GPDU co-founder Monash Adj Professor. Working GP. Past President RACGP (2020-22) Melb Uni board of Enterprise & Innovation. WONCA exec. PhD MBBS, FRACGP, GAICD
My thesis The role of peer connection in Australian GPs.
Learning & support networks. Informal supervision models.
A deep dive into the humanity of the GP profession
Mindlines Heartlines & out of line experiences.
Citation please if you use the work
For convenience I think we should suggest that all patients are able to pick up all repeats at once rather than having to go back to the pharmacy every month. This will save lots of patient time.
AND
Lots of health care dollars.
Win win.
@nick_coatsworth
I’m very sad that more distrust is being promulgated by you. There are major issues in the transactional nature of our culture that are destroying institutions of trust. This is an unhelpful & generalising statement. Really sad given your past roles of public leadership & trust.
Level C telephone Medicare restored but ONLY for the prescription of Covid antivirals
Whilst we welcome this news. It is only a part of what is needed.
Chronic, isolated & vulnerable patients will now either
-need to be cut off at 20 mins
-Come in face to face
-go without
Up early to welcome a significant investment ($1B) in General Practice that will go towards the 10 year plan to create a sustainable future for health care in this country. Our economy depends on a strong health system which is built on primary care.
Well done
@Mark_Butler_MP
…
@abcnews
please note immunocompromised vaccinations with a 3rd dose are not a booster shot but the third shot in the primary course. So they are not technically a booster shot but a part of the primary course of vaccination. Technical language important here.
The message is clear.
Astra Zeneca vaccine has saved lives but may have a very rare side effect.
Covid is a more dangerous disease.
In Australia we have done well with Science.
Due to that we can afford to wait & secure another vaccine for younger people.
Sciencey ✅
Shane Fitzsimmons awarded NSW Australian of the year. So well deserved. Speaking again of team effort, collaboration, inclusion community down to the names of the fallen firefighters children. Well deserved.
@ShaneFitzAU
🖖👏👏
Thanks
@BreakfastNews
for highlighting the resources GPs need to keep going.
When x1 hospital admission can fund a patient to see their own Gp twice a week for a year (!) you know something is out of balance. We need “time to care” resources. And we needed them yesterday.
What’s so exhausting about health care reform. A SA premier goes for a night on a metro ambulance service to see what health care workers have been advising for years. He seemed surprised it was relentless but I’m sure no HCW is surprised. Good on him I guess but frustrating 1/2
Just hearing about all the flak Doctors receptionists are getting. 🥺
Please be kind. The front desk staff are doing a simply magnificent job in changing circumstances. 😢
We are all pretty safe in Australia and will continue to be if we continue to follow ATAGI advice. 😷
The number of Good GPs reporting they are quitting is confronting
@Mark_Butler_MP
I’d like to see these dreadful suggestions substantiated. So far I saw three docudrama examples. And Margarets own thesis saying this ⬇️ which contradicts her statements today
My ❤️ daughter. Pulled from physician training into the hospital Covid-19 clinic. Working there solidly 3 weeks. Not sure what happens to the other patients on wards. And as a Dr-Mama bear: yes I worry.
So yes please. Do what she says. ⬇️⬇️⬇️
Now immediate past President
@RACGP
and having a little rest. Likely lurking but will be back.
Thanks to all the wonderful humans I met who held hands and joined forces across the issues of the days we lived.
It was fierce and brilliant.
Just so you know GPs have no leave entitlements like you do in hospitals.
No sick leave ever. Largely Self employed sole traders or contractors.
On top of the “medical culture” pressure to carry on seeing patients and not burdening your colleagues
This.
Without exception, nearly every medical practioner I know has years worth of sick-leave untouched.
If you have time off sick, the weight you carry is distributed between already over-burdened colleagues.
If you can walk, you work
(with the exception of D&V- free pass there)
Written consent from a patient for a remote/virtual Telehealth is about the most ridiculous thing yet from the bureaucrazy
Worse-it has the potential to shut out the most vulnerable from Telehealth.
Those who can’t afford technology or who can’t use it=the most disadvantaged.
