SPEAKER_00 0:07

Hello and welcome to our discussion about inside general practice in Australia. I'm Katie White, I'm the Chief Operating Officer of Cornerstone Health, and I'm joined by Henry Bateman, CEO and founder of Cornerstone Health. Henry, welcome.

SPEAKER_01 0:19

Thanks, Katie.

SPEAKER_00 0:20

Today we're going to talk about the future of primary care in Australia. When we talk about primary care, we're often talking about who has access to it, what services do they have access to, and often we're also talking about the availability of GPs. That's all those factors are constantly in flux. When you set up Cornerstone Health 10 years ago now, what were the what were the key factors that you were trying to address?

SPEAKER_01 0:46

From my perspective, as I've said before, general practitioners spend a lot of time professionally trained to become what, become physicians and general practitioners. There's a lot of effort and time that goes into it. And often my experience was they get caught doing the thing they're not trained to do, running a business, administration, tax, accounting, IT issues, landlord issues, things that they're not specifically trained for. They're smart people, they can figure it out. But what they're better to do is to focus on delivering high quality care with a team behind them supporting them to deliver that care. So professional operators running their business for them, which is us, really frees them up to deliver quality care to their patients and focus on the things that they've spent a lifetime training for.

SPEAKER_00 1:32

Yeah. I mean most doctors want to see patients not do paperwork, right?

SPEAKER_01 1:35

Absolutely. And then and it's sort of a core for source of frustration. In other words, doing things that are not clinical care when that's what you're trained to do. I I totally understand why that causes frustration amongst medical professionals.

SPEAKER_00 1:47

Yeah. And that would have only increased in the last decade since you first set up Cornerstone Health.

SPEAKER_01 1:51

Yeah, absolutely. I mean, I think doctors carry a disproportionate burden of from an administrative perspective in the healthcare system. I think they are really relied upon by specialist hospitals and everybody to do a an administrative chunk of work. Um, whatever we can do to support them to reduce that administrative aspect and focus on clinical care, that's what we do.

SPEAKER_00 2:12

What other factor has changed the most in the last 10 years for you in terms of primary care?

SPEAKER_01 2:16

Um I think the challenge forever has been uh not enough general practitioners that to provide care that's needed across Australia. Um, Australia's a wealthy country. Um I think access to primary care Bok build is a fundamental right for Australians. We're we're heavily taxed, you could argue. We can afford to deliver primary care Bok build. Um, if there's not enough GP to deliver that care, that becomes a pinch point for access to patients. Um when I started 10 years ago, it was becoming particularly acute. More recently, they've opened the the gates to overseas train GPs, which has been great for the Australian community. I felt a little conflicted by it personally. In other words, some really great healthcare professionals are coming from overseas. They were trained by countries overseas, and now they're losing their talent to us. Um, however, that that constraint is sort of seems to be lifting, and I think that's a positive for the Australian for Australians. I'm not so sure about the countries that they're coming from, but we'll be missing their great professionals.

SPEAKER_00 3:20

Yeah. We've certainly got some great overseas trained doctors in our network.

SPEAKER_01 3:24

Yep.

SPEAKER_00 3:25

Um, the the issue of not having enough GPs in Australia is a complex problem. And Cornerstone Health was actually one of the we we were um one of the pioneers, I guess, in trying to really quantify how the size of the problem, particularly as you look into the future and you see our aging population with the Cornerstone Health GP Workforce Report, I think the first edition was um released in 2019. So I do think um calling attention to that issue has has gone a long way in terms of starting to think about ways that we can address it. The intro the access to more overseas trained doctors is certainly happening in the short term. Is there anything else you think we could do in the medium to long term to help with this issue?

SPEAKER_01 4:10

I I'm a passionate advocate for we should be training our own GPs and giving access and opportunities to our own students who I think are clever enough and hardworking enough to become general practitioners. Um, you know, a lot of GPs I talk to have aspirations for their children to go into medicine. And when they get 98 ATAR, which is a fantastic result, and still can't get access to becoming a general practitioner or a doctor, I think I think something's not quite right there, and intuitively that doesn't feel right to me. In other words, that seems like a pinch point for enabling access for lots of really keen students to become great doctors. Um, I have nieces and nephews who would have loved to who would who are at university now and love to become doctors. They've now been taken other paths because they're just too hard to access. So I I think we need to open uh the access to medicine as a as a subject for for students to ensure that we have this our own supply of GPs. Obviously, supported by overseas trained doctors is is helpful, but I think that needs to be a medium to longer term focus for us as a nation. Um the study we did with Deloitte's called into issue. There was uh a decreasing supply of GPs in in an increasing need environment. And federal government started to cite our report, which was pleasing. They're now doing their own report, which is even more pleasing because I think they're the ones who should be driving this agenda, not us. But it's something I was very passionate about. I I saw general practitioners, general practice shrinking to greatness, which is not what we wanted to see, and not growth of the Australian population in terms of healthcare needs.

