Wednesday, September 14, 2011

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 53

GPs set to ditch Medicare Locals contract over board restrictions


GPs at a division awarded one of the first Medicare Locals contracts have warned the Federal Government that they will “walk away” from the deal if they are forced to give up control on their boards.
Medical Observer understands the contracts, sent to many of the first 19 winning bidders in recent weeks, explicitly state the Medicare Local (ML) must have a board of 7–10 directors with no single profession dominating.
NSW division, GP Access, is involved in one of the first tranche of MLs, and currently has six GPs among its eight board members. Board member Dr Arn Sprogis said the clause was “obviously aimed at GPs”.
“No other organisation would put up with such a prescriptive clause,” he told MO.
Dr Sprogis said for the first five years of transition from GP divisions to MLs “all the heavy lifting... has to be done by GPs”.
This includes most after-hours care and hospital liaison, he added.
“If you’re expecting GPs to do all the work, you wouldn’t put a clause in that says their numbers are to be reduced.”
It comes as the Federal Government this week officially invited the AGPN to set up a new national body to coordinate MLs.
The AGPN, which is currently constitutionally bound to looking after divisions, had widely been expected to assume that role in relation to MLs but the invitation solidifies its function once the funding for divisions ends.
Acting Health Minister Mark Butler said divisions funding would now continue until the end of next year, not 30 June as was previously announced, which would mean AGPN takes on its new function from the start of 2013.
Meanwhile, fellow GP Access board member, Dr Allan Kirkpatrick, said a board meeting to discuss and potentially sign off on the ML contract last week was postponed due to concerns about the governance clause.
“We may have to go back to the drawing board and say [to the Health Department] ‘sorry’. The membership may not go for it either,” he said.
GP Access was discussing the contract with the Health Department and remained hopeful it could be renegotiated to create greater flexibility on board membership as MO went to press.
“If we think our community isn’t going to be better off with the contract that’s on offer, then obviously we’ll walk away from it,” Dr Sprogis said.
Sydney GP Dr Harry Nespolon, chair of the Northern Sydney General Practice Network, which missed the first tranche of MLs, was concerned that if GPs involved in the first round of contracts did not ensure adequate representation on their boards, future MLs would suffer as a result.
Dr Nespolon warned that the Health Department would assume it had resolved contract problems, meaning all subsequent MLs would be forced to sign uniform “vanilla” contracts.
“One of the great promises was that they were supposed to be local, and we would be able to tailor the business for its constituency,” he said.
The Health Department had not responded to MO queries at time of press.


