The History of General Practice in Australia - 1950 to the 1999

Prime Minister Minister of Health Political party
19/12/49 to 26/1/66 Rt Hon Robert Menzies, KC MP Rt Hon Sir Earle Page, GCMG CH MP (from 6/7/45 to 11/1/56)
Hon Dr Donald Cameron, MP (11/1/56 to 22/12/61)
Liberal/Australian Country

    Most general practices are solo practices. Typically they are located in a house or a small shop.

    More Australian based teaching positions for specialists became available. It became more common for a doctor to enter straight into a training program without first working in a community based general practice. This meant that most specalists had no (or little) experience in general practice. Technology was improving and there were now many effective drugs. The specialists now became better at diagnosis and treatment of illness. Consequently their prestige and their incomes increased.

    Increasing management of patients by specialists in hospital saw some decline in general practice. The prestige of general practice was reduced by the view that specialists had obtained further training and hence were better. Also, any doctor who failed his specialist exams ended up in general practice, re-enforcing the underlying notion that specialists were better doctors than GPs.

    A young Australian doctor, Dr Collings, under a Nuffield scholarship, studied genaral practice as it then was in England. He published his findings in the Lancet on 25th March 1950. His comments were blunt. General practice in the UK was in a poor state, despite the hard work of conscientious doctors. The editor of the Lancet was fair in his comments about the paper and warned that this report could not be ignored. He noted that Dr Collings, as an outsider, was well-placed to make objective findings. Collings had seen general practice in Australia, New Zealand, Canada and the United States. Collings' article sent ripples throughout the UK medical establishment. Far from viewing themselves as the best in the world, they were now having to do something to catch up their status in health care delivery. One result was that the British College of General Practitioners (BCGP) was formed (on 9th November 1952). Its aim was to improve education and standards. The establishment of this new college was opposed by the three royal colleges (RCP, RCS, RCOG). The BCGP was not universally welcomed by GPs in the UK as it entailed further study and further costs. There were many Australian doctors among the founding members.

     Dr William Arnold Conolly was one of a small number of Australian GPs who were foundation members of the BCGP in Australia. He was instrumental in the formation of a NSW faculty of the BCGP. A meeting was held at the home of Dr Warburton in Pymble, NSW for the purposes of forming a NSW faculty. The NSW faculty of the BCGP was formed on 30th October, 1953 and Dr Conolly was elected to the position of chairman. Within a few years a number of other state faculties were started.

  • In 1954 the Queensland faculty was formed.
  • In 1956 the WA and Vic faculties were formed
  • In 1957 the Tas faculty was formed.
  • In 1958 the SA faculty was formed
     In 1953 the federal government (a liberal-Country Party coalition), with the blessing of the Australian branch of the BMA, launched the first national insurance scheme. Under this scheme, partly funded by taxpayers, private (not-for profit) insurance companies would provide rebates for medical services to fund members. Memebership was voluntary. Rebates for specialists were set at a level above those for general practioners, re-enforcing the idea that specialist consultations were of a greater value, however to access the specialist rebates, patients had to be referred by the GP. Under the same legislation, those patients recieving a Commonwealth pension would also have access to medical rebates through the Pensioner Medical Service. This meant that doctors treating pensioners in their rooms for free would now gain some re-inbursement. By the end of the 1950s most people (about 85%) belonged to a private (not for profit) health fund. Of the remainder, many received benefits via pensions or as war veterans.
    In 1955 members from NSW, Qld, Tas and WA attend a meeting with the view to establishing an Australian council. This was formed in November of the same year. Dr W A Conolly became the chairman and was later elected as president of the association at the first annual general meeting. A number of doctors met at the first Annual Scientific Meeting in Sydney in 1957 and made the decision to form a national body. In 1958 the states were amalgamated (with the support of the BCGP) to form the Australian College of General Practitioners (ACGP). Conolly became the first president of the college and its office was registered at his rooms in Cessnock, NSW. He became the first Fellow. The college established three committees; one for undergraduate education, one for post-graduate education and another for research.

