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Will the new-look divisions really serve the locals? (Australian Doctor, opinion editorial)
08 June 2010. By Dr Harry Hemley, president of AMA Victoria.
THE federal budget last month sounded the death knell for divisions of general practice. Contracts will not be renewed. Soon, divisions will be either converted to Medicare Locals, or simply wound up and disbanded.
Many GPs rely on the services of their divisions for practice support, preventive health initiatives, training and a host of services. For others they are simply a waste of money, arguably costing each GP about $8000 a year in foregone rebate rises.
There is no doubt that many divisions provide no-cost or heavily subsidised services that improve general practice businesses, and improve patient care. Will Medicare Locals do the same? From the budget papers, it’s hard to tell.
The first priority of Medicare Locals will be to improve access to after-hours care.
Paradoxically, this will be done by removing the practice incentive payments to general practices for taking care of their patients’ after-hours needs. Without the $2, $4 or $6 per patient as an incentive, I wonder how many practices will just stop providing after-hours care.
Medicare Locals will not just look after general practice. The broader focus of Medicare Locals has the potential to dilute the role of GPs in governance and, more importantly, reduce the access of general practices to services. For example, current divisions’ IT support services will have to help hundreds of new clients.
That’s assuming that Medicare Locals will even be asked to provide services currently undertaken by divisions. First, there is the prospect that services will be cut. Buried deep within the budget papers is the promise that existing divisional contracts will be allowed to expire. Nowhere is there a promise that existing service will be maintained.
Second, there are plenty of other organisations that will be happy and willing to take on the tasks currently undertaken by divisions if they are still funded.
Government agencies, not-for-profit organisations and commercial entities have all expressed interest in running the Medicare Local businesses in whole, and/or offering competition for services.
Indeed, it would be difficult — given the recent Auditor-General report into the school building program — for government to justify reletting divisions’ contracts directly with Medicare Locals rather than put them out for tender.
The funding involved is significant. Divisions of general practice employed 3000 staff in 2008, and managed about $1 billion in contracts over the past five years. There is even more money on the table for Medicare Locals.
There will be several organisations, old and new, wanting to get their hands on this money.
There’s definitely a sense of unease among GPs regarding Medicare Locals. The funding for divisions originally came from cutting MBS rebates for general practice. As a result, many GPs have a sense of entitlement to services from divisions. Others just want their money back.
No one seems particularly keen for divisions to morph into Medicare Locals to provide an unspecified set of services to a wider range of providers, other than the existing staffs of divisions.
The real test will be how Medicare Locals help general practice provide better patient care.
Divisions have had a patchy record in this regard — some have been sensational, and some ordinary at best.
At least the divisions of general practice were nominally ours, nominally run by and for general practice. I can just see Medicare Locals co-located with existing Medicare offices, using the same call centres, and providing the same generic services to all primary care providers.
Medicare Locals may end up simply an extension of the vast Medicare bureaucracy — another 3000 health bureaucrats.
Disclaimer: AMA Victoria owns three businesses: mpstaff, a staff recruitment business; mppracticesolutions, a business providing practice advice; and Solutions Plus Training, a training provider. Should divisions’ contracts be put out for tender, AMA Victoria-owned businesses may bid to provide services currently managed by divisions of general practice.
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