In classical Fabian tradition, the federal Labor government has embarked on a series of reforms that will have an impact on the welfare of “Australian working families”. The rationale for the health reforms1 has been exhaustively detailed in the reports of the National Health and Hospitals Reform Commission2 and the taskforces on the National Preventative Health Strategy3 and National Primary Health Care Strategy.4

A significant and unifying theme in all these blueprints for health reform is the centrality and crucial involvement of general practice in achieving change. Indeed, these reforms would come to nothing without the willing acceptance and widespread cooperation of general practitioners.

In this special General Practice issue of the Journal, Kidd summarises the reform schedules for general practice (page 71).5 However, there is mounting evidence that GPs are already experiencing difficulties meeting the constant and ever-changing demands placed on their practices, as illustrated on the cover of this issue. To impose yet another structural reform agenda in an already chaotic environment will be a monumental challenge.

Generally speaking, reform is more readily acceptable if it:

• lessens rather than increases the workload;

• improves the efficiency and effectiveness of tasks;

• increases the quality and safety of services; and

• provides tangible incentives for participants.

Without a doubt, a major source of frustration and consternation with the federal government’s reform agenda is the very clear sense that it is essentially a top-down approach, rather than a bottom-up consultative process.

In fact, if there were to be a national poll of GPs ranking current health reform initiatives, “e-health” — the use of digital data transmitted, stored and retrieved electronically in support of health care6 — would definitely emerge as a major priority. Such information technology infrastructure is crucial to all health care communication in the 21st century but, to date, all we have achieved in Australia has been to indulge in expensive and time-consuming chatter. We have been talking the talk but not walking the walk!

It must be acknowledged that e-health has been on the federal government’s agenda for more than a decade. In 2000–01, the then Health Minister, Michael Wooldridge, announced the planned development of HealthConnect — a national system of e-health records that could be shared over secure networks with strict privacy and consent controls.7,8 The system was trialled in pilot studies across the country and, in March 2004, the government allocated $128 million for national implementation.8 But then, in 2005, Health Minister Tony Abbott (now leader of the federal Opposition) pulled the plug on HealthConnect.7

Around the same time, the federal, state and territory governments established the National E-Health Transition Authority (NEHTA), with a clear purpose:

• to lead the uptake of e-health systems of national significance; and

• to coordinate the progression and accelerate the adoption of e-health by delivering urgently needed integration infrastructure and standards for health information.9

Since its inception in July 2005, NEHTA has been spending just under $164 000 a day.7 It is yet to deliver any e-health outcomes beyond a 2009–2012 strategic plan and the development of a national health care identifier system that was recently ratified by the Australian Government.10

In May this year, the federal government allocated NEHTA a further $466.7 million over 2 years, ostensibly to fund development of core national standards and tools that can provide all Australians with access to a personally controlled electronic health record from 2012–13. The federal government will thus spend $639 315 each day on the implementation of personally controlled electronic health records.7 Despite this, vigorous debate is ongoing as to who will actually control the records! Confusion reigns.

It must be remembered that the realisation of e-health infrastructure in Australia is underpinned by taxpayers. Whether it will ever produce a functional electronic communication and record system, which actually improves health care delivery, is the million-dollar question.