Modern Systems. Same Values.

General practice will look different in ten years, but the real question is not whether change is coming, but whether GPs help shape it or are expected to adapt to reforms designed around us.

The next President of the RACGP won’t just inherit today’s challenges, they’ll help shape what general practice becomes over the next decade.

My goal is to ensure the RACGP remains the strongest advocate for the profession as healthcare changes, our patients live longer with more complex needs, and general practice continues to evolve.

As both a practising GP and practice owner, I’ve experienced those changes while continuing to care for patients every day. That experience shapes how I think about reform.

General practice doesn’t need convincing to modernise because it already is. New technologies, new funding models and new ways of delivering care have become part of everyday practice. What’s lagging is whether government policy is keeping pace with that change or continuing to hold it back.

I’m optimistic about technology, including Artificial Intelligence, when it’s used thoughtfully. It has the potential to reduce administrative burden, improve access to information and give GPs more time with patients. But technology should support clinical judgement, not replace it.

Leadership during this period isn’t about resisting change or accepting every reform that’s proposed. It’s about ensuring GPs are at the table early enough to shape reforms that work in real practice.

Change Is Inevitable. GP Leadership Matters.

General practice has always evolved. Gold was still a therapeutic option for rheumatoid arthritis when I was a medical student, now we have biologics and monoclonal antibodies. The profession we practice in today is not the same as the one we entered decades ago, and nor should it be.

Workforce shortages, population ageing, chronic disease, mental ill-health and rising patient expectations mean our systems must keep changing. Practices need better ways to share information, coordinate care, support teams and reduce avoidable and odious administration.

The status quo in Australian general practice is not sustainable because GPs are spending up to a third of their working week on compliance and non-patient-contact tasks, and because outdated systems make it harder for patients and clinicians to navigate care.

Reform isn’t in question anymore. What matters now is which kind we choose.

Technology Should Strengthen, Not Replace Care

Technology can make general practice better. It can reduce duplication, improve access to information, support clinical decision-making and remove low-value administrative work.

But technology is a tool, not a model of care.

A digital platform cannot replace clinical judgement, and an algorithm cannot understand a patient’s history, family, community and changing circumstances in the way a trusted GP can. Convenience is useful, but it is not the same as quality and should not override the value of continuity and humanity in the doctor-patient relationship.

We should judge technology by whether it gives clinicians more time for care, improves safety and strengthens the relationship between patients and their GP. If technology creates more work instead of less, it isn’t solving the problem.

We’re already seeing what this looks like when it’s done well:

• Secure messaging now let’s patients contact their GP directly for repeat scripts and referrals, and receive care asynchronously, without losing the benefit of a GP who already knows them.
• A request for a repeat contraceptive pill script can become a prompt to flag an overdue cervical screening test, arrange overdue STI testing and bloodwork before the next visit, or add a note for follow-up.

The GP is remunerated for that judgement, and the patient gets convenience without losing continuity.

The Future Is Team-Based, But GP-Led

Team-based care will be essential to meeting the growing needs of our communities. Nurses, pharmacists, allied health professionals, practice managers and other clinicians all bring valuable expertise, but only the expert generalist has the breadth of training and experience to oversee the clinical governance of teams managing complex, multi-condition care.

The scope-of-practice case against fragmenting care has already been made in full elsewhere (see The Retailification of Healthcare, Independent Pharmacy Prescribing Is Not About a Turf War, and What Happens When Political Decisions Override Clinical Governance?). The question worth asking here is narrower: what makes multidisciplinary care safe to scale as practices modernise?

That is not simply asking different professionals to work together. It’s giving them shared records and clear systems, properly funded, so a GP can stay across a patient’s care wherever they’re seen, rather than it depending on whichever provider holds the most recent note.

MyMedicare ostensibly seemed to be a step in the right direction, promising to formalise the relationship between a patient and their usual GP, and giving that GP clearer oversight of their team. But as a scathing senate committee review has just revealed, it only works if it’s flexible enough to reflect how patients actually live. Care doesn’t always sit inside one practice, and Aboriginal and Torres Strait Islander patients in particular often need care across more than one service. The model must flex to that reality, not the other way around. The current iteration of MyMedicare is causing more problems and barriers than it is solving.

GP-led care doesn’t diminish the contribution of other professionals. It creates the systems, governance and continuity that allow every member of the team to contribute safely. That’s as much a design challenge as it is a workforce one.

The future of primary care is not less GP-led. It is more GP-led than ever. That is the only safe way to do it.

Modern Reform Must Protect Clinical Autonomy

I’ve represented general practice in major health system reforms before, and the lesson has been consistent: GPs must be involved from the beginning when governments design new models of care. We cannot continue to be consulted after decisions have been made and expect to absorb the consequences.

General practices understand their communities. A rural practice, an outer-suburban clinic and an inner-city service may all need to organise care differently.

Reform should give practices the flexibility to respond to those needs, not force every community into the same centrally designed model.

The recent Assignment of Benefits changes illustrate exactly why GPs must be involved early in health policy design. Efforts to modernise Medicare created unintended consequences, with many elderly and disabled patients likely to struggle with new digital signature requirements, while practices faced uncertainty about Medicare compliance and billing.

The College successfully worked with government to secure practical concessions including a 12-month grace period, continued use of verbal patient consent during the transition, and an educative rather than punitive approach to compliance. This protected patients and practices while longer-term solutions continue to be explored.

But this shouldn’t have needed fixing after the fact. Earlier consultation with practising GPs would have identified these problems before implementation. Every additional layer of regulation that makes general practice harder and more expensive to run ultimately affects patients, not just the clinicians trying to care for them. Modernisation should solve problems, not create new ones.

The fundamentals of GP clinical autonomy, billing autonomy and practice self-determination are not obstacles to a sustainable and efficient health system. They allow innovation to work locally and reflect the responsibilities of highly trained medical professionals. As we modernise Australia’s health system, these principles should be strengthened, not quietly eroded.

The Future Should Be More GP-Led, Not Less

My vision is not to preserve general practice exactly as it is today. It is to preserve what matters while changing what no longer serves patients or the profession.

We should:

• embrace technology that reduces red tape,
• build multidisciplinary teams that expand capacity,
• use data more intelligently,
• fund modern models of care; and
• make it easier for practices to innovate.

Modernisation isn’t about replacing what makes general practice valuable. It’s about giving GPs better tools, better systems and a stronger voice so we can spend more time doing what expert generalists do best: caring skillfully for patients.

Modernisation isn’t something that should happen to general practice. It’s something general practice should lead.

That’s the kind of leadership I believe the RACGP needs. Leadership that delivers reform which strengthens our profession, protects GP-led care and gives every practice the confidence to build for the future.