leakage of urine during sleep.

According to the kit’s co-authors, paediatrician at the Children’s Hospital at Westmead, Associate Professor Patrina Caldwell; and paediatric urologist at John Hunter Children’s Hospital, Dr Aniruddh Deshpande, such a resource is essential in providing additional support to all those affected by nocturnal enuresis.

“We know there are delays diagnosing and treating nocturnal enuresis. Patients and their families require support throughout the treatment journey. Healthcare professionals sometimes need additional help to support their patients, particularly when initial attempts at treatments fail,” Professor Caldwell said.

“The Nocturnal Enuresis Resource Kit is designed to offer this support, by providing current and relevant information on nocturnal enuresis management and how to address the challenges and barriers that may present.

“There is a common assumption that bedwetting resolves spontaneously. However, the impact of bedwetting on those who continue to experience nocturnal enuresis is often ignored. Bedwetting can significantly impact sleep quality, self-esteem, emotional wellbeing and daytime functioning, both at school and socially.

“This stigmatising condition is often not talked about, as children are usually very embarrassed about it, leading to feelings of shame, guilt, and helplessness.”

As many as 20 per cent of children continue to wet the bed at five years of age, while nocturnal enuresis, which has a male skew, affects as many as 10 per cent of 10-year-olds.Research shows that the risk of bedwetting increases if the child’s mother, more so than their father, experienced enuresis as a child.

Dr Deshpande said we now know how nocturnal enuresis affects a child’s psychosocial development and perceived quality of life. This impact is not severity dependent, but rather, age and gender dependent.

“Although the negative impact is broadly felt by all affected children, it appears to be perceived significantly more by girls and older children,” Dr Deshpande said.

“This is perhaps counter intuitive and mandates an appropriate response at the primary care level. Research also suggests children who are treated for nocturnal enuresis show improvements in their working memory and other daily activities.

“However, the management of nocturnal enuresis appears to be inadequately taught in medical schools and perhaps even in junior medical staff years, so many GPs may not feel confident initiating treatment of an enuretic child, or know what to do should the initial treatment fail.

“We believe GPs can successfully manage a significant proportion of these children. Therefore, we would encourage the GPs to use the principles, tools and steps outlined in the Nocturnal Enuresis Resource Kit, and offer treatment to enuretic children who seek help.”

Continence Foundation of Australia chief executive officer Rowan Cockerell said the common assumption that children will always simply outgrow bedwetting is something that needed to be addressed.

The Nocturnal Enuresis Resource Kit features the latest clinical evidence for the condition, including non-pharmacological approaches, such as pelvic floor training and transcutaneous electrical nerve stimulation (TENS) therapy. The updated pharmacotherapy section also reflects current, evidence-based practice recommendations and algorithms.

CHRIS JOHNSON

A copy of the Nocturnal Enuresis Resource Kit can be downloaded at: https://www.neresourcekit.com.au

The Young People with Urinary Incontinence report can be found at: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0003/421896/ACI_0024c-PISCES_Patient-experience-report-A4_FINAL.pdf

[Editorial] Essential diagnostics: a lever for health systems reform?

Last week, WHO released its first Essential Diagnostics List. Designed to complement the Essential Medicines list first released over 40 years ago, the list defines an essential package of diagnostic tests for use in primary care and laboratory settings. 58 of these tests are aimed at supporting the diagnosis and monitoring of common conditions such as cardiovascular diseases, diabetes, and anaemia, and 55 tests are targeted at high priority diseases including HIV, hepatitis B and C, and malaria.

New AMA President promises to fight for GPs

Dr Tony Bartone is the AMA’s new Federal President, following his election to the office on the final day of the AMA National Conference in Canberra on May 27.

Dr Bartone replaces Dr Michael Gannon as President, and was the AMA Vice President over the past two years.

In a three-way contest for the top job, Dr Bartone emerged the victor after delivering a rousing speech to conference delegates promising to fight for GPs, represent all medical professionals, and build the AMA’s membership and influence.

He also signalled an intention not to go easy on politicians and policy makers.

“Our Health Minister needs to understand the time for rhetoric is over. We need to see real action now,” he said.

“We will have a Federal Election in the next year, and I am ready for any early election call.”

