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Question from Members

Please note: Duplicate questions have been removed. One question has been removed as containing

inappropriate content. Three others have been edited to remove some inappropriate content.

No Theme Question

1 GPs in Training

How do you plan to support the current GP registrars due to sit exams in October? The lack of information is causing increased stress in an already stressful environment.

Thank you for providing this information. As RACGP President I will undertake to provide both personal regular clear communications and an ability for all candidates to message me via the Faculty of GPiT regarding any concerns or problems to ensure all participants are provided with equitable access to information, materials and support. I will work to ensure there is open transparent communication to all candidates throughout the pre-exam and post-exam period from RACGP Exam team If necessary I will advocate on behalf of the entire group with respect to assessment issues.

2 GPs in Training

A lot of registrars have felt let down by the RACGP on various topics for a long time. What will you try to achieve for GP Registrars if you become elected RACGP President?

Thanks for putting forward this viewpoint. The first thing that I would want to do as President is ensure I have a full understanding of the current issues and what solutions GPiT are asking for. In order to facilitate this goal I plan to set up a regular communication forum for GPiT via the GPiT Faculty where members are able to ask questions, suggest solutions to problems and have these issues aired and addressed in an open, transparent, meaningful and accountable way.

3 GPs in Training

What are the main issues affecting GPs in training and what will you do to improve them as RACGP president?

As President, I would be wanting to know from GPiT what the issues are and what they feel are the best solutions. As one of the Director’s for RACGP responsible for setting up GPiT faculty, one of the desired outcomes was to ensure GPiTs had a mechanism to ensure the Board was aware of issues and enable a voice via their Chair. Issues I know will need addressing as President:

1. Flexibility of the training program – particularly for women on maternity leave

2. Remuneration and the loss of income and Employee benefits when moving out from Hospitals to Community

3. Assessment – process, costs (and transparency around where the money goes), communication around what, where and how

4. Equitable access to training resources 5. Funding of the non AGPT pathways programs – costs, what support and

resources are provided 6. Quality of the Supervision provided in approved posts.

4 GPs in Training

How do you see yourselves closing the gap between GP supervisors and registrars when it comes to remuneration in a way that both parties are happy?

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Are you satisfied that the fellowship exams in their current format are helping the purpose of producing an independent GP who may practice anywhere in Australia? Do you see that RTOs (in the current set up) are delivering similar training programs across Australia?

Thanks - 1. Remuneration – Under our current model the GPRA and GPSA should

continue negotiating a contract between themselves. The RACGP could provide assistance with mediation services if requested.

2. Assessment – Yes, I believe our current process has been producing safe and competent GPs for Australia. We should always be looking to improve and as President I would encourage ongoing regular reviews and discussion about alternate options with the aim of continuing to have a world class Assessment process

3. RTO’s are currently funded to deliver an outcome. This outcome is Drs who are competent to work as independent GPs around Australia. They are not mandated to deliver a particular program. The transition of funding for GP Training back to RACGP gives us an opportunity to ensure all the GPiT receive a similar package of education and support during their journey along the training pathway.

5 GPs in Training

Employment conditions for GPiT are atrocious and enrolment numbers have been dropping over recent years. The pandemic has exacerbated and highlighted these challenges with many registrars either losing their jobs or having their hours cut. What is your plan to address the gross inequities in entitlements and pay compared to our hospital counterparts, with a view to attracting more doctors to the specialty and whilst supporting practices to take on registrars?

I agree, we have a problem! The current funding inequity between hospital and community based Doctors in training needs to be addressed urgently. If we want to attract junior Doctors into GP they need to see it as a great career option and this includes a fair and equitable remuneration package during training. It also requires a good remuneration package once they graduate as FRACGP! The whole issue of funding during training and beyond is key to solving the problem of long term sustainability for GP into the future. As a Director RACGP, I have already raised the GPiT remuneration with the current Health Minister and strongly advocated for a funding package (including portability) that can solve the current problem. As President I know that I need to strongly advocate to Government for extra funding to be allocated to the training program as a matter of extreme urgency.

6 GPs in Training

What do you intend to do about the financial impositions being placed on general practitioners in training by the RACGP's refusal to reduce the cost of exams and its charges for practice exams in a year when registrar incomes have been, in many cases significantly reduced?

Thank you for raising this issue. As a Director, I have been advocating for transparency around the Assessment costs by the RACGP management team. As President I would continue to push for this transparency and also ensure that Assessment fees equate to assessment costs generated by the exam process with no profit being generated.

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I will also advocate for financial support to facilitate participation in the Assessment process being provided to any GPiT who due to financial distress would be otherwise be unable to participation in the Assessment process.

7 GPs in Training

What are your thoughts on paid maternity/paternity leave for GPs in Training? How would you support practices with this?

See answer to question 5. Funding equity for Doctors in training across all specialities is essential. Access to paid leave, such as maternity / paternity leave is part of the extra remuneration package required from the DoH to ensure equitable funding for GPiT around Australia, regardless of where they are working. How this is going to work (given the complexity of employment options for GPiT) will require a lot more discussion and negotiations and I suggest that the GPiT be part of all discussions going forward to ensure all parties are satisfied with the potential solutions on offer. I have already been party to discussions with Greg Hunt and am aware he wants to solve this dilemma and is keen to be part of finding a workable solution. As President I would be in a good position to push these discussions forward to achieve a solution.

8 GPs in Training

How do you plan to fix the widening pay and condition disparity between GP registrars and hospital registrars?

Please see answers to Qu 5 and 7.

9 IMGs IMGs are poorly represented at all levels of RACGP, AHPRA and medical

boards...etc, what is your plan to improve their representation?

What is your plan to end discrimination in payments to trainee GPs (item 53 v

23)?

