Irrigating the garden of general practice

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Spring has sprung with an abundance of fragrant blossoms, buzzing bees and warmer weather. Inspired by nature, my family felt the time was right to invest in a rainwater irrigation system. I was convinced that it would be a quick, easy, cheap and enjoyable DIY project with lots of opportunities to acquire valuable new knowledge and skills.

As with most improvement projects, including those in healthcare, the ‘lived experience’ of the ‘implementers’ did not quite match the rosy expectations of the policy makers. However, extending the timelines and scope of the project did provide me with ample opportunities for reflection, and I would like to share a little of what I learned about two types of irrigation systems, and the unexpected analogy with general practice.

The first type is Spray Irrigation. Sprayers are easy to install and produce satisfying, sashaying splashes of water over large areas of the garden. They can be wasteful, there are often mismatches between the supply of water and requirements of individual plants, and water distribution is affected by the wind. Plants like roses like to have dry leaves and suffer regular outbreaks of fungus from indiscriminate spraying.

The second type is Drip Irrigation. Drip irrigation requires considerably more effort to install and you hardly notice when the water flows through the system. The tubing for each dropper needs to be cut and assembled according to the distance between the plant and the main water line. Droppers must be positioned close to the roots of the plants and are susceptible to blockages unless they are individually stalked. However, the extra investments of time, effort and resources in drip irrigation is rewarded handsomely by efficient use of our scarce water supply and flourishing plants.

Many healthcare policies and some secondary care services are like Spray Irrigation systems. They are aimed at large patient populations, are often widely promoted, and undoubtedly have some impact. However, they seldom deliver fully on expectations and require considerable and ongoing investments of resources and effort. The Institute for Healthcare Improvement (IHI) coined the apt phrase ‘spray and pray’ to describe this type of approach.

General practice, on the other hand, is like a drip irrigation system. Care is tailored to the unique needs of individual patients in a quiet and efficient manner. In contrast to ‘spray and pray’, we provide ‘drip on demand’ care.

In our garden we installed both types of irrigation systems, selecting either sprayer or dripper according to the needs of different plants. The two systems are supplied from the same water tank and operate in tandem. However, from a distance, it is mainly the sprayers that draw the eye.

The Australian healthcare system is one garden with two irrigation systems. The distinction between State and Commonwealth funding is an accounting sleight-of-hand to obfuscate the fact that primary and secondary care share the responsibility and privilege of caring for the same consumers and communities.

For too long, the contributions of general practice have been overshadowed and undervalued. As we enter a metaphorical period of financial drought, it is an opportune time to strongly advocate for additional investment in the irrigation system of general practice.

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