A quiet revolution has been taking place, driven by both ideology and pragmatism. Its aim is to dismantle general practice and eviscerate the ranks of its medical practitioners. The signals are loud and clear.
In 2008, Nicola Roxon delivered the annual Ben Chifley Memorial “Light on the Hill” address to the Labor Party faithful, in which she outlined her vision for the public health sector, proposing that health care services be delivered by new players in ubiquitous teams. Unfortunately, there was little clear delineation of the respective roles of the members of these teams, which appeared to be amorphous and overlapping. Such a proposal inevitably begs two questions: will the services offered be safe, and will they be cost-effective?
However, Roxon’s address has given the green light to setting in motion a series of actions that will effectively dismember general practice as we now know it.
Understandably, this proposal has received strong support from nursing associations, and, almost 1 year on, nurse practitioners are to be granted access to the Medicare Benefits Schedule and a restricted Pharmaceutical Benefits Scheme, as well as the capacity to order investigations and refer patients. Also of significance is the Australian Capital Territory “trial” of nurse-only clinics.
Following on the heels of this quiet revolution are calls for the term “general practice” to be buried and replaced with “primary care”. And, interestingly, there is a push for another change — namely, that all practitioners working in primary care, irrespective of their qualifications and expertise, be now called “doctor”. Such a collaborative model readily brings to mind the sovietisation of health care.
Whatever the motivations for this change, its perpetrators can claim “mission accomplished!” Powerful political forces will take care of the general practitioner. Sadly, concerted political manoeuvring by those with the ear of the Minister has exposed the disorganisation and naivety of some in organised medicine. Their response conjures up images of lemmings rushing towards oblivion.
The Medical Journal of AustraliaMartin B Van Der Weyden, Editor.
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