Public or private, Australians just want to see a GP when they’re sick

Nearly one-third of medical graduates are now training to become GPs.

This is a good thing.

One of the ways to tackle our rising levels of chronic disease is more investment in good primary care.

But simply producing more doctors won’t solve problems, especially with rural healthcare.

For example, in Cloncurry, Queensland, doctors are salaried by Queensland Health but also work from a community general practice. Medicare revenue flows back to Queensland Health. The local council helps with accommodation.

Or in Clermont, after the town lost its permanent GP, the Royal Flying Doctor Service has stepped in, using the same fly-in doctors on a regular rotation to preserve some continuity of care.

These are sensible solutions…but they’re also workarounds.

Australia’s usual model of general practice relies heavily on private businesses earning revenue for each service they provide. That can work reasonably well where there are lots of patients and doctors (i.e. cities). It works less reliably in a town of a few thousand people, where maintaining a viable practice can depend on rents, accommodation, hospital arrangements and whether somebody can cobble together funding from three levels of government.

The result is what the RACGP calls ‘patchy’ coverage.

Around seven million Australians live outside major cities. Australia Institute research shows that rural areas have far lower Medicare expenditure per capita than metropolitan regions:

The outcomes – premature death and avoidable hospitalisations – are, frankly, appalling.

Perhaps the lesson from Cloncurry is that we should stop thinking that the market is a solution. In places where the invisible hand struggles to sustain healthcare, governments can commission it directly: salaried clinicians, multidisciplinary teams, shared infrastructure and integration between hospitals and primary care.

Most Australians don’t care about the business model. They just want to be able to see a doctor when they need to.