Speech by AMA President, Dr Bill Glasson to the GP Summit "The future sustainability of general practice?" Australian War Memorial, Canberra

General practice - the forgotten profession

Good morning fellow doctors, ladies and gentlemen.

We are here today to share our concerns about the future of general practice.

We are here today to once again offer some policy solutions to our reluctant political leaders.

Above all, we are here today to present a united front on behalf of all Australia's GPs.

I only hope that we can carry that unity beyond today and beyond this GP Summit.

General Practice is Australia's forgotten profession.

Once the cornerstone of every Australian community, the family doctor has been ignored, trodden on, insulted or beaten into submission...or all of the above.

Not by patients, mind you, but by successive Governments of both persuasions over many, many years.

Our GPs have had the goodwill squeezed out of them and now there's nothing more to give.

They can't make a living and they have to sit and watch as the Government shifts the cost burden of health onto their patients.

Australia's world class health system is being run down.

Doctors are being forced to leave practice or retire early.

Patients have to search high and low to find a doctor.  And when they do, they have to pay more and more for their health care.

Families are paying more.

The old and the infirm are paying more.

The poorest and the sickest Australians are being forced to pay to prop up the health system because the Government is walking away from its responsibility.

In 21^st century Australia, this is simply not good enough.

We have to fix it. 

The groups assembled here today - the AMA, the ADGP, the RACGP and the RDAA - represent not only all Australia's GPs - whether they are members or not - we represent all the patients, too.

We must use our group strength - and the strength and numbers of our patients - to influence change.

There is every chance there will be a federal election some time next year.

We must make the Government and the Opposition listen to our ideas, our policies, our solutions to make sure the best possible health policies are on show for people to vote on.

Quite frankly, the policies on display at the moment are not good enough.

They do not properly address the big issues - access and affordability.

As individual organisations, we are all doing our bit to improve the lot of GPs and their patients.

Starting today we have to do more - a lot more - as a team.

You probably all know that I am a specialist - an ophthalmologist. 

Well, let me tell you that as Federal AMA President, I am now a self-appointed honorary GP.  I'm working for you.

I am indeed fortunate to have the support of a wonderful GP Vice-President, Dr Mukesh Haikerwal, and a dedicated and talented AMA Council of General Practice, all of whom are here today.

In my work in Queensland and East Timor and Norfolk Island, I work alongside many GPs and I see the work of many GPs.

Wherever I travel, they are respected and they are hard working.  They are the salt of the earth.

They are - you are - an important resource worth preserving...but not in a museum as Government policy would have it.

I want you all preserved in your communities - city, outer-urban, rural and remote - looking after your patients.

I also want to restore general practice as a much-sought-after career by our brightest and best and most devoted students.  We'll have to make the unfunded bonded medical places funded places as a first step.

More than one-third of the AMA members are GPs, many of them young doctors just starting out.

We must make a difference for them and those who will come after them.

As we commence this summit, we must ask the question:  why is general practice neglected? 

The sad reality is that general practice is no longer an attractive profession.

Even those who are established in the profession are moving out.  They worked through the good days and don't like the look of the bad days.

Besides, it is no longer affordable to maintain a flexible working life in general practice.

The participation rate of 64 per cent is falling and one in 6 GPs is not working in medicine.

Recent figures indicate that there has been a decline of around 3 per cent in total number of GPs since March 2002.  That's a lot of doctors gone missing.  That's a lot of pressure on those who remain.

What is worrying, however, is that nearly all the dramatic changes in general practice have occurred in the last six months.

There is no doubt that general practice has done its utmost to support a health system and financing structure and to try and make it work.

This commitment has been one-sided.

The Government, like Elvis, has left the building.

The Government has exploited the goodwill of general practitioners.

Many GPs have put themselves, their businesses and their own and their family's security at risk to continue to provide affordable care for their patients.

Some GPs did see the writing on the wall and took control of their lives and their business.

Those who have taken the big leap and decided to value their services appropriately rather than let the Government tell them what they think they are worth are not looking back.

Many have said to us that they experienced a sense of incredible relief after taking the decision to take control of their practices.

Valuing your services does not mean compromising your principles about helping those in genuine need.

The Government's neglect of Medicare is proof that they do not value your services.  You must do it yourself.  It is the only way you can stay in practice and ensure that your patients and your communities continue to have accessible and affordable health services.

In late 2000, the federal government rejected the outcomes of the Relative Value Study - the RVS.

Shortly after, we saw the largest drop in bulk billed services in seven years - a trend that has continued.

It reflected a recognition by many in the profession that Government was walking away from its responsibilities around access and affordability.

The level of Government neglect reflects the growing unattractiveness of general practice.

The AMA listed 11 specific policies to turn things around in our supplementary submission to the Senate inquiry on Medicare.

They include:

• the ongoing reduction in training places
• the 1996 provider number legislation
• the under valuing of the cost of medical practice reflected in a schedule fee which has nothing to do with reality
• the imposition of non fee for service and targeted incentive schemes that are complex and impose heavy red tape burdens, and
• the rejection of the RVS and the increasing intrusiveness of Government into general practice.

A recent AMWAC careers survey showed a direct relationship with many of these policies and some of the major reasons doctors are contemplating leaving medicine, including:

• Working conditions, including long hours and poor pay;
• Low and decreasing levels of autonomy coupled with increasing government interference;
• Medical indemnity issues;
• Concerns about job security; and
• Lack of appreciation by the public.

Independent surveys of GPs show that if they had their time over again nearly 40% would not specialise in general practice.

And why?

Well, 33% spent 10 hours or more doing paperwork a week, the average working week for a middle aged general practitioner was around 55 hours and, on the whole, they felt highly under paid and unappreciated.

What can we do?

We must ensure that consumers - voters in other words - take a stronger role in demanding the health system they need for themselves and their kids and their kids.

We must get a long-term vision for health in this country.

We must continue to educate our patients and the public that the Medicare rebate is their rebate and that the Government is dudding them big time.

The focus for the profession must be on the real value of services and how this is reflected in the schedule fee.

In terms of a financing system, general practice ought not depend on Government for its sustainability and, in future, most likely will not.

Workforce policy will determine the future sustainability of general practice and this is sadly - and I must say most inappropriately - in the hands of the Government.

It is my pleasure as AMA President to be here today to work for a better deal for all our GPs and their patients.

We must forge partnerships and teamwork that produces a compelling force for change that the Government cannot ignore...especially as we enter an election year.

Let's do our best for our medical colleagues and the patients of Australia.

Thank you.