Thank you – there are 2 issues here: 1. As President I would be seeking to increase GP representation from across all sectors of our community. This includes rural, remote, outer urban, female and IMG’s. This could be achieved by a program of both actively seeking out members to be involved in representational work as well as a concurrent program of upskilling and mentoring to provide skills in leadership, advocacy and governance. 2. It is my understanding that all GPiT on AGPT pathways receive the same Medicare payments as those who have an FRACGP or are VR. Item 53 is the payment for all other Doctors, those not on training programs and anyone on non AGPT pathways to Fellowship. As President I would advocate for all Doctors who are on pathways to Fellowship programs being given access to the same benefits of training. Equitable training and access to equivalent Medicare payments.

10 IMGs Considering a big proportion of GP workforce are IMGs, what measures is the

RACGP going to take to address the unfair moratorium restrictions on RACGP

fellows (i.e. Medicare restrictions 19AB and 19 AA) even if they are trained in

Australian hospitals and completed the fellowship via an RACGP training

provider?

The issue of GP workforce and sustainability is key to ensuring the Australian Health care system continues to provide best health outcomes for our population.

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As President I undertake to ensure that addressing the issue of the moratorium restrictions will be high on my list to be addressed with the Health Minister and DoH.

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No Theme Question

11 IMGs The current training programs discriminate between local graduate and

overseas graduate IMGs. Local graduates are issued with provider numbers

which allow them to practice anywhere in Australia. IMG provider numbers

allow them to practice in MMM2-7 only. Also IMGs have to spend 10 years

in the Bush before they are allowed to practice in Metropolitan areas. What

steps are you going to take to stop this institutional discrimination?

Thank you for raising these IMG issues. Unfortunately they are not an RACGP imposed restrictions and so do not have easy pathways for solutions. My understanding is that the barriers imposed on IMG’s relate specifically to the type of visa issued by the Australian government, and are imposed when the Department of Immigration grants each visa to each applicant. I agree with the questioner that the restrictions impose unfair discrimination to all IMG’s and I have long advocated for these restrictions to be reviewed and changed. As President I undertake to advocate for changes to be introduced with respect to the visa restrictions imposed on IMG’s to enable more flexible access to Provider numbers around Australia.

12 IMGs What is your view on the 10 year moratorium for overseas trained GPs?

If you are elected president, what advocacy will you participate in for

overseas trained doctors who are subject to the 10 year moratorium?

Please see answer to Qu 10, 11. 13 Membership

Engagement

How do you feel your past experience with involvement/activity in the

College will shape your presidency and how will you ensure our Board does

not make mistakes which might alienate its members?

I believe that my past experience with RACGP brings a huge benefit to my future Presidency. In particular, as a current Board Director, I have a deep knowledge of RACGP- internal and external. I have been working for 2.5 years to improve Culture and governance for members and have been instrumental, along with the current Board, in securing governance review and significant changes to Management in this quest for Improvements. I have also been Chair of the committee who oversaw the appointment of our new CEO, Matthew Miles as well as having been privileged to have worked alongside Harry Nespolon for the 2 years of his presidency, and have good relationships with relevant stakeholders and powerbrokers in the primary care space. As President I intend to work collaborative alongside the Board and members to ensure all key decision making puts “You, the GP” at the centre of all my work.

14 Membership

Engagement

How will the College ensure that its history is well documented via its own

Archives to better inform its future leaders?

Great question – RACGP already has a process to do this and as President I would definitely continue to support the funding of the Archives Committee, as well as ensure we have a process of communicating our history to members and leadership within the RACGP.

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If you are aware of any potential ways to do this better or any barriers to this work I would appreciate you making contact with me so solutions can be achieved.

15 Membership

Engagement

Why should I vote at all? The college feels so far removed from my day to

day reality as a coal face GP. If not for some I would not know much about

anyone even on my state RACGP board or national board or their values. It

seems I pay a fee to RACGP so some GPs can make a career out of clinical

governance and unfortunately based on my education and training (

overseas ) I won’t even stand a chance to be noticed when they do their

succession planning ( as RACGP last campaign showcased).

I am really sorry that you feel this way about RACGP and appreciate that you have sent in this question. Please vote and make sure your choice of president has your support. I would also encourage you to make contact with someone like myself to let us know how we can represent your needs better. Communication is key to ensuring we do a better job. In NSW/ACT I have been working hard to ensure members have a voice– this has meant trying to really find out about local issues and engaging with local GP groups and providing better mechanisms for communications. However, I am mindful that RACGP is huge and it is easy as an individual to feel that you are invisible. As President, Member engagement will be a top priority – finding better ways to hear from you and provide you with timely communications is essential to meet your individual needs!

16 Membership

Engagement

Why is the annual subscription so high?

Are you aware of the struggle of the current COVID circumstances?

AHPRA has waived the necessity for CME this year!!

Are there specific reasons?

2020 has been a really difficult year! RACGP is acutely aware of how hard it has been for many GPs. As a GP at the coalface I am acutely aware of your concerns. Did you know that you can apply for special consideration with respect to fees due this year? This was an option that I, along with the current Board, asked to be provided for all members who were financially disadvantaged this year. If you think you qualify, please make contact with RACGP member services. Due to all of the difficulties with access to education AHPRA has waived the need to report CME but as professional GPs, we are still beholden to make sure we are up to date with our clinical knowledge. Ongoing reportable CME requirements will continue as dictated overall by the AMC. As President I will continue to ensure Member wellbeing is a priority.

17 Membership

Engagement

Do you think there should be a GP (Doctor) advocacy group just as we have

patient advocacy group to assist members when they run into problems with

AHPRA or any other body for just cause? If so how would you go about it?

If not why do you think it is unnecessary?

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Great idea – as President I would like to take this idea up and see if we could implement a service that can provide this level of service for members.