SPEAKER_00 5:48

No, I think the Australian population generally really values the our primary healthcare system and they wouldn't want to see that. We've talked a lot about uh the GP workforce, and over the last six months there's been a lot of noise in the media about the bulk billing incentive that was brought in in November 2025 to increase access to bulk bill GPs. I think it was unapologetic from the government that that was their intention. How has that contributed to the sustainability of general practice?

SPEAKER_01 6:17

It's the single biggest leap forward in the last decade for mine. Um pleasingly, you've got a health minister in Mark Butler who listened, uh sought wide counsel from lots of people who were actually out there delivering the care and general practice, understood and appreciated the value of general practice to all Australians, and recognised that without proper funding, bulk billing would cease to exist. Um I've run bulk billing centres for 25 years. I'm a I'm an absolute believer in free not what we pay for in our taxpayers' dollars, but access via Medicare to health care. Um and we're at a point where financially it was getting very difficult to justify to continue bulk building, we just couldn't afford to keep doing it. This change enabled us to continue to bulk build our patients, which I'm thrilled about.

SPEAKER_00 7:05

Yeah. Is there anything else that you could see the government could do to improve the future sustainability of general practice?

SPEAKER_01 7:12

Yeah, I think again, that training piece is really important. I think we've got to work on our own workforce. It's a really important element that if you don't work at it endlessly, you wake up one day and find there's a shortage, and often you have to seek other ways of solving that problem. Um, so for me, it's about the pipeline of students coming through who want to practice general practice. I think fundamentally supporting it via funding will encourage students who spend a lot of time and a lot of money going through university, they can see as a genuine pathway to have a successful professional career and meet their sort of family and social needs as well.

SPEAKER_00 7:50

Yeah, I mean, those students want to see a return on investment for their time and and their money.

SPEAKER_01 7:55

Absolutely. Absolutely.

SPEAKER_00 7:56

We talked about the incentive for um bulk bill practices and and GPs to continue to bulk bill. There has been some criticism that that encourages five-minute medicine. What do you say to that?

SPEAKER_01 8:07

Look, that's a slur that's been repeated for 25 years. Um it just doesn't bear any scrutiny. In other words, doctors in our practice see 4.2 to 4.3 patients an hour. I think the national average is about the same. Um, it's just simply not true. Um, and in any event, there are checks and balances in place internally at Cornerstone to ensure that appropriate care is delivered. Member Clinical Council, we have lead doctors, peers tend to self-regulate, uh, and also Medicare itself regulates them as well. In other words, it's sort of it's a slur that's was been made for a very long period of time. It's out of date, it's it's not true. Um, I hear it from time to time, I shrug my shoulders and go, well, you obviously haven't been in one of our general practices, yeah. And you haven't seen one of our doctors. Yeah. So, you know, from my perspective, I think it's more, I suppose some GPs would like to be paid more to be general practitioners. I think you can bulk building can earn a great salary and have a great um professional career. Uh, I I think if you want more, maybe you should be in some other profession, in my view.

SPEAKER_00 9:16

We couldn't have a conversation about uh the future of general practice in Australia without talking about AI. I don't think you could have a conversation about any industry without talking about AI at the moment. We talk about how it might help with clinical outcomes, we talk about how it might help with patient experience, potentially with operational efficiencies. Do you see value in the hype around AI or is it just going to introduce more complexity?

SPEAKER_01 9:41

Look, I I think value, but in healthcare you've got to be cautious and careful. Uh, obviously dealing with sensitive information. So, where does that information sit? Is it sitting in servers in Australia or somewhere else? That these are all sort of underlying questions that need to be answered. But fundamentally, if we can sort those issues out, I think it adds value. I think it supports GPs to get better clinical outcomes, it takes away some of the um administrative burden, otherwise, even just dictating notes and getting clear, clear notes into the patient record, it's a really valuable aspect of it. Um, and over time, if it helps from a triage perspective, I think that's useful. But I always view that doctors will continue to have a role, they need oversight, and also general practice is about people. It's about talking to people, it's about appreciating where they're at and where they're coming from, um, you know, understanding how they're interrelating and how they're in other words, they can often present for a clinical clinical issue. And in fact, if you listen to them and talk to them, they're depressed, and there's another issue the doctors have got to unpick as well. That's the art, I suppose, of general practice that really experienced GPs do really well. In other words, and also they sell you the plan. In other words, you know, I always I refer to my father, he said, you know, if you walk out of a general practice consultation without a plan, there's no plan. In other words, a plan to get better, a plan to improve your health. You need doctors to convince you to do that. Yeah, they need to convince you that this is the pathway to go down. And I think it's a really important part of general practice that's not appreciated or understood. Um, they are really about improving your long-term healthcare outcomes. They're not treating the acute one-off issue, they're treating the whole you, and they want to see you thrive and have a great healthy life. Um, that's why I love general practice so much, is that that that is that holistic element. I think AI will have a role to play. Um, I think it will support them, but I think I I maybe maybe not in my life till next life, then they'll take over general practice, but I but I doubt it.

