Primary care pioneer

RACGP GP of the Year Dr Patrick Byrnes talks to Andrew Bracey about speaking his mind and making a difference.

AFTER 30 years in general practice, Dr Patrick Byrnes is a GP used to doing things his own way. He certainly isn’t afraid to take the odd risk or say what he thinks. 

It should come as no surprise, then, that after being named the RACGP GP of the Year, he took the media attention as an opportunity to label Health Minister Nicola Roxon’s planned nursing reforms as “bureaucratic stupidity”.

“The Health Minister has either been misled by her bureaucrats or we are all being conned,” he recently told The Australian.

As someone who has trialled different approaches to service delivery within general practice – including being among the first to employ a nurse practitioner (NP) – he is well placed to make such observations.

Last year his unique and successful experience of working with an NP was drawn upon by the college, when it enlisted him as its representative on the Government’s Nurse Practitioner Advisory Group. 

The committee was charged with drawing up the collaborative arrangements to which NPs must adhere if they are to claim the new MBS items and PBS prescribing rights. 

The eventual legislative arrangements reflected broadly his recommendations to the Government. 

“I was working with an NP and felt I had a lot of experience in practical application that could help to make sure we ended up with a system that benefited both doctors and [NPs], rather than an adversarial system that benefited one side over the other,” he told MO.

His NP – formerly his practice nurse, whom he had supported through the necessary training – has since left the practice to take up a post at the local hospital.

He is unsure whether he will seek to replace her, noting the MBS rebates now on offer for NPs are unlikely to make it viable for him to employ another.

While proud of his involvement in the historic negotiations, Dr Byrnes seems amused by the novelty of the process. 

“I tend to be a bit naive and run off at the mouth, which is okay, as I don’t have any political ambition at all,” he laughs. 

“That’s okay because the worst that will ever happen is that nobody will ever ask me to represent them again [on a government committee]. That would not worry me.”

From the beginning of their career together, Dr Byrnes and his wife, Dr Margaret Crawford, have never been afraid to take a punt to make things work. Having completed their training, the young husband and wife GP team took a gamble, moving to Bundaberg, Queensland, to establish their own practice, despite question marks over the viability of such a move.

“Practices were going broke and nobody wanted any new doctors – there were literally two jobs advertised in the whole of Queensland general practice in the second half of 1979. So we decided if we were going to starve somewhere, we might as well come to somewhere pleasant and starve,” he laughs.

“We had a 12-month ‘ramp-up’ phase, but after that first year we were making enough money to keep up the overheads.”

The gamble paid off, and in 2006 their clinic was named the RACGP’s practice of the year. It was perhaps an odd juxtaposition at the time, given the infamous reputation his town had attained following Dr Jayant Patel’s tenure at Bundaberg Base Hospital.

“I don’t think [the community] realised how bad it was until the whistleblower stuff happened, but they knew there was something wrong,” says Dr Byrnes of that dark period. “You just tried your best to keep people away from the base hospital – if you could possibly treat someone as an outpatient, you would.”

The fallout of that scandal ultimately led to new national mandatory reporting laws that force health professionals to report their colleagues for suspected misconduct. Like many GPs, Dr Byrnes is highly critical of the regulations. 

“I would like the same degree of penalty to apply to the bureaucrat that I report to. Patel was reported and they didn’t act,” he says. “All they have done is say: The doctors have to dob in other doctors and we have fixed the problem.”

Through all this, the GP has continued to focus on delivering the best care he can to his community. 

He and his wife have worked to establish innovative models of care, designing and piloting their chronic care protocols and systems. 

Now also involved in primary care research projects with the University of Queensland, Dr Byrnes says innovation and a personal quest to diversify his skills and practice remain a driving force.

“I used the money from the 2006 award to do a certificate in advanced skin cancer [procedures]. I like doing courses that give me extra skills – it makes my life more interesting,” he says. 

“It is something new and it is also a skill that you can pass on to your registrars – it creates a ripple effect outwards.

“I will probably use the money from the [GP of the Year award] for a course in something. I don’t know what yet – I guess I’ll have a look around and see what is different and interesting.”