30 March 2023
Competing with Dr Woolies, and alleged war criminals
In the last week Woolworths announced its venture into the wild wild world of telehealth GP consulting via its HealthyLife subsidiary, and Avant, one of our biggest indemnity insurers, announced that it would no cover doctors who were practising asynchronous text-based consults without a prior in-person consultation.
There’s quite a bit to unpack here so I won’t get to all the reasons tech is so pivotal to the future prosperity of GPs here (I’m guessing you all just can’t wait for that long-winded article though).
The move by Woolies, the Avant decision and the move of the Medical Board of Australia to regulate asynchronous telehealth far more rigorously had a bevvy of entrepreneurs, VCs and so called disrupters up in arms this week on social media.
Various personalities complained that the entry of Woolworths was bad for GP access and innovation but didn’t make the reasons why very clear (see below), and that removing insurance for doctors practising asynchronous consults and regulating it further would destroy innovation and reduce patient access.
But if you were scoring the week as good or bad for GPs I’m fairly certain that, for once, GPs came out on top this week (yay).
As much as we all should be encouraging innovation, we can’t if it’s at the cost of patient safety. And telehealth, in the hands of the various privately funded telehealth organisations that have been ramping up recently, was not heading in a good direction for patient safety.
We know this, not just because it’s obvious – if you don’t know a patient and never physically see them at any point, a lot can eventually go wrong – but because at its heart Avant is a business that deals with risk and its actuaries have put their foot down: insuring doctors who practise medicine like this is just way too big a risk.
They’ve done the maths.
The Medical Board of Australia clearly thinks what Avant thinks, even though it hasn’t got an army of mathematicians in the back room calculating risk like Avant does.
So chalk up one for the idea of GP-centred continuity of care and the concept that without some face-to-face engagement via a GP at a bricks-and-mortar establishment, care is obviously a lot less safe over the long term.
But once you’ve had a small celebration on this small win, have a bit of a think about why Woolworths decided to dip its toes into the medical consultation market in the first place.
Sure setting up telehealth and leveraging deep and longitudinal data profiles of all its supermarket and insurance customers to optimise its business is one possibility, but it’s probably not Woolies’ whole plan.
Here’s one thing that Woolies could easily be thinking:
“OK, to scale telehealth now, it looks like we might need our own doctors in physical locations … we can test that … and if that works, wow, we might even get Medicare rebates on telehealth with our customers and, wait for it, that might solve a whole lot of other problems for us getting into health in a much bigger way because every time we try to convince the government to let us have pharmacies they won’t because the Pharmacy Guild keeps arguing it would be unsafe but how unsafe would it be if we have a team of doctors in there already? …”
You might feel that this is a bit of a stretch.
It’s a big play if all this was envisaged in an endgame.
But healthcare is very big business and getting bigger and organisations like Woolworths have the most comprehensive data on individuals via their checkouts, insurance and credit card data than potentially any other market facing consumer group, including the banks.
If Woolworths and Coles can move in and out of hardware, liquor and insurance, to leverage their customer bases, is it really that big a stretch to suggest they might one day get serious about health.
Health is becoming a much more accessible market to players like Woolworths because of technology.
If Woolies could crack in store pharmacy eventually – it bought long time online pharmacy operation SuperPharmacy last year so it’s intention seems clear – that alone might entice them to go to all the trouble of actually putting doctors’ surgeries inside some of their centres, and they could go from there.
Telehealth was a logical first move: despite what all the other telehealth companies out there say to us about how they are innovative and disruptive, none of these groups, including current private market darlings like Pilot, Mosh and Instant Scripts have any innovative technology advantage at all.
Everything a group like Pilot or Mosh does can be done easily by a group with a lot of money and ambition.
And if that group happens to have access to masses of adjacent customers via existing businesses, and piles of longitudinal data about customers’ shopping and other habits, as Woolies does, well, you’d have to think that this week was a lot more worrying for all these privately run telehealth players that say they are innovators and disruptors than it is for GPs.
Woolies has all the requisite assets to walk over the top of all of these smaller startups and scaleups, if it plans and executes properly.
The argument about access to GPs would all be in Woolies’ favour if it went this way with the right marketing and government lobbying.
Notably, Woolies owns one of the biggest and best data analytics companies in the country, Quantium. It isn’t that big a jump to be analysing supermarket and insurance customer buying data and working out who might need a few adjacent health services.
Most people love to argue that the US is different to us so you can’t look that way – but for what is happening here, it isn’t, and this is happening in the US big time now.
Walmart has both GP-manned care clinics and a connected pharmacy play which it is attempting to scale (it’s planning on opening 4000 healthcare super centres by 2029 including comprehensive clinical services – maybe it can buy Healius instead of ACL?) and Amazon recently acquired OneMedical, a giant telehealth setup.
Certain RACGP personalities came out this week on social media and damned the entry of Woolies into health suggesting it would further deplete access to GPs.
But this is not necessarily the case.
At first blush the whole idea of Woolies having a health division feels wrong when you think about a proud and effective history of community medical practices and the continuity of care that created versus a practice inside every Woolworths one day.
