Patients are sorting themselves by experience as much as price. GPs need to start thinking like brands.
A colleague asked me recently why her appointment had felt so rushed when her sister’s, the same week, with the same complaint and the same rebate, had felt completely different.
One of them walked out feeling looked after. The other walked out feeling like a number.
The exchange has stayed with me, partly because the answer is not actually mysterious, and partly because the question is being asked at a moment when general practice can no longer afford to keep ducking it.
Pharmacists and nurse practitioners are taking on wider scope. Urgent care centres will see your patient tonight without a gap. Anyone with a phone has a passable diagnostic conversation in their pocket before they pick it up to call you.
None of that is anyone else’s fault, and none of it is reversing.
Whether the policy settings get re-litigated or not, a lot of what general practice used to consider its quiet bread-and-butter is being done elsewhere in the meantime. We can spend a lot of energy debating whether that should be happening.
It is happening either way.
Which makes this a good moment to be honest about what general practice is actually selling, and at what price.
Healthcare isn’t a handbag. Nobody needs a Birkin. People need a doctor. So I’ll get the obvious objection out of the way early. But the market for general practice is already stratified. Patients already sort themselves by experience as much as price. We just don’t say so out loud, because saying so feels uncomfortably close to luxury retail, which is the comparison I’m about to make anyway.
So, with apologies to anyone about to spit out their coffee, here is the shelf.
Hermès. Brunello Cucinelli. Patek Philippe
When you buy a Birkin, you don’t really buy a bag. You buy the one-of-a-kind experience. The sales associate who knows your daughter’s name. The private appointment in a room above the store the public will never see.
The concierge medicine tier hams it up the same way. A dedicated doctor who has read your file before you walk in and remembers your last holiday. Whole-genome sequencing, wearable data streaming into a dashboard your GP actually looks at, an MRI because it’s Tuesday. An Avengers-level multidisciplinary team already briefed.
This is the tier built for people for whom time and attention at this density cannot be mass-produced.
Chanel. Dior. Rolex
The boutique tier. A waiting room that feels like a lounge. The room smells lavish. Hour-long appointments because the model is built around them. Tissue paper, tasteful follow-up, packaging you keep.
In primary care this is the practice where every touchpoint has been thought through, the technology is genuinely premium (AI doing the documentation, a patient portal that works, allied health down the hall), and the ritual around the consult is part of the offer.
Coach. Longchamp. Swatch
This is my shelf, so I’ll own it. The unpretentious middle. Real craftsmanship, real brand, no theatre.
In primary care it’s the neighbourhood GP who runs slightly over because she listens, bulk bills pensioners, charges a modest gap for everyone else, and uses the boring tech well: AI scribe so she’s not documenting at 9pm. A recall and reminder system that works.
The Kmart plastic bag
The six-minute mill. Vinyl chairs, perspex, a doctor scrolling with minimal eye contact. Every touchpoint quietly tells the patient how little time anyone has for them.
To be clear, this is not a description of bulk billing. Plenty of bulk-billing practices sit higher up the shelf. The mill model is a specific business design, not a billing decision.
Every other industry gets to ignore the bottom shelf. Healthcare doesn’t, because per-person funding for general practice has stayed roughly flat for a decade while hospital funding has risen by almost a third. The patients who most need continuity and time are the ones often funnelled into the tier least equipped to give them either.
Stratification of experience tracks stratification of income. It is an equity problem, and it sits underneath everything else here.
The equity problem doesn’t, however, get any of us off the hook for the harder conversation.
For a long time, there was a quiet assumption that primary care was general practice, full stop. That if a patient needed something, they would come to a GP eventually, and that the existence of that pathway was permanent.
That assumption was probably never quite true and is certainly not true now. Most of the routine, single-issue, transactional work that used to be the steady ballast of a GP’s day is being done somewhere else, by someone else, faster and often cheaper.
So, if a slice of the work is going elsewhere, the question for every GP is what’s left, and whether their practice is built to deliver the part that’s left, well.
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What’s left is the bit general practice has always been quietly best at, and most embarrassed to charge for: the continuity and the capacity to hold complexity over time. The doctor who has known a family for 15 years, who can sit with three diagnoses and a difficult home life at once, and who notices the thing the patient hasn’t said.
None of that is in opposition to other primary care providers. It is just the bit of the job that gets harder, not easier, when patients see lots of different clinicians for lots of different things, and the bit that benefits most from someone holding the whole picture.
In the language of business/start-up strategy, that is what’s called a moat.
Which means the question for any GP reading this is not really “Should I charge a gap?” It is whether your practice is built to deliver the bit only general practice can hold together.
If you are charging a gap, the gap must be earned in that experience.
A Coach handbag at a Hermès price is a worse buy than the plastic bag, because at least the plastic bag is honest about what it is. Patients pattern-match. They know when the price and the experience match, and when they don’t.
The opposite applies.
If you are running a premium practice and apologising for the fee, stop. The patients who want continuity, integrated care and a doctor who remembers them will find their way to you, and they’ll be glad they did.
None of this argues against advocating for better Medicare funding. The equity problem acknowledged above is real and structural. It just means the work of running a good practice can’t wait for the funding fight to be won.
So, the ask for my fellow GPs:
Walk through your own front door like a stranger. Sit in the waiting room for 15 minutes. Read the first SMS a new patient gets. If this were a brand, what shelf would it sit on, and is that the shelf you charge from?
Then the harder question. As more of primary care is genuinely shared across the system, what is the part you and your practice are uniquely placed to hold together, and is your model built to deliver it well?
If the answers don’t line up, pick a direction. Invest in the experience until it earns the fee, or set the fee at the level the experience can honestly meet.
Both are legitimate. What isn’t legitimate any more is assuming patients will wait while we decide.
Most of us didn’t go into general practice to think about shelves and tiers and fit-outs. We went in to look after people. The work hasn’t changed. The room around it has, and the patients noticed before we did.
Dr Janice Tan is a Sydney GP who is passionate about innovation in primary care. She’s general manager of clinical innovation at Bupa and contributes to the RACGP’s Expert Committee for Practice Management and Technology and the Specific Interest Group for Digital Health and Innovation, as well as the Central Eastern Sydney PHN. All views expressed here are her own.