1956 - 11th January , Donald Cameron (Liberal) became the Health Minister. His term ended on 22nd December, 1961
1956- Halothane was used as a general anaesthetic for the first time by Dr Michael Johnstone in Manchester, UK. It had bee synthetised for the first time in 1951 by C. W. Suckling of Imperial Chemical Industries.
    In 1959 the ACGP appoints committees in the following areas:

  • undergraduate education
  • postgraduate education
  • research
  • preventive medicine
  • publications

    Antihypetensive drugs become available.

The 1960s

Prime Minister Minister of Health Political party
19/12/49 to 26/1/66 Rt Hon Robert Menzies, KC MP Hon Dr Donald Cameron, MP (11/1/56 to 22/12/61)
Senator Hon Harrie Wade: Minister for Health (CP) (22/12/61 to 18/11/64)
Hon Reginald Swartz, MBE (Mil) MP (from 18/11/64 to 26/1/66)
Liberal/Australian Country
26/1/66 to 19/12/67 Rt Hon Harold Holt, CH MP Hon Dr James Forbes, MP Liberal/Australian Country
19/12/67 to 10/1/68 Rt Hon John McEwen, MP Hon Dr James Forbes, MP Liberal/Australian Country
10/1/68 to 10/3/71 Rt Hon John Gorton, MP Hon Dr James Forbes Liberal/Australian Country

    The Australian College of General Practitioners has to deal with membership issues. Should all general practitioners be allowed fellowship? If the College is to lift standards then fellows need to be a of a certain standard. The best way to guarantee this is to set an entrance exam. This proposal is not universally liked, but became the accepted route to fellowship. The College forms an association with the AMA; the College will focus on education and standards and the AMA will focus on advocacy and medico-political representation. When the government proposes univeral medical insurance, a common fee schedule is set. The amount for general practitioners is seen as inadequate by the College. In its first test of support for general practitioners, the AMA fails to be representative, supporting the fee schedulae against the wishes of the College.

    New graduates are still able to obtain registration and move immediately into general practice (ie no inten year) in the early 1960s.

     Neonatal intensive care units are established. Babies of 600g can now be kept alive.

