What needs to be done to achieve this?
Prevent GP burnout and make general practice an attractive speciality for medical graduates.
GP Remuneration is the elephant in the room. This relates directly to GP burnout. Our remuneration is linked to MBS rebates which means that the work we do with the time constraints we face, coupled with the increased incidence of complex chronic disease and an ageing population, encourages ‘high turnover per hour’ medicine. This model is unsustainable.
- The MBS rebate must factor in the cost of running a sustainable business whilst delivering care to the vulnerable. I will advocate tirelessly to achieve this change.
- Legislation should not restrict GP gap fees. The government needs to understand this.
- Redesign the outdated 20-year-old GPMP. It was created for single chronic disease and doesn’t reflect the complex multimorbidity we manage.
- Telehealth must be expanded to provide care for sexual and reproductive health services, access to marginalised groups and specialised GP services, without prior enrolment.
- RACGP needs to convince the government to supplement GP trainee income and bring this in line with salaried HMOs. GP registrar income is generated by billing patients for the work they provide, unlike salaried HMOs. Fewer medical graduates are selecting general practice training because general practice remuneration is federally funded and tied to MBS fees. The government needs to realise that the cornerstone of the health system is being eroded without their support.
- The government should support the funding of GP practices who provide this training to make it attractive to GPs.
- Address the maldistribution of GPs in rural and remote Australia:
- (a) introduce an RACGP led business establishment package subsidised by the government, through tax benefits over several years.
- (b) RACGP and ACCRM funded training opportunities for metropolitan GPs, to increase the pool of doctors who can be rostered on in times of need, to remote/rural practices. This opens the opportunity to swap practice locations for a time – ‘job-share’, for relief, family needs, disaster relief, professional development.
Strengthen our relationship with the Primary Health Networks (PHNs)
The Primary Health Networks have been around for 5 years and are here to stay. The government has committed $1.45 billion over 3 years to plan and commission mental health, which relates to the 3rd pillar of Australia’s Long Term National Health Plan (2019). PHNs are frequently referenced in this agreement. There are good ones and not so good ones. The better PHNS have GPs in their leadership and are GP-centric, fund lots of project development and some less so.
- We need to work with PHNs to make sure that they are GP centred and advocate government, ensuring that the leadership bodies of PHNs include GPs.
- The objectives of PHNs must have GP central to them.
- We need to make PHNs work for GPs more.
- We need to drive their agenda the quality improvement. Incentive money is coming through PHNs and is likely to increase over time and we need to make sure that this is administered to general practice and GP led.
Build confidence in the RACGP and strengthen membership
The member needs must be at the heart of the organisation, otherwise the fees charged each year don’t make sense. CPD training will no longer require an RACGP membership to be administered. Is the fee for administering this still required?
- I will build trust between members and the RACGP by forging a responsive relationship that allows meaningful input from members into how the college is run and moves forward in the form of webinars called, ‘fire-side-chats’. Members will be given the opportunity to have questions answered and to hear about the topics that are relevant to them, in informal and interactive sessions with our President, Board and CEO, facilitated by a moderator.
- I will be accessible, will listen and I will encourage debate. I will ensure that the RACGP represents the collective GP voice.
- I will build a strong relationship with the board and CEO to ensure that the RACGP spend is on priority areas and core initiatives that respond to the needs of our members.
- I will insist that we work continuously to ‘close the gap’ and uplift the health of indigenous Australians.
- Deliver communication in a timely manner, which aligns with what members need.
Establish an RACGP led National Primary Care Consortium of Research Excellence for Health Reform
COVID 19 has revealed that responsive national trials in times of urgent need are a reality. Unless we translate how the collective effort of 41,000 GPs, who bill the 423,900 Medicare item numbers daily around Australia, impacts better health and each of the Four Pillars of the Long Term National Health Plan, our achievements are diffused by Government concerns around the growing GDP percentage directed to fund health. Our impact on all levels of the health care system is considered of high importance but of low value in comparison to our other specialist colleagues. Currently, only 8% of the health budget is allocated to general practice and in other countries, this is up as high as 10-13%. Our efforts are measured in Medicare item number billings and not by how this equates to health outcomes.
