To the Editor: The recent issue on general practice (7 July 2003) contained many statements that were inaccurate and unfair to a profession that has existed before most specialties and will exist beyond their passing. It is unfortunate that the issue represents an opportunity missed.

Notwithstanding the funding issues, general practice is not “in crisis”, as many of your authors would attest.1 It is vibrant and leading the way in healthcare reform in this country, and much of its loss of appeal to new doctors has to do with the attitudes of many of the authors, who talk it down rather than up.

The quoted comment from Donald Berwick — “we are carrying the nineteenth-century clinical office into the twenty-first-century world”2 — is surely the most inaccurate statement. Modern general practices bear no relationship to even their mid-20th-century counterparts, whereas the average specialist office still looks the same and functions in a similar way. General practice is over 80% computerised,3 unlike the practices of our specialist colleagues. General practice has been responding to the challenges of a community-centred approach, while specialists still respond to a disease-centred model. Indeed, many members of the profession correctly talk about research as a means of raising the profile of general practice — in this regard, the specialties have been hiding behind the power and influence of research institutes.

Until funding bodies such as the National Health and Medical Research Council give general practice research priority over such esoteric areas as “Major porcine antigens for the generation and modulation of immune responses to neovascularised pig tissue xenografts” ($480,000)4 in allocating research grants, things will not change.

Further, many of your articles still reflect a degree of discomfort with general practice as a distinct discipline — reflected in the confusion over “general practice” versus “primary care”. These are two separate areas, and, while general practice is well defined, primary care is not.

Several authors5,6 in the recent general practice issue speak of Divisions of General Practice and of the opportunities for collaborative research therein. Unfortunately, academia has failed to engage with Divisions. Although the Board of the Royal Australian College of General Practitioners has several professors, the Board of the Australian Divisions of General Practice sports a couple of part-time senior lecturers. Divisions report that academics often have a paternalistic attitude towards general practice, without understanding the true potential of partnerships with GPs.

General practice remains the most important, popular, and utilised part of the healthcare system, both in Australia and overseas. It is embracing change and responding to demands, often in innovative ways. We should be celebrating its achievements, rather than talking about imagined “crises”.

In reply: I would be heartened to believe that all is well in Australian general practice, that it is indeed “vibrant and leading the way in healthcare reform in this country”. But the reality appears to be otherwise. Surveys attest that doctors are unhappy, and Australian general practitioners have not escaped the mood of discontent and disillusionment.1,2

That more than 80% of our general practices are computerised is laudable. But is this technology being used in a patient-centred way? Are visits coordinated so that waiting times are minimal and queues a thing of the past? Do practices use their computers in a way that efficiently integrates office processes, patient care, patient records, prescribing, pathology, referrals and health outcomes over time? In short, is this technology being used as a vibrant tool for practice efficiency and quality patient care? It appears that there is still some way to go, as a recent survey of GPs revealed that less than 50% use their computers for prescribing and less than 30% for managing appointments and clinical records.3

Whether specialists hide behind the façades of research institutes is uncertain. But what is certain is that research output in the field of general practice in Australia lags far behind that of medicine, surgery or public health.4 Furthermore, the National Health and Medical Research Council awards research grants on merit, not on a subjective assessment of what each sector “deserves”.

I am disturbed to learn that all is not well between some Divisions of General Practice and general-practice academia. A recent review of the Divisions’ role5 makes no mention of this divide, but submissions to the review did outline the need for stronger relationships between Divisions and academia. It takes two to tango and the solution lies with both parties.

Finally, I am encouraged that, despite the alleged “crisis” theme of the Journal’s recent issue on general practice, there are those who believe that “general practice remains the most important, popular and utilised part of the healthcare system”. However, on the issue of whether there is a “crisis”, participants in the recent Australian Health Care Summit would beg to differ: the general opinion was that not only is general practice “in crisis”, but so too is the whole healthcare system.6