1960 - The first Australian General Practitioners’ Convention is held in Melbourne
1960 - The Menzies government introduced a 50c payment for PBS subsidized drugs. Formerly these drugs were free.
1960 - The Tasmanian Section of the Royal Flying Doctor Service (RFDS) is formed
1960 - Methoxyflurane is used for the first time by Drs Joseph Artusio, Alan van Poznak et alia.
1961 - One of the first grey-scale ultrasound picures of a foetus is demonstrated by Australians George Kossoff and Dr William Garrett from the Royal Hospital for Women, in Sydney
1961 - 2nd December, Harrie Wade (Country) became Health Minister. His term ended on 18th November, 1964
1961 - "The college became affiliated with the AMA at the AMA’s invitation. This frees the college from medicopolitical problems, allowing it to concentrate on its academic programs of education and research."2
1962 - "Dr Patterson records widespread opposition in the college to the idea of a college examination, an idea floated by the Medical Education Committee."2
1962 - The BMA Branches of the Australian states and territories formally merged into the Australian Medical Association
1962 - The College designs a five year training course for new graduates and a training program for those who had reccently entered general practice. Participation was voluntary. 1963 - The first Practice Management Seminar is organised by Dr N E Carson at the Batman Inn.
1963 - The College proposes formal undergraduate tems in general practice, ie a term spent in general practice. This was not met with support from educators. 1964 - 18th November, Reginal Swartz (Liberal) became Health Minister. His term ended on 26th January, 1966
1964 - Human trials of IV ketamine commence (Dr. Günter Corssen et alia).
1965 - Requirements for entry into the ACGP include a rotating internship for two years, three years approved training in general practice and a requirement to satisfy the Censor-in-Chief of proficiency in general practice.
1966 - Human trials of enflurane commence (Dr Robert Virtue et al). 1966 - the NSW faculty recommend grading of professional priviledges re hospital appointments "provided that the doctor agrees the rules of the hospital and satisfies the Credentials Committee as to their integrity, experience and proven competence". The NSW Health Commission creates a Medical Appointments Advisory Committee for the purpose of approving appointments, taking control away from the College.
1966 - 26th January, Jim Forbes (Liberal) became Health Minister. His term ended on 22nd March, 1971
1967 - the ACGP establishes an entrance examination via a trial examination in Melbourne.
1967 - A scheme for student attachments in general practice is set up.
1968 - The ACGP conducts its first open entrance examination.
1968 - The ALP Opposition manages to set up a Senate Select Committee On Medical and Hospital Costs 1968 - There Coalition set up a three man Committee of Inquiry into Health Insurance, chaired by Justice J A Nimmo. The Nimmo Committee of Inquiry into the Medical Benefits Scheme is completed and states that the current system is too complicated and recommended changes.
1968 - Health economists, Drs Scotton and Deeble, from the Melbourne Institute of Applied Economic and Social Reform, make proposals, which the ALP use as their basis for their stand on health reform for the 1969 election.
1968 - St Vincent Hospital performs Australia's first heart transplant.
1969 - the ACGP became the RACGP following the Queen's blessing.
1969 - As a result of the Nimmo Inquiry the government announces the concept of a common fee and guaranteed to fund this amount minus $5. The common fee was meant to represent the median value of the most commonly charged fee for various consultations. Specialists' fees were set at a higher rate. At the time this may have seemed fair because the specialists spent many extra years of study and work at low pay rates and because honorary specialists were treating many of the poor patients for free. The governemt set a maximum gap fee for billing of $5. The gap for a standard consultation was 80c and for a home visit was $1.20. As a result of this proposal, GPs providing the same proceedure as specialists, were being paid less. This became a dis-incentive for GPs to perform proceedures and caused GPs to consider that their services had been devalued. With the devaluing of these services and the lowered prestige of general practice, fewer graduates would seek to train in general practice. With more specialists and the devalued incentives for GPs to perform proceedures, fewer GPs provided these services, resulting in fewere GPs training in areas such as anaesthetics, obstetrics and surgery. There was also a fear that the government was setting up a national health service by stealth.
1968-1969 The General Practitioners' Society of Australia was formed to oppose the government's national health insurance proposals.

The 1970s

Prime Minister Minister of Health Political party
10/1/68 to 10/3/71 Rt Hon John Gorton, MP Hon Dr James Forbes Liberal/Australian Country
10/3/71 to 5/12/72 Rt Hon William McMahon, MP Hon Dr James Forbes, MP (10/3/71 to 22/3/71)
Senator Hon Ivor Greenwood, QC (22/3/71 to 2/8/71)
Senator Hon Sir Ken Anderson (2/8/71 to 5/12/72)
5/12/72 to 19/12/72 Hon Gough Whitlam, QC MP Hon Lance Barnard, MP Labor
19/12/72 to 11/11/75 Hon Gough Whitlam, QC MP Hon Dr Doug Everingham, MP Labor
11/11/75 to 7/5/82 Hon Malcolm Fraser, MP Hon Don Chipp, MP (11/11/75 to 20/12/77)
Hon Ralph Hunt, MP (20/12/77 to 8/12/79)
Hon Michael MacKellar, MP(8/12/79 to 20/4/82)
Liberal National Country

A defining time for general practice. The term itself was under threat as the RACGP actively sought to introduce the terms "family medicine" and "family physician". These terms did not catch on. The terms were more commonly used in North America, but UK doctors, with whom the Australian doctors were more likely to identify, did not use these terms, despite seeing themselves as family physicians.

