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Big year ahead for general practice
This will be a very big year for Australia’s GPs. But we are yet to see if it will be big in a good or a bad way.
It is a Federal election year. It is a year in which we expect all the loose ends of the Government’s health reform processes and consultations to be tied together in an election health policy package.
But what sort of package will it be?
A lot of the hints from the various taskforces and commissions last year did not build confidence in the general practice community.
Doctor substitutes. Fundholding. Managed care. GP Super Clinics and proposed Comprehensive Primary Health Care Centres. And little support or incentive for smaller local community practices. These are signs of an erosion of the independence and the traditional primary care leadership role of GPs.
While most of these things are not Government policy that we are aware of, the Government did little to talk down the possibility of these threats to GPs and their patients becoming a reality.
Nothing of substance on the nature of future health reforms came out of the December COAG meeting either, despite huge expectations ahead of the talkfest.
Throughout 2009, both Prime Minister Kevin Rudd and Health Minister Nicola Roxon were on the public record supporting GPs as the leaders in primary health care.
In 2010, we need to see that support translated into policy and action.
It is the job of the AMA to keep the Government honest in its support for GPs. And we had a lot of success in this role in 2009.
Perhaps the biggest achievement was winning an amendment to the Health Legislation Amendment (Midwives and Nurses Practitioners) Bill 2009 that specifies a formal requirement that midwives and nurse practitioners must work in collaboration with medical practitioners.
This amendment creates a collaborative care model that is supported by all the GP groups and provides confidence and security for GPs and patients – and for midwives and nurse practitioners. The AMA will be vigilant to ensure the Government does not back down on this vital amendment to the legislation.
We had success, too, in securing important changes to Medicare audit arrangements under the Health Insurance Amendment (Compliance) Bill 2009. Following AMA lobbying, the Government deemed that only medical practitioners (not clerks) employed by Medicare Australia can view patient records during audit processes.
Audits of Medicare billing will only occur in cases where Medicare Australia has a reasonable concern. The audits will not be random.
The AMA has strongly represented the interests of GPs in Senate hearings and in all the consultations with major reform groups such as the National Health and Hospitals Reform Commission (NHHRC).
More importantly, we are the only medical group to have presented the Government with a plan for immediate achievable health reform.
The AMA’s Priority Investment Plan for Australia’s Health System provides the Government with well-informed recommendations to support and promote general practice as the cornerstone and leader in primary care.
We propose GP Primary Care Centres – which build on existing general practice infrastructure – as superior options than GP Super Clinics or Comprehensive Primary Health Care Centres.
We propose more GP training places.
We propose improved MBS arrangements to support and encourage greater use of general practice nurses. The AMA considers this a priority policy area.
We propose review and simplification of MBS GP items to enable patients to receive rebates that better reflect the high quality acute care, complex care, chronic diseases management, and preventive care provided in general practice.
We also seek greater support and incentives to enhance the role of GPs in mental health, Indigenous health, aged care, and rural and remote health.
It will be a good year for GPs and patients if the Government takes advice from the AMA as it develops its election health policies on primary care.
If the Government adopts some of the more radical proposals floated by its commissions and taskforces, affordable quality primary care for all Australians will be put at risk.
Dr Andrew Pesce is President of the Australian Medical Association. This column first appeared in Australian Doctor on 7 January 2010.
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