18 Membership

Engagement

Is there any plan to support SOLO GPs networking?

I believe we are a dying breed with little support on the professional and

financial aspects. All funds for any projects go to big clinics? Little attention

from all organizations including PHN!!!"

Great idea – I understand why you might feel isolated and unsupported as a Solo GP. As President I would support you in linking up with the FSI and see if you could create a group for Solo GPs within the current specific group of GP practice owners. Please contact the Faculty of Specific interests to find out how to link in and join up with this group. I would be happy to discuss with you further how this might work and in particular what special needs your group might have.

19 Membership

Engagement

How do you think the RACGP should support the mental health of its

members, especially in regard to the recent extreme stresses of bushfires

and COVID?

As President I certainly intend to prioritise the mental health needs of GPs. GP Wellbeing is a particular interest and passion of mine and so it has been prioritised in my work as Chair for NSW/ACT Faculty since 2017. For example, we held NSW/ACT GP Well Being conference in 2019 and 2020. The goal being to give GPs space to prioritise their health and be more available to deliver high quality care. 2020 has been a disruptive year throwing up multiple stressors to the entire community and GP’s are at the coal face, professionally and personally. I know the importance of prioritising GP mental health and the need to assist everyone to address mental health concern. My intention as President would be to ensure the GP Wellbeing programs are easily accessible throughout Australia and we also prioritise mental health services being made available to our members via online platforms.

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No Theme Question

20 Membership

Engagement

What plan do you have to defend GP rights when it comes to Bullying tactics

by DOH compliance department such as the “nudge letter campaigns “?

Great question- thanks! RACGP, led publicly by the President, needs to directly address the issues raised by any Government driven bullying campaigns and ensure our members are safe and protected at all times and I would be fully intending to lead this “anti-bullying” advocacy. I believe that it is vitally important that GP’s do not stop doing the essential services required in their communities because they fear being targeted by these “big brother “campaigns. For instance, stopping provision of palliative care services due to the campaign against opioid prescribing. I would work to ensure Government campaigns aimed at improving health outcomes do not unfairly target GP’s and most importantly do not have unintended consequences in our ability to do our job!

21 Membership

Engagement

So there is a great debate about the RACGP’s role and its obligations to its

members. The College is a professional body for education, standards of

education and quality assurance in General practice or it is also a lobby

group for representation of General Practice in Australia. We are keen to

find out if you will settle this issue once and for all. In your view what is the

best way forward and what change you will bring which will satisfy many

members who feel disenfranchised?

Again, a great question. The RACGP is indeed the General Practice Academic College and so has the really important role of setting the standards in Education, Assessment and Quality Assurance. As of 2021 it will also oversee the provision of the GP Education program. We are the biggest GP membership organisation in Australia. For many years our members have felt increasingly disenfranchised by organisations that might have competing interests and GP members have asked the RACGP to take on Advocacy for General Practice. The latest member survey confirmed this as being an extremely high priority to the majority of members. As President I would be supporting the strategy that RACGP do both of these key roles. I would also hope that they are both accomplished with extensive member consultation and good communication resulting in better long term member engagement with RACGP.

22 Membership

Engagement

How do you plan to change the perception of general practice - in the

community, in other medical professions (including specialists, hospitals and

junior doctors considering GP as a career) and with government?

Changing attitudes takes time. I suggest that we also need to address this pervasive attitude in ourselves - classic example being, “I am just a GP” as well as the medical fraternity -“why would you waste your talents in GP when you could be [insert non-GP specialty here]”. This needs addressing during Medical school and in hospitals – probably as a system wide medical media “blitz”.

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I believe community attitude is supportive of GPs, with advertising campaigns such as “expert matters” feedback show GPs are highly regarded and respected. As President I would go to Government with clear statements selling our value proposition – general practice is the most cost effective part of the healthcare system. General practice decreases preventable hospitalisations. Continuity of care in GP reduces mortality. General practice is the affordable key to solving the growing dilemma of coping with multiple, chronic preventable diseases in our ageing population.

23 Membership Engagement

Engagement of members within the College is increasingly important. What is your strategy to change the narrative from the commonly used 'The College', to 'My College'?

As President I would undertake to engage more directly and regularly with our membership – enabling a sense of ownership and belonging- and believe that the results will speak for themselves and the “the” changing over time to “my”. I would undertake a 2 tier strategy

a) GPiT: actively promote the narrative of “my” college along with a value add membership package

b) Current members: go and find out what members want and ask for solutions to engage better and ensure value is delivered

24 Membership engagement

GPs who specialise in aged care have a unique set of issues and challenges facing them on a daily basis. What do you see as the main areas that need attention with regard to helping and supporting these GPs, and do you have a plan for this? If so, what are the main elements of this plan?

I agree 100% that the needs of GP’s who specialise in Aged Care differ from many of their colleagues. Did you know that there is a network for GPs with specific interest in Aged care? The Faculty of Specific Interests was set up to enable GP’s with specific interests to socially network and share resources. The FSI is then able to provide a forum for each Specific Interest Group to have a “voice” around standards of care / funding and advocacy. As President, I would need to be informed by those GPs working in Aged Care about the areas of needs so would specifically request the Aged Care SI network to consult amongst their membership to produce a plan that both articulates issues and proposes solutions.

25 Advocacy Financial viability is a major stress for practice owners. Can you please discuss your plans to ensure GP clinics remain financially viable. I believe this is the most important issue at the moment. Do you agree?

My ultimate goal as President is to achieve significant improvement in the sustainability of general practice for the current and future GP workforce. Sustainability for our profession requires us to remain financially viable and optimally to financially flourish. This will require our specialty winning increased flexible funding for general practice that addresses the unique needs of rural, regional, and urban models of care. To do this, I will need to sell the strong argument to government that general practice is the most cost effective part of the healthcare system and that general practice is the only affordable key to solving the growing

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dilemma of coping with the multiple, chronic preventable diseases in our ageing population. This can be done by ensuring I have a strong media presence through the use of Morning Radio and TV shows to dictate strongly the tone and subject matter of our GP advocacy.