Total health expenditure almost tripled in the 10 years from 1961 to 1971 ($683M - $1.7B)

1970 - The RACGP members overwhelmingly decried the fee proposals as inadequate and decided to campaign against it. The AMA, however, supported the fee proposal. This difference in opinion caused a rift between the AMA and the RACGP.
1971 - 22nd March, Ivor Greenwood (Liberal) became Health Minister. His term ended on 2nd August, 1971
1971 - The Hornsby Vocational Training Scheme commenced. Seven JRMOs trained under a pilot scheme supervised by Dr A Himmelhoch, for the purpose of training and as a study for the college’s vocational training ideas.
Public concerns regarding perceived wastages and inapropriate prescribing resulted in the government setting up the Select Committee of the House of Representatives Inquiry into Pharmaceutical Benefits. The RACGP was able to demonstrate the appropriateness of GP prescribing. The Australian Prescriber was set up in response to the college's recommendation that an independant prescribers journal be formed.
1971 - The Annals of General Practice were replaced by the Australian Family Physician (AFP)
1971 - 2nd August, Sir Ken Anderson (Liberal) became Health Minister. His term ended on 5th December, 1972
1971 - Accreditation of teaching posts in family practices and hospitals commenced.
1971 - The Australian Capital Territory Sub-Faculty of the RACGP was formed.
1972 - The Labour Party wins the Federal election after a 23 year hiatus. It proposed radical changes to the health system funding and in particular proposed a national system of health insurance funded by a tax surcharge and by federsal government funding.
1972 - Isoflurance is used as a general anaesthetic.
1972 - The issue of the common fee persisted. An inquiry was held (the Mason Inquiry). The RACGP argued that a GP consultations range in complexity and consequently four fee structures were adopted based on consultation length.
Check ups at 6 weeks, 15–18 months and 8 years of age were recommended by the RACGP's Preventive and Community Medicine Committee.
The first issue of Practice Management was released as a supplement of the AFP.
The World Organisation of Family Doctors (WONCA) was established.
1972 - Medical Practitioners (Amendment) Act 1972, was passed. It established a separate register of specialists
1972 - 5th December, Lance Barnard (Labor) became Health Minister. His term ended on 19th December, 1972
1972 - 19th December, Doug Everingham (Labor) became Minister for Health . His term ended on 11th November, 1975
1973 - Declaration of Singapore was signed between the RACGP, the RACS, the RACOG and the AMA.
1973 - The government announced its plans for a National Health Scheme. This was met with mixed opposition from the different RACGP faculties, with the result that the RACGP did not oppose the government's plans.
1973 - The AMA opposed the Labor Party's National Health Scheme proposal, seeing it as a form of nationalised medicine akin to the UK's system.
1973 - The RACGP ended its close affiliation with the AMA (amicably) due to the diverging directions of the two groups.
The General Practitioners Society of Australia sees this as a betrayal of the RACGP. The RACGP resolves not to be involved in political representation.
1973 - The CHECK Program was first published.
1973 - The government created the Hospitals and Health Services Commission.
1973 - The Family Medicine Program (FMP) began and had an inital funding of $1.1 million to launch the program. This was provided by the Interim Hospitals and Health Sercices Commission under the government's "Community Health Program". This funding was controversial as many doctors did not want to see the training of GPs as being a government provision. The objectives of the FMP were:

  • To increase the standards of primary health care
  • To involve family physicians and other members of the health team with community health care, education and research, on a regional baasis, thus reducing isolation.
  • To educate teachers and ensure training posts met a suitable standard
  • To develop suitable training resources
  • To undertake research into community health issues.
To this list eas later added:
  • To provide re-training for graduates who have been away from the practice of medicine for some time, eg women who have left to raise a family.
The General Practitioners Society of Australia (GPSA) Formed in 1968 the GPSA was a right-wing organisation which aimed to represent GPs. The GPSA opposed the introduction of universal health insurance, believing that it would destroy the rights of GPs. It opposed any part of government interferece with the delivery of private medical practice. It was particularly opposed to the idea of bulk-billing. The RACGP was seen by the GPSA in a bad light because of its acceptance of government money to provide GP training. The AMA was not left out of its firing line because the AMA accepted the government proposals in the form of Medibank.

NB the General Practitioners Society of Australia (GPSA) is not to be confused with the current GPSA (General Practitioner Supervisor Association), a completely different organisation.

