SPEAKER_00 0:07

Hello and welcome to our discussion today about general practice in Australia. Today, in particular, we're going to talk about what accessible quality primary health care looks like in 2026. 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_02 0:25

Thanks, Katie.

SPEAKER_00 0:26

Let's get straight into it. Today we talk about a lot about the pros and cons of a bulk billing model. But outside of the Medicare modelling of it, how does bulk billing contribute to more better quality care?

SPEAKER_02 0:44

Yeah, I I think there's multifacets to this, right? And there's multiple layers. The first one is from a clinical perspective, in other words, the doctor. They just provide the best care they can without having a discussion around price. And whilst they all say it won't change how they practice clinical medicine, they practice, they deliver what's required versus what they think the patient can or can't afford. It's a big difference. In other words, if you're Medicare bulk billing, including the pathology services bulk build and the radiology services bulk build, which happens in our centers, the decision is based on the what's in the best clinical needs of the patient, not what they can afford. So that's the first thing. It changes the discussion from a from a professional perspective significantly. The second aspect of it is just the operating model of how we do it. We're open seven till ten, three sixty-five days of the year. Monday to Friday, nine to five. We're like every general practice that's in Australia. Uh your regular patients coming in, a lot of chronic disease presentations, a lot of um pediatric type presentations which need access to care, which is really important. Weekends and after hours, so after six o'clock at night and weekends, what we find is younger, fitter patients generally seeking more access. Uh they often don't have a regular GP yet. In other words, they haven't seen a GP outside their family arrangement before. And they often got kind of clinically acute presentations or singular issues that need dealing with. So the clinical mix is different as well. And they're turning up because they can medic, it's Medicare Bulk bill. In other words, they can get access and they don't have to pay.

SPEAKER_00 2:24

I mean, there's no doubt in today's environment that costs is a huge factor to access and having no out-of-pocket costs makes a big difference. What are the other factors that um affect access to primary health care?

SPEAKER_02 2:36

Yeah, I mean, the other other factors are um you know opening hours, which I talked about, um, choice of doctor. In other words, I I I you know, in our setup, you can choose between a range of on any given shift between 15 to 20 GPs. And it's interesting, patients will see different GPs for different things based on their perceived needs. Um, so they have their regular doctor for regular catch-ups, they've got a skin cancer doctor for you know their skin annual skin check, they've got another GP they see for something specific. In other words, that is the variation where you can sort of may have a different choice. I think choice is important because I'm not so I don't feel comfortable with this doctor on it relating to this clinical issue, but I feel comfortable with a different doctor. That's a really important aspect of access. I think the other element of access is I can go and see my GP, but I might need an x-ray for a suspected fracture. I need my uh wound dressing dealt with. Having the on-site facilities means I can go then get all my primary care needs met in the one location. So it stops a lot of unnecessary ED type visits presenting. Um in ED, they come to a general practice and know that all their primary care needs are met in the one location.

SPEAKER_00 3:49

Yeah, I think for me, uh having all the services on one site, there's not a group of patients that that doesn't benefit. If you've got mobility issues, if you've got a lot of kids in tow, if you're a busy professional, you want to just know it's a one-stop shop.

SPEAKER_02 4:03

Yeah, and I I actually think the other other element that's really sort of rarely talked about in Australia is appointments are in fact a barrier to entry. Um, you know, uh, you know, families with you know a psychotic child or uh you've you're you know issues, mental health issues, for example, often don't keep appointments, often don't get don't aren't able to get navigate a system of appointments, our doors are open. If you turn up, we'll provide access to your care, take a seat, you'll be seen, and get access to a general practitioner of your choice. Um and what we find is also in lower socioeconomic areas, appointments again are another barrier to entry. So if you reduce that barrier and simply say, walk in and we'll provide access to care, that is a really important element of what our model's about. Um so you can be the wealthiest person in Australia or have nothing, you'll get the same level of care and the same level of access regardless. I think that's a really important element of a bulk billing and b a no appointment system.

SPEAKER_00 5:07

Yeah, I mean life doesn't follow appointments. You don't know when you're gonna get sick, you don't know when your kids are gonna get sick. So, or your parents if you're caregivers for parents. So knowing that you can get access to care when you need to is important.

