Recent attempts by several corporate entities to secure more of Australia's primary medical care profits have so far been unsuccessful, but it is probably not the last we will hear from them. The 2020 scenario,* far fetched though it may seem, depicts general practice succumbing to the dollar lures of the Corporates. It is a primary healthcare model characterised by heavy regulation, structural division, detachment and constant change. An interventionist government bureaucracy and a ruthless commercial administration have effectively removed all autonomy and personalised attention from the individual's practice. Adherence to strict administrative protocols protects the commercial interests of the company, and both take priority over providing quality primary care.

"Practice management" has become "policy management", and the general practitioner's needs are second to those of business managers who have become slaves to legislative conformity. GPs no longer have support staff to help them provide quality care; rather, the tables have turned and the doctors assist the administration in toeing the company line. As a result, Dr Zen has been forced to compromise on almost every value and ethic crucial to best care.

Today, the profession is witnessing unprecedented bureaucratic proliferation. Multiple regulatory bodies, including federal and state governments, make demands of increasing quantity and complexity. The cost of practice administration, insurance and government regulatory compliance is escalating at an alarming rate.1 The financial pressure presently being brought to bear on general practice may ultimately precipitate the collapse of bulk billing and "universally accessible healthcare for all Australians".

To prop up a dying primary healthcare system, the federal government may continue to add legislative "patches" that succeed only in transforming a once simple primary healthcare model into one that will ultimately be too complex and financially unsustainable for the medical profession.2 At that point, frustrated, overworked and underpaid doctors, no longer able to cope with the administrative convolution and burdensome regulatory demands being forced upon them, will finally abandon their practices in search of an easier way. The attraction of the Corporates lies partly in the promise of inexpensive, efficient, centralised administration.3 Yet, as a profession, we should recognise that a corporation's loyalty necessarily lies with its shareholders and that there are inherent dangers in "selling our souls" to these groups.

Dr Zen's passing self reminder to raise the issue of quality care again at the next managers' meeting is illustrative of the gap that has opened up between our future practitioners and administrators. An increased administrative complexity demands attention from managers and diverts valuable human resources away from the patient's comfort, confidentiality and care, and from work relationships.

A centralised administration is, by its very nature, one that operates remotely and, in this case, one that uses technology to monitor and control the performance of its human resources. The digital revolution will continue to influence virtually every aspect of our professional lives, but only time will tell if that influence will be for the betterment of general practice. Given the sheer volume of information in which we presently trade, it is inevitable that clinical records will ultimately pass between practitioners exclusively in a digital format. In the nightmare scenario, patient records have become an "online resource", with potential compromise of privacy. Therefore, as we develop systems in which confidential information is exchanged, "secure" communication channels must be among the highest priorities for software developers, the profession and law makers.

At Corporation Enterprise, technology primarily serves the administration by monitoring the activities of practitioners inside the consulting room. Time has become the single most valuable commodity. Quality care comes a distant second to the commercial interests of the firm.

Can we imagine a better future?

The Federal Government and general practice representatives emerged from their latest series of goodwill talks on regulatory reform today to confirm that the future of independent private practice was guaranteed. The restructuring of general practice under the "Red Tape" reform package has seen the elimination of inefficiency over the last three years by removing administrative complexity in general practice structures and payment systems. Outmoded bureaucratic systems were scrapped virtually overnight, and new payments systems, linked to better patient outcomes, were introduced. Dr I M Spock, National President of the AMA, said that "simplified administrative systems combined with a better use of technology" meant that the costs associated with practice would be halved by 2022 and that "the funding crisis could be averted after all". It looks like government-funded universal healthcare is back, and community groups around the country have applauded the initiative. A union representative from the Australian Medical Borg, an army of half-human, half-microprocessor humanoids, said today that "assimilation into this new system is inevitable and resistance is futile".