1973 - The RACGP produced a prototype for medical record system.
1973 - A number of universities established Chairs of Community Medicine (General Practice).
1973 - The NSW Health Commission was established. 1973 - The Doctors Reform Society of Australia (DRS) was formed because of concerns regarding Medibank3.
1973 - The government published its proposal of changes to the health system: "A Community Health Program for Australia". 1974 - Sydney University includes General Practice as a separate discipline in its curriculum (now reduced to 5 years).
1974 - The Health Services Commission is formed. This was the beginning of formal healthcare planning in Australia. It was headed by Dr Sidney Sax 1974
The Family Medicine Program (FMP) commenced and 238 trainees were enrolled.
Entry to the FRACGP was determined to be via the examination pathway.
The RACGP Health Record was published.
the Ballarat Sub-Faculty of the RACGP was formed.
1975 - The government instigated its medical insurance reforms under the name "Medibank" on 1st July. The main principles were:
  • medical and surgical benefits provided to all Australians
  • 85% of the scheduled fee being paid for all consultations, investigations and procedures
  • no limit was set on what doctors could charge for their services
  • treatment in a public hospital was provided for free
  • The Pharmaceutical Benefits Scheme was increased
  • Direct billing of Medibank (at the 85% fee) was encouraged.
The initial funding by a 1.35% tax levy was rejected by the Senate and the whole scheme was funded by the government. 1975 - November. The Labor Party lost power and was replaced by a Liberal-National Party government. The new government instigated a review of Medibank and determined that it was not viable financially. Universal free hospital access was ceased in almost all hospitals in successive years. Free access was determined by means testing. Doctors could no longer direct bill the government except for pensioners and unemployed patients.
1975 - 11th November, Don Chipp (Liberal) became Minister for Health. His term ended on 22nd December, 1975
1975 - 22nd December, Ralph Hunt (National Country) became Minister for Health. His term ended on 8th December, 1979
1976 - The National Trainees Association is established.
The RACGP proposed to the AMA that general practice should be recognised as a speciality.
The Manual of General Practice, a revised version of the New Zealand manual, was published
The Newcastle/Hunter Valley Sub-Faculty of the RACGP was formed with close ties to the medical school at the University of Newcastle.
1978 - The National Specialist Qualifications Advisory Committee (NSQAC) recognise general practice is a "specific and defined discipline in medicine".
The first RACGP Computer Conference was held in Jolimont, Vic.
The RACGP Medical Education Committee set up a sub-committee on rural practice and holds a conference for rural doctors: "Country Towns, Country Doctors"
The RACOG's Joint Diploma in Obstetrics and Gynaecology was created.
1979 - Rural registered posts were created in Lismore, Dubbo, Orange and Wagga Wagga
1979 - 8th December, Michael MacKellar (Liberal) became Minister for Health. His term ended on 20th April, 1982

Medicare Rebates Short Standard Long Prolonged
1976 $6.00 $8.20 $15.60 $23.50
1977 $6.00 $8.20 $15.60 $23.50
1978 $6.50 $8.90 $17.00 $25.50
1976 $7.90 $10.20 $19.40 $29.00

The 1980s

Prime Minister Minister of Health Political party
11/11/75 to 11/3/83 Hon Malcolm Fraser, MP Hon Michael MacKellar, MP(8/12/79 to 20/4/82)
Senator Hon Peter Baume (20/4/82 to 7/5/82)
Hon Jim Carlton, MP (7/5/82 to 11/3/83)
Liberal/National Country
11/3/83to 20/12/91 Hon Bob Hawke, AC MP Hon Dr Neal Blewett, MP (11/3/83 to 4/4/90) Labor

Rural registrar training posts were no longer available.
Specialist skills training posts become unavailable due to opposition from specialists
The Formative Evaluation of the Family Medicine Program was published
The RACGP's Scope for General Practice and Training for General Practice was published
The RACGP's progressive trainee assessment began
The RACGP published Computer Systems for General Practice
A stream for training rural GPs within the RACGP commenced in SA
The RACGP published Computerised Medical Record Systems – Proposed Minimum Standards.
A Joint Diploma in Obstetrics became available (RACGP and RACOG) but was not initiated until 1982