26 Advocacy I would be interested in the candidate's opinions about reform to the payment arrangements within Australian general practice. Is a payment system based on fee for service non-negotiable? Or does the candidate have a willingness see the RACGP exploring new payment models as have been introduced in a variety of international models of the patient centred medical home?

The Vision for general practice and a sustainable healthcare system describes the model of care advocated by RACGP since 2019. Funding for this model of care calls for a mixture of FFS and flexible funding payments. Government has made it clear that increased funding into GP will not be via FFS but linked to “value based care” options via models such as Voluntary Patient Enrolment with a General Practice of their choice. As President I will represent the RACGP position to ensure General Practice achieves increased funding. My stance will be informed by the Board – who in turn will be advised by our REC Committee, Funding and Health System Reform and CEO. I am mindful that we urgently need to achieve an increased level of funding that will attract new Drs into GP and keep current general practices open and delivering high value care.

27 Advocacy Is the Medicare system fixable for GPs? If so, how would you go about making changes and what main areas of Medicare for GPs would you target? If not then how would you propose to radicalise the broken Medicare system?

See qu26. I don’t think Medicare is broken but as a GP see that it is no longer fit for purpose – having been designed in 1960s to deliver “reactive” care. Medicare has delivered a world-class National Health Insurance system but now needs updating! I want proper funding for Preventive care, Chronic disease management and Palliative care as well as proper payments for collaborative care between the care team. Over the last 10-20 years General Practice has been increasingly starved under the FFS model of payments and we need to be open to consider alternative payment options to ensure we can continue deliver high value care for all Australians. As President I would be advocating for increased funding to GPs aligned to value as well as volume. However, I would strongly advocate everyone being given choice about adoption of any different funding models with no compunction to change.

28 Advocacy How do you defend GPs against financial loss caused by pharmacies, Medicare? How you can protect our profession against other professions trying to take financial advantage? Pharmacies administer flu vaccine and in some states children’s vaccinations. How you can protect prescribing in a GP’s job and not allow others to take it?

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As RACGP President I will undertake to strongly advocate on behalf of our 40,000 + members and the Australian population to prevent any further encroachment on GP care. Pharmacists need to deliver high quality care in pharmacology – dispensing medications and ensure medication is used in a high quality and safe way. GP’s need to deliver and oversee referrals for all Patient centred care - Diagnosis, Management and delivery of preventive care and palliative care. This advocacy needs to be non-negotiable and the RACGP needs to go hard and strong! As President I would take this advocacy strongly into the media space via Morning radio and Television so that we can dictate both the GP subject matter and ensure we promote a strongly patient centred argument with the reasons for keeping this care in the GP Domain.

29 Advocacy The government won't change any strategy until BB rates drop. How would you go about organising the College to advise its members to drop their BB rates, essentially as a tactical show of power? If most health expenditure is wasted in/on hospitals, what role do you see the College having in talking to State governments to get this money diverted to GPs, who as we know, from copious amounts of data, do a more efficient job?

RACGP needs to sell the strong argument to government that general practice is the most cost effective part of the healthcare system and that general practice is the only affordable key to solving the growing dilemma of coping with the multiple, chronic preventable diseases in our ageing population. As President I would ensure that the story is constant, unremitting, compelling and demonstrate the need to divert funds away from the expensive “bottomless” pit of hospital based care, into General Practice, in order to achieve the overall goal of a sustainable health care system. I would also ensure this story is presented to the community via media such as morning radio, TV and written publications such as SMH, Guardian, Daily Telegraph.

No Theme Question

30 Advocacy Some candidates advocated to increase GPs’ remuneration from Medicare. This is unlikely to be fruitful, given the economic reality of Covid-19. Some of the candidates however are also practice owners who charge GPs a service fee of 30-40% before tax which leaves many GPs struggling. Would you advocate limiting the service fee to 20% as a way of helping GPs to have a decent income?

As President I will continue to advocate for more funding into Medicare for General Practice to ensure sustainability for both GP’s and practice owners. RACGP should advocate for all GP’s to be adequately and appropriately remunerated for the work that they deliver to patients under the Medicare system. I do believe that if I strongly sell the argument regarding “bang for your buck” that we will achieve more funding despite the current financial constraints. As President I don’t feel that I have any role in telling Practice Owners what fees they can charge their GPs. These conversations should be part of the contractor / employee negotiations. However, I can and will go hard and strong to achieve increased funding for the specialty of General Practice!

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31 Advocacy GPs across Australia have embraced Telehealth and the flexibility that it gives us in providing patient centred care. I have found that Telehealth is a wonderful tool to provide care for my patients with disability as one example. What will you do as RACGP president to advocate for the continuation of Telehealth item numbers for general practice post COVID-19?

I agree 100% - I will personally be a very loud and strong advocate for the continuation of telehealth post COVID19. The RACGP has been strongly advocating this position and will continue to do so. As President I will use a number of strategies to communicate this message – both in direct negotiations with Government but also using media such as radio, TV and published media in order to more strongly dictate the arguments and community support for ongoing Telehealth funding.

32 Advocacy The COVID19 Pandemic has really highlighted the problems GPs have working within a state based healthcare system, and yet being federally funded. We are following the guidance of our state based chief health officers, but we are often forgotten in state based planning. I would love to know the candidates’ thoughts on this, and their suggestions for a solution.

I agree 100% - our health system is made much more complicated and “siloed” due to this disconnect between State and Federal funding. RACGP needs to continue to advocate for adequate funding of a health care system that delivers the best health outcomes to all Australians – wherever they live - in the most cost effective way. As President I will undertake to be “noisy” in the media about these issues and highlight the need to reform these areas of our health system.

