| Project Objectives / Summary:
The broad aim of the project was to facilitate the introduction of a "futures" focus into Divisional planning activities.
'Futures Studies' is both a practical and applied field of endeavour in which members of communities, organisations or professional groups:
- Identify the structural and socio-cultural levers which act as long term drivers of action within their professions, communities or organisations;
- Develop ideas and visions about their preferred directions and longer term futures (10+ years); and
- Develop and implement strategies to bring about their preferred futures.
The Future of General Practice Conference, organised by the Brisbane Inner South and Redcliffe Bribie Caboolture Divisions of General Practice was held in Brisbane at the Novotel Hotel on 11 & 12 February, 2000.
This was the first conference of its kind to be attempted within the realm of general practice in Queensland.
Collaboration:
- Redcliffe, Bribie, Caboolture Divisions of General Practice
- Queensland Divisions of General Practice
Project Outcomes:
Key conference outputs included systems maps devised by facilitated groups of 8 -12 participants and 'possible' and 'preferred' scenarios were developed within the groups. Once the probable scenarios had been delineated each group generated a preferred scenario. This was followed by a process of back casting to identify a path from the 'future scenario' back to the present.
Conference Outputs: The Scenarios
Participants developed a range of scenarios that shared several similarities.
The variations and similarities were analysed and refined to produce a final series of four scenarios. These are as follows:
High Tech (Possible alternative titles: digital doc, dr. robot, IT)
Drivers: Technology and image of progress
Time: 2010-2050
Features of this future include:
- Germ line engineering (eliminating genetic defects for current and future generations);
- Genomics (customised gene therapy);
- Pharmaco-genomics (the study of how a patient's genes determine his or her response to a drug);
- Robodocs and smart cards (ephysicians.com and edr.com and health-bots (interactive wearable computers that monitor one's health);
- While technology is the driver, the key to the high-tech scenario is that technology is miniaturised to meet the needs of patients;
- Doctors, while overwhelmed in this future, become far more holistic in their treatment, focusing on what technology does not give patients;
- Divisions are bypassed, as middle-man type management and information services become redundant; and
- Funding for GPs could come from Health Care Organisations (which would include hospitals) or large Internet Corporations or giant Pharmaceuticals.
Corporatist (Possible alternative titles include: Big business, piracy)
Drivers: Economy, efficiency and corporatist worldview
Time: 1999-2010
- Consumers will gain because of lower cost and seamless service;
- However, for GPs there would be a loss of control with a faceless executive making health decisions;
- In time, the overall quality of health services will decline since cost considerations would become primary and managerialism would take over as the dominant organisational model;
- Alternatively, it could be possible for GPs to develop a national corporation that has equity in, and market control over, services such as radiology, pharmaceuticals, nursing homes and private hospitals. GPs would then lead the money instead of following the money as they do now. This variation would allow benefits to consumers while keeping health GP-led; and
- Funding comes from the Commonwealth (either through fee for service or GP works for the government as a salaried professional) or as employees of large corporations.
Worst case (Possible alternative titles: Drone, More of the Same, 'Big / Brother')
Drivers: power, technology, big capital and values
Time: 2000-2035
Possible features of this scenario include:
- Doctors lose their autonomy and feel disempowered;
In the Big Brother scenario, "technological developments play into the hands of centralists by both increasing specialist monopolies and also eroding the meaningful relationships that are at the core of the GP Ethic";
- Clinical governance creates a hegemonic culture wherein GPs lose their manoeuvrability in creating the futures they desire. They feel trapped.
- The opposite of this scenario is the return to basic values - doctors as caring and concerned professionals. Listening to patients and developing wisdom; and
- Funding comes from giant Multinationals and the Commonwealth,
- Divisions play very little role in financial management.
Networking/multidoor (Possible alternative titles include: back to values, quality & network, Division cooperative, GP & consumer ownership, medi- network.)
Drivers: Values, consumer needs and democratic image of health
Time: 2005-2025
This future consisted of a more diverse but strongly connected system - creating a feeling of community.
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The central point in these networks/multiple doors is that doctors remain the gatekeepers with divisions or associations playing a systems coordinating role;
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Partnership with other GPs;
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Empowerment of patients;
Focus on Quality of Life;
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Community instead of hospital focus;
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Family friendly and community members feel part of the system;
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Divisions provide the following roles:
?< advocacy with local services,
?< research interpretation (separating the gold from the crap on the web),
?< brokerage role through virtual amalgamations as well as a
?< Funding role.
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Funding comes through divisions (via DHAC). Additional income is generated through patients.
Recommendations:
- It was recommended that the current draft systems be continually modified and updated, and be used as a means of both explaining, and exploring possible new changes to the health system which are in the interests of consumers, the Government, and the general practice profession.
- In order to fund and facilitate this process, it is recommended that the State Based Organisation be asked to consider taking responsibility for this activity on behalf of all Queensland Divisions of General Practice.
- It is also recommended that ADGP consider facilitating or supporting additional state or national conferences of this type.
Disseminating Project Information:
The Future of General Practice Conference, organised by the Brisbane Inner South and Redcliffe Bribie Caboolture Divisions of General Practice was held in Brisbane at the Novotel Hotel on 11 & 12 February, 2000.
Website:
The proceedings of the conference were posted on a website which is accessible at www.gpfutures.com.au
National Divisions Forum, Brisbane August 2000
Lessons / Assessment:
This project was innovative in its design and scope-quite different in its approach to general practice thinking. It served as a valuable platform for other work undertaken in Queensland in relation to issues such as capacity building in Divisions.
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