But we already have GP corporates which focus almost entirely on having their practices in large shopping centres. The biggest one of those – MyHealth – is part owned now by Medibank. So the idea of seeing a GP while at your local shopping megaplex is already in play.
If you are cringeing reading this (I’m cringeing writing it), then here’s a positive thought.
If this did happen on any scale then it very likely wouldn’t be GPs that would be the worst impacted and with a few things going right, it might end up being good for GPs.
The first casualties of something like this would likely be all those telehealth outfits that are saying how innovative and disruptive they are, but which in large part are practising some pretty risky medicine by automating telehealth at high volume without properly understanding or physically seeing a patient.
As things stand these groups are going to be immediately impacted by the Avant and Medical Board of Australia decisions on asynchronous consults.
But if Woolies got going?
And if Coles followed, as it would, then these so-called innovators and disruptors could be in a lot of trouble (some might just get acquired by the big guys).
But GPs would not be, almost certainly.
If a trend like this got any traction, then GPs would be needed in spades.
And if you’re Woolworths and want to attract GPs, you’re going to have to make it worthwhile with good pay and conditions to get them on board.
Things are going to change quite a lot in how we deliver health over time now, a lot because of technology (more next week) and in that process how GPs work and who they work with is likely to change a lot.
No one likes change, but in all this change there is one very important baseline: GPs will need to be at the centre of care delivery in the community, no matter what it eventually looks like.
It is feasible that if big business starts getting more involved, then there might be better income and more flexible working conditions for GPs.
Why did the RACGP keep quiet about this employee?
The RACGP isn’t saying much about how it employed an ex-SAS soldier who had been accused of a war crime in a Four Corners exposé and stood down by the military – or why it kept quiet for a year after being told about the connection.
This is a disappointing lack of transparency. A few weeks ago the college called a press conference to announce it was cutting up to 15% of its non-training staff, emphasising that it had made the announcement in that fashion because the college was now running on a pillar of significantly increased transparency to the membership.
Going to press late last Friday, this letter is all that college members had been told:
Some of you may have read news reports that one of our employees has been arrested today and charged with serious offences.
We are treating the matter seriously and taking appropriate action.
We were not aware of this issue when the employee became employed with the RACGP.
This is a criminal matter, and we need to let the court process run its course. We are committed to the presumption of innocence. We also recognise these are serious charges.
As for the employee’s ongoing employment, we need to manage this as an employment matter and address it directly with our employee. As you would appreciate there are confidentiality and privacy issues.
If you find the news distressing, please remember that confidential EAP services are available for you and members of your family.
It was signed by RACGP Board chair Dr Lara Roeske, president Dr Nicole Higgins and CEO Paul Wappett.
The “we were not aware” line above might turn out to be true, but it’s very misleading, because yesterday we found out that the college was made aware a year ago that former SAS soldier Oliver Schulz, manager of the college’s Future Leaders Program, was alleged to be the person in the video shooting an unarmed Afghan man.
These are the fairly simple questions we think members should have answers to:
- When exactly did the college employ this person? We are assuming it was after he was stood down by the army, which happened in 2020 after the ABC report.
- Did the college contact his previous employer for a reference and if not why not? The college may have done so and the army may have had legal issues with providing a reference, but wouldn’t that be a red flag? It doesn’t feel like employing this person at the time the college did would pass any pub test.
- Why did the college do apparently nothing to investigate the allegations when it was alerted to them a year ago?
- Why did the college not do something like stand this employee down (even with pay) if this cloud was hanging over him, rather than have him continue to work closely with its members who were kept in the dark about the allegations? Schulz presented at GP22 in November last year, at least eight months after senior college leaders must have known about the allegations.
Wild Health understands that some college members who have been involved in the leadership program, some of whom are veterans, are now extremely upset.
And why wouldn’t they be?
If the college is going to be transparent it needs to hold an immediate independent investigation into how such a catastrophic breakdown in its processes could have taken place: in employing this person in the first instance, but then much more seriously, in apparently doing nothing when it was informed of the allegations.
So here are some more questions.
Who among the college leadership knew about the allegations a year ago?
Who decided that it was OK to bat back the inquiry – the correspondence was forwarded to Wild Health – with the words: “The RACGP does not respond to unsubstantiated allegations”?
And what happened after the college did that a year ago, given no one else at the college seemed to know outside of whoever dealt with this inquiry, until this week when Schulz was arrested?
Why did the college think it was OK for this employee to present at GP22 given what it had been told?
There are any number of other questions that I imagine members would like answered, including one we got yesterday after publishing this story, which asked why the college felt that the military model of leadership (which is largely command and control) was something that would be relevant to the leadership training of a doctor?
From any PR crisis management perspective, saying nothing about what has happened here to your members is the worst possible thing the college could do.
The researcher who alerted the college told its media team he was planning on writing publicly about this employee, so the college had to expect it would come out at some point.
It is not a problem the college can smack away with “innocent until proven guilty” (he is) or a reminder that it’s sub judice.
All the questions above are about the college and its processes, not about the person who has been charged with a crime, or the crime itself, so answering most of these questions is not going to affect the impending legal proceedings against their employee.
Schulz faces court in May.