33 Advocacy Is the RACGP's 'Vision for general practice and a sustainable healthcare system' (https://www.racgp.org.au/advocacy/advocacy-resources/the-vision-for-general-practice) still relevant, appropriate and useful? Do you believe that it should be the basis for the RACGP's discussions and negotiations with government and other third party funders of health care? If you think that it needs to be changed or updated, in what ways should it be changed or updated?

As President I will advocate for increased funding into General Practice as the most cost effective solution to our looming health care crisis. The vision statement is the policy document that informs RACGP discussions with Government around future funding. As President I will be representing the RACGP using document– I note that the current version was updated in 2019 after extensive consultation with members and stakeholders. As President I will ensure all my advocacy discussions are informed by the RACGP Board of Directors. The Board may decide to support variations to current policy after advice from myself or the CEO. Any variations would be the result of expert advice and not at my personal “whim”. I also draw everyone’s attention to the AMA 10 year Framework for Primary care which the Government will also no doubt reference in our future discussions about funding options.

34 Advocacy Why are we called "" just GPs"" but AHPRA register us as Specialists? Why are we not called Family Medicine Specialists? I believe websites of medical centres should change the title of fellows to Specialist Family Medicine Physician or Specialist Generalist Physician and non

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Fellows should be classified as Family Medicine Physician Registrar or Generalist Registrars while those not training should be called Career Medical Officers - our integrity is down. What are your thoughts?

I am a proud GP and I proudly hold a FRACGP. I am a Medical specialist in the field of generalism. I don’t think the name Family Physician encompasses who we are and what we do, although they are also specialists in being generalists (as are paediatricians and geriatricians). In fact, I would go further saying there are many GPs and community members who would not relate to the term Family Physician - as they don’t relate to “family”. Names are difficult and we need to be very careful that we don’t disenfranchise anyone in the process. More importantly a name change does not answer nor change the real problem which is sustainability. As President I will work tirelessly to sell the value of our brand “GP” to the medical and general community – both to attract junior doctors into this specialty and to attract funding from government.

35 Advocacy Regional and country practices are being subjected to new restrictions in recruiting and training new doctors and facing immediate workforce shortages. How do the candidates address the shortages and improve the distributions of GPs?

This is a “wicked problem” and I confess that I do not have the solution to your question. However, after many years of hearing lots of opinions from multiple informed (and less informed) sources it would appear that I am not alone in this opinion. I believe that as President I would need RACGP (and in particular the Rural Faculty) to be willing to look at innovative and “out of the box” options of primary care services to better address workforce shortages and ensure all of our communities have access to high value care options. It may well be that a range of options need to be funded and piloted – with not one but multiple solutions needed for our regional areas.

36 Advocacy The RACGP lacks a national online members-only forum in which members can discuss issues among themselves. The Faculty Facebook groups go only a little way towards this. The GPs Down Under closed Facebook group with 7 837 members is the de facto national discussion forum for members of the RACGP. Are you satisfied with this situation? If not, how do you propose that the RACGP should enable members nationally to discuss issues among themselves?

Thank you. As President I agree that I should prioritise establishing safe and secure platforms for GP member social and professional communications and networking. Although the Facebook GPDU group is subscribed to by 7837 GP’s the RACGP has 40,000+ members (and GPDU is a forum for ACCRM and RACGP members). There are many GP’s who do not and will not engage with Facebook as a communications platform and I see this as an unsolvable barrier if we want only one platform for communications.

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As with many things GP – there is probably not one method to engage with everyone. We should embrace member differences and use the full range of technology to improve communication - emails, online forums, social media platforms, regular member surveys on single issues, podcasts, website chat room etc. Ultimately, as President, my goal is to achieve increased membership engagement by whatever means they choose.

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No Theme Question

37 Advocacy If elected as president of RACGP what measures you will take to make the Govt understand the importance of GPs in primary healthcare as GP specialists and improve the Medicare rebate and improve the quality of service as GPs we are offering to community? Improved access for allied health services for chronic medical conditions instead of 5 visits per year and to make it as 10 visits per year.

As President I will continue to advocate for more funding from Medicare into General Practice to ensure sustainability for both GP’s and practice owners. We need to sell the strong argument to government that general practice is the most cost effective part of the healthcare system and that general practice is the only affordable key to solving the growing dilemma of coping with the multiple, chronic preventable diseases in our ageing population. The story needs to be constant, unremitting, compelling and demonstrate the need to divert funds away from the expensive “bottomless” pit of hospital based care into General Practice in order to achieve the overall goal of a sustainable health care system. This advocacy includes asking for increased numbers of allied health services, targeting patients who are more complex and require more service providers as well.

38 Advocacy There has been a lot of talk by one candidate in particular - about GPs needing a lobby group akin to the pharmacy guild. What are your feelings on this and the ethics of general practice using tactics like “pay for play”? (Donations to all political parties)

I believe that the RACGP with 40,000+ members is already in a position to strongly lobby for GP and the members have asked for RACGP to be the oversee of their advocacy. Copying the Guild is not the way to go. They have lots of money and buy reform! However, we can emulate the Guild model of using “the pharmacist in every suburb and town in the country” and use our strong nationwide GP membership, along with strong community respect that GPs generate. As President I would encourage the RACGP to resource all members to go to their local politicians and be the GP Advocate to MPs and senators at the electorate level – petitions, posters, social media, form letters and media releases using local media. We can use this mandate to achieve the wins that we need to achieve sustainable funding into the future.

39 Advocacy Considering the success of other groups who use professional lobbyists (e.g. Pharmacy Guild, NRA, etc) in achieving their advocacy goals, would you consider the same approach to be suitable for the RACGP? Why or why not?

