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.

The outcome of this summit will be, for many, a disappointment. Why..? Because the catchcry that emerged of increase and index the rebates, and all will be well, is the ‘either’ in the story, but there was no ‘or’. We all know that significant increases in rebates is not only unlikely to happen, but will not really solve the issue we as a country face in the longer term, it would just be kicking a slightly larger can down the road. There needed to be an ‘or’, so it went, “either there is a large increase in rebates to maintain viable practice…or…you (GPs, and the Govt) need to accept the inadequacy of the fee for service model, in this day and age, and set about setting up a proper GP career pathway, paying a comprehensive salary, for what has now become a very comprehensive job. It’s that simple really people. And until you accept that, you may as well keep p*ssing into the wind. I realised this about 45 years ago, not long after I entered GP, (working predominantly in low socioeconomic areas sharpened the focus I guess), and nothing has happened to change that view, and now I’ve retired. Go figure…and I stand by what I say here…

Actually the decline began soon after 1972 when MediBank, the precursor of Medicare, was introduced by the Whitlam government, and private health funds were banned from subsidising outpatient medical service costs. It rapidly became clear that the rebates were not going to rise with inflation. The Liberals who came back into power in about 1975 propped it up by restoring the ability of the private funds to subsidence outpatient costs, but did not increase the basic rebate from MediBank.

Come the Hawke and Keating Federal government – MediBank was privatised, Medicare was created, and private health subsidy of outpatient services was again banned.

In the later 1990s I was involved in committees of the state branches of the RANZCP and the AMA and at one time met with a local my Federal MP (Alexander Downer) to point out the fact that since 1975 the Medicare rebate had risen by only 65% of inflation annually for 20 years. He was polite and listened (and made me a cup of coffee) but did not promise to do anything about it.

The rebate decline, relative to costs, has continued.

Commenter arguing against increased rebates must understand that the rebates are much less than any other specialty and even less than comparable Medicare rebates for psychologists. It is a symptom if the lack of respect and general lack of understanding of the complexity of general practice and the training requirements. So yes, by all means charge a private fee but the rebates must be increased as well to keep pace with the CPI and to put general practice on an (almost) level footing with other medical specialities.

AHPRA has made many GPs professional lives hell. AHPRA consumes many millions of $ per year with scarcely discernible results for positive community outcomes.

During my stint as President of the Australian Senior Active Doctors Association it became very clear that it is time for our GPs’ to be consulted re the removal of AHPRA from their practice and a good starting point would be for the RACGP to undertake studies to confirm GPs attitudes and design and implicate better models.

Asking for increased rebates is not a feasible long term solution. Mass free social services do not work for obvious market reasons.

Charge what you want to charge, if you’re worth it patients will come. Forget Medicare. Peace of mind.

The people of Australia, and the medical profession, were sold a pup with the introduction of Medicare. It was inevitable that the possibility of universal bulk billing would lead to over servicing as the price signal was removed for both the patient, and the doctor, leading to unaffordable increases in costs over time. We can see the same thing happening with the NDIS, but at a more rapid rate.

Bulk billing should be restricted to the truly needy and be means tested and the possibility of copayments reconsidered. While it may be less convenient, there is a lot to be said for giving patients the bill so they realise that it is their responsibility, even if the rebate is accepted as full payment.

Of course as others have said the rebates should be indexed to keep up with costs.

Firstly, I am a 70 year old surgeon, not a GP, but I strongly support GP’s in their state of frustration! GP’s have endured increasing workloads with diminishing government support for so many years now. They have been devalued from their proper status as professionals to that of public servant service providers, leading to a lack of respect across the board including their patients. All governments over the years, since the introduction of Medicare, have held them done, controlling them financially and socially. Their altruism is their primary reason for their career, but it has been used as a lever to subjugate them. GP’s must remember that doctors are the most intelligent subgroup in modern society! They are highly educated. Their degrees have been costly both financially and often privately They deserve to be treated well in every aspect of their work! So I support GP’s taking aggressive action to provoke improvement in all aspects of their careers!

