The General Practice (GP) profession in government funded models

Australia’s “universal medical insurance scheme”, Medicare, offering healthcare to Australians, is based on the British NHS model. For too long, a critical shortage in investment into general practice in UK has lead to unsustainable pressures that are beyond the coping threshold.

On average, a general practice receives £136 per registered patient for an entire year of unlimited medical service. This is less than the cost of an annual cable TV subscription. Not surprisingly, patients are lining up for this free-for-all, leading to waiting lists of up to 3-4 weeks.  Under the contractual agreements between general practices and the NHS, practices are prohibited from offering a private service to their registered patients, due to a conflict of interest. Here are some of the consequences that UK is experiencing with this model:

  • Growing resentment amongst GPs, leading to an ever increasing number of GPs quitting full time work, or prematurely retiring from the profession all together, and not being replaced by younger trainees due to a lack of incentive, enthusiasm and practically unrealistic service targets.
  • Surgeries are facing a recruitment crisis.
  • Increased demand and poor funding from the rather stagnant Federal budgets means that the demand simply cannot be met. Safe, effective, efficient and high quality comprehensive medical care would become a distant dream.

As such, general practice is on the brink of collapse under UK’s current model. It’s a real shame that Australian politicians and the Grattan Institute are looking up to this model, without learning from the UK’s lessons. The only way general practice will be sustainable is if there is increased investment into the industry, whether it is from the government or from patients directly, or both. Under-investment is simply not feasible. Bulk billing is not feasible unless the Medicare rebate is in line with the AMA recommended fees, which at present is around $80 for a standard consult. $37.05 is the current Medicare rebate, which is a far cry from the minimum funding required to deliver healthcare.

It’s a shame that the Australian government is already planning to trial this “annual subscription” aspect of the UK model with its Australian title, “health care homes” :