The Covid-19 crisis in Australia highlighted major structural problems around general practice as it is currently funded and organised in Australia. The vocation of many GPs is admirable and honourable — but we need to be clear-eyed about how general practice is currently working https://twitter.com/engagedpractx/status/1266264211757256707

General practice is a quasi-market — created by government funding, regulated via accreditation and quality standards and funding rules, prices set by Medicare — so most GPs are small businesses or contractors. That introduces certain problems...

The main problem with quasi-markets is the incredible difficulty of steering the market in the direction of socially desirable outcomes. You can change the rules and hope they incentivise change in the right direction. Or you can just directly pay for provision.

In that environment, instead of the market of providers pulling together to execute a public strategy — and let's be real, it's hard enough getting public services to do that — we get calculative rationality, an 'if you want that, you have to pay me to do that' mentality.

This thread started with my response to @timsenior's tweet saying that GP should be included in any funded strategy to improve access to mental health services.

Based on my professional and personal experience... I would rather see money for community MH services.

GPs can manage MH up to a point. The reason they manage such a large proportion of mental illness is because of the missing middle — the public outpatient mental health service sector is desperately underfunded. There's a chasm between GP and public hospital inpatient care.

What that means, in practice, is if you're too unwell to be managed by a GP, you need more support than ten sessions on an MHCP, but you're not actively suicidal or a risk to others, you're out of luck, unless you can afford to pay for private psychiatry and counselling.