General Practitioner: The Protected Class

Yes, this is about class warfare.  

At the highest class, sits protectionism, those who have done their time at University and often (but not always) paid their way to the top.

Private schooling, private tuition and all that goes with becoming the 1% of school leavers.  

And now we have a workforce which is well paid, increasingly part-time, highly protected, and deeply insulated from accountability to the Australian public.

It is a workforce that increasingly demands flexibility and security, while still clinging to the status, income, and authority of a profession that once ran on duty and full-scope commitment.

This is well entrenched in politics nowadays.

Mark Butler has just committed nearly $4 million dollars to refurbish a 'bulk billing' GP clinic in Canberra, a state with 3 sitting Labor MPs.

This series shines a light on elitist power structures that no longer meet the structural needs of our health economy.

We’ve built a system that pretends general practice is still the backbone of care delivery, while excusing its frontline from the realities of access, coverage, and load-bearing service delivery.

General Practitioner workforce participation has shifted

The average GP works less than full time.

Many younger GP’s work 2–3 days a week.

And yet they remain the only door through which patients can access publicly funded allied health support, imaging, referrals, and basic care plans.

Whilst the largest generation to ever shoulder the burden, the baby-boomers, are exiting the workforce and leaving very little behind to replace them for a growing populous.

We’re running a 2025 population on a 1985 clinical access model.

And this wouldn’t be a problem if we just admitted it and adjusted accordingly.

But instead, we’ve entrenched a culture of gatekeeping and scarcity — one that expects GPs to hold authority without absorbing their full responsibility.

The result?

A bottlenecked, protectionist model that keeps care locked behind closed doors.

And when you zoom out, the consequences ripple across the entire health economy:

·       People die waiting for ambulances

·       Emergency Departments overflow with preventable presentations

·       Chronic conditions worsen due to delayed intervention

·       Sick notes become the price of admission to basic healthcare

All because a patient couldn’t get in to see a GP.

At the centre of the health system, they are often too busy.

Perhaps now not even working that day or those hours.  

Or worst of all, spending their precious clinical hours writing medical certificates and managing musculoskeletal (MSK) pain they aren’t trained to assess.

And this is where we need serious Medicare Reform.

Musculoskeletal complaints make up a large proportion of GP consults, estimated around 20%.

General Practitioners aren’t MSK experts

They aren’t trained in detailed movement assessment.

They don’t prescribe exercise.

Their only clinical lever is medication — often prescribed without follow-up, outcome tracking, or multidisciplinary input.

Meanwhile, allied health practitioners trained to manage MSK conditions, chronic pain, trauma, and recovery are stuck waiting for GP referrals.

They're outside the gate.

And that gate is guarded by a highly influential governing body, with tentacles reaching far and wide within the political sphere.

Meanwhile, the pharmaceutical industry has no problem with this.

In fact, the entire model is built around it.

Big Pharma’s ideal setup is a medical gatekeeper at the centre of health.

“The scandal was contained, The bullet had just grazed… At all costs, keep your good name”

It’s a top of tree practitioner, ready to prescribe.

Meanwhile, RACGP themselves note that nearly 40% of GP appointments involve a mental health component.

That is enormous.

The more patients are funnelled into this single point of entry, the more medication becomes the default answer.

And yet allied health has quietly become the antidote.

We treat what can’t be medicated.

We coach behaviour, address lifestyle, retrain movement, unpack trauma, engage in long-form care.

And we do it with actual evidence literacy — not industry-fed summaries.

But we’re kept structurally peripheral.

Not because we aren’t effective, but because we don’t play by the referral rinse-and-repeat model.

The truth is:

·       The GP monopoly isn’t about safety.

·       It’s about protectionism.

·       And it’s hurting everyone.

No one is saying general practice shouldn’t exist.

But general practice as it currently functions is not sustainable.

Not for the system.

Not for patients.

And not for the clinicians burning out under the weight of a model that was never designed for this kind of load.

It’s time to decentralise.

To distribute responsibility.

To let allied health professionals work at the top of their scope — not beneath the thumb of a gatekeeping structure that is cracking under its own weight.

It’s time to grow up and evolve the system.

In part three, we will discuss the role of the Digital Medicare Wallet, a revolutionary new system to bring universal access into the 21st century.

If you'd like to read the entire series, you can download it in pdf form here.

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Problem #2: The system is built on protecting itself, not on directing patients to where their care is best delivered.

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BACKGROUND

Recently the Royal Australian College of General Practice (RACGP) took a big swipe at allied health professionals.

Arguing that allied health professionals should be operating inside their businesses OR effectively under the supervision of a GP.

This was a flailing fist from an ageing giant, one who knows that the sun is going down on the idea of the General Practitioner being the go-to for every form of healthcare.

The reality is that General Practice ideology – GP at the centre of care, sits in conflict with modern consumerism – Patients at the centre of care.

Private citizens have moved far beyond these narratives decades ago, and if we are asking to go back to the 1980’s, that’s just not going to happen.

But instead of looking backwards, why not look forward at what could easily be achieved by 2030, if we took a genuine reformist approach to Medicare.

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