The current focus on primary health care reform has left GPs feeling confused, nervous and anxious, if this piece from rural GP David Monash is anything to go by. He writes:
“The elephant in the room that is not being spoken of or referred to in the current plethora of reports and indicated reforms in the area of Primary Health Care is: What do our General Practitioners actually do? And what is to become of them?
According to the reports released in the last six weeks, general practitioners appear to be ineffective, inefficient, have no professional identity, minimal skills, easily reproducible clinical skills and are at least obstructionist to team care if not entirely unnecessary in their current role. Reading this literature I’m not sure what they are doing or why they are doing it so badly.
Surely some of the 22 000 GP’s this country funds are doing something effective? Apparently not if you believe the literature we are being fed.
Besides this we don’t have enough of them.
Or do we in fact have too many given their total ineffectiveness? If this is the case why are we increasing their numbers? The department has believed for years that we have too many GPs per capita and the answer is apparently to reduce the numbers and replace them with allied health personnel. Is that what we are doing? The recent increase in training numbers will replace the retiring GP work force but not increase it. Have we been manoeuvred into this position where the GP shortage can be used as a reason and lever for this level of reform?
Reading the multiple submissions made in the consultation process it is apparent that general practitioners can be replaced easily by allied health personnel. This includes nursing staff that merely need to be given prescribing, pathology and referral rights to match GP skills.
The DoHA website is running a survey: “Would you be willing to see a nurse practitioner for some types of care and not a GP if it was quicker and if your quality of care was unaffected?”
Is this a reflection of their attitude to general practice?
According to this survey, which is “Yes Ministerish” in its directional questioning, the implication is that treatment from nurses will not affect the quality of medical care and will be quicker in delivery. It probably will be quicker until they too are buried in the bureaucratic red tape that has killed the ability of general practitioners to utilize their clinical skills or they meet their first serious problem masquerading as a simple issue. Assuming this situation is recognized as such. If it is not recognised them it will take no extra time at all.
In relation to the independent nurses working alone or in pharmacies: Will they need to work from accredited premises? Will they need to keep accurate and defensible clinical notes? Will they be able to complete Centrelink forms, disability parking permits, taxi subsidy applications, death certificates, sick certificates for 2 year olds who can’t attend their day care, obtain authority prescriptions, and complete the myriad of paperwork that surrounds work place injury? Work place injuries that they may be the first to see and treat. Or are all these bureaucratic issues solely the province of general practitioners?
This attitude of omnipotent competence not only applies to nurses but appears to include psychologists, physiotherapists, pharmacists, podiatrists and other allied health personnel all of whom are seeking direct patient access with MBS funding. Will patients or the tax payer pay for patients who see a psychologist for a year while their hypothyroidism progresses? What about the patient with the tumour receiving six months of physiotherapy with only temporary improvement.
“The need to improve the level of teamwork in primary health care, encourage greater integration and improve affordable access to a range of non-medical services is well accepted, although there is debate around where the GP sits in the team.”
Further to this debate, general practitioners apparently do their tasks so poorly that it will be necessary to develop specific and directive funding formulas to drive them to work in a manner and direction the bureaucrats, the ivory tower specialists and the authors of the multiple submissions, believe they should be working in.
Perhaps there should be some concern in relation to these developments as clinical skills applied carefully to individual illness and circumstances is replaced by pre-determined protocol applied universally to all according to a set funding formula.
So where will general practitioners go? Is there a role for them at all? Should they all specialise? Or is the development of an allied health tier in the primary health area pushing them into the realm of general practitioner specialists? If this is the case you can guarantee they won’t receive funding appropriate for this role!”