Tag: Primary Care Reform

  • Hang on a Minute, is General Practice Living a Life of Coercive Control?

    Hang on a Minute, is General Practice Living a Life of Coercive Control?

    I’ve been feeling increasingly uneasy about the layers of policy and regulation being laid over my profession — seemingly every few weeks — as the federal government rolls out its new reality for general practice.

    I find myself inside a funding and regulatory enclosed space. With every announcement, one of the four walls closes further in, until I’m in a tight confine with so little room to move that I cannot use the full extent of my professional capacity without fear of wrongdoing being levelled against me.

    Now I may no longer be able to exercise my billing and clinical autonomy either. The air holes are closing over.

    The walls are closing in

    Measure by measure, how we earn an income has been proscribed:

    • The 2025 bulk billing incentive demands that a practice and all its independent contractor GPs commit to bulk billing 100% of consultations — without exception — to access a 12.5% incentive. And they must display Medicare branding throughout their premises to receive it.
    • Federal MPs and the Health Minister have publicly disparaged practices that haven’t enrolled, encouraging patients and politicians alike to shame those GPs — despite knowing at least 30% would be substantially worse off if they participated.
    • Many practices can no longer charge for procedures because patients — conditioned by government messaging — simply refuse to pay, believing private billing has been abolished.
    • Those wedded to universal bulk billing are now entirely dependent on Medicare indexation for their income. The government has indexed Medicare at 2.6%. Practice expenses will rise with CPI at 4.2%. Wages face mandatory 4.75% indexation.

    Within twelve months of the scheme, general practice is already going backwards by around 2%.

    A rock or a hard place

    And if you think informed consent will be simple — the requirement for a signature from every patient, every service, every time, is throwing the sector into turmoil. Try getting that from an elderly or disabled patient.

    The new funding streams offer a rock or a hard place.

    As published recently in The Medical Republic, only practices that universally bulk bill (Stream 1) or bulk bill under-16s and concession card holders (Stream 2) retain access to WIPs and PIPs. Practices that choose to privately bill lose them entirely.

    For many practices, WIPs and PIPs are the only thing standing between viability and insolvency — including those that do privately bill.

    The message is clear: survive financially by practicing faster, 8- or 10-minute medicine. Then be criticised for only spending 8 or 10 minutes with patients who deserve better.

    The funding reality

    Meanwhile, the funding picture is worse than it looks.

    General practice received 8% of the health budget in 2003. It is 5.5% in 2026.

    Following the bulk billing announcement, the government quietly removed multiple mental health item numbers from general practice — stripping another $90M a year from the sector. That follows fifteen years of successive item number removals: fracture management, four-year-old health checks, asthma and diabetes cycles of care, cervical screening incentives, team care arrangements, joint injections, smoking cessation, nurse items.

    So while the scheme purported to invest $8B in general practice, we have lost the equivalent of 2.5% of the entire health budget over that same period.

    At least half of Australia’s practices haven’t signed on — because to do so would mean certain insolvency.

    An uneven playing field

    Some sectors are favoured. Others are left to flounder.

    Urgent care clinics attract $250–$300 per service from a $1.8B funding pool. The rest of us receive $43 for an item 23.

    Many bulk billing practices are now running at a loss every time they perform a procedure on their own patients.

    The federal government is spending $4–5M on greenfield bulk billing clinics in direct competition with existing mum-and-dad practices — an implicit acknowledgement that bulk billing is only financially viable with significant subsidy, while the existing private clinics are left unable to compete with a “free” service.

    Regulation without consistency

    And the regulatory burden?

    Asymmetric.

    General practice rises to accreditation, billing compliance, prescribing compliance, antimicrobial stewardship, and safe medicines obligations.

    Meanwhile, the Pharmacy Board is commissioning a review that could enable pharmacists to independently store, prescribe, profit from, and sell all medications — including drugs of addiction — in complete isolation from any other clinician.

    It is an offence under law for a doctor to profit from the prescription of medicines. Apparently, that concern does not extend universally.

    When we call this out, we are dismissed as greedy and turf-warring. We are told our work is simple enough that anyone can do it.

    Looking for an air hole

    I am trying to find a way to push one of these walls back. To poke a much-needed air hole in this shrinking space.

    That may well come from our patients — who I hope still bear witness to the value of expert general practice, even as that value seems to be slipping from the consciousness of the people making decisions about our future.

  • Lessons Australia Should Learn from the NHS to Protect GP-led Care

    Lessons Australia Should Learn from the NHS to Protect GP-led Care

    The National Health Service (NHS) remains one of the most recognised healthcare systems in the world. Yet many doctors and patients who have experienced it firsthand describe a system under immense strain.

    In this article, Dr Anita Muñoz examines the lessons Australia should learn from the NHS experience and why recent policy directions raise important questions about the future of GP-led care.

    “We have one of the best healthcare systems in the world. Any change must be certain to improve outcomes, not squander what we already have.”

    Why Australia should think carefully before importing a failing healthcare policy

    Many Australians working in healthcare know a doctor or patient who has come to Australia after experiencing the realities of the NHS.

