Australia’s universal healthcare system, Medicare, started in 1984.

Much has changed in the four decades since, but the government’s approach to general practice – the backbone of our health system – hasn’t kept up.

As this report shows, a system designed for an earlier era hasn’t been updated to respond to the rise of chronic disease, or to tackle gaping disparities in access to care, rates of disease, and life expectancy.

The complexity of GP work has grown immensely, as the population has grown older and rates of mental ill-health and complex chronic disease have climbed. But the model for general practice has changed little. GPs are struggling to fit more and more care into appointments that still average 15 minutes, and lack the support of a broader team.

Other countries have reformed general practice, and their rates of avoidable hospital visits for chronic disease are falling. Australia has spent 25 years on a merry-go-round of tests and trials that have not changed the system, and our rates are holding steady. We are spending more and more on hospitals, while neglecting general practice: the best place to tackle chronic disease.

Patients suffer the consequences. People with chronic disease live shorter lives, with more years of ill-health, and lower earnings. The effects are worst for poorer Australians, who are twice as likely to have multiple chronic diseases as wealthy Australians.

Australia’s health workforce is also struggling. Hospital staff are overwhelmed with demand. And GPs report being stressed, disrespected, disillusioned; struggling to meet increasingly complex demand in a system that does not support them.

More of the same won’t work. To turn the tide on chronic disease, Australia needs a new Medicare, with three big changes.