**Long telephone Telehealth reinstated.
Level C consults a welcome addition to managing covid in the community for general practice. ✅
Extended for 6 months
**PPE access for GPS. (P2/N95masks) ✅
**Health direct triage upgraded ✅
**Access to covid + pathways via Rat + too ✅
As I said on
@sunriseon7
this morning. Three important things Australians can do
1. Book in for your booster
2. Follow the public health advice. Yes! a mask/distance/ventilation/test/isolate.
3. Be patient & kind.
Things are going to be challenging in the next few weeks.
Medicare Faux
Still trying to understand how this confident assertion of a quantifiable number is arrived at from a largely qualitative thesis that states the estimate is not quantifiable.
& reported as “fact” by high end journalists 🤷🏼♀️
Even the statistics gurus seem confused
To our UK GP Colleagues & community. From Australia.
We see you defending safe patient care. We discuss it on our forums & watch in horror as Generalism is deskilled
We know the complexity of
undifferentiated pts.
We know the good GP is invisible
We know
'Be fast, have no regrets' – Dr Michael Ryan on what's been learned from Ebola -
Well this rings out resoundingly for emergency pandemic response.
Don’t be paralysed by the fear of making a mistake. Be fast and ahead of the virus.
👏👏🍀
Thank you to the Townsville hospital specialists who recognise the terrible injury inflicted upon trust in the health system.
#Leadership
The degradation of General Practice. The jewel in the crown of any health system, without which ALL healthcare is harmed.
@Mark_Butler_MP
Thanks to the GP who saw my mother with a potential post chemo complication after hours and quickly. Communicated with both patient and treating oncologist. And it was Mums birthday. So thank you very much.
High quality GP care likely saved a hospital admission.
Going to my second Zoom funeral today.
Devastating.
Second one during a Covid lockdown.
Second one of a health care worker.
Second one of a suicide.
Both beloved people within our circle of family and friends.
People are fragile.
Take care of each other.
However it was impressive that he included the WHOLE health system & mentioned General Practice. The solutions were thought bubbles- again WE KNOW that investing in Primary Care is the basis of any high performing health system. Perhaps the States & Feds can work together ❤️2/2
The GP crisis affecting Australia’s healthcare system
That’s our superpower,” says Price. “Our therapeutic relationship.”
A comprehensive dialogue on General Practice.
& Yes TW: I do dislike the Marvel “super hero” movies. (Controversial opinion )
On Medicare. Drawn from limited data. Sensationalist reporting.
Let’s look at the real issues that Medicare is underfunded to support chronic complex health care. The inverse care law.
Why now one week before national budget? One can only guess.
Really important. Whatever ideology says video Telehealth —— at the moment in a pandemic winter and with vulnerable patients with their usual GP-the data says telephone Telehealth is working. It’s the workhorse for vulnerable folks.
We need it restored yesterday.
‘Why are we discriminating against people? Especially when we are in the middle of a third
#COVID
wave’:
@BoultonMaria
is one of a number of GPs who are calling for the reinstatement of
#Medicare
support for longer
#telehealth
phone consultations.
@alvchua
@brookmanknight
@Ahpra
@RACGP
@ama_media
I was reported to
@Ahpra
for supporting
#pilltesting
.😇
Many of us were publicly threatened with reporting, on this site & others, for having the temerity to suggest that COVID19 was transmitted by aerosol.
I support the process.
But vexatious complaints should be unmasked.
So devastated for the loss of healthcare.
So devastated for the loss of welfare to women and girls.
So angry at the privilege that assumes what is best for someone else’s life.
How many will suffer or die due to this archaic decision?
Watching USA with horror.
#RoeVsWade
The primary care physician —an increasingly rare & undervalued Dr.
Quote. “In a system which values technical knowledge over relationships, the doctor who is the authority on a given body part often feels superior to the doctor who is an authority on the patient as a whole.”
"as a health system we fail to realize that we're paying a huge financial price for not having enough primary care doctors.
Most healthcare researchers agree that good primary care is the bedrock of a healthy society"
@FamPhysCan
@OntarioCollege
A new COVID-19 wave will hit 'within weeks' | AusDoc
Get your boosters now. 3rd and 4th dose numbers lagging. This helps us all surf the wave.
Mask up +ventilated spaces + and stay home if unwell. Test if sick.
Working together is what works.
General Practice provides 177 million GP services a year to 24 Million people for
ONLY
7.4% of the entire Health Budget.
Unless this changes **nothing changes!