SPEAKER_02 5:17

And also busy professionals. In other words, I've got a space of time now, I could duck down and see the GP now. If you ring up and there's no appointments, or you try to book online, there's no appointments, you defer it, you delay it. That's not great healthcare. No. Like deferred and delayed health care, generally speaking, is not a good outcome. Dealing with that at the time or getting access when you need it is a really important element of quality care and continuity of care.

SPEAKER_00 5:41

Yeah, access definitely contributes to continuity of care.

SPEAKER_02 5:45

Absolutely.

SPEAKER_00 5:46

What about for new doctors that are relocating or joining a clinic for the first time? How they might be concerned about the no appointment model. How does that work for them?

SPEAKER_02 5:56

It actually works in their favour because they get the opportunity to pick up new patients or patients that are agnostic about the doctor of choice, and it's an opportunity for them to build a practice. So young doctors often the number one question to me is Henry, am I going to have enough patients? Our practices, given that we're open and bok build, we have a huge patient demand. Although patients love the service we provide. So that's the first element that's that I say to them. The second element is if you work weekends and after hours and you see a patient that doesn't have a regular, regular GP, and they're often there for a singular issue. You can go, look, I'll deal with this singular issue, but when was the last time you had your skin checked? Take their blood pressure, do a family history. That's an opportunity to create a relationship. Uh, it's an opportunity to show that you care about their health and start them on their healthcare journey, and that enables them to build a relationship with the new patient who then goes, yeah, I felt cared for, you know, I did have a family history of X and Y. I probably should follow that up. And that is the opportunity for particularly young doctors or doctors from out of area to build a practice really rapidly. And doctors, when I say it to them, joining us within three to four months, you'll have a very strong patient base, don't believe me. You know, I can then go back three to four months later and say, How's your practice going? Oh, I've got more patients than I need, which is a great outcome for them. Um, and again, it's just increasing access to patients who often have a regular GP. So it's an opportunity for them to see a GP of their choice as well.

SPEAKER_00 7:24

And those patients come in for the first time, they meet the new GP and they also start to think, why have I been going to the traditional or not going to the traditional models of general practice and they become patients of the of the centre generally?

SPEAKER_02 7:37

I mean, often we pick up a lot of regular patients because the others are shut and not open. Yeah. In other words, oh, it was it was it was Good Friday, it was, you know, a public holiday. I went there because I needed immediate care. Uh, I went back to fall up for the results, oh, they're always open, they're always available. I mean, I I got four kids. And when they were little, they didn't get croup Monday to Friday, nine to five. They generally got it at seven o'clock at night. You're worried about the night ahead, you're anxious for your child, the alternative was hospital or your GP, you'd see a GP, you'd have a great experience, and then it became our family general practice. So that's a sort of common experience of how you build the practice. Um, and over time, the doctor that I had an appointment for on a regular basis, I went, well, I'm better just to go back to my regular doctor at our medical necros nest. So that's that's an example of how it works.

SPEAKER_00 8:28

You mentioned that consideration of do I go to a medical centre or do I go to ED. The difference being in a hospital emergency department, the types of presentations that we see in general practice aren't considered emergencies, but in Cornerstone Health or in our medical centres, they become the priority.

SPEAKER_02 8:45

Absolutely. And and I mean it's a commonly known thing. There's a lot of what emergency departments describe as clinically inappropriate patients turning up to ED, you know, minor scratches, minor cuts and abrasions, burns of a lesser nature, coughs and colds, they don't belong in that environment. Um, and the general practice is a better setting for them to do it. I I think the other thing GPs particularly enjoy is they love the fact there's a different pathology presenting. In other words, the variety, the clinical mix of patients that turn up in our centres is much broader and professionally stimulating for them. Uh I remember my father said, you know, a weekend shift or a night shift, you'd always see lots of different things you hadn't seen in a long time, but you'd train for and had the skills to look after. And it's sort of kept him professionally stimulated in general practice. And I hear that repeated from so many doctors now. It's like it's really broadened my practice again. I'm doing things I haven't done for a long time. So I think you know the healthcare professionals are professionals, they enjoy things that they train for and are stimulated by. I think that's part of it as well.

SPEAKER_00 9:48

Um some doctors might get a little bit nervous about that type of presentation in our medical centres. You've got nurses, full treatment rooms, and they're not.

