Dr Gavin Colthart is one of three GPs in the running for RACGP president.
Running against two long-time state faculty chairs, Queensland GP Dr Gavin Colthart is something of the outsider candidate in this year’s RACGP election.
With less than a week left until voting opens, the New Zealand born doctor sat down for a chat with The Medical Republic.
TMR: In the candidate video uploaded to the RACGP website, you say that part of the purpose of your campaign is to galvanise the college to dissent more strongly. Can you tell me more about what you meant by that?
Dr Colthart: Standing for this position wasn’t in my playbook until it became apparent that things are moving at a faster and faster pace in terms of what’s happening out there in the world and what’s happening in other countries that are swamping over the top of us.
It seems like the college tends to be very, very good at maintaining the status quo. But the downside of that is that it can be a little cautious on dealing with some of the big issues, because it’s understandably keen to keep its networks with politicians [healthy].
There’s that balance always between how outspoken you can be [before] you get lots of doors shut in your face.
How much of your effectiveness requires that polite approach, and how much can be a bit more robust?
At the moment, it feels like there is no such thing as too much dissent. I think we can go hard on this, and I think we’ve got that moral authority.
We’re a pretty respected group … who a lot of people have actually had face to face contact with. Galvanising the membership as much as galvanising the college machine was part of it.
If I can influence the college, if I happen to win this election – which may happen – then it would be about improving the degree of dissent that the college can tolerate, and finding out from members a lot more about what they think and feel as time goes on, not just waiting for a presidential election cycle.
TMR: There’s been some discussion recently about how GPs should present themselves in advocacy and whether it would be worth taking on a more adversarial role. How do you see your own leadership style?
Dr Colthart: I don’t think adversarial is the right word.
I think my interest is really from the college point of view. I think the president, to some extent, follows the college rather than leads in many ways.
They’re responsible to the board, elected by the members.
The main thing, really, is for the college to actually have some red lines.
It’s not that we need to go out there and be belligerent or aggressive. It’s that we need to know where we stand and where we’re not prepared to go, and I think that’s a little lacking at the moment.
TMR: What do you see as the biggest threat facing general practice?
Dr Colthart: Well, that depends on the time frame.
TMR: Let’s say the medium term.
Dr Colthart: How long is a medium term these days, with the speed that things are changing?
TMR: Three to four years.
Dr Colthart: Then I think the biggest threats are actually completely external to general practice.
I think in the time frame of three or four years, there’s an extremely good chance that we may have significant political change here, to the extent that there’s no longer any commitment to universal healthcare.
We’re seeing governments press their allies to change their health policies.
We’ve seen this with the relationship between the United Kingdom and the USA, where they’ve been required, almost forced into an agreement whereby they’ll pay higher prices for drugs in exchange for various other things.
There’s a distaste for socialised medicine amongst the political movements that are now prominent in the US and prominent here as well … any medicine that is available to everybody at minimum cost or that is just taxpayer-funded, they call it socialism, if not communism.
So that’s the biggest threat.
I think that that we will be forced into, over that period of time, unravelling what we have now, which is a largely government-funded healthcare system.
GPs will not be at the top of the pecking order.
If you look at family practice in the US, it’s an entirely different business to here. It’s very, very marginalised.
Patients go direct to specialists, and the specialists tend to use GPs, or family practitioners, as a way to funnel business their way, rather than as a way to more effectively manage patients.
It’s an entirely different setting, and I just wonder how many 30-something doctors are sitting there today wanting to practice like that, if at all; the number of jobs in America for family physicians is lower as a percentage.
So yeah, I think it’s a threat.
There’s a tidal wave potentially coming. We’re already seeing the starts of it. There’s constant pressure on budgets. There’s constant talk of returns on investment in the health sector, using other professions as a way of saving money.
I think where that all ends up potentially is, well, there just is not a universal healthcare system in any meaningful sense.
TMR: How does your answer change if it’s the short term, as in the next two years?
Dr Colthart: If you look on the Facebook pages and general correspondence and chatting to people, doctors – particularly younger doctors – are terrified that they’re just not going to have a job, whatever commitment to socialised medicine there is or not.
There’s encroachment from other professions which I think is a real issue and needs to be addressed. It’s become a little tribal, which is concerning.
But nonetheless, the government stated that it wants to make primary care much more multidisciplinary.
