Rural GP Ewen McPhee is overworked.
So are many of his colleagues and for some, it's become too much.
"I'm seeing general practices closing almost daily around me now and [patients] that I've never seen before coming hundreds of kilometres to see me because there is no doctor," Dr McPhee said.
In fact, the odds of being able to see your GP quickly in parts of rural or remote Australia can be slim.
That's certainly the case for people trying to see Dr McPhee, who is based the Queensland town of Emerald.
"A routine appointment for me takes three months to get in," he said.
"We have major issues with access, major issues with chronic disease management."
It's a situation that worries Dr McPhee, who wants to see a major shift in focus and investment towards primary healthcare, in order to prevent chronic disease and keep people out of hospital.
That aligns with the findings of a new report released by the Grattan Institute, which says Medicare no longer works for patients or for doctors, and suggests the universal healthcare system needs a drastic revamp.
It suggests overhauling not only the way general practitioners work but also how they get paid.
The changes Grattan wants to see include more support for team-based chronic disease care and funding matched with community need.
That would mean investing more resources into communities where there are poorer health outcomes.
'Primary healthcare is in crisis'
Earlier this year, Federal Health Minister Mark Butler said primary healthcare was "in crisis in Australia", and announced the establishment of a Strengthening Medicare Taskforce.
The government also set aside around $250 million a year to fix Medicare.
Peter Braedon is the health and aged care program director at the Grattan Institute and he hopes the report will influence how the government spends that money.
He said one thing is obvious.
"It's pretty clear that a system that was built 40 years ago actually needs major updating," he said.
He's worried about inequity and the problems poorer people and those in regional and rural areas face in trying to access healthcare, as well as the burnout experienced by GPs who deal with marginalised patients with more complex health needs.
"In Australia, the poorest neighbourhoods report twice the level of psychological distress and mental health concerns compared to the wealthiest areas," he said.
"But, compared to the wealthiest areas they have half the level of Medicare funded allied health."
The report says doctors are actively rewarded for seeing lots of patients in quick succession, rather than spending time with those who have more complex needs.
"GPs are still doing the same consultations that average 15 minutes, but they're trying to cram more and more people with more diseases, mental health concerns."
Mr Braedon would rather see Australia adopt models that are seen overseas where GPs are supported by clinicians, like nurses and physiotherapists, and together they provide a more holistic approach to healthcare.
That approach, he said, would help to reduce the burden of chronic disease across the community and lead to a better quality of life for patients.
"Overseas you see that GPs have a whole team around them to help them share this care and provide early access and the best possible care to patients.
"But here GPs are largely forced to go it alone — it rewards speed instead of need.
"It's not adjusted to how complex patients are to treat [so] it actually blocks team-based care, as do many regulations."
The other main recommendation is for governments to provide general practices with greater clarity about the goals it expects them to work towards, and to provide GPs with the support to achieve them.
Funding a healthcare team, rather than doctors
Grattan suggests Primary Health Networks (PHNs) should play a greater role in achieving outcomes, such as creating team-based models.
The report says PHNs should be in charge of distributing a large part of the funding being set aside to fix general practice.
That suggestion is strongly opposed by the Royal Australian College of General Practitioners (RACGP), which is the major body representing GPs.
RACGP president Dr Nicole Higgins said the idea would put "another layer of government in there with the PHNs, which are the very large bureaucratic entities and not nationally consistent".
She said PHNs have "variable relationships with the GP on the ground and we'd like to see that money directly given to the GP and their patients".
"What they're suggesting in the Grattan report is we're going to have funding, like a block of funding, and that will go to a team," she said.
"There's no clarity about how that will work, there's no clarity about will that get increased.
"Do we end up with a system like the UK where you have doctors and their teams actually having to do a lot more for less, at the expense of patient care?"
She also worries that increasing the use of clinicians could have negative flow on effects.
"I became a GP to have continuity of care and have that long longitudinal relationship with patients and I'm a little concerned that this may lead to some fragmentation of care," she said.
The federal health minister has been provided with a copy of the report, but the minister was not available to comment on it.
But Mr Braedon from the Grattan Institute hopes the government will consider the report, as it moves to fix the nation's health system.
