Here’s an update on a few of the issues AMA Victoria is working on for members, including:
Cohealth review highlights shared responsibility and the path forward
AMA Victoria provides feedback on proposed VVED ADHD pathway.
Cohealth review highlights shared responsibility and the path forward
AMA Victoria welcomes the release of the Review into cohealth's general practice and related services, Final Report.
We have consistently advocated for the report to be released publicly. Given the significance of the issues involved, and their impact on patients, clinicians and communities, transparency matters.
While we are still working through the report in detail, our initial view is that it provides a balanced assessment of a complex situation.
Importantly, the review rejects simplistic explanations. It does not conclude that the inadequacy of Medicare rebates and funding arrangements for complex multidisciplinary care alone led to this situation. Nor does it place responsibility solely on cohealth. Instead, it points to a combination of factors, including Commonwealth funding settings, longstanding pressures on community health infrastructure and capacity, the characteristics of the patient population, and cohealth's own governance and management.
The review's recommendations are directed to the Victorian Government, the Commonwealth Government and cohealth itself. That seems appropriate. The review makes clear that all three contributed to the circumstances that led to this situation and all three have a role to play in addressing it.
The review also highlights the patients at the centre of this issue. It identifies high rates of chronic disease, mental illness, homelessness, refugee status and financial hardship among cohealth patients. Many require longer consultations, continuity of care and coordinated multidisciplinary support. Almost 40 per cent were assessed as being at urgent or high risk of hospitalisation.
Many of these patients cannot simply find another doctor down the road. They rely on trusted clinical relationships built over many years and on models of care that bring together general practitioners, nurses, allied health professionals and community services under one roof. For some, losing those services means losing the wraparound support that helps address both medical and social needs.
It is also important to recognise the clinicians who choose to work in these services. Many community health doctors could earn considerably more in private practice or elsewhere in the health system. They work in community health because of a commitment to vulnerable patients and communities. That commitment has sustained these services for many years, but goodwill alone cannot sustain them indefinitely.
Some of the governance and management issues identified by the review are specific to cohealth. However, the broader pressures facing community health are real. Victoria's community health sector provides care to people who are often unable to access or navigate mainstream services and delivers enormous value to both patients and the wider health system.
The review should end any suggestion that this was simply a cohealth problem. It identifies failures and pressures that extend beyond a single organisation and raises important questions about how governments, health services and the sector support care for some of Victoria's most vulnerable communities.
AMA Victoria will now work through the report's findings and recommendations in detail and engage closely with our members working within cohealth and community health regarding the practical reforms needed to support patients, strengthen these services and secure their long-term sustainability.
For the patients, clinicians and communities affected, the measure of success will not be the report itself. It will be what happens next.
AMA Victoria provides feedback on proposed VVED ADHD pathway
AMA Victoria has provided feedback on a proposed Victorian Virtual Emergency Department (VVED) pathway that would allow eligible adults with an existing ADHD diagnosis to access a short-term prescription when they are unable to see their usual treating practitioner.
In our submission, we supported efforts to improve access to ADHD assessment and treatment. However, we questioned whether a virtual emergency department is an appropriate setting for ADHD prescribing. We noted that ADHD is a chronic neurodevelopmental condition requiring ongoing assessment, monitoring and continuity of care, and that prescribing decisions form part of a broader therapeutic relationship between a patient and their usual treating practitioner.
The proposal includes safeguards such as diagnosis verification, medication history review, SafeScript monitoring and specialist oversight. While these measures may assist in addressing risks relating to inappropriate prescribing and diversion, we argued that they do not address the more fundamental question of whether interruption to an established ADHD prescribing arrangement constitutes an emergency presentation requiring management through an emergency service.
We also sought further clarification regarding how eligibility would be assessed, how inability to access a usual treating practitioner would be determined, and what safeguards would apply to ensure the pathway remains confined to its stated purpose. In particular, we raised concerns about the risk that the pathway could become an alternative source of prescribing rather than an exceptional mechanism for unforeseen circumstances.
We also noted that continuity of care requires communication between clinicians and argued that prescriptions issued through the pathway should be communicated to the patient's usual treating practitioner. We further questioned whether the proposed supply period of up to 30 days is proportionate to the pathway's objective of providing short-term access pending review by a patient's regular clinician.
Our submission concluded that a virtual emergency department is not an appropriate setting for ADHD prescribing. Should the proposal nevertheless proceed, we argued that stronger safeguards around eligibility, repeat use and communication with usual treating practitioners will be essential.