Abstract
Participation as a founder member of the International and Overseas Network (ION) of the Royal College of General Practitioners (RCGP) presented me with the fortuitous opportunity and challenge to pause, to reflect, and to take stock of my experience of life as a GP in Australia and as a GP in England. This article compares and contrasts the primary healthcare systems in both countries from the vista of the individual, practising GP working in those systems, and considers the approaches and developments that each system might learn from the other. Following 20 years as a coalface GP, who has also held various NHS management and healthcare leadership teaching positions, I departed the UK with my family in 2016 to follow my wife as she stepped forward to accept an exciting new corporate job opportunity. Contented as a GP in England, emigrating — for me, as an individual — was categorically about ‘moving towards something new’ rather than an expression of dissatisfaction with my career or life in England.1 Frequent immersion back in the UK — five visits in 18 months, interspersed between growth and consolidation of experience in Australia — has allowed for an evolving and reflexive2 overview3 of the two health systems from the standpoint of the individual GP. My experience in England was as a GP practising in a relatively affluent socioeconomic locale. My Australian experience is in a similar socioeconomic urban setting. As such, my reflections are drawn from comparing and contrasting the healthcare systems’ impact in these specific contexts. GPs practising in rural and remote settings, or those working with indigenous communities, will have different experiences of the UK and Australia. Further, a variety of healthcare reforms are underway in Australia which will alter this experience, just as UK …
Highlights
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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
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
Summary
MAG(idhTTbo6nPMihhfiuPdguaSeeetlAg,ihUosecmn.ntfswiaDm2nimoriontnbic)awitTgsbiogihedluedh,eineadnrdhiern2sr,dflinoes,owcwieScs-rlfMaeracioeinnGsilgsemiuieognceuPpktfiaepddpscahlurocalier.lycSltoalrrtEitauvrtamubaaaeidllslnylsptrsyaiEor,totlnGaedudtneasehtPnesoruesetdsgneuocd..AlsnaoemMTkcdctvliohahnaieeoeneyindlilefxlnsbei.ehpdrsmxnHoaAetestteurerdeciaebenrranvnantoectditcetetosomoeienocmfnn,PerahcdpnrryrlnaeeliituenmdvcdBpthiiocnettaoatraughhdsraAlreyeeerrumciddughnlHioinsi,sofilcadedmlrRe1avseiasa8laoerlagghultteynphneeoriddaenonssbrNgpdsiwMsliio1estetiag0nitestichl0ses,wdorunuwaun0ioeepcns0hrpratekla0ekouonlqlrrl,ocoepyuEekkMwae.dutestnhnTntiueiece-nhwsceilnyfinbiessaeztp-.loectNl1cy.ldti,uoeao3eoHcaurdrunWenerlw.lds,dte1aseHrMa,apyaeasyr,rAneeoesfibedpsusulibuwetonsitninodristststmruduuadsharaatsileomnuniuynavwregaieieb;lcle,awlseeayrr, htoigwh.h2eTnhhise ilsasitmhpaodrtmanatlaarisa.delayed treatment has unfavourable consequences.[1,3] We report how a CInatsroedruecptoiortn GPA, wyiothunngoUcklirnaiicnaial nulwtroasmoaunndcoemxppleariinesnocef ,lorweceorrbdaecdkipmaaingeasndwiuthrinaarpyofcrekqetu-esinzceyd. ultrasound device (PSTUhDe) puantdhesrosfutpheersveistihorneetopecoonpfliermmaaycnoemveprlehtaevAe cchroillsessedte;nydeot nherrueptthuerey.aTrhei,sdceonuizldenpsroefsethnet aCanleawis iAJPnuadnr3itgc6ical-eiytp.ieoaaTntrhi-ofeoonylrdatGusmPrnaunufltoperuaxtnspoodeuearniremdmn.acekemedsbhaeicfrtutopefrimpthaaeirnyInactbaeorrenvea‘ctiltoihnneica’lritgahnhadtt hwOeeveelsreastcecuaospmNinpeatnhwieeodrhkeba(IyrOtaNonf) atohufedtiuhbneleoRfsfoincyaiapl wrCeohfuilleggeseprcoinafmtGinpegno.enHreaelwiPmermaecketeidtnidoatnienelryJsuh(laRydC2Gd0i1Pff6)ic.purletysewnatelkdinmgeanwdith[3] thhoeurfos rltauteitroucosnospupltoerdtuannitoyna-ncdallcGhaPl.lePnogsetoeripWoariutahsneok, nlteloysrwbeaeflsleliicntgm, aewndidtihcatoal sttuaepknepdleisetrso,dcekwpeorfeasmrseiyoinmexm3pecdrmiieanptecreloyxoicmfhlaiflleetnoagstehadeGbcPyalicwnahnAaeutuswmtreawlisaaesea.nfodHuoanwsd.acAaGncPtwivien. Notwithstanding the failures, the fudges, and the frustrations of technology implementation, and of staff adoption and adaptation, the net impact as a practitioner in the UK is a system where the infrastructure — the ‘train tracks’ — for digital transformation exist This allows the individual GP to encourage patients and their families to access their full medical records, including clinical progress notes, results, and hospital letters; it enables patients to view information online before and after consultations using ‘safe search’ options facilitated by their GP practice; and it allows GPs to make optimal use of m-health and app technologies to interact with patients in between their consultations.[11,12]. The distinct funding models — item-of-service in Australia, and capitation in the UK — are the likely root causes for these differences and drivers for efficiency.[15]
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