The GP publication Australian Doctor recently took the rare step of publishing a front-page editorial – one of only a handful in its 30-year history – attacking both the Australian Medical Association (AMA) and the Royal Australian College of General Practitioners (RACGP).
The editorial says the speciality’s lack of political influence over the last ten years had “left general practice in the wilderness”.
Paul Smith, the magazine’s deputy editor, said there was a fundamental need to debate why general practice was being attacked by the Federal Government. The deeper question was why, for all the familiar rhetoric about the importance of tackling chronic disease in Australia, there had been no significant investment in the speciality for a decade.
“As we state in the editorial, the tragedy is that general practice is being left to stagnate,” he said.
Where is the GP leadership? Lack of influence has left general practice in wilderness
Australian Doctor editorial:
As the specialty sails through the wreckage of the MBS rebate freeze, a policy that is striking at the heart of quality care, it is time to ask the pointed question about who is leading general practice.
The RACGP, as we reported last week, is battling to become the political voice of the profession — in fact, it has been battling for some time. The college clearly feels something has gone wrong and that the AMA is not up to the job.
It is an important shift for the RACGP. Its traditional motto since it emerged from near bankruptcy in 2002 — when it was burnt by previous political dalliances — has been about standards and education.
But now it says membership is close to 30,000, and it clearly believes it has a mandate that the AMA, whose GP membership number remains top secret, lacks.
This is the RACGP’s justification for the awareness campaign it’s running on prime-time TV, the justification for its plaques and posters branded with the College logo it has been sending out to its GP members, and the spending of hundreds of thousands of GP dollars.
Many among the College rank and file are wondering when they sanctioned the spending of their membership fees on such a high-cost strategy.
But the bigger question is about the value of making the RACGP a brand in the public mind and whether it has the strategy and capacity for wheeling and dealing in Canberra, where the real decision-making happens.
Of course, it is this kind of political influence that the AMA has always claimed for itself.
“When it comes to advocacy issues, the first point of call on any GP matter, whether it’s the media or the government, is the AMA,” the association declared last month.
“When reversing cuts to GP funding from last year’s budget, the Prime Minister publicly acknowledged the impact of the AMA’s advocacy.”
But there should also be some tough questions about what the AMA’s self-heralded lobbying might has really achieved. This time last year, the AMA had a seat at the ministerial table, having been asked to help fix up the Government’s first $5 co-payment disaster.
What actually emerged from these consultations was a new policy more damaging to general practice than the first.
The specialty was suddenly taking the brunt of $3.5 billion in Medicare cuts, as well as accusations by Prime Minister Tony Abbott that too many GPs were practising “sausage-machine medicine”.
The sum total of AMA influence in this case was the worst policy to hit the specialty in at least 25 years.
And this was the policy, when it was unveiled in December last year, that ACRRM actually praised, commending then health minister Peter Dutton’s “courage in taking a stand for quality and value for taxpayers’ money”.
This was the policy that the RACGP described as having “some merit”. The AMA said little until it was deluged by angry emails from doctors.
The truth is that for all the lip service about the fundamental importance of general practice to the future of Australian healthcare — and all the government inquiries, commissions and reform taskforces — there has been no significant new investment in the specialty since GP rebates increased to 100% of the schedule fee in 2005.
General practice has been left to stagnate for a decade.
No one could ever pretend the job of lobbying government is a simple science, or pretend that leadership of a specialty with such staggering diversity is easy.
But debate is urgently needed on why general practice leadership has been so ineffective for so long, and more importantly, what can be done to bring about change.
• This editorial was published by Australian Doctor on July 6, 2015. It is cross-posted here with permission.