Medicare Reform - Beyond The Sick Note Economy

“The who's who of "Who's that?" is poised for the attack”

We have built a health system that confuses bureaucracy with care.

At its core is a relic: the idea that patients need permission to access help.

This permission often comes in the form of a GP consult that exists not for medical necessity, but for paperwork.

GPs have become human permission slips.

Medicare Reform - A Focus On Accessibility

Need time off work? You don’t need a recovery plan, you need a sick note.

Need to see a physio for your back?

You can’t access Medicare funding until you get a GP to rubber-stamp it.

And even then, they’re just authorising access to someone who actually knows how to treat it.

The system delays care, adds cost, and insults both patients and allied health professionals.

Worse, it clogs the entire system with avoidable administrative waste.

We’ve created a loop where patients are forced to see GPs for conditions GPs aren’t trained to treat, simply so they can be passed on to someone who is.

It’s not uncommon to wait days or weeks to see a GP just to access five rebated physio sessions.

By the time the patient walks through the physio’s door, their pain has often worsened, their anxiety has spiked, and their chances of full recovery have declined.

Meanwhile, Emergency Departments are bursting.

Why?

Because patients couldn’t get into a GP, and the system gives them no alternative.

In trying to protect care pathways, we’ve created bottlenecks.

In trying to regulate quality, we’ve manufactured dependence.

And the kicker?

In 2025, most employers don’t even need a GP to write a medical certificate.

They’ll take a letter from a physio, a psychologist, or an OT.‍

The gatekeeping is symbolic.‍

It’s a vestige of control in a system that no longer needs it.

The sick note economy doesn’t serve patients.

It doesn’t serve clinicians.

And it certainly doesn’t serve the future.

It’s time to move on.

We don’t need to invent a new system.

We just need to stop pretending the current one is functional.

Across the country, allied health professionals are already acting as the first point of contact for millions of Australians.

People self-triage.

They see a physio for back pain.

They book a psychologist for anxiety.

They seek an OT for fatigue and function.

And they’re doing it without asking permission.

The system knows this.

And in the shadows of Medicare, we already have models that reflect it.

Medicare Reform - Time To Catch Up With The Private Sector

WorkCover schemes allow workers to access early intervention through physiotherapists without first seeing a GP.

In fact, many employers actively push for this – because it works.‍

Early intervention reduces time off, improves recovery, and avoids medicalisation.

Doctors only get involved when more complex support is needed. It’s triage by function, not by hierarchy.

Private health insurers do the same.

Bupa’s models offer direct access to allied health through corporate health programs, community initiatives, and partnerships.

No gatekeeping.

No moral panic.

Just common sense.

And many employers accept absence certificates from physiotherapists, psychologists, and other clinicians.

Why?

Because they trust the provider.

The GP isn’t inherently more capable – they’re just more entrenched.

We’ve built an entire parallel health economy that relies on clinicians outside of medicine to deliver outcomes.

We just haven’t admitted it publicly.

This isn’t about abolishing general practice.

It’s about evolving a system that can no longer justify its inefficiencies.

We’re not asking to disrupt care.

We’re asking to reflect care as it already happens.

And to stop pretending the old structures are still working, when every outcome says otherwise.

In part two of this series we discuss the role of the general practitioner, a protected class within healthcare and why this is unlikely to change.

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

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Problem #1: General Practitioners are heavily burdened by low skill work, writing referrals, sick notes and basic medications.

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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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