Has ‘Your’ GP Dropped the Ball?

broken stethoscopeIf you ask an Australian city-dweller nowadays (and remember that 89% of us are urban) the name of their GP, the likely answer will be that they don’t know. They attend a bulk-billing clinic either near home or near work, and see whichever doctor is available. “If someone in my family is really ill,” they might add, “we would call an ambulance; if it is not that serious, we would go to the nearest public hospital. If we rang the local medical centre, that’s what they’d tell us to do – or to phone a deputising service for a visit from a doctor we don’t know and who doesn’t know us.”

What has happened to continuity of the care of the seriously, chronically ill, especially if they are elderly? The AMA website proclaims “Your family doctor: invaluable to your health” and the website of the RACGP states, “Your GP can help with a huge array of health issues. This includes everything from the routine to the complex at all stages throughout your life”, but both statements depend on your actually having a family doctor.

City general practice is now dominated by profit-seeking corporations or companies which ‘employ’ doctors (on a ‘contractual’ basis), many (if not most of them) part-time, with an ever-changing list of doctors’ names on a board somewhere.

Bulk-billing means that you will be called back to the clinic if you need a repeat prescription or results of tests or the re-issuing of a referral to a specialist, even one whom you see regularly.

Will you see the GP of your choice? That will depend on whether or not she (or less likely, he) is attending at the clinic on the day, or during that morning or that afternoon. If you attend a clinic near your workplace and another near your home, neither doctor will know what information about you the other clinic possesses. If a member of your family is seriously or chronically ill, it is likely that one of the specialists at the nearby public hospital will be co-ordinating their care; communication with general practice easily becomes sub-optimal, especially when it is to a group of GPs rather than to one named doctor.

So where does the blame lie for this betrayal of continuity of personal medical care?

First, with John Gorton’s government and the $5 gap between rebates paid to specialists for work which, until then, had often been done by GPs. This led to massive patient demand, at a cost of a  mere $5, to see a specialist for anything and everything. This, with an accompanying move of GPs with special training into exclusively specialist practice, reduced the family doctor’s role to the periphery of patients’ coordinated care.

Second, with Laurie Brereton and the NSW Labor government (backed by the Australian Competition and Consumer Commission), which authorised advertising by doctors. This opened the door to commercial interests, better able to afford mass advertising than the local solo GP or small GP partnership.

Third, with Neal Blewett and Federal Labor, which encouraged Geoffrey Edelsten with his bulk-billing clinics and their grand scale advertising – forcing neighbouring GPs out of business and paying them to work in his clinics. Edelsten was soon followed by other like-minded entrepreneurs.

Remarkably, the bulk-billing rebates for GP services – long portrayed by the AMA as insufficient recompense for a GP’s training, experience and skill – somehow have enough ‘fat’ in them to provide dividends to the shareholders of the corporations and companies which ‘employ’ the GPs and bulk-bill.

Fourth, and perhaps fatal to continuity of patient care, has been the feminisation of the medical workforce, especially in bulk-billing GP clinics. These practices offer married women doctors the opportunity to work part-time – certain days of the week, mornings or afternoons – whatever is convenient for baby and child care, and for accommodating the needs of primary and high school children. Often married to other (well paid) professionals (often also doctors), women doctors are not deterred by low rates of pay from the clinics. The lifestyle-friendly hours are more than adequate compensation.

As for continuity of care for the individual patient? If that is what you want, move to the country, preferably one with a good local hospital frequently attended by GPs. If you prefer to remain in the city, put the non-availability of continuity of care, alongside pollution and traffic congestion, as another of the disadvantages of city-dwelling.

  • rathbeg

    Unfortunately the country is being taken over by the bulk-billing corporations, with shocking over servicing and revolving door
    doctors, all of whom are from overseas. It is the local nurses that staff the local hospital who are the real heroes.

    • Jody

      My recently deceased uncle had a medical practice in Liverpool, Sydney. He had a picture of Bill Hayden on the wall of his surgery with “Bulk Bill” written underneath it.

      My GP runs a practice which exclusively bulk bills everybody over 60 and all children. I regularly get letters from them telling me to “book an appointment to discuss your ongoing health management”. Read into that what you will. Suffice it to say, I’ve never been asked whether I have the means to pay for my consultations or whether it’s justified that I get free X-rays and a range of pathology services for nothing. Indeed, the only charge I incur is the $2-50 train fare, courtesy of the taxpayer because I’m a NSW ‘senior’. It’s all outrageous profligacy!!!

  • Rob Ellison

    I was scratching my head until the last paragraph. Move to the country. Whatever you do – don’t go to Yeppoon. It’s absolutely horrid.

    I have a chronic condition and nominally have a ‘health care team’. These day they do what I charmingly tell them to do. Bulk billing is available and the co-payment for others hasn’t changed. I have had experience in both the public and private hospital systems. It is all about the same. Even the food.

    I spend a lot of time in bed with my laptop – so if I am on here a lot making unpopular comments – so sad too bad.