SPEAKER_02 9:56

Look, we've got registered nurses that are available to support, but also other doctors who are available to support. In other words, there's a wide range of clinical skills and and and and I suppose interests. In other words, doctors all have different interests within primary care. Um, what we find is there is internal referral. In other words, you know, Dr. Dr. X really loves skin work. I recommend you go and see him or her for a skin check. Um, pediatric's the same. So you'll see this referral pattern that starts to occur. I'd really go and say that they're great at following up endocrine crine issues, etc. So that's from my perspective, I think that's where it works really well, and that is the nuance that develops over time in a mature practice in our medical.

SPEAKER_00 10:37

And you've talked about the fact in our medical centres, you've got pathology, radiology on site, but also due to the scale, you also have allied health specialists on site as well.

SPEAKER_02 10:47

And again, it's that's it's that sort of availability. In other words, you can walk down the corridor, not get back in the car, go to another's place, make an appointment, walk down the corridor and get access to those additional services. Um, you know, you've got a diabetic patient load, you've got a diabetic educator, you've got nurses that can support you, you've got the pathology on site, all those things working in concert. Uh convenient for the patient, get a better clinical outcome and ensure immediate follow-up, not sort of deferral and delay, which is a really important aspect of continuity of care, not not pushing it down the road.

SPEAKER_00 11:22

And the GPs can build a relationship with the physio, with the dietitian, with the specialists, and they feel like they're working on the care for that patient together.

SPEAKER_02 11:30

Yeah, like you've you've got something you're concerned about, you send the patient down to radiology, the radiologist answers the phone, and they can actually walk back up the corridor and say, Look, I need to come down and have a conversation with you. In other words, that corridor conversation doctors tell me is is really invaluable. So again, it's the nature of how why we've set the model up the way we have. A lot of radiologists want to report remotely. One of the criteria we have is no, you've got to be on you've got to be on site to provide support to the GPs, the technicians, and others to get the best clinical outcome, which doctors, GPs particularly appreciate.

SPEAKER_00 12:04

And the doctors know that they can refer a patient to radiology, get the get that patient prioritised and get the results back straight away so they can provide the end-to-end care in one visit.

SPEAKER_02 12:13

Yeah, absolutely. And radiology is open on the weekends, Saturday and Sunday, not sort of come back Monday. It's like, no, we'll deal with it now. And it's just that um accessibility element of being open and available to solve the help the doctor solve the clinical problem they're trying to solve. It's a powerful model that works well.

SPEAKER_00 12:33

Uh it adds that little extra edge, just having the radiology seven days, having pathology seven days, not just five days. Yep. So that that kind of leads me to my final question. When you have that access, when you have those co-located services, what do you think improves first? The patient experience, the doctor experience, or is it both?

SPEAKER_02 12:53

Facetiousness aside, it's both. Um it's it's it's um the doctor has the tools at hand to solve complex problems, which often general practice presents. They're unreferred. You don't know what's going to clinically walk through that door. So you are trying to understand often complex issues, multifaceted presentations, and having that on on that support that gives you the confidence and the ability to treat it rather than I'm not sure I'll have to refer you to someone else. So that gives them the ability to treat what's in front of them. From a patient perspective, the convenience is hugely popular. In other words, I know I can go there, see the doctor, get my blood test, get my script filled. In other words, you know, you go to the GP, you've got a script, and the chemists are all shut. That's really hard.

SPEAKER_00 13:38

Yeah.

SPEAKER_02 13:39

Our chemists are up until 10. And as I said, going back to that, the example of the child with the crew, you know, you get the script for ready, Pred. Um, it doesn't solve your problem that night, but it certainly goes a long way to starting the starting the process of making sure your child's safe and well for that night. Those the that sort of convenience from a patient perspective is is loved. And once patients get used to it, they expect it.

SPEAKER_00 14:01

Yeah. I mean, there'd be nothing more frustrating than finally getting a script and not being able to get it filled.

SPEAKER_02 14:06

Yep.

SPEAKER_00 14:06

Um, so having the pharmacy on site is really important too. Yeah, yeah, absolutely. Henry, thank you for talking about accessible quality healthcare with us today. Really appreciate your time. And thank you all for listening. Follow Cornerstone Health on LinkedIn for future updates about general practice in Australia.