Dr Joe
19th Jul 2011
2:34pm
Dr Nespolon is spot on.Sadly there will be divisions which will be blinded by the light of government dollars and jobs for (what they believe to be) life.
ondocfarm
19th Jul 2011
2:40pm
Did the ML potentials (ie old ADGPN's) sign up without READING the FINE PRINT?....
So they have sold out GP for what?!?!..... Serves them (but not the rest of us) right!
GET OUT NOW...it may be too late! .... UK style National Health by Stealth being FORCED on to Australian Family Medicine!?..... Come in Suckers!!
Babyteeth
19th Jul 2011
2:49pm
Harry Nespolon, there is a reason everyone doesn't want GPs running things anymore, you GPs had a go and we saw how it was run. Harry Nespolon, I don't want you running Medicine in the CBD of Sydney. Harry, can you please tell me all of the activities of the Regional GP Divisions, and every thing the GPs involved used that authority for, including that which you don't want to state publicly. In particular, how did Regional GP divisions deal with Rogue Drs, miscreant Drs, or Drs, the consensus of Regional GPs, didn't want practising in their Area or Region ? (I see, Harry, you don't like a Vanilla world, well I give you Vanilla Ice, a Vanilla question with bite).
TIBOR
19th Jul 2011
2:53pm
The Greater Metro South Birsbane Medicare Local has limited membership to organisations and there will be no opportunity for individual GPs to become a voting member. GP's are classidied as Non-Member Stakeholders and they have the right to attend, but -not- speak or vote at any general meeting. So much for doctors having a central and important role. The ML governances, even though initially, some doctors already in the division will have roles, but eventually they will be forced out by organisation representation. Who knows what these so called organisations are. The doctors so far involved, should pull out now, as there is nothing for the medical profession in these MLs in the long term and they may be ultimately doing a disservice for the profession.
Pav
19th Jul 2011
3:06pm
I was hoping someone could answer this for me. Exactly what products and/or services would be offered to a patient/client who walks into the new ML GP Access (I am a GP in the Newcastle region) and how will this enhance their health in ways other than the current Hunter Urban Division does? How transparent will their accounts be? Will they simply be a "project funding committee" (as another former poster here has suggested)? I guess a lot of the healthcare funding will go towards new laptops/iPads/smartphones for the staff of the MLs.
At the moment I am at a loss to explain the functions of the ML to my patients.
Detracter
19th Jul 2011
3:20pm
This is simple old fashioned politics.
The divisions had too much power, influence and unity. So lets sucker them in to MLs where we can change the rules and control their behaviour and then replace them by bureaucrats from Canberra, who know where to send health funding credits properly.
The GPs will all blame their local GP political leaders and miss the fact that we now run them, and we can get nurses to do their jobs, as we direct, for a fraction of the cost, because that is what its all about when we have a NBN and Carbon Tax to fund.
Doc Sheri
19th Jul 2011
4:22pm
Tibor, Harry, that level of excluding GPs from the governance framework is totally unacceptable and no ML should accept such a proscriptive clause. I feel sorry for Detracter & Babyteeth, as their Divisions allegedly did nothing to support their practices. Did they in fact seek to be active contributing members, or did they expect to be spoon-fed? Well, now they can be governed into the periphery if the rest of us kow-tow to this limitation. Maybe then they will be happy??? I think not, nor will their patients be when there is a reduction in continuity of care which most good GPs aspire to maintain, rather than the improved care levels espoused by the promotion of MLs.
And this says nothing about the additional workload of supporting eHealth and its benefits for the long term!
ed
19th Jul 2011
4:38pm
Ha, all these divisions and their so called leaders have done nothing but waste money having plenty of staff who do nothing and think of great projects which would suit WHO in a third world country but not have meetings whereuselesstopics are discussed. Harry name one initiative which has improved health care which you are your people have come up with.Apart from justifying their jobs nothing happens and everyone is paid inspite of failures
Doc Sheri
20th Jul 2011
10:56am


So, Ed, your division provided no IT support to practices, no mental health counsellors to work in your practice, no access to allied health workers for your patients - what a shame, cos that's the kinds of services many good and worthwhile Divisions/Networks provided and continue to provide.
khanGP
19th Jul 2011
5:23pm
I have been crying out loud, for a fair while now - Our GP Divisions & the AGPN have betrayed their Loyalty towards their Fellow GPs - they have been fooling us GPs at the Coalface, saying that GPs' best interests lies in being in the thick of things & being involved with so-called ' Health Reforms ' & staying involved & assisting the formation of MLs. It is still not too late for GP Divisions to pull out en-masse from having anything to do with MLs & inform the innocent Populace that GPs believe that the formation of MLs will be the commencement of the end of the Family Doctor.
DR. AHAD KHAN - GP
Doc Sheri
20th Jul 2011
11:04am


Hope it doesn't come to that, but this is Labour Policy, and was what lead to the issue raised by Amateur Observer in Victoria when doctors where removed from hospital boards (apart form a few DHS-employed persons with medical quals not in regular active practice). This has certainly led to a dilution in appropriate skills representation on many Hospital Boards, and is evident in some of the current poor planning decisions taken during the current wave of building programs which have as many holes in them as did the pink batts and EBR programs federally.
Amateur Observer
20th Jul 2011
10:04am
As someone who has been a Regional Training Network board member, as well as a little involved in a GP Division, I can see that there can be evils from both extremes of board membership.

