How technology and lifestyle is changing General Practice

Many GPs are old enough to remember a time when, not only were there no desk computers, but a time when a role for them was not even envisaged.

Now we can’t do much without a computer!

Thirty years ago, GP care was largely episodic. People came to the doctor when ill and then went away again. We have certainly embraced chronic disease management – as the next development phase – but we have not yet made the leap to population health. Computers, however, have made this at least possible.

You may have heard of the new QI (or quality improvement) initiative. This involves payment to General Practices for sharing aggregated de-identified data with PHNs (Public Health Networks). It is entirely likely that this is the thin end of a very big wedge.

Using big data to understand population health outcomes and, importantly for General Practice, reward improvements in this area will be an increasing trend.

This leads to the next prediction.

We talk a lot in this country about GP remuneration, and as we all know, fee-for-service is the dominant funding mechanism in this country.

But there is increasing disquiet about this.

It probably serves us well for episodic care but is it the best way to fund chronic disease management? Increasingly, people are starting to say no. As you will know, we have toyed with block funding as an alternative. But the trials related to this have not to date produced new models of care. We often still see chronic disease dealt with in an episodic way. Once this barrier is overcome via sharper insight, we will see increases in block funding and new models of care. These will likely involve more telemedicine and, perhaps, a greater role for nurses.

PHIs (private health insurers) will increasingly agitate to fund quality General Practice and this demand will eventually become unpreventable.

General Practice will not be immune to various types of disruption.

The greatest of these will be patient demand for information. Especially information about themselves. We all know about the myhealthrecord. This comprises the tip of the iceberg.

Eventually, patients will access the file on their home practice database in real-time and, if being treated under a block funding model, will expect to interact with the practice electronically. They will make telemedicine appointments online and pay with a stored credit card. When actually attending the practice, they will arrive themselves on the patient app and pay with a stored card when leaving (much like Uber does now).

And, of course; their receipt will be emailed. What about an instant rating for the service? We can’t rule it out.

This development has been referred to previously. But let’s emphasise the point.

Patients will expect to receive communications from the practice electronically and, equally importantly, expect this communication to be two-way. They will want to view periodic tests (e.g. HbA1C) as soon as they are available, annotated with a comment from the doctor or nurse.

If they want some extra specific dietary advice, they will expect to relay this order to the practice and have a scheduled telemedicine conference with the dietician at a convenient time.

This level of interaction will result in patients becoming increasingly “enmeshed” with their home practice, resulting in fewer transfers between practices.

This is already a well-established trend. And, with increasingly complex knowledge and increase in the domain of General Practice, it is a trend we will see continue.

But the real change will likely be in the nature of group practice. Patients will no longer identify as the exclusive patient of Dr X. Patients will engage with the practice as a whole. And the practice may have doctors with a special interest in skin, women’s health, aged care, sports medicine etc. It will likely be the case that one doctor will oversee all care for particular patients. But they won’t manage everything.

There is an increasing trend of GPs working part-time in clinical practice – both male and female.

While some choose this to have a better work-life balance, we now even see GPs working part-time in General Practice and part-time doing something else. This might be working sessions in A&E, working for a PHN, working as a medical advisor for software companies etc. The list is endless.

This allies with special interest General Practice. Some of those special interests will be outside clinical medicine. Even now, finding a GP who works full time in General Practice is probably the exception rather than the rule.

Despite common perceptions, corporate ownership is by no means the dominant ownership model in Australian General Practice. But with the increasingly demanding endeavour of practice management due to the factors outlined above, we will see it become so.

And due to superior resourcing and management, we will see it become the voice of General Practice.