Medicolegal expert, health economist and GP Dr Michael Wright is one of five doctors battling it out to be the next RACGP president.
Sydney-based GP Dr Michael Wright has thrown up a hand for the RACGP presidency, vowing to use his economic expertise to restore general practice to its former glory.
With a PhD in health economics, a second career as chief medical officer at indemnity firm Avant Mutual and a long history with the RACGP’s expert committees, he brings serious chops to the leadership contest.
TMR: What would your priority be as RACGP president?
Dr Wright: We’ve had chronic underfunding of the MBS for a number of years.
We’ve talked about a crisis in general practice, but we now have greater urgency because of these new models of care that have been proposed as the solution to improving primary care.
These are unproven, untested, and I think they’ve got the potential to worsen the health of our patients and to worsen health expenditure.
My priority for the college is to try and get us out of this crisis.
Through my experience and skills, I’ve [come up with] a number of solutions, and I’m really keen to share those with the members and to work with the college to get ourselves out of what is a pretty bad situation.
Can you outline those solutions?
It might be helpful to talk about what those skills are – I’ve been in general practice for about 20 years, but while working as a GP I’ve also sought additional training in health economics and research.
I have held a number of leadership positions [and] gained the skills to understand what the benefit of general practice is from a clinical point of view – which I think we know and our patients know – but also to explain the benefits and value of general practice from an economic point of view.
I think the thing that’s been missing is that we haven’t been able to clearly explain to funders and policymakers what the economic value of general practice is.
Michael, you’re probably best known for your work with medical indemnity firms, and you’re also a healthcare economist. Does the college need a numbers and rules guy in charge?
That’s an interesting way of phrasing it. I’ve always looked at myself as a portfolio GP.
Fundamentally, I’m a GP who has added extra skills and knowledge.
I think that’s what a lot of doctors have done as we’ve taken on specific interests to augment our understanding.
At the moment, we desperately need a president who [not only] understands clinical care but who can speak to the economics of general practice, and who can negotiate with funders and policymakers in terms that they can understand.
That’s why I’m standing for the role, and that’s why I think my experience and skills are what the college needs right now.
Your background in health economics sets you apart from the other candidates, can you tell us about the research you’ve done in that space?
Initially, I had started doing some work with the college talking to funders and policymakers and I would express why I thought something was important – and they would say, ‘well, you would say that because you’re a GP’.
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I realised I needed to understand what their language was, and that is the language of funders and the language of economics.
So, I did a master’s in public health and health economics in the UK, and I ended up completing a PhD in health economics back in Australia.
My PhD was about the value of continuity of care, something that we think intrinsically is valuable, but quantified in economic terms.
More recently, I’ve been looking at how health funding is changing and how much of the health budget goes to general practice.
What we’ve seen over the last decade is that it’s dropped from over 7% of the total health expenditure, down to maybe 5.6% in the last year.
In the last year alone, the evidence which I’ve been looking at shows that there’s a billion dollars that’s been taken out of funding for GP services in the MBS in the last financial year.
If practices feel it’s harder, if our patients are feeling it’s harder to get in to see a GP and if it’s harder for us to do the work, then I think that sense that we’re feeling is right: we really are in the middle of an unprecedented financial pinch.
And we need some solutions to put more money back into general practice to allow us to provide the care that our patients need.
What do you see as the biggest challenges facing general practice right now?
I don’t want to say funding, funding and funding, but I mean…
First of all, we do need more funding to go into the MBS to reward longer consultations.
We also need to change the MBS so that we can open it up to include our team within the consultation items.
Then we need a broader foundational shift in non-MBS funding.
We keep trying to change the funding within the GP part of [the health budget], but that GP part is less than 6% of the total budget.
We need to look at what the other 94% is doing and look for savings there that might be brought back to general practice.
If I were to define my campaign platform, it’s around two key issues: restoring remuneration and restoring respect.
Particularly in terms of respect, over the last few years it feels like general practice is increasingly sidelined in the discussions about what the health system should look like.
And that needs to stop, because we know that general practice provided over 160 million consultations last year, nearly 90% of the population saw us, and all for a pretty modest part of the health budget.
We are the heart of the health system, but we’re just not being acknowledged for that.
Part of what I want to do as president is to restore that respect, but it starts internally.
We need a positive narrative about how amazing general practice is, to inspire doctors in training and medical students to say, ‘general practice sounds great’.
My dad was a GP, and I was really inspired growing up by seeing the patients coming into his surgery, and nearly universally leaving in a better place.
We don’t know what the Scope of Practice Review will recommend when it delivers its report later this year, but it seems likely that it will involve broader scope for allied health professionals. If you win as president, you’ll be stepping right into the middle of it – how would you respond?
It’s a tough one, because we don’t know what’s going to come out yet.
I work with a medical indemnity provider, and we’ve provided lots of feedback [to the review] talking about the concerns of fragmenting care and the effect that it could have on increasing risk to patients and doctors.
We need to focus any [proposed] changes through a quality and safety lens.
It’s crazy to think that we wouldn’t have that as our primary basis on which we look at these recommendations.
I think that’s probably where we need to step back and say, ‘look, what are we doing here? How is this improving safety for patients?’, and if it’s not doing that, then it’s definitely something that we would have to oppose.
Dr Wright, are you a candidate for change or a candidate for consistency?
I’ve been involved with the college for over 15 years and a member for longer.
I’ve not been on the board or led the college, but I know how the college works intimately.
I think there’s definitely room for improvement in how the college gathers its messages and we can certainly provide more evidence of success in our advocacy.
That’s where I’d like to focus, in terms of funding reform: workforce initiatives, making sure the college represents all of us, shifting the focus of our work, pushing back against administrative tasks and helping us focus more on clinical care.
They’re all areas that I think we can provide evidence back to the members that we are succeeding and evidence of our advocacy.
I’m an optimist, I think the future is bright.
A detailed breakdown of Dr Wright’s priorities can be found on his website.
TMR will be back with another RACGP presidential candidate interview later this week.
Have a question for the candidates? Email holly@medicalrepublic.com.au.
This interview was edited for length and clarity.
