Where does General Practice fit in the overall Australian Health System?

Nathan Pinskier *

AGPA has the potential to play a vital role in the future of Australian health policy development as the status of General Practice within the overall healthcare system has never been comprehensively defined. General practitioners have a clear role but does General Practice?

General Practice is not by definition a public healthcare service yet it provides a comprehensive range of services to the public. It is largely regarded as a private primary care service but is underpinned by federal dollars (Medicare, DVA, PIP etc..) and as a result is subject to some oversight and a level of control by the Federal Department of Health.

The relationship however with state health services is variable and often poor. There is no formal relationship or compacts with the state systems in terms of expectations, care coordination and care handover. I would suggest that as a consequence tertiary services struggle to define, develop and maintain a relationship with general practice

PHNs are perceived to be the gateway between primary care and the tertiary system however this is problematic as PHNs are funded by and responsive to the federal government and have no clear relationship with the state system nor really with many general practices.

The federal government also funds a national direct consumer access and medical literacy service Healthdirect which also has no formal relationship with general practice.

A further challenge to defining their role is that general practices vary so widely  in size, capability and capacity. There is no standard model. At one end of the spectrum a general practice can consist of one unaccredited GP opening limited weekday hours with no after-hours coverage or at the other end can be a large seven day extended hours accredited multi doctor practice with a multidisciplinary team and a range of onsite allied health services including pharmacy, radiology and pathology. It is important to note that whilst general practice accreditation defines a minimum set of capability requirements it is not a mandatory process and the meaning of “an accredited practice” is opaque to most consumers and even other healthcare providers.

So given the above issues can we develop and enshrine a clear role for General Practice in the Australian Healthcare system?

Perhaps the starting point is to develop a set of principles regarding its role, capacity and responsibilities and communicate this document to all key stakeholders. This would include a set of clear statements defining what each party can expect. This could form the basis for a compact at a future point in time that would assist in clarifying the role of general practice in the overall healthcare system. We all recognise the need for a clearer definition as to the role of the practice in an environment of multi-doctor practices with what are frequently transient GPs as well as patients.

Developing a more comprehensive set of principles is a  piece of work that AGPA is ideally placed to lead.

*Nathan Pinskier is a Melbourne GP and practice owner

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