Cafe Society: Community care the key for our health

HUONVILLE GP Bastian Seidel has a different approach to solving the health crisis.

Bastian Seidel is stepping down after his two-year term as president of the Royal Australian College of General Practitioners. Picture: SAM ROSEWARNE

DR Bastian Seidel has learnt croissants do not travel well on his bicycle. The Huonville GP, who completes his two-year presidency of the Royal Australian College of General Practitioners today, often rides to work from his Mountain River home.

But not on Saturdays, when he travels by car so his colleagues receive their pastries intact from the Summer Kitchen Bakery at Ranelagh. Taking his car also means he can make home visits on a meandering return drive to his 40ha farm, where he lives with his wife Alexandra, toddler son and new baby boy.

At the moment Seidel is out of action as he recovers from spinal surgery. He can’t drive, let alone ride, following a spinal fusion and artificial disc insertion a few weeks ago.

He has a firm hold on his coffee cup, though, when we meet at the sourdough bakery at 9am. Over his fourth flat white, he confesses to being not only a caffeine addict but a terrible patient who tried to delay what turned out to be urgent surgery for spinal cord compression.

Two years ago the German Australian became a father on the same day he was elected to his national role. Life has only become busier. He has since married Alexandra, become an Australian citizen and expanded his Huonville practice.

Throughout, he has aimed to amplify the GP voice, shifting it from the periphery, reacting to health policies, to play a proactive role in trying to shape them.

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As he steps down, Seidel is calling for the State Government to lead an urgent overhaul of the Tasmanian health system.

His biggest insight over his presidency is that we are too hospital-centric. Nationally, he points to a $4 billion annual saving to be made by reducing avoidable hospital admissions.

Seidel believes the only way to reduce Tasmania’s heavy chronic disease burden is to strongly back a community-based system, with GPs working alongside allied health teams that include psychologists, physiotherapists and nurse practitioners.

“It’s far more cost-effective and frankly it is what people want,” he says.

Over time, this approach would not only decrease the emergency presentation rate, but shift the emphasis towards preventive care.

The maths is compelling. Attend an emergency department and the taxpayer cost is at least $250. Arrive by ambulance and it’s $800 more. Visit your GP and it costs the taxpayer $37.05.

Change relies on patients being able to get in to see a GP at short notice, though, and funding for key health services in communities to treat chronic conditions. Even basics such as public and community transport to get to a doctor are wanting currently.

Propping up a failing system is not the solution.

Seidel holds little hope of the Royal Hobart Hospital redevelopment alleviating pressure, with the Premier admitting last weekend the health system is failing to meet demand. Emergency department admissions have soared over the past two years.

“When it comes to health funding, the smart money is on preventing hospital admissions in the first place,” says Seidel.

“If we feel the solution is just to have a renovation of a building, then clearly something hasn’t been understood.

“We need more sophistication in our thinking about how we keep Tasmanians healthy.”

It is time, he says, for us to build an evidence-informed health system. We can look north for pointers — obviously to Scandinavia, but also to Queensland, where such a shift is under way guided by the core principle of subsidiarity, whereby nothing should be done by a large and complex organisation that can be done just as well by a smaller and simpler body.

Seidel uses the medical practice he and Alexandra own to trial some of the ideas they believe in.

He finds an individualised approach not only achieves better patient outcomes. Continuity of care brings deep meaning to his work. Cradle to grave care is a great privilege.

“The trust that patients allow to develop is just enormous.”

Seidel understands grief. His first wife, eminent medical researcher and writer Erica Bell, died five years ago from a brain haemorrhage. It was their love that first brought him to Tasmania in 2008 and he remains deeply committed to the place.

His rural practice, like most, has found it hard over the years to attract doctors, but Seidel no longer tries to lure GPs with a lifestyle pitch and part-time work promise.

Broadly, he says, that approach has only contributed to a generation of people not having a regular GP.

Now he just tells it to the young doctors straight.

“It’s difficult medicine, it’s tough going, you will be paid less [than hospital and city doctors] and you will need to be here a minimum of four days a week, often on Saturday. It takes a particular type of person to agree to that.”

The least he can do is buy them croissants.