We all say we want unity in the profession. I wonder, though, if what we really want is “Unity around the positions I hold”!
Disunity makes us all uncomfortable, as well as making it easy to ignore us in policy development. However, our desire for unity is not absolute. There are many positions which I might hold that the profession would not unite around, even though I think they should. (Compulsory cultural safety training, anyone? That the profession should do more on climate change?)
We need to be aware of the history of our organisations, and how we’ve reached where we are, and then be aware of the constituency each organisation brings along. I’ll leave others to define what those are.
We need to remember the diversity of GPs. At the moment the only categories we have are rural or urban; corporate or small business. I, for one, don’t know where I fit in there. Fundamentally GPs are doctors of place. We are immersed in our communities, which is why we are diverse. Yeundumu is different to Wagga. Even in urban general practice in Sydney, Pymble is different to Bondi is different to Fairfield is different to Campbelltown. Katoomba and Bowral are unique! Each place where you find a GP, you will find a GP who knows the local community and its geography.
I suspect unity, if we achieved it, may be meaningless. Collaboration, though, is priceless. Each organisation can bring their unique constituencies to bear on complex problems. The one thing I think we want to do is to improve patient care. I’d suggest that this is most urgent among our communities with the least resources, over-represented in rural communities and Aboriginal and Torres Strait Islander people, but not uniquely so. Often doctors are the only people with a voice that is listened to in these communities, and we should advocate on their behalf.
We would all agree – and have evidence to show – that high quality primary care, with generalist physicians – improves equity and improves health.
Collaboration, though, like unity, is only comfortable in the abstract. The process can be a bit messy, and involves compromise and discomfort. It’s as if we are all in separate little dinghies on the sea, and we all need to get in the same boat. If there is no rocking the boat, we will get nowhere. But if there is too much rocking the boat, we get thrown overboard.
Here’s to a better health system, and interesting times ahead.