Excellent primary care must find a way to be sustainable.
Fourteen years ago, almost to the day, I found myself unexpectedly having to build a general practice from scratch.
Last week, I was in direct receipt of the observation from a retired medical colleague that she was deeply saddened that my general practice had “become a business”.
I have sat in deep, sad thought this fortnight with that sombre sentence/complaint from someone I have always respected.
I understand the nostalgia behind it. I share the concern about affordability and the increasing pressure on patients. But general practice has not suddenly become a business.
Rent had to be paid in the 1960s. Receptionists and nurses needed to be employed in the 1990s. Equipment, insurance, accreditation, technology, cleaning, leave, continuing education and clinical governance have never been free.
What has changed is that the true cost of providing good general practice is no longer being hidden.
Business has never been and will never be the purpose of our practice. It is the scaffolding that allows the medicine to be sustained. It allows us to provide 20-minute appointments rather than rushed medicine. It pays for skilled nurses, thoughtful, trained receptionists, secure systems, careful results management, infection control, staff training and continuity of care.
A greater than average proportion of the patients who choose our practice are themselves doctors: medical students, interns, registrars, GPs, specialists and retired medical colleagues.
To me, that speaks volumes.
They understand medicine. They recognise careful, high-quality primary care.
That’s exactly what I want when I see my own GP.
I don’t want self-service medicine because I’m medically literate. I don’t want to interpret every result alone, devise my own management plan or decide for myself when follow-up is required.
I want my GP to think. I want to be advised, directed and cared for. I want to be respected as a patient rather than treated casually as a colleague who can manage herself.
And I expect to pay appropriately for that expertise.
Related
If we routinely bulk billed every doctor, specialist, registrar and medical student who attended our practice, that generosity would not be funded by an invisible third party. The rent would not waive itself. The nurse would still need to be paid. So would the receptionist. The software, insurance, accreditation, equipment, follow-up systems and clinical governance would still be required.
The cost would ultimately be carried by the practice, by the team, by the next GP we could no longer afford to recruit and too often by women GPs who have long absorbed additional time, complexity and invisible care.
Asking individual GPs to solve a national funding problem by repeatedly discounting or giving away their labour isn’t health policy. It’s a slow erosion of our profession – a death by a thousand cuts, many of them so small and socially accepted that they’re barely even noticed.
Dr Nerida McDonald is a GP and founder/owner of Walker Street Doctors in North Sydney since 2012.
This article was first published on Dr McDonald’s LinkedIn feed. Read the original article here.