A GP himself from Melbourne and a former President of AMA Victoria, Dr Bartone said he was ready for his new challenge.

“I now want to fight for Australia’s doctors so that they can continue to deliver the same quality health care that my father received,” Dr Bartone said.

“General practice has been systematically starved of funding, putting at risk its very survival.

“The AMA, under my leadership, has the solutions. A GP President will send a message.”

Dr Chris Zappala, a thoracic physician from Queensland, was elected Vice President to replace Dr Bartone.

Dr Zappala won a four-way contest for the vice presidency.

The two-year terms for the new AMA President and Vice President took effect immediately following the vote.

CHRIS JOHNSON

[Articles] Cardiovascular disease risk prediction equations in 400 000 primary care patients in New Zealand: a derivation and validation study

We constructed a large prospective cohort study representing typical patients in primary care in New Zealand who were recommended for cardiovascular disease risk assessment. Most patients are now at low risk of cardiovascular disease, which explains why the PCEs based mainly on old cohorts substantially overestimate risk. Although the PCEs and many other equations will need to be recalibrated to mitigate overtreatment of the healthy majority, they also need new predictors that include measures of socioeconomic deprivation and multiple ethnicities to identify vulnerable high-risk subpopulations that might otherwise be undertreated.

Your AMA Federal Council at work

Dr Chris Moy	Federal Council Area representative for South Australia & Northern Territory	Australian Digital Health Agency My Health Record Expansion Program Steering Group	8/8/217 & 7/12/17
Prof Mark Khangure	Member of AMA Federal Council and AMA Health Financing & Economics Commttee	ADHA My Health Record Diagnostic Imaging Programme Steering Group	5/11/17
Dr Richard Kidd	Chair – Council of General Practice	My Aged Care Gateway Advisory Group	05/03/18
Dr Richard Kidd	Chair – Council of General Practice	PIP Advisory Group	09/03/18
Dr Richard Kidd	Chair – Council of General Practice	DVA Health Provider Forum	12/04/18
Dr Richard Kidd	Chair – Council of General Practice	PIP Advisory Group	13/4/2018
Dr Tony Bartone	AMA Vice President	TGA Consultative Committee	10/04/18
Dr Gino Pecoraro	Federal Council Member – obstetrician/gynaecologist	National Strategic Approach to Maternity Services Advisory Group	06/03/18
Dr Beverly Rowbotham	Chair of Federal Council	ADHA My Health Record Pathology Steering Group	23/04/18

How common is doctor hopping?

Over a quarter of Australians see multiple GPs for their healthcare, according to new research published this month.

The study of 2400 adults, led by Sydney-based GP Dr Michael Wright, found that while 90% of people had a usual GP and 80% had a usual practice, around 25% also saw at least one other GP in the previous year.

Unlike in many other countries with subsidised public health systems, Australians are able to see multiple GPs at their own discretion. Although this may promote choice and competition, it also may also fragment the care patients receive, says Dr Wright.

“In Australia, a patient’s usual GP does not receive information about any ‘non-usual’ practice attendance, if the information is not volunteered by the patient,” he notes. “If important information is not shared between practices, patients could potentially experience worse health outcomes.”

The study found that younger people were most likely to hop between doctors, as were those living in big cities.

A significant finding was that those who had seen more than one GP in the previous year were 56% more likely to have also attended an emergency department. This suggests that those who see multiple GPs have different patterns of health service use and were possibly more likely to have poorer outcomes.

Dr Wright says fragmentation of care engendered by multiple doctor use could be improved if practices shared data with the patient’s usual GP, rather than leaving it up to the patient to volunteer the information.

“The rollout of My Health Record will improve the sharing of patient information,” he adds. “But My Health Record does not have access to the records at a general practice. So patients should still tell their usual GP if they have been to another practice so their GP is aware and their practice record can be updated.”

RACGP President Dr Bastian Seidel says the new research is concerning, as international evidence has found patients significantly benefit from having a usual GP.

“Patients who maintain strong relationships with a usual GP or practice team experience better health outcomes,” Dr Seidel says.

“These patients are significantly less likely to need expensive emergency department or hospital care. Every minute a GP spends with a patient allows them to obtain more information about their life, concerns, fears and expectations.”

You can read the full study here.