Clara Tuck Meng Soo | The closure of Hobart Place begs the question, what is happening to general practice?

We discussed his recent blood test results. We then had a long discussion about whether he should go on medication to prevent a chronic condition and the answer was not obvious, but after a long discussion we agreed to give the medication a go.

This man has two children with disabilities and one of them had recently been in hospital. He wanted to talk about what had happened at the emergency department and what the Sydney specialist had advised him. I then gave him a pathology form to check his son's bloods again next week. His son has multiple co-morbidities and I felt the time was right to have that difficult talk with this man about his son's limited life expectancy, and advise him and his wife to be realistic about his chances.

By now, the 15-minute appointment had become a 45-minute consultation and I was looking anxiously at the number of people waiting to be seen in my electronic timetable. He then said he wanted another letter from me for NDIS for his son. As he would have to wait another three weeks to get another appointment with me, I decided to let myself run a little later and write him the letter. I then bulk-billed this man.

I don't think I'm unique amongst GPs. Many of us, faced with such a family, would do exactly what I've done. But what the erosion in the Medicare rebate for doctors means is it is getting harder and harder for us to do this kind of work.

We used to bulk-bill everyone who had a concession card and economic reality forced us to give that up a few years ago. But obviously, even with a more stringent attitude to bulk-billing, we are still not tough enough on access to bulk-billing for our patients and so Hobart Place General Practice has to close its doors.

Some people will still get access to good general practice, the kind that takes time and is very rewarding for patient and doctor. The people who won't get access to good general practice will be some of the ones who need it the most. What is driving disease patterns in Australia is chronic illness and often there are socioeconomic factors as to why chronic illness affects one person more severely than another.

READ MORE:

Governments all around Australia are grappling with overflowing emergency departments and long waiting lists for their outpatient clinics. The solution they all seem to be grasping at is to have walk-in clinics and urgent care clinics. These are the wrong places for the management of chronic illness. Emergency departments and walk-in clinics, and even urgent care clinics are not the places people with chronic pain, drug dependency, chronic mental illness and complex psychosocial problems should be going to.

All that happens is the people with these chronic conditions and the health workers at these facilities get frustrated because these facilities are not set up to deliver this kind of care. General practice is where these people should be and there is lot of research to show this.

When governments fund these Band-Aid solutions, they actually make the problem worse. Even something common like diabetes has many possible outcomes and it can often mean a GP spending lots of time with a patient to understand how to help that patient to manage their diabetes well.

The problem is governments around Australia don't want to spend money on quality general practice and even when they do, they don't know how to direct it to where it is going to do the most good. Bureaucrats worry about accountability and want boxes to be ticked for money spent.

That encourages tick-box medicine which large corporations are good at; the GPs who actually want to spend time looking after their patients are the worst at ticking the boxes and filling in the forms to get this kind of money.

I don't want to argue Interchange General Practice/Hobart Place General Practice should be immune to the workings of the marketplace. I do admit I am not the best businesswoman in town. After all, I trained to be a doctor and the healing arts are what inspires me.

I do worry the system we now have will leave big holes for the disadvantaged to fall through. And I do worry the system discourages altruism in doctors and is fostering a more hard-nosed mercantile attitude in GPs. Most of all, I worry about whether I will find a good GP to look after me in another 10-20 years when I will really need one.

We've made it a whole lot easier for you to have your say. Our new comment platform requires only one log-in to access articles and to join the discussion on The Canberra Times website. Find out how to register so you can enjoy civil, friendly and engaging discussions. See our moderation policy here.