I am recently retired. The issue unfortunately reflects Australian Politician’s long term views that they can free up resources for their new, vote catching ideas by restricting indexation and workforce for services they are responsible for . Teaching ,Nursing as well as others have experienced the same fate. This was a perceived risk when Medibank was hatched and unfortunately has come to fruition. Many Practices wouldn’t universally bulk bill from the start for this reason. Separating the Patient effectively from the financial requirements of a service only encouraged overservicing and the Government’s ability to blame the professions greed when BB rates fell. It also enabled the Doctors who were not providing a quality service to prosper as have the Care Planning item numbers. The Profession has never seriously considered an effective measure of the Quality of a Doctor’s performance. APHRA and facility accreditation aren’t the answer. Politicians crave the need to control services they don’t even understand leading to the measures that they thought would address quality, where they perceived it was lacking. The more powerful Specialist and Pharmacy lobby groups have directed the funds elsewhere. The perception of General Practice by Graduates is unlikely to be changed within the next 5 years by an increased rebate. Defunding item numbers in GP like joint injections only encouraged the perception for many Gp’s that they shouldn’t bother maintaining clinical skills. We never appreciate what we had until it is gone. Public Hospital ED’s and OPD’s deflecting patients to Primary Care Gp’s who aren’t interested or don’t have the skills or time to sort out complicated issues is another disaster in motion. Decent Primary Care practice needs to be supported by an ease to achieve a quick referral when required. The outlook for Primary Care in Australia is bleak. It is in a similar situation to so many required services in our society that have been decimated by our Political masters. Who ever thought that selling off the Social Housing stock and privatising essential services would benefit all the Community. Increasing the Rebate can only be a small start.

Without a union or effective lobbying organisation combined with our effective isolation from each other (as compared to Hospital based colleagues) we have had been at the mercy of governments and their short term agendas. They have failed us over and over. But I’m equally disappointed in our specialist colleagues (and AMA in the past) and their self interest, who have done little if anything to support us.

Unbelievable downtrodden behaviour The Queensland government is a problem including their support for pharmacists to undertake traditional medical care

The government (Labor or Coalition – for the last 25 years) considers it does not have the money we are asking. At least, there are other places to put it with greater electoral advantage. We have had 3 significant – indeed substantial durations of – cessations of the Medicare mandated yearly fee increases. The AMA will tell you how degenerate the bulk-billed fee now is, compared to average weekly earnings and cost of living over the last three decades. The government’s response is likely to be the same as Howard’s, when abruptly he discovered what effect freezing accessions to Medicare billing had done. Bring in a substantial cohort of foreign trained (largely from Asia) doctor to increase GP numbers. They will be grateful for the opportunity to emigrate to Australia, and will be happy to bulk-bill. That well could be Labor’s response to the current imbroglio. In the meantime, many of us will start to largely charge private fees, with the government’s tacit request we bulk bill the under privileged, the chronically ill, the elderly. And will not raise any obvious objection as we charge ‘those who can afford to pay’ that extra to cover what we should be recovering from those we bulk-bill. That was the norm as I began to practice in 1970. Was considered necessary and ethical.

Since we have been “hit with Covid”….”so called EXPERTS” are everywhere! Lets have a RESET….Who are the Experts,are who are the “wanna-be’s !!

Actually, suspect GPs will continue to take it. As long as they see as the solution an increase in rebates – i.e. ongoing dependence on the government teat – rather than respecting their worth and dispelling the notion that a GP consult should be free, there will be no relief (especially given the fact there is no extra money in the foreseeable future). Charge what you’re worth – like every other specialist, physio, chiropractor and psychologist, for whose fees patients somehow find the money – and accept that in a market, there will always be those that undercut your price. If what good GPs do is as valuable as they believe, patients will see that what they get from from 5-minute medicine in bulk billing corporate monsters is not the same value.

So many things need fixing: – rebates need to be at least tripled to match practice costs and allow quality – too many “interested parties” taking money from GP-patient relationship (e.g. PHNs, corporates, AHPRA, accreditation companies) via their fees and regulation imposts – GPs absent from the hospitals, so junior doctors do not see the worth of general practice – too many patients come bearing forms or requesting forms, meaning general practitioners too distracted by red tape And so it goes….

Government has made General Practice unattractive and unviable for Australian trained doctors. As per press reports this morning, government is instead working to rob other countries of their doctors, regarding them as “gold mine”, knowing that doctors from developing countries can be treated as indentured workers. The reality is that Australian patients need Australian General Practitioners.

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