To the Editor: A fundamental shift in the nature of general practice work and workplaces has occurred over the past decade and is gathering pace. Increasingly, general practitioners are performing, and being asked and funded to perform, more managerial and coordinating services, rather than merely providing clinical services. We are being placed into teams where practice nurses, mental health nurses, allied health providers and even students are contributing to the provision of services.

What has led us to this change? A review of general practice reforms between 1989 and 2009 noted a decline in the autonomy of general practice and an increase in “processes initiated and managed by government with involvement of a broad range of medical and other groups”.1 The National Primary Health Care Strategy, first released in 2008, reflected some of these changes. It included incentives for GPs to practise quality preventive health care, and had an increased focus on multidisciplinary care from primary care teams.

At the coalface, the financial implications of these initiatives have led to a change in workplace structure, with shifts from solo to group practice, from small group to larger group practice, and even to Super Clinics (a component of the National Primary Health Care Strategy) where team coordination is more feasible and practical. The administrative and information technology requirements of these new initiatives have made it increasingly difficult for smaller and more “traditional” individual practices to survive. The larger financial investment involved has led to an increased vulnerability to medical corporatisation and a steady decline in independent practices, especially those servicing populations with a non-English-speaking background.

Also, a generation gap in general practice is emerging from this consolidation process, with older GPs — who were nurtured on the concept of general practice being limited to looking after your patients yourself and occasionally getting specialist advice and input — having trouble coming to terms with this shift. In contrast, registrars, junior doctors and even medical students are well used to the concept of team and coordinated care arrangements.

So is this a good thing? Certainly, the increasing number of patients suffering from chronic disease will benefit from a broader based and more coordinated management approach. Also, financial rewards for managing complex conditions in a comprehensive and holistic fashion should be encouraged. However, there are dangers. The resulting increase in bureaucracy has already become evident and continues to alienate GPs. Small, independent practices are a dying breed, and the loss of much-needed experienced GPs, or at least the alienation of them from their communities, is something the nation’s health will lament.