@DrKate_Miller
@RACGPPresident
@GilliantheGP
@mariamtokhi
@imaanjoshi
Often undercharge a long consultation. In health assessments any other work done is given for free.Emails for free. Home visits done at cost. Lying awake worrying about the clinical care of complex patients for free too! Education checking results & letters all free
Really heard from younger people yesterday how much they want to get through this pandemic. Yes vaccination is the way out. But nothing has changed. Hold on for the right vaccine for your circumstances. For the rest of everyone over 60 & needing second AZ doses. See you soon
Wow. The stories I’m hearing from the hospital sector in Melbourne. Sadly. People bewildered frightened & scared being laid onto their stomachs to help them breathe through Covid.
They thought they could wait for vaccinations. Crying. Wishing they got vaccinated sooner. 😔
“We know that primary care is the best available system to drive accessible quality care to all Australians no matter where they live, so we need to put general practice back on a sustainable funding footing.
In Denmark 9 out of 10 medical issues are managed in primary care. They actually cut the number of hospitals by reinvesting in primary care.
-Economic evidence
-Mortality evidence
-Morbidity evidence
-Access evidence
@GregHuntMP
@CatherineKingMP
Minister Hunt committing to 2021 being the year of the GP.
Of course we dropped off some PWC modelling showing the savings to the Australian taxpayer and health system by investing in high quality General Practice.
A wrap around community to support good medicine. ✅👏
Well primary care hit 4 million vaccinations this week
so there’s that.
Well done GPs and clinic staff.
👏👏👏👏👏👏👏👏👏👏👏Keeping on and stepping up for the community rain hail or shine.
Yes a mammogram saved my life. It’s true. Nobody should delay their screening or their check ups.
And women without private insurance should have access to full reconstruction and currently they do not. It’s not cosmetic.
This is what GPs do. The distributed mass vaccination centre of the country. Safe care. Care explained. Care given over a lifetime. Not defined by disease by defined by longitudinal relationships.
@RACGP
@GregHuntMP
@markbutler
@MarkCoultonMP
It’s health care that works.
This is how to work together.
This is helpful for patient safety.
This removes conflicts of commercial interest.
This is a career path
This is quality care in the community.
18 million vaccines in Primary care. Still the biggest mass vaccination centre in the country. General Practice is awesome. The community trust placed in us we both understand and treasure. I said it this morning. GPs care about their communities and ensuring vaccination. 👍
General Practice is a specialty.
You can’t fail another specialty and get into GP.
Plenty of people from the top academic echelons choose General Practice.
It’s a uniquely broad & compassionate discipline which needs a lot of training across ALL diagnostic categories
Got my 2nd. AZ vaccine this week. I’m definitely < 60 yoa. Got my first way before TTS fully known. V. glad to be fully vaccinated. My arm is still sore.
Take care out there.
GPS can help you implement that public health advice. For you ✅
Let’s together get this done.
#gpdu18
#CrazySocks4Doc
Doctors are really good at hiding the symptoms of mental health distress.
Change the black dog to the golden dog of collegiate opportunity.
Ask. Are you ok.? Let’s have a coffee. Reach out and get help.
There is a huge story on the General Practitioners donating time & charitably under billing to help those less fortunate or to avoid Robo audit.
⬇️
Nobody is talking about the vulnerable patients unable to access healthcare.
THAT is the story
Meanwhile GPs are leaving the job
RACGP - Taskforce prepares to tackle Medicare failings
I said loudly. “We can’t go on with GPs being devalued and disrespected because we will run out of GPs – and the whole health system will be the worse for it.”
@alexbhathal
COVID-19 vaccines are free for everyone in Australia regardless of Medicare or visa status.
If you don’t have a Medicare card, or are not eligible for Medicare, you can get your free vaccination at:
▶️a Commonwealth Vaccination Clinic
▶️state or territory vaccination clinic.
Your GPs are 10-12 year trained specialists in Generalism. That means we cover a lot in diagnosis & management
Don’t delay your medical care. We can see you & help you through these challenging times. From your rash to chest pain to worries whatever IT is. We diagnose iT .
It’s World Family Doctor Day.
Generalism should not be underestimated. A specific set of skills in the vortex of complexity.
Generalism has the best evidence of bang for buck AND health outcomes.
Because.
They.
Are.
Funded.
Better.
Than.
Most.
Parts.
Of.
Community
GP.
(As they should be.)
Message is to show what can be achieved by investing in primary care.