    Health services expenditure is one of the things the public likes a lot. Co-payments are a reasonable means to manage demand. I’d suggest a more progressive health card system with benefits phasing out at higher incomes. If you are not going to tax the rich – at least don’t subsidise the bastards.

    • Jody


    • ianl

      > ” … making unpopular comments ”

      Perhap not unpopular – just bad-tempered.

      Now please make me laugh with another blast of polemics ! 🙂

      Oh, and stop looting “the rich”; Robin Hood beat you to that by many centuries.

    • Rob Ellison

      What thin skins we have. It was obvious irony. An allusion to bottom of the harbour schemes, Cayman Island accounts and Singapore based headquarters. There was as well the humour of self deprecation that stands up well against Iain’s cheap shot.

      But the churn of middle class welfare is a fact. One obvious starting point on spending reform is no transfers to those who don’t need it. This would seem obvious and might even lead to lower taxes.

      We may contrast with Pauline Hanson’s strange whine that marginalised black people get more transfers than she does. There is a lot wrong with the indigenous industry but inverted transfer envy is just cheap and nasty. Pauline Hanson is the sour face of petty gripes. I prefer expansive and inclusive ambitions for my felix Australis.

    • Lo

      The rich get taxed don’t they? And pay enough tax that they’re entitled to use the scheme they pay for I’d suggest.

      • Rob Ellison

        Entitled to social welfare? Whatever.

  • Salome

    I go to a clinic that is privately owned (it would appear) and that requires a co-payment (although it appears not to do so for health care card people and pensioners). Unlike the bulk billing clinic around the corner, I can generally get an appointment on the day if I am sick, although usually not with my ‘regular’ doctor, for whom I need to book early if I am wanting predictable appointments like annual checkups. My parents used to go one to the bulk billing clinic and the other to mine–and I don’t think I need to tell you the one at which they agreed patients received better care.

  • Simon2808

    I have moved a lot throughout the past 15 years, but having settled in Adelaide now I finally have a ‘family doctor’. Mind you, the fella isn’t cheap, a 40 minute consult will set me back $350 (minus a $48 rebate from Medicare). In all reality, if I’m already paying seven times what I’m entitled to from Medicare, I don’t understand why so much of my tax needs to be allotted to ‘health’.

    • Rob Ellison

      What on Earth do you find to talk about for 40 minutes? If I am not out in 5 I get fidgety. Results – printout – I want a prescription for… thanks…

      • Jody

        Yes, that’s because you’ve got to get back to bed!!!!

        • Rob Ellison

          I got a wheelchair last week – poor me. I forgot that making self deprecating jokes about my disability is opening the door to whatever thus is. Do you find a chronic conditions funny Jody? Do you laugh at blind people and cancer patients?

          There are two levels of consultations in my local clinic – simple and complex. Simple costs $65. I like to keep it simple and to stay in control of my own health.

  • Jack Brown

    As well as the factors mentioned for declining numbers of family GPs there are two other aspects one can add, if not more. The first pertains to the fact that GPs were note just providers of medical services but also owner/managers of small businesses. The burdens of micro level government regulations over the past thirty years which in bureaucracies would be administered by a dedicated work unit just meant an unsustainable imposition on GP owner/managers which working all evening and on weekends still meant they risked sanctions for even tardy compliance. This created an opportunity for businesses to professionally manage the business side of medical practice and free GPs from the administrative burden. The other factor is that GPs used to rely on selling their practice for goodwill to provide a significant part of their post working life income stream, having no 3rd party employer sponsored superannuation fund to do so. The changes in the business arrangements under which medical services have been provided means that most GPs faced the prospect of having to just walk away from the practice when they could not work anymore. Government caps on salary sacrifice superannuation contributions which typically might be made by employees already being looked after quite handsomely by the employer sponsored funds cut hard on self employed people. Peter Costello briefly made this avenue a semi workable retirement funding option for self employed babty boomers but it has since been tightened to an unworkable solution. These two factors in conjunction have made it hard for any GP to resist the once in a lifetime golden buyout figure offered by corporations for their practices in return for signing up as a contractor to supply medical services to the corporation for a period of years leading up to retirement.

    • Rob Ellison

      Most practices seem to have multiple doctors as well as a range of other services. I imagine administration is more efficient that way.

  • Lo

    I don’t understand this article. I live in a large regional Victorian town and have been with my GP for 14 years. The practice from which he works has perhaps 8 GPs, most of whom I’d be happy to see if my guy was away or on holiday – rare. All my medical history is on file there of course.
    I looked up General Practitioners on the internet, random choice, for Ivanhoe, Richmond and Kew, they all have practices with named GPs, from whom you can choose I guess. This article seems to suggest they don’t exist but if I can find them, and I don’t live in Melbourne, surely you can. Are you suggesting that they should all be available all the time just in case you need them urgently next October?
    Also, a GP legally has to provide care for someone quite ill. My appointment for 9am might be delayed because a child has been brought in with something that requires immediate attention. He can’t tell the parents to bring the child in at 4.20pm because he has a slot there. I have, when desperate, Sunday pm eg, had excellent care from the local bulk bill clinic but they don’t have my complete history and I prefer when practical to pay to see my own GP.

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