What if Dominic saw this in his GP’s clinic?

8 minute read

When are GPs actually going to say, “I’m as mad as hell and I’m not going to take it anymore…” and then act on it?

As you know, I’m not a GP and as such, I often fail to get to the finish line when it comes to understanding what goes on inside the head of many GPs. 

I try to offset that significant disadvantage by ringing a spread of GPs I know, whenever I really don’t get what’s going on, and asking them to explain. But I’ll admit, I often can’t figure things out even after doing that. 

Last Sunday, I listened incredulously to the late afternoon press conference held by NSW Premier Dominic Perrottet in which he announced his decision to allow pharmacy prescribing trials in that state. 

Queensland we sort of understand. Over the years its government has been beholden to property developers first and pharmacists second for some reason. So you tend to allow that state a bit of slack on the crazy and the sometimes clearly politically corrupt stuff when it comes to healthcare.

But NSW? It’s not been known to be part of the pharmacy lobby fraternity. In fact, NSW has been known to resist a lot of the ideas put to it by the Pharmacy Guild, whose influence is greatest in Canberra and the Sunshine State. 

The NSW thing came out of nowhere. So it’s been very hard to get a line on what actually happened, other than the very obvious political expediency of promising patients more access to care but without having to care much about or pay for the promise.

Perrottet’s presser performance made it seem like the idea had landed on his desk within a day of his making this announcement. He hadn’t been briefed properly and he didn’t appear to know what he was talking about.

His main line was that the plan would increase disadvantaged patients’ access to drugs and care and reduce hospital admissions (which it very obviously wouldn’t). But while explaining this, he failed to point out that patients would have to pay through the nose for that access.

They’d be up for a pharmacist consult fee and potentially even more for the drugs because the federal government won’t be subsidising any drugs prescribed, as they do through the PBS, because the idea is so dangerous and stupid.  

I’m pretty sure Perrottet wouldn’t have even understood this problem existed when he made the announcement. 

He also didn’t get anywhere near discussing the safety issues involved in allowing a pharmacist, who is not qualified to diagnose and who would likely have no access to any longitudinal patient records, to check for obvious issues in prescribing for things like contraception or UTIs.   

Nor, of course, was there any mention of the more than obvious conflict of interest and danger in profit taking from prescribing. 

It’s apparent neither he nor any of his staff briefed or discussed the idea with any GP groups prior to the press conference. Rather, it looks like they just listened to someone from the Pharmacy Guild talk about how fantastic those trials are going in Queensland. And jumped on the idea.

But you know all this stuff. It’s Groundhog Day, right?  

Another day, another politician chipping away at the fundamentals of care and GP access through a combination of ignorance, apathy and political expediency. 

But what wouldn’t I be able to take if I was a GP watching that press conference?  

What would make me “madder than hell, not able to take it anymore” would be how deeply patronising and offensive the NSW Health Minister Brad Hazzard was toward the GP profession. 

“We need to look after our patients and you should be part of that equation, not blocking it,” he told ABC reporters when asked about GP groups’ objections. 

“Nobody is suggesting for even a second that patients shouldn’t go and see their GPs regularly,” he said, “but if you need to get that antibiotic, you should be able to do it quickly — not wait for a GP for possibly six weeks.

“My message to GPs is: ‘I love you dearly, but you need just to relax’.” 

Cool. Just relax, everyone. Brad has this. 

It’s lucky that Hazzard is retiring because being that patronising – notwithstanding GPs never seem to fight back against this sort of stuff – is something a lot of GPs are never going to forget.

There is a limit, which lies somewhere in the not too distant future, to GPs being so congenial, polite and accommodating.

I wonder if we’re starting to get near it. 

So I rang a few GPs, and while I struck the normal, community-minded “don’t get down in the gutter with them” ones, I did hit one or two others who said, “nope, I’d do that”. 

Do what? 

Fight back. 

Fight back dirty, even. 

Here’s a quick “two can play at this game”, fight back dirty idea: 

How do we think Dom and his mates on Macquarie Street would feel if the poster we have attached to this article (and reproduced below) started appearing in GP waiting rooms around the state? 

Click here to download

Imagine if he saw one in his own GP’s waiting room? 

You wouldn’t even need that many to go up. You’d just need photos of them in situ in a few practices, ideally one in Dom’s electorate, to do the rounds on relevant social media with a couple of smarty pants hashtags – #Domdontcare, for example. 

Get a reasonably-profiled consumer journo – Nine and the ABC surely owe the GP profession a favour these days – and it could easily become a pretty embarrassing story pretty quickly.  

Someone would have to explain how such mild mannered, community-minded, apolitical professionals suddenly got so mad and a bit radical.

Some GPs looking at this poster are going to be taken aback, because this poster doesn’t play fair. It’s imputing a whole lot in oversimplified take-outs to get a point across. Which is pretty much what politicians do in dumb-ass doorstops on a Sunday afternoon. 

But even if the whole thing feels like it’s an insane, political stunt, consider for a minute what the pharmacy lobby has been saying about their sly victory.

With Queensland nearly under its belt and NSW now in play, they could have the whole east coast of Australia soon, and once that happens they can set their sights on pharmacy prescribing nationally via the states’ backdoors.

Wow. Could that really happen given how badly the Queensland trials are going, the conflict and the safety issues?

Well, they’ve got NSW now.

We know from Queensland that the trials are more or less contrived and designed to rubber stamp the whole process.

If you look around there aren’t any serious political stakes being put in the ground by GPs to slow such a domino effect. And Victoria is now in election mode so you can bet the Guild is trying it on down there too.  

Yes, we have the usual, sensible objections from the AMA and the RACGP. 

But look how Brad Hazzard fobbed them off – literally “relax dudes, you’re a bunch of panic merchants, we’ve got this, sit back, wait …trust us”. 

Does it seem like he feels threatened in any way? 

He does not give one toss. He’s even prepared to start poking the profession.

When politicians are acting this smug, the only thing they are going to respond to is direct threats at the ballot box.

One respondent to my quick survey of GPs asked whether I thought that if she put a poster up, would she then get targeted for a payroll tax audit by the Office of State Revenue. 

Such a response goes to just how beleaguered and fearful some GPs out there are of government and what they might be capable of. 

And how cynically some have come to view their governments. 

After the recent NSW government shenanigans surrounding jobs for the boys in New York, and some pretty obvious interference direct from Macquarie Street in the processes of senior public servants, you can forgive the GPs for being cautious. 

But for what it’s worth, I really don’t think that a NSW state politician would be able to get away with ringing the Commissioner of the Office of State Revenue and saying: “Listen, I saw this nasty poster on the wall at my GP’s this week about me and pharmacy prescribing, and I think she needs a lesson in who’s the boss around here.…send her an audit letter.”   

It might make a script on a new series of Rake though. 

Download the poster here

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