Question of the week:

Who Owns General Practice?

Do GP’s own General Practice? Do non-practice-owners own General Practice? Do practice-owners own General Practice?

Do non-GP’s own General Practice? Can General Practice be bought and sold? Does it matter?

Who owns General Practice?

I’ve realised that my reason for entering this campaign was a concern that we are asking the wrong questions about our role and our future. Unless we address some fundamental issues we will spend all our time and energy trying to answer the wrong questions. Not necessarily unimportant questions (like funding and role boundaries) but not the ones which will define our future. And we risk losing focus on the larger threats to General Practice. So, how about a new question for the week (or longer)?

Why does it matter who owns General Practice?

At the heart of our role as doctors, and the source of our authority as impartial advocates for health, is our commitment to pretty high ethical values. Most of us pledged to uphold the Declaration of Geneva or some variant, which states:

“I solemnly pledge to dedicate my life to the service of humanity; The health and well-being of my patient will be my first consideration …”

The key questions we ask, as GP’s who believe in primary care and our role within it, should therefore address how we can hold ourselves to these pledges and identify the key threats to our ability to do so.

My campaign so far has identified a collection of wider world threats to our ability to uphold our pledges. And I’ve proposed as a key action that we fairly radically democratise our College, identifying that the College would be strengthened by a broader and deeper input from members. This would allow it to take a more courageous stand on key issues in a world becoming increasingly unstable and increasingly unsupportive of GP’s continuing to act in service to humanity and its wellbeing.

Why is this question of the week?

I’m still wondering about some of the issues I initially thought to be important and would love to get questions and suggestions on them. And then earlier this week, near the end of a batch of quite long candidate questions forwarded via the College was this fine example of brevity (kudos to the anonymous questioner):

“Can you please tell us about your past and current associations with industry and pharmaceutical companies?”*

Now, I suspect the member may not have meant me to interpret the question so broadly but it made me wonder: what do we mean by industry? What does “industry” include? Is General Practice just another “industry”? If an insurance company or private equity firm buys up some general practices (15% or more of practices so far), are they buying General Practice? Will the interests of these owners allow GP’s to continue to be GP’s? Will we be permitted to speak out on funding or practice ownership? Or on women’s health? Or treatment of vulnerable groups? Or Palestine? Sudan? Ukraine? Climate change? Democracy?

As contractors, do the vast majority of GP’s have any security of employment if they speak out or refuse to follow practice policy? What if the practice owner is no longer a dedicated and ethical local GP but a distant insurance company? A company seeking to maintain good relations with whatever government is in power. Perhaps a government which is intent on waging war, criminalising abortion, ignoring indigenous history, or deporting colleagues of the wrong colour or background?

GP’s are currently expressing a lot of fear of being controlled by the government through Medicare or erosion of our role. But would we be better off working for a corporation? And how much freedom to truly advocate for our patients do we now have if we are contractors or salaried employees? They say you don’t know you are on a chain until you reach it’s limits. How long is your chain?

The College has made considered comment on this in the recent past, most notably after the acquisition by BUPA and Medibank of large existing practice groups to add to their already sizable presence in the GP practice world. And there has been some coverage in the medical press. How far will the College go in opposing this drift to corporatisation and non-GP practice ownership? Should it? Would this be a conflict of interest for those GP’s who currently own practices on which corporate offers might be made?

I don’t know the answers to these questions but they need to be asked. The College President can only ask questions and persuade the Board - the role has no power to create policy or advocate outside Board approval. But I believe a more democratic College might empower our Board to ask the hard questions and make a stand for the future of all its members in their service to humanity.

• In the 1980’s or thereabouts I worked for a company which made its money from selling research to pharmaceutical companies, and in this job I also edited some publications which relied on pharmaceutical advertising. Since then I haven’t knowingly attended events sponsored by pharmaceutical companies, eaten any lunches paid for by pharmaceutical companies, accepted meetings with pharmaceutical sales reps, taken any branded items from pharmaceutical companies, or received speaking fees or travel/accommodation from pharmaceutical companies. And I’ve still managed to attend CPD, feed myself, outfit my office, and take holidays. There are many fine folk working for pharmaceutical companies and they produce some useful stuff, but I wouldn’t feel comfortable if one of my patients were sitting with me as I accepted offers which were designed to influence my impartiality. But that’s just my take on things.