An enviable starting position
Gold Coast residents enjoy some of the best health care facilities not just in Australia but also globally. The city boasts a network of more than 830 general practitioners in 205 general practices who are supported by secondary and tertiary health services across three high-level public hospital facilities and some four large private hospitals.
A focused approach to continued investment and improvement by private and public players has seen the Gold Coast achieve positive health outcomes that are just as much a draw for potential interstate migrants as the sun and sand that the city is famous for. Exhibits 1 and 2 show that the Gold Coast has achieved six years of improved life expectancy metrics and today has an average lifespan better than six of the eight Australian states. If the Gold Coast were a country, it would have the 13th highest lifespan globally, beating out the UK, Canada, Germany and New Zealand.
Supporting such outcomes is of course a substantial undertaking. Healthcare is the Gold Coast’s largest sector employing some 44,000 locals which represents some 14.5% of the city’s total workforce. This sector is also one of the fastest growing – in just five years, since 2015, it has added some 10,000 additional jobs reflecting an annual growth rate of nearly 6%.
Strong headwinds ahead
Notwithstanding an advanced starting position, the Gold Coast faces strong headwinds with respect to primary healthcare, resulting from a forecast spike in demand over the next decade. This is being driven not only by demographic trends of strong interstate migration and greying of the local population (see Barcley’s report Gold Coast 2030), but also by an increased tendency for people to visit their GP. Over the last 10 years, the average person has gone from visiting their GP 5.3 times per year to today visiting them around 6.3 times per year. On the Gold Coast the percentage of adults who reported seeing an GP in the last 12 months has increased from 74.3% in 2013 to 79.5% today; moreover, this number is likely to continue to increase trending to the Australian average of 83.2%. Such demand side pressure is likely to mean that the Gold Coast Health System will need to maintain its historic growth rate of 5 – 6% just to keep up. Unfortunately, financial, infrastructure and staffing limitations are likely to make such supply side growth unfeasible, meaning that increased demand will instead need to be addressed through improved efficiency and asset utilisation.
Beyond demand challenges, industry players will need to consciously address lingering performance gaps. Whilst the Gold Coast typically performs better than the national average across standard KPIs, there remains a significant gap between customer expectations and current industry performance. The largest gaps in primary care are unsurprisingly around the GP – Client experience. Nationally, patients report that nearly one quarter of doctors don’t always spend enough time with patients and do not always carefully listen to their patients.[1]
In addition to quality of patient care, availability of primary care still requires attention, particularly as efforts increase to use primary care to take pressure off the hospital system. For normal matters, some 19% of patients nationally report that they waited longer than they felt acceptable to get an appointment with a doctor. [2]
Transformative change is required
The continued building of robust primary care infrastructure is at the core of responding to the city’s healthcare challenges. Whilst primary care only directly accounts for around one third of total health care spending, it is estimated that general practitioners influence up to 80% of healthcare system costs. General practitioners also play a crucial role in empowering patients and delivering more responsive, more proactive and better coordinated care. We consider that preparing for the future of primary care in the Gold Coast will likely require three transformative changes.
Overdue industry consolidation
Today, the Gold Coast has an average of just 4.3 doctors per practice. Large corporate ownership remains highly limited and is estimated at less than 15% nationwide. Ownership remains primarily private with one or more GPs owning and operating small single or multidoctor surgeries.
Unfortunately, smaller practices will find it increasingly difficult to compete with larger firms and rising customer expectations. Whilst generation X-ers valued the one-to-one relationship offered by their neighbourhood GP, today’s millennials have more complex requirements, demanding the possibility to access a primary care provider at the time of their choosing, through a contact channel of their choosing and all enabled by seamless access to their medical data. These are changes which have already taken place in most customer-focused industries including banking, government services and telecommunications, but which still lag in primary care.
Twenty-somethings correctly question why they can lodge a centreline claim, take out a home loan and buy a car all from convenience of their smartphone but that simple prescriptions still require laborious visits to a neighbourhood GP. However, transforming the complete patient-user experience is an expensive process, well beyond the resources of a one-doctor GP practice.
Telemedicine is a prime example, designed to provide 24/7 access to general practitioners and seamless connections to specialist providers; however, its implementation will heavily favour larger practices. It is these practices that have the depth as well as breadth of medical staff to fulfil the promise of the technology. Equally, it is only larger practices that will be able to justify the required investments in IT infrastructure, staff retraining as well as customer marketing and education.
