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General Practice Reviewing its Business Model

I enjoyed the Rural GPs' Conference in Wellington this past weekend. Much of the content was aimed at professional clinicians and out of my league - much as I might have appreciated some inside knowledge of the latest treatments for gout!

But as always the real value was in the corridor conversations and a couple of stand-out sessions.

The most interesting session by far was from John Macaskill Smith, CEO of the Midlands Health Network based in Hamilton. John is always good value, being in the vanguard of setting up Integrated Family Health Centres in New Zealand. He spent several months last year attached to the Nuffield Trust in the UK and said he was appalled at the state of the British health system.

The sub-text of John's presentation was about the need to accelerate change in health service delivery. He noted that every GP practice sees itself as "different."

He got me thinking. As part of the aging population, my generation failed to comprehend in our youth that we were going to live - and work - for a whole lot longer. Even now we still see the GP as a place we go episodically when we are sick, rather than regularly to stay well. We aren't into preventive maintenance on our bodies in the way we are on our homes and cars.

That has to change - the health system just won't be able to cope with the grey tsunami otherwise.

I even started to wonder whether today's general practice is the right institution for the maintenance of wellness. Returning to the vehicle analogy, we go to a garage for repairs and a testing station for our warrants of fitness - two entirely different services and business models. Maybe there's a lesson there - if I want a preventive maintenance checkup a nurse, rather than a doctor, may be the best port of call.

With GPs in New Zealand having an average age well into their 50s, something has to give. Devolution of the more straightforward functions is an obvious example. I sensed at the conference that nurses are ready to pick up the challenge. But sadly I wonder whether the doctors are ready to cede some of the control. In time there will be no option.

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