SPEAKER_00 11:45

Patients need to buy into their own health outcomes and they need a relationship with their regular GP in order to do that.

SPEAKER_01 11:51

Absolutely. Yeah, and I and even like the rise of telehealth, I still think, I still know, I don't think I know that face-to-face consultation with general practice practitioners gets the best clinical outcomes. Telehealth can support, it is uh an aid, it's it's an add-on, but nothing, in my view, can substitute for a face-to-face consult with your actual GP, where they clinically assess you, physically examine you, and ensure you get the you're you're you're healthy and well.

SPEAKER_00 12:19

Patients value the convenience of telehealth. It doesn't matter where they live in Australia, but it's important that they're talking to experienced GPs and that those GPs are making the appropriate recommendations for them to see a doctor in person as as often as they should.

SPEAKER_01 12:32

Yeah, and look, I think telehealth's a support to general practitioners, so we're doing face-to-face consultations. In other words, I see it as a support mechanism uh rather than a replacement. So a bit like AI, it's another thing, another element that adds to a better clinical outcome for patients.

SPEAKER_00 12:48

We've talked about uh GP workforce and we've talked about sustainable long-term funding for general practice. Is there anything else that you see is the greatest risk in terms of quality of primary health care moving forward?

SPEAKER_01 13:00

The risk is that cheaper substitutes are bought in that deliver lesser outcomes. I don't love the fact that pharmacists can prescribe uh antibiotics to a patient when they're not the regular GP. I think that's a significant risk. I know why pharmacists want to do it, but it, you know, to use the phrase it's Fox in charge of the hen house. Whereas I like the separation where general practitioners deliver the care they prescribe and the and the pharmacist controls the prescription into the community. That's worked so well. Equally, I like the process where a patient has to see a GP first and the coordination of care is managed by the GP, then they go to the specialist. I'd hate to see direct access to specialists. I just think that's again not the best outcome for patients because there's a coordination piece to general practitioners that's not often understood. So you have a diagnosis of cancer, there are lots of specialists, there's lots of diagnostics, there's lots of information. A GP at the center of that coordinating all the specialists, all the care gets the best clinical outcome. And any fracturing of that, I think is a significant mistake. And you often see vested interests and parties. So, for example, chemist warehouse wanting to do enter into the space, I think that's a disaster for healthcare in Australia, personally. They have their role to play, but the more they creep into uh elements they shouldn't, I think that's a mistake personally.

SPEAKER_00 14:29

It's that ongoing relationship with the general practitioner that we were talking about earlier that's important for the long-term health outcomes.

SPEAKER_01 14:36

Yeah, and and don't get me wrong, they have their role to play, they they they are an element to it, but the coordination and the continuity of care that GPs deliver is second to none, and we are the envy of the world. In other words, everyone wants to repeat what we've got. Um, I think eroding that would be a big mistake.

unknown 14:55

Okay.

SPEAKER_00 14:56

Just I had one uh final, more personal question, I guess, you uh uh to ask you um in terms of future of healthcare. Your second generation in general practice. Yeah. Do you see your children moving into some aspect of primary health care in the future?

SPEAKER_01 15:12

Um, I've got four children. Um, and I think so far each of them are clever enough to do medicine. Um and I would love them to go. I mean, I love what I do. I would love them to go into it if they're up for it. Um the challenge I think for them, I've got a daughter who's university now. She would have loved to have done medicine, didn't get the marks, has chosen a different path. I think that constriction that that constraints are a problem. Uh as I said, I've got nieces and nephews who are the same. They've gone into finance, they've gone into law, they've gone into um AI. Um, they've gone into different areas because the initial rebuff meant they went down different paths. I think for them to go into healthcare, I think that they really need to reduce that barrier. The sons and daughters of doctors, I deal with them all the time. If I speak to doctors on a regular basis, what's your aspiration? They're trying to get into medicine. I would hear that at least twice a week. Yeah. Um, and I think you know, they're clever, they've worked hard, they get uh good results, and then not getting access to study, I think is a shame personally. And so I think that barrier needs to be brought down. Uh, I'd like my kids to do it, but I want them to be happy and do what they want to do, so ultimately it's up to them. Um, you know, the youngest is 11, I think he worries about playing cricket more than he worries about uh what's he gonna do when he gets a job.

SPEAKER_00 16:36

Yeah, so he should.

SPEAKER_01 16:37

Yeah.

SPEAKER_00 16:37

Well, watch this space, I guess. Henry, thank you for sharing your perspectives with us today, and thank you all for listening. Follow Cornerstone Health on LinkedIn for future updates about general practice in Australia.