These research bodies exist and already conduct exceptional research. Many are struggling to fund the next project. An RACGP-led Research Consortium can strengthen each component of the primary care research sector. Australia has the opportunity to lead the way in primary care research.
WONCA (World Organisation of Family Doctors) understands this and of its 131 member nations, all agree that primary care research is essential to steer health reform for the benefit of the nation. If we don’t imagine a Nation’s health reform being led by GPs, then our destiny is in others’ hands, mostly from finance-driven consultants who perform a cost analysis of services, collate this, then advise the government.
- RACGP needs to demonstrate how pivotal our influence is on all 4 Health Priorities set out by the Health Minister in 2019. This requires evidence, and the bigger the body of evidence, the stronger the advocacy impact.
- A national centre of practice-based research excellence which includes University Practice-based Research Networks (PBRNs), the Primary Health Networks (PHNs), the Australasian Association of Academic Primary Care (AAAPC) and the RACGP, could dedicate itself to this. The Research Consortium will measure either how we reduce the overall cost to the health system, or how we deliver better health outcomes or both.
- RACGP provides members with the opportunity to learn research methods, supporting the transfer of wisdom and experience into professional growth opportunities.
- Invest in ideas by GPs by offering venture programmes for GPs. GPs know the patients, the problems and solutions perhaps better than most.
Real-time analytics: COVID19 has exposed the reality of this need
COVID19 has revealed is how underprepared the world is to respond. Now is the time for real-time analytics as part of our day-to-day practice. If we don’t harness and develop technology that delivers this now, we will be asleep at the wheel whilst large corporates further encroach on the primary care sector.
Health is the biggest industry on the planet both in significance and investment.
Real-time analytics informs governments and corporations globally who then build health models.
- RACGP can partner with industry and Health Informatics departments, within the Research Consortium to develop innovative purpose-built systems. The scope is endless.
- RACGP should commit to having GPs at the forefront of that transition so that ultimately GPs benefit as a result of that transition.
Improve RACGP crisis response and membership benefits
COVID19 has highlighted the vulnerability of GPs and business owners across the Nation.
- An RACGP Crisis Management On-demand Resource, accessible to members via an App/ desktop alert, is necessary. An end-to-end advisory service for members who have suffered loss during this time would help affected GPs on the roadmap to recovery. It can become our National go-to centre.
- Support for GP well-being, culture and leadership in the medical workforce is essential.
- RACGP to provide an online forum that is available to GP members from sister organisations, encouraging collaboration between the organisations on key issues.
- Work/life balance: the RACGP should work strongly towards achieving this for their GP population.
- Provide Membership benefits that reflect our values and care. Such as access to health /fitness programmes, financial and business training, mental health services. Providing this as part of the membership package can help our members plan for their retirement/ superannuation/ buffer periods of income shortage.
College-led training of GPs
RACGP and ACCRM will be delivering all GP training by 2022. This transition needs to be streamlined.
- We need to support and advise registrars about the training programs and requirements, allowing goals, aspirations and needs to be identified and reviewed.
- We need to manage the allocation and placement of registrars to undertake their training within accredited practices.
- Integrate general practice training with other educational and professional organisations, such as universities, Primary Health Networks and Rural and Metropolitan Workforce Agencies to ensure future GPs have the skills to meet training and community needs.
- RACGP Faculty of National Specific Interests Group is an underused resource and one we should be proud of promoting. RACGP-FNSIG can provide buddying/mentorship, leadership, direction, education and information to GPs and trainees with which to plan their careers, through early and direct engagement.
- RACGP needs to provide end to end training pathways for GPs in training and GPs advanced in their careers, who are seeking new opportunities (mentoring, teaching, research, advocacy, leadership, community NFP/NGO participation).
Support GP trainee well-being by improving culture and leadership in the medical workforce.
- Overseas trained doctors (OTDs) and foreign graduates of an accredited medical school (FGAMS) will continue to train on the Rural Pathway. They require support to integrate into their community.
- Improve flexibility in GP training so that registrars retain their leave entitlements and these entitlements should follow them around the state, allow them to move between practices and hospitals.