    According to Lord Darzi’s independent review of the NHS, the system has faced significant underinvestment over many years, with growing workforce pressures and declining patient satisfaction. It also noted that general practice is increasingly expected to manage more complex care without corresponding increases in resources, infrastructure or authority.

    The report’s findings may sound familiar to Australian GPs:

    “GPs are expected to manage and coordinate increasingly complex care, but do not have the resources, infrastructure and authority that this requires.”

    As policymakers consider future reforms, Australians should be asking a simple question:

    Are we beginning to adopt elements of a system that many countries are now struggling to sustain?

    Australia should learn from international experience—not import policies that have contributed to workforce shortages, declining continuity of care and growing bureaucracy.

    What has driven the NHS crisis?

    While the NHS has many strengths, several structural issues have created significant challenges for both doctors and patients.

    1. Access has been prioritised over continuity

    The NHS increasingly measures success by how quickly patients can access care, rather than whether they can see their own doctor.

    Many patients are allocated to whichever clinician is available. Telephone consultations dominate. Patients are often restricted to discussing a single issue per consultation and may never see the same clinician twice.

    The result is reduced continuity of care and fewer opportunities for doctors to build long-term therapeutic relationships with patients.

    International evidence consistently demonstrates that continuity of care improves patient outcomes, reduces hospitalisations and increases patient satisfaction. Yet continuity becomes difficult to maintain when healthcare systems prioritise speed of access above all else.

    2. Funding has shifted away from General Practice

    While patient complexity continues to increase, funding growth for general practice has not always kept pace.

    At the same time, targeted funding programs have encouraged the employment of non-GP clinicians such as pharmacists, nurses and physician associates.

    This has created a paradox where experienced GPs can struggle to find work despite ongoing workforce shortages. In the UK, concerns have emerged about declining GP numbers, rising patient-to-doctor ratios and growing pressure on remaining clinicians.

    Between 2009 and 2014 alone, more than 12,000 GPs left UK practice, with a significant proportion under the age of 50. More recently, reports have highlighted growing difficulties retaining experienced GPs within the NHS workforce.

    The reality remains unchanged: a GP’s expertise comes from years of medical training, supervised practice and clinical experience.

    3. Bureaucracy has expanded

    As systems become strained, administration tends to grow.

    Referral pathways, approval processes and reporting requirements have become increasingly complex, creating delays for patients and significant administrative burdens for clinicians.

    Time spent navigating systems is time that cannot be spent caring for patients.

    Poor interoperability between systems, increasing compliance requirements and growing administrative expectations have all contributed to clinician frustration and reduced efficiency.

    UK GP-to-patient ratios have continued to rise, with reports citing more than 2,200 patients per GP in some areas, contributing to increasing pressure on continuity of care and appointment availability.

    4. Workforce morale has declined

    A healthcare system cannot thrive if the clinicians delivering care are exhausted, unsupported or choosing to leave the profession.

    Recent UK workforce data paints a concerning picture. Surveys have found that only 4% of GPs report being satisfied or extremely satisfied with their work, while 54% report low or very low morale. Around 40% indicate an intention to leave the NHS altogether, and many report concerns that current workloads may compromise patient safety.

    When experienced clinicians leave the workforce, patients ultimately bear the consequences.

    5. Patient satisfaction has fallen

    Patient satisfaction with the NHS has fallen dramatically over the past decade, dropping from approximately 70% to 21% in national surveys.  For patients, the issue is not simply how quickly they can access care. It is whether they can access the right care, from the right clinician, at the right time.

    Many patients report frustration with fragmented care pathways, reduced continuity and difficulty navigating increasingly complex systems.

    Is the NHS entirely negative?

    No. There are aspects of the NHS that deserve recognition.

    • GP training standards remain high.
    • Some mental health services are more accessible than in Australia.
    • Contraception is widely available.
    • Care remains free at the point of delivery.

    However, the experience of underfunding, workforce attrition, rising demand and growing bureaucracy raises legitimate questions about whether the model remains sustainable in its current form.

    Healthcare systems should not be judged solely on their intentions. They must also be judged on their ability to deliver accessible, high-quality and sustainable care.

    Four warning signs for Australian General Practice

    Taken individually, each policy may appear reasonable. Taken together, they suggest a broader shift in how governments view and fund primary care.

    1. Bulk-Billing incentives and government control

    Recent bulk-billing policies link significant practice incentive payments to conditions around clinic billing behaviour.

    This increases financial dependence on government policy settings and reduces the autonomy traditionally associated with privately operated general practices.

    2. Growing interest in capitated funding

    The Federal Government continues to explore capitated funding models for complex patients.

    Capitated funding involves practices receiving a fixed payment per patient rather than payment for each service delivered.

    While blended funding models can work internationally, their success depends heavily on adequate funding and manageable administrative requirements. Australia’s Healthcare Homes experience highlighted the risks of getting this balance wrong.

    3. Government competition with General Practice

    Urgent Care Clinics receive substantial public investment while many community practices continue to operate under financial pressure.