That throws up all sorts of interesting challenges.
I think in the in the short- to medium-term, quite apart from whether we get a 5%, 2%, 1% or 0% increase in funding, I think the issue might be [the government saying] sure, we’ll pay GPs more or for longer appointments, but we’re going to pay a lot of other people to do stuff, and maybe they’ll be cheaper.
TMR: Can you tell me a bit more about your work and where you live?
Dr Colthart: Here on Magnetic Island, we’re about 14 kilometres off the coast of Townsville.
We’re accessible by ferry. It’s a popular place to come for the day, or for the weekend – or from out of state for a week of decent weather if they live in Melbourne – but it’s kind of a suburb of Townsville separated by water.
It becomes a remote location if the ferries aren’t working, or if the ferries have stopped working [for] the evening, or we have some other sort of catastrophe.
We have a clinic here. It’s a service facility rather than a hospital. We have a resus room and clinic rooms, but we don’t have any inpatient beds.
We have a group of SMOs who are all GPs who cover the clinic, and we work there on a rota.
If we have to helicopter people off, if we can’t get them on a ferry before the ferries stop running, we have reasonable facilities here for managing patients and stabilising people, but we don’t have any imaging beyond ultrasound.
We do a lot of primary care for reasons that are a bit historical, in that the GP practice on Magnetic Island fell into disarray several years ago, just through inability to recruit staff as far as I can tell. And so the Queensland Health clinic was seeing an awful lot of GP work and an awful lot of the results of not-great GP management.
The clinic’s been taken over [by local Townsville doctor Associate Professor Michael Clements] in the last few years and is running much better.
It’s been a really big success for the island. But it doesn’t stop people coming off their scooters because they’ve got drunk, or taking unusual drugs at one of the local hostels, or people on [walking] tracks in the middle of nowhere having falls. We deal with pretty much anything and everything.
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TMR: I see that you did medical school in Otago, but then you did GP training in the UK. That makes three countries where you’ve had experience working in the health system – New Zealand, the UK, and now Australia. How do they all compare?
Dr Colthart: Would you like the short answer or the long answer?
TMR: Let’s try medium.
Dr Colthart: They’re so similar [in terms of training structure] that talking about the differences isn’t that relevant.
What’s happened in the UK since I left is that they’ve underfunded general practice.
I think this is the thing: if a government wants to fund medical care properly, it doesn’t really matter too much what system you’re using.
They obviously have capitation systems there. GPs tend to run in partnerships; they don’t tend to be practice owners with lots of contractors. It tends to be that most of the people in the practice are partners in the practice. Maybe some have salaries.
I experienced a time in the UK when they expanded the budget for healthcare significantly, when Tony Blair first got in. It was, I think, a 15% or 20% increase.
Things were great. No one was arguing about capitation versus private or anything. We could see patients, we could employ people, we could employ nurses, we could afford to do stuff.
The hospitals were running really well. Patients were getting hip replacements in three months.
The private specialists were having to take their kids out of private school because they weren’t getting enough business.
It was a very different thing, and it was all about funding properly.
I think that’s the key argument really – if a government that has some degree of either malice towards GPs and doctors or just has a feeling that it’s a good place they can save money in healthcare generally, no matter what system [you have], they’ll get you.
We’ve seen a big Medicare freeze. We didn’t need a change in structure to threaten a lot of practices’ viability.
TMR: What would you change internally at the RACGP?
Dr Colthart: I think the RACGP is a big machine.
It’s taken on the entire training load for general practice, pretty much, and so a lot of funding and a lot of HR stuff flows through the college because of that.
I think doing that is an exceptionally worthwhile thing.
Members don’t pay for that, so this is the interesting thing: the membership funds aren’t used to pay for GP training. That’s funded by the government.
I think [the college] training, CPD home, all these things really, really well – what concerns me most is advocacy and membership engagement. Those are the two things that go hand in hand.
At the moment, we don’t get a huge turnout for elections. Members tend to be generally positive towards the college, despite what you might see on social media.
My experience is that it usually gets a cautious thumbs up, but a lot of people are disengaged.
A lot of people are doing supervising, and they might even be doing sort of more senior roles in the college but are not really involved in any advocacy stuff with the college. They’re just heads down, do the teaching, do the supervising.
