Inadequate government funding has brought general practice in Australia to a ‘critical juncture’, according to the Royal Australian College of General Practitioners (RACGP), which has noted that only 15.2 percent of surveyed final-year medical students listed general practice as their first-preference speciality for the future, the lowest number since 2012.
The College has also highlighted how the COVID-19 pandemic has severely disrupted GP practice and will present ongoing challenges as the coronavirus lingers.
These are among the key findings in the RACGP’s Health of the Nation report, an annual review drawing on the experiences of Fellows across Australia as well as information from the Australian Bureau of Statistics, Medicare, the AIHW and various government publications.
The report, released in late October, said feedback from the 1386 GPs showed they were bracing themselves to manage the bulk of coronavirus patients into 2022. It called for a major funding overhaul to cope with demand on primary care as more people catch milder cases of the virus and need treatment for ‘long COVID’.
RACGP president Karen Price said, ‘General practice is the backbone of the vaccine rollout and will be the backbone of COVID-19 care pathways, including the long-term care of those with long COVID. My message to all GPs, practice managers, nurses, receptionists and administrative workers involved in the rollout is well done and keep up the great work.
‘Unfortunately, it has not been an easy experience for many practices. Our survey found that almost three out of five GPs reported managing patient expectations about vaccinations to be one of the most challenging issues arising from the pandemic.
‘Repeated changes to vaccine eligibility requirements left many patients confused and frustrated and unfortunately some took this out on general practice staff…
‘The repeated changes in the vaccine rollout left patients disgruntled and some took this out on practice staff.’
Introducing the report Dr Price wrote, ‘Ask any GP and they will likely report more and more patients presenting with mental health concerns. This is part of a longer-term trend. For the fifth consecutive year, psychological conditions, including sleep disturbance and depression, were the most reported reasons for patient presentations.
‘Over 70% of GPs selected ‘psychological’ in their top three reasons for patient presentations, a number that has risen steadily from 61% in 2017.’
The RACGP President called for changes to Medicare items, saying, ‘GPs are the first port of call for many patients with mental health issues and four out of five surveyed GPs reported that they have patients with mental health conditions that are mostly managed within general practice.
‘To help patients in need we need new Medicare items for longer mental health consultations so that we can really get to the bottom of what is going on.
‘It’s also important to keep in mind that GPs are the only medical practitioners that specialise in managing patients with multiple health conditions, including complex health issues. Almost three quarters of surveyed GPs reported that most of their patients have multiple medical conditions.
‘Unfortunately, during the pandemic we have witnessed patients delaying or avoiding screenings and consultations with their GP and this is particularly problematic for people with complex health issues that need to be carefully managed. Yet Medicare discourages GPs from treating more than one condition in the same consultation and this must change.
‘Now more than ever, it is essential that we remove this barrier and incentivise longer consultations to support comprehensive care by GPs.’
The 2021 Health of the Nation report identified key issues affecting GPs and their patients, including:
- treatment of multimorbidities in general practice
- the increasing mental health burden on general practice
- restrictions to GP involvement in aged care
- barriers to the use of video telehealth services
- the COVID-19 vaccine rollout
Regarding workforce issues, Dr Price said that while international medical graduates will bolster the workforce, ‘We must address what is holding back future doctors from a career as a GP. A key part of that is putting general practice on a more sustainable, long-term financial footing.
‘If we are serious about boosting the general practice workforce at a time when it has never been needed more by communities across Australia, we must address long-term funding arrangements. The task of attracting more junior doctors to this career path would be made that much easier and the savings for the entire health system would be immense.
‘If we shy away from this challenge, it will be detrimental to the entire health system and the health of the nation.’