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Doctors issue health warning (Ballarat Courier, opinion editorial)
With the ink on the Commonwealth Government’s $½ billion Medicare Locals cheque barely dry, regional and rural Victoria should brace for change to the GP-patient relationship.
Last Tuesday the government accepted tender applications for the first tranche of Medicare Locals which are due to start operating in July.
The Commonwealth Government’s model dilutes a fundamental, hallowed and crucial premise upon which modern community medical care is built – the relationship between the doctor and the patient.
The Victorian Government recently issued a paper that supported the implementation of Medicare Locals. In response, AMA Victoria has written to Premier Baillieu urging the Victorian Government to oppose the rollout of Medicare Locals in its current form.
Medicare Locals is a poorly conceived model put together by bureaucrats who, in their quest for another layer of bureaucracy, have paid little or no heed to expert opinion from the profession.
Indeed Medicare Locals is a development that should trouble every Australian who values excellence in health care just as much as it is troubling members of the medical profession. It could well mean that Australians’ access to their doctors will be restricted.
The government document that outlines the program is worryingly vague. This paucity of detail suggests that bureaucrats in the capital are either unsure about where to take health care, or they have other plans in the bottom drawer ready to roll out in the wake of this agenda.
There must be no doubt in anyone’s mind that the primary health care organisations in Ballarat – indeed across Victoria – are, quite simply, family doctors and not bureaucracies. Under the Medicare Locals program yet another bureaucracy will be established with people remote (from both a geographic and knowledge viewpoint) to coordinate primary health care delivery and address needs and service gaps.
In essence this means that a Medicare Local office will potentially ration access to quality medical services. Staff with no direct knowledge of patient history will “assist” patients with their journey between the GP, the specialist and the hospital, and with issues such as accessing diabetes equipment, Centrelink liaison and aged care placement. The big danger is that this may well lead to Medicare Locals restricting patients’ access to their own doctor and the services that he or she provides.
Chip away the political rhetoric and you find another layer of complexities looming large – a speed hump, if you like – between the surgery and the positive patient outcomes. A remote voice on the phone or an unknown face behind a counter are no substitutes for the service provided by the GP and the team at the surgery. Certainly this should be a concern for people living in regional and rural Victoria where the relationship between GP and patient is so crucially important.
This month AMA Federal Council voted to oppose Medicare Locals and called on the Commonwealth Government to defer the establishment of any primary health care governance organisations until there had been genuine consultation with the medical profession.
AMA Victoria is keen to achieve better patient care and has proposed principles supported by AMA’s Federal Council. Under these principles the money that would be spent establishing Medical Locals (the budget is $477 million over the next four years) would be allocated to the provision of Care Coordinators who would work in the same place as the GP and talk with patients to help them to navigate referrals and other care needs.
Without another layer of costly bureaucracy there would be significant savings which could be more sensibly spent on, say, aged care services and primary mental health care, both of which are areas in dire need of support.
The Medicare Locals train is rolling along at an alarming rate. The Federal Government has decreed that Medicare Locals may be formed by a single organisation, a group, partnership, joint venture or consortium. What this means precisely no one is quite sure. One thing is for sure: individual family doctors will be excluded.
With such scant detail on basic operational expectations and haphazard direction within the guidelines document, there is a real risk that successful tenders will be either groping in the dark or making it up as they go along .
AMA Victoria’s vision puts the patient’s interests first, delivering coordinated care where it is needed. If the Medicare Locals plan stays as is, we are all in for a complex and unnecessarily expensive bureaucratic juggernaut which adds nothing to patient care.
Dr Harry Hemley is president of AMA Victoria.
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