I’d like to see people much more involved. I think we’re all professionals. I think we’ve got an ethical commitment, and I’ve highlighted that a lot in my website and in statements.
I think it’s beholden on us to get involved.
[What I would like to explore is] the idea of how we get members involved on a more day-to-day or a more permanent basis instead of just when they vote.
[One] idea is that there’s some kind of role or a committee or a council of members that are advisory.
What’s been floated before – and I think it’s [Dr Anita Muñoz] that’s floated it most clearly this time – was an idea to appoint a presidential advisory body.
My read on this, listening to people talking about it, is we should go much further than that.
I think we should have a randomly selected group of GP members who would be advisory, but with teeth.
They would flag things that they didn’t feel the college was dealing with or wasn’t seeing … and they would have the power to maybe even require the college to do a poll of all its members on some critical issues.
If they flagged, for instance, that women’s health was being eroded by lots and lots of legislation coming through threatening abortion access, they could get together and say, look, I think you need to poll all the members as to whether we should [say] we may personally have problems with abortion, but we feel that it’s a woman’s right and that we would like to do what we always do, which is – if we have a conscientious objection – get somebody else to deal with it and make sure that the person is cared for. We don’t legislate against it.
There’s a lot of good examples around the world on how people have mobilised groups like this to work effectively. Random selection is something that’s been used to deal with thorny issues.
I believe it was used in Ireland when they were trying to deal with abortion, but nobody could talk about it without fear of getting thrown into one camp or another. They managed to come up with a considered approach.
I think that often it’s those frontline people who come up with the most considered approach and are less fearful of putting things forward.
If another candidate gets the post, I would encourage them to go for [a system like this] because I think there’s appetite in the membership for it. It’s not a huge burden on people.
It would be a few hours a month reading things, reading briefing papers, perhaps participating in a vote on something, and there’d be no career in it.
There would be no “I’m saying this because I want to progress in the college or politics locally” or anything like that.
It’d purely be that you’re part of a fairly large group of people who have been asked to tell the college what they think.
[We would] make sure that it’s representative of members – IMG mix, gender mix, geographical origin mix, age mix. All these are very easy to do. We do it all the time with medical research, with choosing study groups that are comparable.
[We could even look at the] possibility that we say, look, you’re a member of the college, you have got to vote, it’s compulsory, we expect you to vote. And if you don’t vote you need to tell us why not or you get a little black mark or whatever.
I don’t know how you work that one out, but we have compulsory voting in Australia. It hasn’t ended the universe as we know it, and I think if you’re going to be a member of a group and want to have your say, then you’ve got a responsibility [to vote] as well as a right.
TMR: You’ve said in a few different places now that you don’t necessarily expect to win, but you do hope to make a change. What do you think other candidates could learn from your approach?
Dr Colthart: A win would be unexpected because I didn’t come into this campaign with a lot of money spent on advertising or anything.
I’d not done any pre-pushing of ideas or canvassing of opinion to have a campaign, as such.
If we were in much better times – if we weren’t under this impending tidal wave of badness coming in our direction – I think people who’ve been in the college before and have got the experience and make ideal candidates.
I’d like to encourage [the other candidates] to be just a little more challenging and to feel happy to do so.
TMR: We like to end on a light-hearted note. There are some wonderful nature photographs on your website. You must be a keen photographer.
Dr Colthart: I have a camera that I take with us when we hike, so I am pretty keen.
I don’t know if you read my CV in detail, but it has all sorts of twists and turns. I was a photographer before I was at medical school, and I was exhibiting in New Zealand.
I’ve actually got a piece in the national gallery there – in the basement, not on display, sadly.
But I’ve done a fine art degree. I have photographed for ages.
Basically I’m a snapper with birds. I’ve got a camera that’s not particularly expensive but has enough telephoto to get a good quality.
Wildlife and general nature in Australia is just mind blowing.
It’s the best place in the world if you like nature, wildlife, birds, critters, everything. We’ve got more richness and diversity here than almost anywhere else on Earth.
This interview has been edited for length and clarity.
Voting for the 2026 RACGP election begins on Tuesday 11 August and ends on Friday 21 August.
TMR will be publishing long-form interviews with all candidates. Read Dr Anita Muñoz’s profile here. Dr Ramya Raman’s will be published on Friday. Interviews are being published in alphabetical order of the candidates’ first names.
