We need to accept that GPs are in business and to start behaving accordingly, writes Dr Joe Kosterich
In the upcoming Ashes cricket series, England would love to retain the urn but it wouldn’t be the same if they defeat an Australian “B” team. Hopefully the players strike will get sorted out well before then (maybe before this goes to print).
We all like to have wins. Those with few wins get increased enjoyment out of any small victory. This is human nature.
I was reminded of this by the triumphalism displayed when the pharmacy plan to offer screening blood tests was (for now) stopped. It is important to note that while the pathology provider pulled out, the pharmacy group has not abandoned the idea and will seek another pathology provider.
You would have thought that all GPs were about to get a massive pay rise, such was the jubilation.
The reality is different. There never was a threat to general practice. How many people do we really think will pay the chemist $200 to get tests that can be ordered by a GP and covered by Medicare?
Where people were prepared to pay, getting abnormal results forwarded is no different to getting abnormal results from a life insurance or corporate medical. In fact, the “target group” for the pharmacists, (supported by the federal health department), was those not currently seeing a doctor who might be found, on screening, to need a GP. If anything, there was potential to send patients to GPs, rather than drain them away.
And don’t think that disruption in the shape of people ordering their own tests online is not coming! Or that complaining about it will stop it.
There is a more critical issue. Pharmacists, and their professional body the Pharmacy Guild, have been very successful in finding new revenue streams. They lobby governments and actively engage with other providers. They look to expand what they do and are unapologetic about it. The Pharmacy Guild is a highly effective lobby group and a powerful business ally for its members.
Contrast this with the lot of GPs. When was the last time that either the AMA or the RACGP went out looking for new revenue streams on behalf of GPs?
They may argue that this is not their role. The College could contend that its role is training and standards. Yet the cringeworthy “Not Just a GP” campaign was run on the basis of the College having an advocacy role for GPs. Did this campaign drive patients into GP practices? Did it change anyone’s perception of general practice? Did anyone even have any outcome measures to assess whether the money was well spent? Who knows.
It gets worse. In 2014, a co-payment was put on the table by the Abbott government. This was not perfect, but offered, for the first time, an opportunity for GPs to charge a fee as well as bulk bill. Once the principle became established, it would have been easier for it to slowly increase. In turn, this would reduce the reliance of GPs on the Medicare rebate and government.
Essentially, it would have introduced a new revenue stream into general practice. What did our representatives do? Argue against it. What is the end result? An ongoing freeze on rebates and no new revenue stream.
Private health insurers have explored how they can work with GPs. Were they greeted with a welcome spirit of “let’s see whether we can cooperate for mutual benefit for us and patients?” No. They were pushed away on the basis of any money paid to GPs would somehow be tainted. The underpinning assumption being, specialists can be trusted to work ethically with private health insurers, but GPs cannot.
Even that might not matter if any effort was directed into broadening the financial base of general practice or exploring how it could work collaboratively with others. In pretty much all other industries, representative bodies, which are paid for by members, are expected to lobby on behalf of those members (not to agree to silence for no payment via a compact) and seek to support the business of members. And yes, we are all in business.
A line used by Donald Trump in his successful presidential campaign was that America would be “winning” so much they would get bored with “winning”. History will ultimately judge the veracity of that. Sadly, GPs are at the other end of the evolutionary scale when it comes to winning. It happens so infrequently that we get excited by non-victories.
Maybe it’s time someone, or something, set about making general practice great again.
Dr Joe Kosterich is a general practitioner based in Perth. You can read more at www.drjoetoday.com