See above Qu 38. I agree that the RACGP needs to have a strong plan and seek expert assistance in our approach to achieving success in Government lobbying and would ensure that this approach was utilised immediately.

40 Advocacy The evidence that a strong primary health care sector leads to better outcomes and reduced overall costs is well known, but general practice continues to be the poor cousin of the Australian health system, both metaphorically and literally. How will you convince government of our critical role and secure a meaningful increase in funding of Australian general practice?

Thanks for this statement and question!

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I agree with your concerns. Now, more than ever before we have the opportunity to sell the fact that general practice is centred on the needs of our patients. We must remind politicians of the special trusted place that local GPs have in the hearts of all Australians. As President I will ensure the key message is that general practice is the most cost effective part of the healthcare system. General practice decreases preventable hospitalisations. Continuity of care in general practice reduces mortality. And general practice is the affordable key to solving the growing dilemma of coping with the multiple, chronic preventable diseases in our ageing population. There is no better investment that governments can make than health care – and GPs are the public face of high-quality patient care.

41 Advocacy We believe the Australian Primary Care Physician is facing the greatest challenge ever now. There are many examples from other countries when they did not rise to the challenge general practice became a dying profession or a mere referral and prescription platform. We are being constantly challenged by Pharmacists, Nurse Practitioners and even certain other specialists. (Pharmacy led prescriptions is an example) Young GPs are being exploited by big corporates who puts profit before care. They are being forced to work for lower percentage seeing higher number of patients per day. This leads to significant reduction in quality of care and less confidence in people of their GP. Most of us still believe small family practices are the essence of primary care. But they are struggling to survive when facing giant corporates. When compared to other Specialist colleges, the majority of membership feels RACGP has less control over their training programme AGPT, which may need a touch of redesigning. Could each candidate please explain to members their plans and vision to these challenges.

Thanks for a great summary of many of the key issues facing our profession. Unfortunately I do not have the word space to address these concerns here and so ask that you go and read my candidate statement (available on my website https://www.drcharlottehespe.com/ ) listen to my podcast candidate Q&A and also read the AusDoc questions and answers published each day last week which address these issues.

42 Advocacy Why have AHPRA fees risen when for the most part the income of GPs has fallen and the cost of running a GP business has increased?

AHPRA fees are not linked in any way to the RACGP I do agree that it is increasingly hard for GP’s to survive financially since we have been starved by poor remuneration under Medicare rebates. Please see my previous responses to how as President I intend to advocate for increased funding into General Practice.

43 Advocacy Primary Health Networks offer tens of thousands of dollars to General

Practices to obtain patient clinical data. It is called QIPIP. Our PHN installs

software onto our computers to extract data. We have no oversight or

control. PHN contractors are supposed to de-identify the data. Has your

practice signed up for this Project? Does this Data extraction worry you?

What position should the RACGP have regarding this multimillion-dollar

National Government Project?

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Thank you for raising your concerns. I think it is really important that General Practice be able to demonstrate value through providing data to the policy writers. We should not be afraid to provide this de-identified data but be proud of our ability to provide cost effective health benefits. General Practice should be receiving increased levels of funding to maximise these benefits for Australians. As President I will continue to advocate that General Practices have choice about sharing data and with whom it is shared. Anyone that installs extraction tools on your system should provide complete oversight and control. I will add here that the Commonwealth Government (not PHNs) decided that PIPQI payments should be linked to the extraction of de-identified data. As RACGP President I would encourage all GP’s to share their data to assist the entire GP community in demonstrating to the benefits of investment in our sector.

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No Theme Question

44 Advocacy Characterising patients as "consumers" has eroded the doctor-patient

alliance, causing loss of respect for doctors, unrealistic expectations of care,

less patient responsibility for their health, more defensive practice, rising

complaints and an attitude by complaints authorities that doctors are guilty

until proven innocent. Will you promote abandoning the consumer model

restoring the concept of joint responsibility through the principle of the

doctor-patient alliance?

Thanks for posing this question and the role of terminology such as “consumer” versus “patient” in the role of improving health outcomes and doctor-patient relationships. As President I would be more than happy to have particular issue presented to the GP led Expert committee on Funding and Health System Reform and to ask them for an opinion regarding a solution based response.

45 Advocacy How do you propose to lobby government and make changes to the current

situation of GPs being forced to bulk bill certain Telehealth MBS items? The

government does not force specialists to do this, so why target the frontline

primary care physician? Imagine spending an hour of your time drawing up a

Mental Health Care Plan for a patient you are concerned about, putting

safety precautions in place to protect that patient and get paid all of $138

for your efforts.

As a Director on the Board I am aware that RACGP, under the leadership of Harry Nespolon, has been lobbying for this restriction to be removed since it was put in place in June 2020. This situation arose with no prior consultation with the RACGP. As President I would continue to strongly lobby to have this restriction lifted. This will be done in conjunction with the strategic plan to achieve increased funding into General Practice. This particular issue is a priority to be addressed! My strategy will be to go to the main media via Breakfast radio and TV as well as mainstream printed media to ensure we get good community coverage to support both ongoing rebates for Telehealth and cessation of enforced bulkbilling for GPs.

46 Climate Change

Do you feel the RACGP should play a more active role in Environmental health issues for the well-being and health of our patients? If so, how?

Yes, absolutely! In my role as RACGP Director I have been actively campaigning for RACGP to be a key leader in this space and we need to take this further. As President I can and will play a key role in continuing to promote Environmental health issues. It is important to know RACGP has a Specific interest network “Environmental Impacts in General Practice” active in this space

to promote a forum and network among RACGP members interested in

climate change and other environmental, advocate education and awareness on the impact of environmental policy on health to medical

students, general practice trainees and general practitioners in Australia establish links to support and promote the increased understanding of the adverse and beneficial impacts the environment and environments policies

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have health act as a resource point for the RACGP on environmental and climate change issues as they impact on general practice in Australia.