1980s - Propofol started to replace thiopental as an induction agent.
1982 - 20th April, Peter Baume (Liberal) became Minister for Health. His term ended on 7th May, 1982
1983 - 7th May, Jim Carlton (Liberal) became Minister for Health. His term ended on 11th March 1983
1989 - The government established vocational registration for general practitioners in Australia.
1983 - 11th March, Neal Blewitt (Labor) became Minister for Health and later Minister for Community Services and Health. His term ended on 4th April, 1990
1987 - The RDA (NSW) was formed

Medicare Rebates Short Standard Long Prolonged
1980 $8.20 $11.20 $21.00 $32.00
1981 $8.20 $11.20 $21.00 $32.00
1982 $8.70 $12.00 $22.50 $34.50
1983 $9.60 $13.20 $24.50 $38.00
1984 $10.80 $15.00 $27.50 $43.00
1985 $10.80 $15.00 $27.50 $43.00
1986 $12.60 $17.60 $32.00 $38.0
1987 $12.60 $17.60 $32.00 $38.00
1988 $10.00 $21.00 $38.00 $56.00
1989 $10.00 $21.00 $38.00 $56.00

The 1990s

Prime Minister Minister of Health Political party
11/3/83to 20/12/91 Hon Bob Hawke, AC MP Hon Dr Neal Blewett, MP (11/3/83 to 4/4/90)
Hon Brian Howe, MP (4/4/90 to 20/12/91)
Hon Peter Staples, MP (Family and Health Services (from 7/5/90 to 20/12/91)
20/12/91 to 11/3/96 Paul Keating, MP
Dr Hon Carmen Lawrence, MP
Brian Howe, MP (24/3/93 to 11/3/96)
Peter Staples, MP (Minister for Aged, Family and Health Services) (24/3/93 to 11/3/96)
11/3/96 to 11/3/96 to 3/12/07 John Howard, MP Dr Michael Wooldridge, MP (11/3/96 to 26/11/01) Liberal–National Coalition

1990 - The state RDAs formed a federation of states to form the Rural Doctors Association of Australia
1990 - 4th April, Brian Howe (Labor) became Minister for Community Services and Health and later Minister for Health, Housing and Community Services. His term ended on 24th March, 1993
1991 - The Rural Doctors Association of Australia is incorporated
1991 - The first National Rural Health Conference (NRHC) is run by the RDAA. At this conference recommendations were made to have a dedicated rural training program, rural health training units and a multidisciplinary National Rural Health Alliance (NRHA)
1992 - The Medical Practice Act 1992 repealed the 1838 Medical Act and all its amendments. The Medical Tribunal and a number of other disciplinary and review bodies were established.
1992 - The RDA obtains a grant from the government to enable training schemes for GPs in anaesthesia, obstetrics and surgery as part of a dedicated rural training program.
1992 - Desflurane is introduced as a general anaesthetic.
1993 - 24th March, Graham Richardson (Labor) became Minister Health. His term ended on 25th March, 1994
1994 - 25th March, Carmen Lawrence (Labor) became Minister Human Services and Health. Her term ended on 11th March, 1996
1994 - evofluane is used as a general anaesthetic.
1996 - 11th March, Micahel Wooldridge (Liberal) became Minister for Health and Family Services. His term ended on 26th November, 2001
1996 - Vocational registration becomes mandatory for general practitioners for the higher Medicare rebates.
1997 - The Health Services Act commenced on 1 July 1997, replacing the Public Hospitals Act 1929 and the Area Health Services Act 1986.

Medicare Rebates Short Standard Long Prolonged
1990 $10.80 $22.50 $38.00 $60.00
1991 $11.20 $23.50 $42.50 $62.00
1992 $11.40 $24.00 $43.50 $64.00
1993 $11.45 $24.15 $43.55 $64.20
1994 $11.50 $24.30 $43.85 $64.60
1995 $11.50 $24.30 $43.85 $64.00
1996 $11.60 $44.25 $42.50 $65.20
1996 $11.70 $24.70 $44.65 $65.75
1998 $11.90 $25.05 $45.30 $66.75
1999 $12.30 $25.85 $46.70 $68.80

Colonial Times
Early Federation
1950 to 1999
2000 Onwards