Protect General Practice
- Text Decrease
- Text Increase
- Print Page
A few weeks is a long time in politics
The last few weeks have been amazing weeks in politics for members of the medical profession and for the AMA. We have a Federal Government that has put health front and centre in the political debate. After two years, multiple reports, and endless consultation around the country, we are now seeing some of the details being revealed.
Governments have come a long way since the Dr Wooldridge days with the freeze on medical school places and the freeze on specialist training places that followed. The short-sighted view that, if there were 'fewer doctors to generate costs, the costs would be less' simply transferred problems to the future - and that future is now.
We have finally had recognition that the growth of the medical workforce has not kept up with the increasing demands of a growing and ageing population. The previous Government significantly increased the number of medical students and medical schools around Australia and those future colleagues are now graduating. This current Government has realised that these doctors also need quality postgraduate training and recently announced significant increases in the number of those training places. For example, general practitioner training places have now almost doubled from the nadir in the Wooldridge years of just over 600 places to 1,200 places in 2014, and this is very welcome. Prevocational General Practice Placement Places have been increased to 975 places per year by 2013 (this is some 175 more than even the AMA asked for in our Budget Submission.). We know that all future specialists will gain something in their training by having some general practice exposure.
Training places need quarantined funding for the clinical teachers who will deliver this training and they need the infrastructure to be able to do it. Both hospital and general practice budgets have been run so lean in the last few years that significant investment is still needed in this area. The announcement that the Federal Government would fund 60% of teaching and research and 60% of capital costs in relation to public hospitals was most welcome. But it must be supported by significant infrastructure funding for general practice as well.
One could be forgiven for believing that health reform was all about reform of the public hospitals, with the Prime Minister announcing that he would position the Australian Government to become the dominant, activity-based funder of health care in hospitals. Though this is very important - and the AMA will continue to push for a single public funder - Mr Rudd also announced that the Australian Government would fund up to 100% of the outpatient services in public hospitals and take full responsibility for funding general practice and primary health care services in Australia. This is an essential move to improve the integration of health services, as the easiest cost shift is out of hospital and into the community.
We have been advised that there will be an announcement on this soon, along with e-health, to help all the parts talk to one another.
It would be fair to say that the thinking of the past has been based on a hospital-centric health system. But, with the population growing and ageing, it has become apparent that, unless there is earlier intervention, we simply will not be able to afford to pay for the health care of the future. What we are seeing is the start of the change to a general practice-centric health system.
Once again, the influence of AMA thinking has been important.
Our Budget Submission notes that, when people are sick, they want to see their family doctor, and it is that doctor who forms the basis of primary care in Australia. There was a time when we thought the term 'primary care' had been hijacked by others in the health team, but more recently we have heard, even from the Prime Minister's lips, the phrase, 'GP-led primary health care', over and over.
The challenge to general practice in this health reform is not just to look after ill health but to take responsibility for health maintenance and health promotion as well. To achieve this, we will need to work more in teams and to work in collaboration, not competition.
The AMA vision for GP-led primary health has been severely tested, however. We all recall the Health Minister giving the Light on the Hill speech when she asserted that she was not the Minister for Doctors at a time when she was looking more like the Minister for Nurses. Since then, with extensive work from the AMA with the Government, the result has been recognition from the Government that doctors and nurses should work together, not in competition. The amendments to the Nurse and Midwives Bill passed in the Parliament recently put Australia in the unique position of guaranteeing collaboration between the nursing and the medical profession.
This will be one of the first times that we have not followed America into increased competition, increased fragmentation, and then inevitably increased costs. Doctors and nurses (and midwives) working together with mutual respect for each other's skills is the way it has always been and is the way it should be. It is good to see that the radical few did not derail the debate. The main beneficiaries of the passage of those amendments will be the patients.
The vision of a joined-up health system and GP-led primary health care faces many more challenges.
The mooted Primary Health Care Organisations must not be allowed to put another layer of bureaucracy between the doctor and the patient. The GP Super Clinics must not be allowed to steamroll existing services. They should supplement existing services. E-health will quickly save lives, but needs focused investment both to establish and to encourage its use. Unique patient identifiers are only the first step.
We still need more support for aged care. We still need MBS simplification. GPs need better access to MRI and point-of-care testing.
The AMA has been able to position itself as an adviser to the Government with very good access to the Prime Minister and the Health Minister. We are also positioned as the key health adviser to the Opposition Leader and the Shadow Health Minister. Both Mr Rudd and Mr Abbott made reference to the AMA in their televised debate last month.
Your AMA leadership team will continue to work hard on your behalf to inform the changes proposed by government. Whatever changes are adopted, they must be able to be tailored to local needs. They must not add to bureaucracy and red tape, they must enhance clinician engagement, and they must enhance the family doctor/patient relationship and not detract from it.
We will carry these messages on your behalf right up to Election Day.
Preferred Providers
Next
Prev