47 Climate Change

Climate change has been recognised as the greatest health challenge for the 21st century. How will you ensure that the GP workforce is prepared to face this challenge?

Please also see answers to qu 46,48,49,50,51 As Chair of the RACGP Board in 2019 I personally lobbied to get RACGP to officially endorse the WONCA statement on Planetary Health and sustainable environmental goals following up the excellent work that our SI group, played in developing this internationally relevant and timely statement (special thanks here go to Dr Tammra Warby and Dr Jess Kneebone ). I am very proud that endorsement was achieved and RACGP stands alongside international peers in agreement about these goals. (please refer to WONCA website for more details about WONCA https://www.globalfamilydoctor.com/Home.aspx ) As President I can now ensure RACGP follows this up with

1. Education of GPs and our patients 2. Lead in change in this area (The RACGP Board has already divested of

fossil fuels in their investment portfolio) 3. Advocacy – without influencing the policy makers we won’t be able

to effect greater change

48 Climate Change

COVID-19 has demonstrated the enormous disruption and health impacts caused by a global emergency. The climate emergency effects are arguably more profound. The catastrophic bush fires of 2019-2020 saw lives lost, communities destroyed and GPs put on the front line of action. How will you as RACGP president lead primary care to mitigate against, but also prepare for the impacts of climate change on the health of the Australian people?

Please also see answers to qu 46, 47, 49,50,51 If I become President I feel that the time is right for the RACGP to lead a Member based Forum/ Roundtable looking to specifically address these questions and provide some action statements for the General Practice community. The SI group would be invited to provide key input as well as all other interested GP members and key stakeholders. Questions should include (but are not comprehensive)

How do GP’s want the RACGP to respond? What measures does the evidence suggest we are best to prioritise? How can we best support GP members in these actions and tasks?

49 Climate Change

How can RACGP better prepare for and mitigate climate change, the public health threat of our time? What are our international responsibilities as communities face increasing frequency and severity of extreme weather events?"

Please also see answers to qu 46,47,48,50,51 As President I would oversee the RACGP actively promoting the SI group and assist in actioning the 3 key enablers:

1. Education of GPs and our patients 2. Lead in change in this area (The RACGP Board has already divested of

fossil fuels in their investment portfolio) 3. Advocacy – without influencing the policy makers we won’t be able

to effect greater change

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50 Climate Change

Climate change has been recognised as the greatest health challenge for the 21st century. How will you ensure that the general practice workforce is prepared to face this challenge?

Please also see answers to qu 46, 47,48,49,51 RACGP can play a key role to assist in responding to this health challenge by really promoting the key information to members and assisting them in having the tools to action appropriate personalised plans. As President I would ensure that the RACGP oversee

1. Education of GPs and our patients 2. Encourage each Member to personally lead in change in this area (The

RACGP Board has already divested of fossil fuels in their investment portfolio)

3. Advocacy – Encouraging every member to join in the advocacy campaigns, without influencing the policy makers we won’t be able to effect greater change

51 Climate Change

Congratulations to each of the candidates and I wish you all the very best in the upcoming presidential elections. There is a growing body of scientific evidence demonstrating pollution, such as air pollution, impacts human health. This includes the health of our patients. What role does the RACGP play and what can you do to help address this global issue?

Thank you. Please also see answers to qu 46,47,48,49,50 In 2019 I played a key role in having the RACGP, officially endorse the WONCA Statement on Planetary Health and sustainable environmental goals As President I will take seriously my responsibility and role in ensuring that RACGP continues to action a plan to assist GP members, their practices and their communities also play a role as leaders in this space.

52 Issue Specific Obesity societies globally recognize obesity as a chronic Progressive disease. Why has the RACGP been the only learned medical college in Australia to reverse the unanimous vote of the college presidents? I know the reason. A total lack knowledge of this disease process within college academic circles. Weight stigma is pervasive and without addressing it we cannot progress prevention and management of this global pandemic. How will you address this?

I apologise but I am unable to address your first statement as I am unaware of this vote. If I become President I would be happy to investigate further. I will however, address the core issues you have raised about the serious health threat played by Obesity. The RACGP Obesity position statement recognises that obesity is one of the most important health issues facing Australia and affects the health, wellbeing and productivity of many Australians. As President I would work to ensure the RACGP proactively supports addressing Obesity through improved funding of effective and evidence-based services and therapies including

1. Education and support around “obesity” – including the key issue of stigmatisation

2. Encourage a multi-dimensional approach to developing solutions 3. Call out and openly address social determinants of health and

inequity as being key issues behind increase in obesity

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53 Issue Specific How do you see the RACGP and ACRRM working better together into the future that respects rural and city based GP practice really are different?

Great question, thank you. As RACGP President I would be a key influencer in establishing open and collaborative discussions. Key to this is establishing improved Relationship / Respect / Trust between our 2 GP organisations. My personal dream is that we can both put historical differences aside to focus on achieving long term sustainability for General Practice throughout Australia –for the GP and the Rural Generalist. Ultimately we really need to focus on our similarities rather than the differences and work together to achieve the much needed funding to support our wonderful specialty. Divided we will potentially lose this funding. United, we have a real opportunity to achieve WINS for both Colleges. So, this is the goal – as President I will focus on what we both want and use this as the crucial stepping stone to achieving a united approach to advocacy and funding for GP going forwards.

