BASTIAN SEIDEL. Patients want health not necessarily treatment.

Jun 1, 2017

Achieving recognition of general practitioners as medical specialists in our own right has been an uphill battle  for decades. We only achieved vocational recognition as specialists in the 1990s. For many years we were seen as #JustaGP, a term that symbolises the academic and professional discrimination our members are still subjected to today.  

The College of General Practitioners has come a long way since its foundation almost 60 years ago. As an academic medical college we set the standards for the medical specialty of general practice. We write the curriculum, provide education and hold postgraduate exams ultimately leading to the Fellowship of the College. And clearly Fellowship of the RACGP is the premier qualification of excellence and distinction within the medical specialty of general practice. The RACGP is now the largest medical organisation in Australia. We have over 35,000 active members. 9 out of 10 Australian GPs call the RACGP their professional home.

Achieving recognition as medical specialists in our own right has been an uphill battle for GPs for decades. We only achieved vocational recognition as specialists in the 1990s. For many years we were seen as #JustaGP, a term that symbolises the academic and professional discrimination our members are still subjected to today.

Hospitals and funding

Australia’s health system is hospital-centric. While hospitals in Australia are of the highest standard they are also extraordinarily expensive to run. The total recurrent health expenditure for public hospital services alone is over $45 billion per year — $19 billion are contributed by the Australian Government, the remainder is contributed by the states and privately. The cost of private hospitals is over $12 billion, most of that is covered by private health insurance which, again, is subsidised by the taxpayer to the tune of over $6.5 billion dollars per year.

Compare that with the $7 billion the Australian Government spends on GP healthcare each year – and it sounds like primary healthcare is a 21st century bargain.

Despite best efforts and increased funding over the years, hospitals are now at breaking point. Waiting lists are getting longer by the week. There are now waiting lists to be on a waiting list. Variable care and treatment are making national headlines on a weekly basis.

What we GPs do

GPs find joy in small things. And as my colleague Dr Margaret McCartney recently wrote in the BMJ, small things are indeed big things for us GPs:

“You know these patients, their mothers, their sisters. You know that they are at the practice to have blood tests to monitor the cancer you diagnosed last year. You both know this. The relationship that general practice allows us to form can last decades. They weave between families and overlap across illnesses, presentations, treatment choices and even death. They make it easier to handle uncertainty, to talk about dying, to think about mortality, to grieve, to make rational choices, and to feel joy.”

General practice is a long game, characterised by continuity of care, not fragmentation. This benefits patients, society and of course the taxpayer.

So, what is the value that GPs bring to the health system?

Looking at international evidence – if you increase the number of GPs by one per 10,000 people, the death rate in that community goes down 9%, if you increase the number of non-GP specialists, the number goes up 2%. General practice improves patient’s self-rated health, it reduces health disparities among populations and reduces the effects of income inequality.

Bottom line: people do better with general practice. So why is that? Why are people doing worse when non-GP specialists are the foundation of care?

Well, one reason is that when specialists get outside their area of expertise, they get dangerous. Ask a cardiologist to manage a patient with pneumonia, a gastroenterologist to treat acute myocardial infarction or a chest physician to treat upper gastrointestinal bleeding – they just don’t do as well as GPs do on any given day.

Continuity of care results in a significantly lower risk of death. Continuity of care also leads to fewer hospital admissions, in particular in patients who suffer from multiple and complex chronic medical conditions.

GPs want to spend more time with their patients. Every minute I spend with my patient allows me to obtain more information about their life, concerns, fears and expectations. As a professional I’m trained to put this information into context. Putting information into context over time, I ultimately gain true knowledge of my patients and the more I know about them, the less likely I’m tempted to initiate tests, order procedures or write prescriptions. 

Evidence-based health policies and political will

General practice systems are the natural place of research and exploration. Networks of GP practices will deliver valid research that is applicable to the complex environment we work and live in. If we want to generate the evidence for the delivery of 21st century healthcare we need to do the research in general practices. Not academic silos.

Of course, we also need to enable patients to see their GP. GPs are the most trusted health professionals in the country with satisfaction rates over 90%. That’s an approval rating most politicians here in the room could only dream of. I guess we must be doing something right.

All political parties have now openly stated that they are committed to Medicare and that Medicare deserves to be protected. What that should mean is that funding Medicare should be protected. Specifically, what should be protected is the funding available to patients via the Medicare rebate and the services covered. Medicare rebates should reflect the true value of a service to the patient and the community at large and the actual service should be meaningful, evidence-based and clinically indicated.

The RACGP is politically agnostic. As an academic medical college we are calling for a commitment to evidence-based health policies. It should not be that difficult.

When we point out a problem, we will also offer a solution. This does not need to happen publicly. It’s possible to be an activist for a cause without being an exhibitionist. But it is our role to raise the level of health literacy among our patients, the public, but also among political decision makers and the press.

Health is essential to advance Australia fair. This is what we advocate for and this is exactly why we are opening our office in the nation’s capital today.

Dr Bastian Seidel is Tasmanian GP. He is President of the Royal Australian College of General Practitioners.

This is an edited version of the speech delivered by Dr Bastian Seidel, President of the Royal Australian College of General Practitioners, at the National Press Club on Monday 20 March, 2017.

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