If there is total GP representation on boards, then they can become tram-tracked into a certain mode of thinking which can exclude ideas outside their expertise. I can think of a number of examples where having a couple of other representatives would have been very beneficial, for example, a legal advisor, an accountant, a consumer representative, etc. There were also examples on the RTN board, where occasionally practice-issues were weighed as higher priority than certain registrar teaching issues, and overruled the teaching issues. This ought NEVER happen in an organization which is funded entirely to deliver GP Registrar teaching, but is run by the GP teachers. Unfortunately, some GPs were unable to totally remove their "Practice Partner" hat when making decisions, and allowed those biases to guide their decisions.

On the other hand, the Victorian Health Department a number of years ago expunged ALL doctors off their hospital boards. Quite an absurd and offensive move, lacking in basic courtesy for the role of doctors on hospital boards over many years. They subsequently had to reinstate "advisory committees" of doctors as they had completely lost medical input, but have (as far as I know) not allowed doctors back on the hospital boards. This kind of tall-poppyism would not be tolerated if applied to (say) removing all Economics or MBAs grads on a public sector board for reasons of wanting to remove a particular set of skills, views, and values!

I would be interested if any correspondents here could reply if they are aware of any adverse events resulting from Victorian doctors being removed from hospital boards, as this might help formulating a more considered response to the current Federal policy for Medicare Locals.
Babyteeth
20th Jul 2011
1:46pm


Doc Sheri, seems very sincere about their belief in the possibilities of this system. I accept that is how it should be............. In my area, the Drs were there for their own self-interest and other Business agendas. Many Drs in my area had an issue with me, and I was targeted in a most vicious campaign, and other extraordinary events happened in my Practice. The Regional Division should have intervened and solved this issue and protected me. The reason why Non-Drs have to be brought in to solve these problems at the ML level, is because the Drs in power let everyone down, and to break the power base of the Drs and to avoid corruption of the system. (Admittedly, even non-Drs get caught up in protecting such Dr networks, as is shown recently in the Hospitals) ..................... My proposal, is that in these MLs, every Dr Practice, Allied Practice, every Dr, Allied Practitioner and Community Nurse in the area should be listed as a constituent. Combining MLs with some form of Community Health Service, even situated in the Offices of the Local Municipal Council makes sense. This would be a way of integrating all allied health Services, and Drs in one place, and the Power Drs would feel very uncomfortable in that environment and disappear. I could go as a GP down to these Offices and find about all the various GPs, and for example psychologists and work out where to send patients. I could find a Community nurse, who wants to help follow-up a few patients, or come into the Practise at times. I could also find out the latest and best Computer programmes to run my Practice. This sounds a more friendly way to do things, as I have always been scared of all Dr run organisations, (and that will never change).
TIBOR
20th Jul 2011
6:36pm
Right from its conception, I have never had any dealings or utilised the services of any Divisions, and decades ago I explained to the executives, that I considered they were of no benefit to my day to day medical practice and that they were being used by the government to establish in the future mini health departments with fund holding capabilities. The situation we find our selves in, is exactly that we are facing and worse then that, we have no idea of what the structure and final functions of MLs will be and I believe, nor does the government, apart from a general ideolgy perspective. What the short comings of the Division were is of no relevance, as are past personality issues. The Divisions are dead in the water. The government does not wish the governance of MLs to be doctor orientated, but instead alternate organisation representations and hence a more beaurocratic organisation of public servants dealing with financial and logistic issues.
khanGP
20th Jul 2011
8:26pm
Tibor is absolutely spot on. But, I also believe that all is not lost yet . The MLs' Jumbo Jet will not be able to get off the ground & fly without the necessary Medical Input. If the AGPN & all the Divisions ' pull the plug ' & totally refuse to co-operate or assist the MLs in any way & institute a Total Boycott, things will come to a screeching halt.
DR. AHAD KHAN
TIBOR
21st Jul 2011
6:36am
KHANGP I TOTALLY AGREE WITH YOU AND THAT IS WHAT I HAVE BEEN SAYING ALL ALONG
Prog
3rd Sep 2011
8:39am
I am worried that possible fundholding of medicare local corporations will lead to rationing and eventually a sellout to US Style Managed Care companies,

Concerned