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More patients, more complex problems, more often: the lot of GPs

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Patients are seeing their GP more often, and taking up more of their doctor’s time seeking help with an increased array of health problems, adding weight to medical practitioner complaints about the inadequacy of the Medicare rebate.

A long-running study of general practice has found that the proportion of older patients being seen by GPs has increased as the nation’s population has aged, bringing with them multiple health problems that require more time-consuming and complex care.

The Bettering the Evaluation and Care of Health (BEACH) study, which involves a random sample of 1000 GPs each year, found that between 2005 and 2014 the proportion of patients 65 years or older seen by GPs increased from 27 to 31 per cent.

At the same time, the number of consultations claimed through Medicare climbed 36 per cent to more than 137 million and the number of problems managed per 100 encounters rose from 146 to 155.

Together, these results mean that 65 million more problems were managed by GPs in 2014-15 compared with 2005-06 – underlining concerns that doctor remuneration through Medicare has failed to keep pace with the volume and complexity of the work GPs undertake.

The AMA has condemned the Federal Government’s decision to freeze the Medicare rebate until mid-2018, warning the measure is likely to drive some GPs out of practice and cause many more to cease bulk-billing, potentially deterring the sickest and most vulnerable from seeking care.

Related: MJA – The cost of freezing general practice

While the rebate is stuck, the complexity and multiplicity of problems that GPs are treating has meant a blow-out in the time they spend with each patient. Consultation time has increased from a mean of less than 14 minutes a decade ago to 14.7 minutes last financial year – and the increase in time taken could be accelerating. The BEACH study found that in the last two years alone, the median consultation has increased from 12 to 13 minutes.

While hypertension, check-ups, coughs and colds remain the common reason to see a GP, in the past decade there has been a sharp increase in other types of complaints – particularly those chronic in nature.

Last financial year, GPs has 23 million more consultations for chronic complaints than in the mid-2000s, including many more for depressive disorders, oesophageal disease, heart problems, chronic back pain and other, unspecified, chronic pain.

Not only has the type of patients and the problems they have changed in the past decade, but so has the way GPs operate.

The BEACH study found that GPs now were less likely to prescribe medicine, particularly antibiotics and anti-inflammatories, than they were 10 years ago.

Instead, they were likely to order more pathology and imaging tests, and more readily referred their patients to a specialist.

Adrian Rollins

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