No Theme Question

54 Issue Specific What is the first issue you will work on once you are elected?

Please refer to my first 100 days plan for detail about how I intend to launch my role as RACGP President. This detailed plan has been put together to enable me to address key issues immediately and establish a foundation for the next 2 years of solid advocacy and achievement of wins for General Practice and the Australian community. Front and of utmost importance is to achieve continued funding for Telehealth and removal of enforced bulkbilling. However, as President I want to also ensure that I come to Advocacy with policy that is strongly supported by the RACGP Board and the CEO, as well as you, the members. This means it is crucial that I immediately establish a communications strategy with the CEO and Faculties to facilitate long term improved member engagement and input into policy and advocacy.

55 Issue Specific The barriers to implementing fax-free General Practice appears to be politically driven. There is a lot of commercial interests that act as a barrier (companies already invested money in various platforms). They lobby for an ongoing profit stream. Already implemented, government funded platforms such as CDA/My Health Record platform can be a "not-for-profit" alternative. This supports the HL7 standards and CDA used for interactions between providers. Could each candidate provide a specific, measurable, achievable, relevant, and time-bound policy in collaboration with non-GP specialists to implement a Fax-free workplace by the end of your term? Let's start with provider-provider communications.

Thanks for this very specific but operational question. As President I will strongly support the goal to eliminate the use of fax and implement more secure communications platforms- aiming for Improved Patient safety and high quality care. I am personally passionate about this issue and as such have been actively advocating for changes (locally with my LHD and nationally with ADHA and CSIRO).

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As RACGP President I will lobby for this work to be prioritised by States and Federal departments. I will also consider calling on GP members to set a date after which time we refuse to use the fax as the means to communicate. Maybe we could call it End-of-Fax day! Although this might sound farfetched, often “unionised” action forces responses that otherwise seem too hard to achieve. We have seen COVID19 achieve this for us in the provision of Telehealth rebates in 2020.

56 Issue Specific General practice research, led by GPs, can help to generate the evidence that can be used to guide the development of our profession and the models of care in which we work. I would like to ask the candidates their (a) vision for building the academic general practice workforce, (b) how to engage and enable clinical GPs to generate research questions and participate in research and (3) how we can facilitate a network of practice based research networks across the country.

Thank you for this question. I am passionate about Research and the key role it plays in providing relevant EBM guidelines and government policy/funding decisions. I have already achieved wins for Research as RACGP Director – inclusion in Strategic plan, governance review of RACGP Foundation, prioritisation future fund raising and achieving flexibility for GP Academic terms (but more is needed). As President I would continue this work.

a) Enable more GPiTs to participate in Academic terms with increased flexibility in the training pathway – particularly for part-timers.

b) Clinical GPs need research to be “easy” and not interfere with business as usual. GP projects should be funded to provide extra clinical support and adequate remuneration to compensate for practice time and resources. Clinical GPs should also have access to “Research Made Easy” packages

c) Partner with Practice Based Research Networks (financially and administratively) throughout Australia (preferably along with AAAPC)

57 Issue Specific In what ways do you believe social media realistically and potentially hurts and harms our profession and how can the RACGP do it better?

Thank you for this question. The RACGP and Board have long been acutely aware of both risks and benefits from engaging in social media. The RACGP has therefore already developed some excellent resources to assist members safely navigate the world of social media. Please follow the link to see and potentially make use of these resources. As President I would be in a position to ask management have Social media on our Risk framework reporting schedule so that the Board would be asked to review the policy if new risks or harms arose as part of our member engagement strategy. As in all things, we can always do better so if you have any concerns about current social media or suggestions for improvement or extra resources please let RACGP staff or myself know.

58 Issue Specific I want representation for AMDS GPs. I feel like we have been sidelined as if we are not college trainees/not working towards the fellowship.

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If the criticism is for the doctors who come from different specialities and work in AMDS then maybe this should be brought up at higher level to restrict those doctors from working in an after hours setup.

Thank you for this comment and request. As President I would actively encourage and support you in setting up a Specific Network within our Faculty of Specific Interests to both provide a Forum for you to socially network but also a forum to raise issues and solutions to address the problems. The RACGP has long recognised that many GPs develop interest in specific areas of general practice throughout their career. It values these specific skills and experience through the endorsed groups of RACGP Specific Interests. The faculty currently has 31 specific interest subject areas to join. These provide the opportunity to share information and knowledge by regular contact. Membership is open to all RACGP members. The FSI Manager will be able to let you know the process for starting up a new group.

59 Issue Specific Will you support the new President if you are not successful? Loyalty?

What a great question – thank you for asking. I put up my hand to be President because I am a passionate GP who wants to Champion WINS for achieving a sustainable workforce! I have been NSW/ACT Faculty Chair since 2017 (Vice President in 2017/18, Chair of Board in 2018/19, Chair Remuneration and Nominations committee leading the selection process of our CEO). I put my hand up as I could see there is lots to be done and rather than sit back and complain I am able to use skills acquired over my 20 years of GP leadership roles! If I am not successful I will be obviously be disappointed – but my goal is not about me. It is about us, RACGP Membership – and the need to achieve guaranteed sustainability. So yes, I will support whoever is appointed President. Now is the time for respectful leadership, unity and collaboration.

60 Issue Specific If you are NOT successful in your presidential campaign, how will you continue to demonstrate your commitment to the values and aims you have highlighted in your campaign?

Please see answer to qu 59. If not successful in the President campaign I will continue in my role as a Board Director as continuing Chair, NSW/ACT Faculty (my current elected position has 12 months to run). I will continue to work passionately towards achieving all of the goals that I have outlined in my campaign – but as a Director and member of the RACGP Board rather than as President. In particular I will continue to oversee vCOP (virtual community of Practice) for lead GPs across NSW/ACT - set up under my leadership in response to the COVID19 disaster. It uses a virtual communication platform to

a) enable clinical GPs to have better access to NSW Health and b) enable NSW Health to have better access to Clinical GP feedback and

solutions c) Provide a social network for all the GP leaders across our state and

territory.

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