The country needs GPs to stay.
Aboriginal-run doctors clinics are succeeding where many other GP services are failing - ABC News
A review, published in the MJA found that Aboriginal-controlled community health organisations (
#ACCHOs
) are one of the few parts of the system working well
Stop that false narrative Stephen. Of all people you know it's not Doctors pay.
It's patients subsidy its their tax that's not meeting the can't/gaps of care anywhere. Not to physios OTs dieticians or Doctors.
⬇️
Dental care for the vulnerable?
Come on. Let's get real.
Quote “It’s a huge lie in primary healthcare that you can see someone in quarter of an hour, it’s the greatest, most perverse lie of primary health care.”
There is so much more with human health care.
The moral hazard of not being able to do your best work due to system factors
Many news segments now paid advertorials. Recently in one day I've had to correct two major issues advised wrongly by pharmacist with their expanded scope but lesser training. One was clearly commercially conflicted.
Value pharmacists but not full scope of under qualification.
@dannolan
I tell you what is my favourite. I get to see the digital trace of my late friend UK GP Dr David Lewis who still puts out an automated paper Li long after he has gone (2013). It makes me smile that he is still mentoring and educating from the great beyond.
I miss him.
Victorian Fellowships for new GP. At the magnificent MCG.
That’s the specialist qualification for high quality General Practice.
Something to be very proud of.
And then this. So why WOULDNT an economist fund General Practice??
1. GPs save the health system lotsa $$
2. GPs/Primary health care have the best population outcomes for morbidity & mortality
Anything else is nonsense.
@stephenjduckett
Really? You don't know the profession you are maligning.
Women GP's in particular are walking away
The GP Quitting class.
As an economist making this about a single false issue is a campaign
Many Drs want to serve the vulnerable, do complex care & spend time with pts
This is an exceptionally disappointing summation of health care in the community
Bulk Billing does not support the cost of delivering high quality healthcare for multimorbidity, chronic complex issues, aged care, mental health or teens etc
Why encourage poor continuity of care?
How do you get to $8bn from here?
Quote: If the ABC, Nine and Dr Faux are feeling proud of themselves this week then they might want to stop and think about how much their baseless and fantastical claims affected doctors on the ground out there.
What is happening to the Government subsidy (Medicare) for GP?
A: This is why
There are gaps for patient payments.
We are in danger of running out of GPs
Complex conditions suffer
Mental health care suffers.
Aged care suffers
We are calling for a rebalancing of health care
Trusts exploiting loopholes to hire refugee doctors as PAs
Why does it always get worse?
@NHSE_WTE
/
@gmcuk
- You have lost complete control of this situation
Source:
Bring back trained staff in Aged Care. We lost when RNs were deemed too expensive. You can’t do role substitution with highly skilled workers.
Get the accountants accountable. They don’t understand healthcare.
No tick box regulation will fix losing highly trained staff.
#AgedCareRC
notes highest amount of complaints concern medication mismanagement, food safety, chemical restraint, inadequate wound management and response time by workers for residents.
These are all systemic of chronic understaffing.
#agedcare
The last thing we seem to want to talk about in all this contrived narrative seems to be
Disadvantaged people not able to access high quality health care.
The risks to the Australian health system for all.
The recognised underfunding of Medicare in primary care.
From Dr Faux’s own thesis. “Attributing Medicare leakage principally to medical practitioner misconduct cannot be upheld.”
So what’s going on ?
A grab for patients and MBS data to “help” fix?
I don’t know.
Dear Patients ➡️
Once privacy is gone it NEVER comes back.
“Of the 600 doctors in the region, 110 are sick and medical supplies are still low, said regional secretary Paola Padroni.”
Another of our colleagues is lost.
No PPE. RIP Dr Marcello Natali age 57. 😞
These face shields were made by disability company BRITE for the Doctors of Victoria. We unloaded manually or sent by post boxes into outer areas of Melbourne to assist with healthcare workers protection. —DONATED by persons with disability and Toyota.
@abcnews
@GregHuntMP
From this brilliant piece. When did health care workers and Doctors become the enemy?
Some of the best trained and most compassionate people leaving the profession. It’s a real concern.
Let’s just be really clear too. I ❤️ working with pharmacists. No matter what THE GUILD says. The guild =big business big politics arm.
We want collaborative team based care in a continuous relationship model which we know has best evidence.