    This creates concerns about governments competing directly with the sector they rely upon to provide most community-based healthcare.

    Strong hospitals are important. Strong general practice is essential.

    The most effective healthcare systems recognise that both must work together.

    4. Expanding non-GP Models of Care

    Recent reforms increasingly emphasise access to healthcare through multiple provider types rather than access to a GP specifically.

    While multidisciplinary care has an important role, concerns remain about patient safety, clinical governance and fragmentation when services operate outside established GP-led models.

    The question is not whether multidisciplinary care should exist. It is how it can best support patients while maintaining continuity, accountability and quality.

    NHS Lessons for Australia

    Australia does not need to copy the NHS, nor should we pretend our current system is perfect.

    General practice requires reform, modern funding arrangements and stronger support for managing chronic and complex illness in the community. What it does not need is the gradual erosion of the very features that make it effective.

    International evidence consistently shows that strong primary care systems produce better outcomes, lower costs and healthier populations.

    The challenge is ensuring reforms strengthen GP-led care rather than undermine it.

    As policymakers consider future changes, we should be asking a simple question:

    Will this improve patient outcomes, continuity of care and the sustainability of general practice?

    If the answer is unclear, caution is warranted.

    Healthcare systems evolve gradually. The challenge for Australia is ensuring that each reform strengthens the relationship between patients and their GP rather than weakening it. Once continuity, trust and clinical autonomy are lost, they can be difficult to restore.

    Australia has one of the strongest healthcare systems in the world. Any reform should build upon those strengths—not risk repeating mistakes already visible elsewhere.

    Dr Anita Muñoz is a Victorian GP, healthcare leader and advocate for high-quality GP-led care. She has held numerous leadership and governance roles across Australian general practice and healthcare.

  • Independent Pharmacy Prescribing is not about a turf war – the phrase that shuts down the conversation

    Independent Pharmacy Prescribing is not about a turf war – the phrase that shuts down the conversation

    Every time concerns are raised about independent pharmacy prescribing, the response is often immediate “This is just a turf war.”

    It is a clever line because once concerns are dismissed as professional protectionism, there is little need to engage with the substance of the argument.

    But the real issue is not professional territory. It’s patient safety.

    Why prescribing and dispensing were separated in the first place

    One of the fundamental safeguards in healthcare is that prescribing and dispensing medicines are typically separated. Doctors prescribe. Pharmacists dispense. That separation exists for a reason. It provides an additional layer of scrutiny that helps identify errors, interactions and potential risks before harm occurs.

    As a GP, I value that relationship enormously. This is why I believe the current debate about independent pharmacy prescribing deserves more careful consideration than simply being labelled a turf war.

    This is not about whether pharmacists are valuable

    Pharmacists are highly skilled healthcare professionals and play a critical role in Australia’s healthcare system. GPs do not want pharmacies to disappear, in fact, the opposite is true.

    The current model works because each profession contributes different expertise and acts as a safeguard for the other. The concern is not pharmacists but rather system design.

    Access matters, but patient safety matters too

    One of the arguments used to justify pharmacy prescribing is that patients struggle to access a GP. Yet available data suggests that approximately 99% of Australians can access a GP when they need one.

    The debate therefore shouldn’t simply be about access. It should be about what type of care patients receive once they access the system.

    Healthcare is not a retail transaction. A patient presenting with symptoms may have an underlying condition that requires investigation, diagnosis, follow-up and continuity of care.

    Treating symptoms and diagnosing illness are not always the same thing.

    The conflict of interest question

    For decades, Australian healthcare regulation has recognised the importance of separating prescribing from financial gain.

    The Medical Board of Australia, AHPRA and Medicines Australia all have provisions designed to minimise conflicts of interest and ensure prescribing decisions are driven by clinical need rather than commercial considerations.

    These principles exist for a reason. Patients deserve confidence that treatment recommendations are based solely on what is best for their health.

    Have we forgotten the lessons of codeine?

    In 2018, the Therapeutic Goods Administration up-scheduled low-dose codeine because of concerns about misuse, dependence and patient harm. The result was a 50% reduction in codeine supply.

    That decision reflected an important principle: When evidence demonstrates a risk to patient safety, governments are willing to restrict access.

    The question today is whether the same principle is being applied consistently.

    The politics cannot be ignored

    The Pharmacy Guild has openly articulated a vision where pharmacists administer, prescribe, supply and review medicines within their own scope of practice. At the same time, the Guild reportedly contributed approximately $600,000 in political donations last year.

    Australians are entitled to ask questions about how major health policy decisions are made and whose interests are being prioritised.

    The question we should really be asking

    This debate shouldn’t be reduced to a contest between professions, and it shouldn’t be about turf or convenience alone.

    It should be about whether proposed reforms improve patient outcomes while maintaining the safeguards that Australians expect from their healthcare system.

    Convenience and access matter – but safety matters too.

    When legitimate questions about patient safety are dismissed as a “turf war”, we risk having the wrong conversation entirely.