Comparing general practice in Australia and in England: an Australian perspective and the RCGP International and Overseas Network

What might the UK learn from Australia?

Patients and practitioners in Australia are aware, and are reminded every day, of the cost of each healthcare interaction: practitioners are required to bill the patient via Medicare,¹⁶ our national health system, for each service provided to a patient. Each consultation attracts a fee, and Medicare reimburses patients a fixed dollar amount for GP consultations. Patients are used to paying for many aspects of health care and there are no completely free prescriptions for any resident, regardless of age, but an annual safety net guarantees a maximum amount each year each Australian will pay before the state steps in to shoulder the burden. A safety net also exists for our Australian Aboriginal and Torres Strait Islander patients. The net impact, for me, feels like a more open and transparent discussion about money, and the cost of doing business in health care in Australia. This contrasts with what often feels like the perennial pressure to conjure yet another efficiency rabbit out of the shrinking NHS budget hat. Patients in Australia can arguably exercise more agency in exploring their public and private healthcare options, and innovators seem to be more able to test out new approaches thanks to direct funding by satisfied consumers, rather than wading through the interminable NHS procurement process which will inevitably favour larger incumbents rather than promising new start-ups. GPs also have the flexibility to request additional patient co-payments for their services, and patients are free to shop around for services from other providers. This can mean, for example, charging a premium for peak-hour evening and weekend services, while requiring no additional payment for less popular daytime services. The net result is a healthcare conversation about money which — in the urban, affluent environment in which I practice in Australia — feels refreshing and empowering to patients, compared to our culture of ‘free health care is a right that I am owed’ in the UK. However, this is not the case, I understand, for GPs who work with indigenous communities and disadvantaged populations, where service and prescription fees certainly do act as a significant barrier to healthcare equity.¹⁷

What would I suggest to my GP colleagues in Australia?

Australia ducked the burning platform of the GFC, but risks being slowly boiled by the economic pressures faced by all other OECD (Organisation for Economic Co-operation and Development) healthcare systems.¹⁸ As individual GPs, and as members of larger state and national organisations, we need to anticipate this future, and embrace opportunities now to trial and test promising disruptive digital technologies and novel teamworking practices that maximise rather than retrench skill-mix.

What would I suggest to GP colleagues in the UK?

Make healthcare costs more evident and obvious to the British public. A bill for each GP consultation, for each medicine based on its actual cost, for each allied health professional attendance, for each hospital stay with a subsequent line item demonstrating the 100% NHS rebate. Explore the possibility of opening up patient choice, to allow co-payment for non-standard GP services; practice-based dermatology or fee-paying telephone consultations at the weekend with a named GP partner, for example. This might encourage a shift in attitudes towards the place of money and costs in health care, and our patients may arguably become, in transactional¹⁹ terms, more empowered and equal partners rather than dependent recipients. The potential value of these ideas would have been lost to me, and may well have seemed disturbing, when all I knew was life as a GP in the NHS.

Australia and UK have the second and the first rankings, respectively, in a review of healthcare systems¹⁷ conducted by the Commonwealth Fund. This report highlighted strengths and areas for improvement that each healthcare system could learn from others. Indeed, it is likely that each healthcare system around the world has something to teach and something to learn. Flying visits by the great and the good are one thing, but true organisational learning is probably most helped by immersion.²⁰ The RCGP, the Royal Australian College of General Practitioners, and their sister colleges around the world could best help their members by examining ways to streamline mutual recognition, and to lobby to facilitate the easy movement of GPs between countries to allow for sabbaticals and exchanges: we, as practitioners, will gain from the rich contrast in experience; our practices will gain from new and complementary skillsets; our profession will gain from a reimagining of what and how health care can function; and the sum total of this activity could help to invigorate standards and experiences of quality health care for our patients.