Who are the most influential people in general practice?

Australian Doctor magazine has released its pick for the top 50. Many of the choices are not asurprising – just the sort of people you’d expect, like the Royal Australian College of General Practitioners’ current and incoming presidents Chris Mitchell and Claire Jackson, as well as academic leaders like Chris Del Mar, Jane Gunn, Justin Beilby, Simon Willcock, and Mark Harris, and health reformers Tony Hobbs and Mukesh Haikerwal (who is described once again as “much-loved”; does anyone have a bad word to say about this man?..)

But there are a few interesting ones that may be of particular interest to Croakey readers. It’s a sign of the changing times, perhaps, that a nursing leader and the owner of a nursing business have been picked (but perhaps the times haven’t changed so much – Croakey didn’t spot any consumer health advocates who’d made the list).

Croakey’s favourite choice is the last entry listed below, telling the story of an Egyptian-born doctor who arrived in Australia in 1992 and has since gone on to establish, with his doctor wife, an innovative, award-winning general practice in Wagga Wagga. It’s a nice reminder in times like these that our comunities are often so enriched by those arriving from overseas (despite the prejudices and difficulties that overseas trained doctors often face).

Below are edited extracts taken straight from the document, (which can be downloaded here).

Dr Ruth Kearon, advisor to Minister Nicola Roxon
Doctors who occasionally feel that the Health Minister sees them as the bad guys might be surprised to learn that one of Nicola Roxon’s closest advisers is a GP. Dr Ruth Kearon, deputy chief of staff in the minister’s office, is a Tasmanian-trained GP who practised in Kalgoorlie and Hobart for four years before moving into politics in 2006, first as an adviser for the Tasmanian Health Minister and now on the federal stage. Political insiders say Kearon has the minister’s ear.  “When it comes to GP issues, Ruth is the go- to person for the minister,” says AMA lobbyist Mr John Flannery. “It’s obvious that the minister does place a lot of faith in the advice she receives from and through Ruth.” “She’s a really good operator,” adds AGPN CEO David Butt. “She understands general practice and has a vision for the future, and she feeds that into government policy.” For her part, Kearon says she loved working one-on-one with patients, but “like many GPs, I experienced the frustrations of working within a system that I was not empowered to change”. The move into politics gave her a chance to help shape that system, she says.

Belinda Caldwell, Australian Practice Nurses Association
The CEO of the Australian Practice Nurses Association has been a tireless campaigner for her growing constituency – and there’s every sign the Federal Government has been listening, given the recent expansion of practice nurse funding and roles. In the four years that Caldwell has been at the helm, membership of the association has more than tripled. It now has 1700 members. That growing support might have something to do with her having secured wage increases above the CPI, albeit, as she puts it, “from a pitiful base and still less than desirable”. A passionate believer in the ability of nurses to take a bigger, and more autonomous, role in general practice, Caldwell has found a receptive ear in Health Minister Nicola Roxon.

Louise Stewart, Revive clinics
It might appear strange that a young IT executive would make it onto the list of the most influential people in general practice – but then again Louise Stewart is not your average IT geek. In 2008, Stewart opened the chain of Revive walk-in clinics, which are staffed solely by nurse practitioners and are independent of GPs. Before the Revive clinics, which are mainly in WA, many GPs viewed nurse practitioners as an unworkable concept – a creation of the US healthcare system that would not fly here. Almost two years on and the number of nurse practitioners is gradually increasing and their role is becoming more defined in a new age of primary care. While nurse practitioners have had help from a government that says it is “pro-nurse”, Stewart was the first to show how nurse practitioners could work in primary care. The clinics have also caused a re-think on nurse practitioners. Doctor groups realised that they would have to work in collaboration with nurse practitioners or risk their going out alone and fragmenting care. Hayley Haggerty, one of only two nurse practitioners who works in a general practice, believes Stewart has helped ensure the profession is included in the reform of primary health care. “Her clinics proved that there is an opening in our health system for nurse practitioners to independently treat patients for a range of chronic diseases,” Haggerty says. Stewart started Revive in 2003, initially as an online health directory. She says the idea for the nurse-led clinics was born out of her frustrations as a health consumer and not simply a way for her to make money, as some have suggested.

Jane Halton
The secretary of the Department of Health and Ageing perhaps deserves the prize for most surprising survivor of the 2005 Top 50 list. Halton’s scalp was expected to be one of the first taken when the Rudd government came to power, given her role heading the previous government’s illegal arrivals taskforce and in the “children overboard” affair. But Health Minister Nicola Roxon resisted pressure to sack Halton, wanting an experienced operator in the key role during the health reform process. The two are now said to have a close working relationship.

Dr Ayman Shenouda, a GP at Wagga Wagga
A quick glance at Dr Ayman Shenouda’s practice website will tell you much about how this passionate rural doctor is making his mark on general practice. In the centre of the home page, a photo of the beaming team at his Glenrock Country Practice in Wagga Wagga takes centre stage – eight doctors, five nurses and several allied health staff. To Shenouda, primary health care is all about the team. The page has a long list of patient services that would surpass most city practices. Shenouda and his wife, Dr Samiha Azab, designed and purpose-built their one-stop shop for primary health care long before any politician jumped on the super clinic bandwagon. Most obvious on the Glenrock website is the practice mission: “To provide our communities with quality healthcare services that meet the individual needs of patients, delivering care in a manner and environment that promotes dignity, safety and quality of life.” This is not a mission that has been work- shopped on butcher’s paper for maximum marketing spin. It is a genuine vision for Shenouda, 48: “General practice is the specialty of patients,” he says. “If I care about my patients and I listen to them, my success will flow.” And success has found the Egyptian-born doctor. In 2009, he won the RACGP’s GP of the Year award; in 2007, Glenrock won the NSW/ACT General Practice of the Year and, in May, AGPAL handed the Wagga GP awards in three of four categories. Shenouda came to Australia in 1992, a surgical registrar who had no preconceived ideas about general practice. He is also passionate about training and mentoring international medical graduates.

• Thanks to Australian Doctor editor-in-chief, Dr Kerri Parnell, for providing Croakey readers with this document. It took a bit of work as they had to strip out the pharmaceutical advertising so it could be seen by general readers.
(Declaration, the Top 50 was overseen by Marge Overs, a longstanding colleague of mine)