Not political health policy
One in four COVID cases in NSW outbreak has been a child under 19
Please test
Dr James Best “But as GPs we need to overcome the misconception that a child with mild respiratory symptoms is very unlikely to have COVID and doesn’t need to be tested.”
Telehealth nonsense continues.
So we stop progressive access to healthcare because legislation can’t keep up.
Yet. Covid changes to legislation happened very quickly.
Seems like Government Finance wants to shut down Telehealth.
Very tragic. Another health care worker injured. And now we hear fatally. So very sorry to hear of the paramedics death. Rest in peace and deepest condolences to all. 💐
If GPs charge the first minute at the same rate as the last minute-there is less patient subsidy per minute for longer consults
Every workplace values each minute the same except Medicare.
It down shifts the gears at 20 mins & again @ 40 mins
Encourages short quick & rushed👎
A big day. Pushed that darn submission button. Off sailed thousands of words written in blood sweat years and tears.
It’s not over yet but well on its way. ❤️
So grateful for the many good people who helped supported & challenged me. So exhausted & so ready.
#phdchat
So Yes
@mjrowland68
Get vaccinated.
We will all come in contact with this virus.
How you manage will be determined by your vaccination status.
Vaccines save lives especially for those older folks.
Supplies increasing weekly
Take it easy on the Vacc staff!
@BreakfastNews
Very poorly informed take.
Why?
1. We do not support fraud
2. We just held a Gp crises Summit on this
3. We participate with task forces in funding workforce & compliance
We have said there is a system issue for a long time
Culture People & therapeutic relationships key
We have a problem in the medical profession, we provide
#lowvaluecare
at increasing cost; we over-service; we reject attempts to shine lights on our practices. We need to be open, we need to fix our issues.
#auspol
#medicare
Yes debriefing my hospital Dr daughter on some of the choices made when ICU is full.
Thanks
@DrEricLevi
for reminding everyone to be kind. These are not ordinary times.
@qldhealth
Please include the largest healthcare supplier in the country = General Practice.
People need to wear masks to protect other vulnerable waiting patients like pregnant women, the immunosuppressed, aged, solid organ transplant, chemo & MH folks etc who visit GPs waiting rooms.
GP Save 💲
“We found GPs undercharged at 11.8% of encounters & overcharged at 1.6%. This suggests GPs aren’t routinely defrauding Medicare, -in fact have saved the system equivalent to $351 million in 2021-22 financial year”
& that’s a guesstimate❗️
Indeed we don’t support fraud. But saying there are cancer patients receiving inappropriate care by treating oncology teams.
BIG CALL.
I think we should take our advice from the treating team and not from a Medicare lawyer who has a business advising Drs on Medicare
@ketaminh
@brookmanknight
To be fair, it’s wasn’t just on GPs. A lot of mention on other specialists too. But yes, many unscrupulous actors in our industry too unfortunately
Loved seeing all the new Fellows.
That’s specialist GPs.
So many kids too up on stage with their Mums & Dads.
It takes a long time to train to Australian standards as a Medical specialist. Should never be taken for granted.
Congratulations to all
Especially the kids🥰
Yes Kochie. 11 000 GPS short by 2032.
It’s a crises. It’s been happening for years and it’s time for some major reinvestment & reform without the red tape.
Thanks
@kochie_online
&
@sunriseon7
for highlighting the urgent need to reset General Practice- a complex specialty
Medicare
Quote
“It seems fairly clear that the government has made a policy decision to not fully insure people for care in the Medicare system but is leaving the implementation and explanation of that policy to doctors.”
If GPs are rorting the hell out of Medicare why is so much of their work done for free?
Quote ““Most GPs spend a significant amount of unpaid time on patient care
b/w consultations, an inherent problem of the system,” the Uni of Sydney researchers said.
RACGP - ‘Implausible’
healthcare economist & former health department secretary Dr Stephen Duckett said at no point in his near 50-year career working in health administration has he seen any sign of malfeasance or carelessness occurring at such a scale.
Oh my goodness. Comment 30 from Dr Kate is read with thumping silence.
Beautiful and paralysingly Tragic and Hopeful.
Thank you. Caring for Colleagues.
This is an incredible admission from a senior doctor about an attempt to end his life many years ago, due to the seemingly insurmountable pressures the job put on him. Even more astonishing is comment number 30 below it.