Australians need healthcare that is both accessible and high quality

Last week, as I waited at a local pharmacy, I found myself watching the mix of people streaming out of the in-pharmacy discount GP clinic. They were poor. Agitated. Unwell looking. Chaotic, undernourished kids. Frazzled parents. One was hearing voices. Two didn’t appear to speak any English. Most appeared to have prescriptions in hand.

They were in and out of there within a few minutes.

We need to find ways of making quality healthcare more accessible to those who need it most.

We need to find ways of making quality healthcare more accessible to those who need it most.

I felt a bit sad watching this stream. They were the cohort of my community’s most vulnerable people. They were seeking accessible care, and here it was: a bulk-billing clinic at the back of a large pharmacy, providing quick, curt consultations. So many missed opportunities to provide support, engagement and care to the people who needed it most. I also felt sad for the GPs who were working in this way.

Australia has an enviable healthcare system. For those who need emergency care, for the most part, Australia provides it. But, Australia, we need to lift our game in general practice. We need to find ways of making quality healthcare more accessible to those who need it most. For the mother wanting to discuss escaping domestic violence. For the teenager who needs to talk about their suicidal thoughts. For the baby who isn’t gaining enough weight. For the young man who wants to clean up his drug-habit as he seeks care for his PTSD. For the new refugee who doesn’t understand the scary media stories about COVID-19 vaccination.

In the past few years, I’ve watched, aghast, as general practice becomes increasingly corporatised. Where there were GPs salaried and supported in community health organisations for poorer and low-literacy communities, there are now fewer and fewer. There is no longer any extra comprehensive funding for general practice in areas of need. Income is dependent on Medicare billings, and so community health clinicians are urged by their managers to see more patients, more quickly. Because otherwise, these services are unviable business entities. I know, because last year, I tried to run one such service in the heart of Broadmeadows. And I burnt out: clinically, and politically. There is so much work to do.

Medicare rebates have remained stagnant, forcing many good clinics to add gap payments to cover the cost of running the business. This may not be a big deal for mainstream middle-classes. But it is a massive barrier to care for those who can’t afford their rent, let alone a non-emergency GP appointment. And so we see health and wellbeing slide further among poorer people.

Medicare rebates have remained stagnant.

Medicare rebates have remained stagnant.Credit:Marina Neil

The sad reality is that many excellent GPs are leaving bulk-billing and community health organisations. The system relies on altruistic (and international medical graduate) GPs to work with communities of need. Failing to invest in poor and diverse communities – and in preventative care and complex care – is a serious oversight of government. Yet again, during COVID-19, we see GPs asked to convey complex messages about public health, to our patients. Yet again, we see GPs asked to do this work quickly, and without additional support for those working with Australia’s most needy. Many of us feel overloaded and overburdened if we attempt to do this work.

Anyone who has had a health crisis knows what an asset a caring, knowledgeable ‘family doctor’ is. Someone to talk through complex health decisions. Someone who has the time to call an interpreter. Someone who helps you navigate specialist care. Someone who has the ability to opportunistically raise questions of health and self-care when you pop in for ‘just a script’. Someone who recognises that you’re anxious and struggling. Someone who recognises that you’re sick and need help.

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