It’s one example of a pattern that extends to federal politics.
Eight out of 10 GPs say the government is not sufficiently listening to GPs when it comes to issues related to the profession and patient care – and most concede they are not effective as a political force, according to a national Healthed poll with more than 1900 GP respondents.
Only 9% thought GPs were a ‘very effective’ political force for professional and patient care issues, and 32% thought they were ‘somewhat effective.’ More than a quarter (26%) said GPs were ‘very ineffective’, while the remaining 33% said they were ‘somewhat ineffective’.
So, what’s stopping GPs from getting the government’s ear and driving systemic change?
When it comes to achieving meaningful Medicare reform, time constraints and workload are the biggest barrier, followed by lack of lobbying expertise and GPs not acting as a coordinated group, Healthed’s survey found.
Former AMA president Dr Mukesh Haikerwal says GPs have been increasingly excluded from decisions that affect them.
Peak GP bodies used to collaborate with state and federal governments on strategic issues, he explains. “We would actually write policy together and see good policy implemented.”
“Those days are gone,” he says, noting a different paradigm drives policymaking these days.
“And it’s not about the wellness and the health of the patient and the best patient outcomes. It’s about appeasing squeaky wheels. It’s about keeping themselves elected next time.”
“One of the big problems is that when you’re doing good primary care, general practice, it’s about chronic disease management. There are no buildings to open. There are no ribbons to cut. There are no big picture items. It’s hard yakka.”
“We have been informed by AHPRA that we are not allowed to express our political opinions or beliefs.”- GP in Healthed’s survey
Professor Karen Price, Federal Chair of the AMA Council of General Practice and past president of the RACGP says health policy is being shaped inside “an ideological political bubble.”
“There is an ideological push going on. We know that the Labor Party has factions. We know that they play the unions. We know that the nurses’ union is very powerful. We know that the pharmacy lobbyists are very powerful. And this is just destroying what has been a good health system.”
Last financial year the Pharmacy Guild donated more to political parties than any other healthcare entity, donating more than $600k all up, including around $360k to the Labor party, records from the Australian Electoral Commission show.
Professor Price says that while GPs have enormous expertise, “finding the words to describe exactly what we do is often very difficult.” As a result, people sitting outside of general practice who aren’t chronically unwell and don’t have complex health issues often have no idea. “And I would say that that subset live in Canberra.”
“They are adopting short-term cross-sectional studies and ideas from other countries which have poorer performance, which makes no sense,” Professor Price says.
Forty-six percent of GPs in the survey said GPs’ focus on patient care can come at the expense of political strategy (and their own financial sustainability).
“The compassion a good GP brings is their biggest hurdle to advocating for meaningful change,” Newcastle GP Max Mollenkopf wrote in a LinkedIn post last month.
Dr Mollenkopf says unless GPs are willing to stop bulk billing until there are adequately funded salaried clinics to refer low socioeconomic status patients to, “meaningful change will never occur. It’s unpalatable but it’s also reality.”
“Advocating for truly public operated primary care clinics (for low SES patients) is the only way we will save ourselves from ourselves,” he writes.
Professor Price notes long consultations are already propping up the system, often at personal cost to GPs—especially women GPs.
“Fee-for-service is not the problem. It is the amount of money that is devoted to it. And whether it’s bundled payments, whether it’s capitation, whether it’s fee-for-service—if it’s underpaid, it will not work,” she says.
For their voices to be heard, GPs have to speak up, Dr Haikerwal stresses.
“I think GPs have become far too accepting of a diabolical set of circumstances that they find themselves in. And to their own detriment, if they don’t speak out and turn this around, things will go worse to where they are now,” he says.
“I think that the mouse needs to roar. Or the sleeping lion needs to be woken from its slumber.”
Play the long game
“We may have to resort to short‑term loss to have long‑term gain — but this may never happen as we care about our patients too much.”
“We need more GPs to see the end result of being exploited and this hardens their attitude.”
“We may have to accept short‑term pain for long‑term gain.”
Get political
“We need to stand up for political reform as much as we do for patient‑centred care.”
“Act as a coordinated group & we must improve lobbying expertise. Can we learn from the chemist lobbying experts?”
“Be cohesive, aggressive, persisted and united in lobbying for the better deal for primary care.”
Unite
“The problem: when our professional bodies negotiate, they look over their shoulders – they do not see an army of doctors.”
“Get one strong group talking instead of a bunch of half‑hearted lilies.”
“The government takes advantage of the fact that we are not united.”
“We should employ whoever works for the Pharmacy Guild as our lobbyists!”
Charge what we’re worth
“We need to forget Medicare (it’s only an insurer) and charge what we feel we are worth.”
“Aim to provide quality care and charge appropriately for this, not apologise for realising our worth.”
“Stop doing out of hours visits and clinics and see how much that costs the government.”
“If we all stopped work for 24 hours, the system would collapse.”
“Every GP collectively commit to privately billing everybody. Stop doing out of hours visits and clinics and see how much that costs the government. Unless Medicare pay more and make an item 36 anything over 15 minutes there will be no junior doctors applying to be GPs. Too little pay for increasing workloads. My advice is do not be a GP unless you are already financially secure and know that you can have a sensible work life balance.”
Stronger representation needed
“A person who can articulate the GP position and is visible on mainstream television. Explain to the public what we think and why we think it. Why the current system bad. There should be more research into why policies that may appear good superficially and are usually adopted from overseas should not be transplanted into Australia.”
“A powerful representative advocate is needed.”
“Engage a politically-savvy campaign director who can do grass roots visits to GP clinics, gather signatures and statements from a broad range of stakeholders. Would then be able to formulate a more representative statement of what actually matters to the grassroots GPs, and present these statements in politically meaningful ways to parliament and media. Will require a more coordinated public messaging campaign also, to be able to uncouple the decades-long assumption that GP care should be ‘free’ at the point of care.”
Overhaul the system
“A change in the healthcare model may be an option, where GPs are free from running a business and are solely focused on clinical matters. It appears that GPs who run practices and engage in business models may not be as successful in delivering clinical care. We have sufficient experience from the past to support this view. These business models may create unnecessary competition among practitioners, both within and outside the practice.”
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