We expect the gradual corporatization of GPs not only for the necessity of realizing economies of scale, but equally due to demographical imperatives – RACGP data suggests that 83% of practice owners are over 45 years old and that the next generation of doctors have limited interest in taking over from them when these practices begin to be put on the market as baby boomers retire. With this in mind, corporate chains and private equity will take an increasing interest in what is a profitable and growing segment. Equally likely is the continued rise of the mid-sized ‘consolidated’ practice, which sees a handful of GPs co-located with other health care professionals. These practices allow for some of the same economies of scale enjoyed by the corporate chains, while at the same time offering their owners passive income streams; for example, the revenue generated by employed GPs and the rent paid by co-located health care professionals.
Unapologetic focus on mental health
The layman observer surveying any full GP’s waiting room quickly assumes it would be crowded primarily by patients complaining of colds and flus along with some chronic illnesses and of course the odd sporting injury. They would be wrong. Psychological issues, including depression, anxiety and sleep disorders remain the most commonly seen presentations in general practice, with 64% of GPs reporting mental health in their most common reasons for patient presentations. Indeed, a staggering 22% of young Australians aged 18 – 24 report experiencing severe psychological distress, a figure that has increased 57% in just 3 years. Of those seeking mental health support from a GP, 6 in 10 are prescribed medication; 3 in 10 receive some counselling, education or advice; and only 2 in 10 receive a referral to a psychologist or a psychiatrist.
Unsurprisingly, this is an area where there is broad recognition that greater efforts are required. Almost a third of GPs cite mental health as an area to be prioritized by the local government. This was highlighted by the Productivity Commission’s long-awaited Mental Health Inquiry Report issued in 2020, which calls for a $2.6 billion overhaul of the system, estimating the total cost of poor mental health and suicide to be as much as $70 billion per year.
Moving forward, mental health is likely to become a central focus for primary care providers as health authorities, governments and society increasingly recognise its central importance within the healthcare system. This may mean that some GP practitioners should consider developing and marketing a mental health capability, in the same way that skin centres, family medicine and women’s health have been used as marketing tools over the past decade. We also anticipate a shift in how GPs prioritise treatment where patients present with multiple physical and mental health problems. Whilst historically incentives have favoured addressing straightforward physical conditions as the primary indication, there is an increasing recognition of importance of early intervention in mental health indications regardless of their complexity.
Finally, there have been strong cases put forward for the creation of increased numbers of multidisciplinary GP practices thereby providing access to psychotherapeutic and psychiatric expertise including case-discussion training involving local networks of GPs and MD specialists.
Technology as the key enabler
With the Fourth Industrial Revolution underway, we live in a world where artificial intelligence, blockchain, data, robotics and digital represent the greatest opportunities for GPs to meaningfully improve the outcomes for their patients and increase the efficiency and profitability of their practice.
Technology has, over the last decade, been the major catalyst for better clinical workflows and administration. This is likely to continue as the role of a physician is increasingly centred on creating a human connection with the patient, with the intention of influencing the key drivers of health. Today, it is estimated that 30% of the work being done by physicians can be performed by non-physicians and that 18% can be automated. Advanced backend systems and digital interfaces are automating mundane GP tasks such as clinical documentation, coding for billing, quality reporting and patient scheduling.
Beyond productivity, technology offers the ability for doctors to make better decisions about patient interventions. The next generation of technology will provide doctors pre-analysed, integrated data at a level of detail never considered possible. Data integration software will be able to generate insights using clinical, genomic and behavioural data and cross-match this with consumption as well as environmental data. This new level of information will remove large amounts of uncertainty which today can often only be addressed through diagnostic tests. Moreover, AI will have the ability to sift through these vast quantities of data and deliver to the GP’s desktop only information that is pertinent to a patient’s treatment plan. Beyond solely data, AI will enable more sophisticated decision support taking into account the most up-to-date research and evidence based information even on a real-time basis.
Finally, digital will allow doctors to influence patient actions through micro-triggers. Algorithm or behaviour generated triggers would allow follow-up on a patient who is yet to fill a script or who has abnormal biometrics; providing new and sustainable ways doctors can undertake proactive and preventative patient management.
Conclusion
Gold Coasters benefit from an enviable healthcare and primary healthcare system which supports a world-class quality of life. However, demand pressure and rising customer expectations mean that the sector will require significant change if it is to meet the rising bar. Central to sector change will be structural consolidation permitting greater investment and innovation at a practice level. Much of this will be enabled by new technologies which promise both better patient outcomes and practice profitability. Equally, GPs will need to adjust their service offering to better align with patient presentations – this will mean a greater emphasis on mental health.
About the author
Luke Ingles is the Managing Partner of Barcley Consulting, a boutique strategy consulting firm located on the Gold Coast. For more information, contact one of our business advisors on the Gold Coast or email luke@barcley.com.au
[1] RACGP
[2] ABS Patient Experiences in Australia
