SWSLHD and Bowral's Health - 59

HCCC denies doctors the ‘option to state their case’

2nd Dec 2011

Byron Kaye   all articles by this author - Medical Observer

THE NSW Health Care Complaints Commission (HCCC) has been forced to scrap its standard practice of giving every complaint recipient the chance to respond as it struggles with a sharp rise in notifications despite falling staff numbers.

HCCC commissioner Kieran Pehm also revealed, in the commission’s annual report, that the agency has stopped contacting each complainant to discuss their grievance, and its “service to complainants and providers has suffered” as complaints against the state’s medical professionals rose 16.8% in 2011.

The spike came as permanent staff at the HCCC, the only state-based health watchdog since all others merged into AHPRA, continued to decline from 85 in 2007–08 to 77 now.

“In response to the increasing number of complaints, the commission has had to alter its practices, which has resulted in an inevitable reduction in the level of customer service,” Mr Pehm wrote.

“As a result of the increased demand on its resources, the commission had to limit the action it takes on complaints. This means that in more cases, it no longer clarifies the issues with the complainant, does not seek a response from the provider and gives notice of the outcome only in writing.”

An HCCC spokesperson said the report specified that the new strategy of assessing notifications “solely based on the information provided in the complaint” applied mostly to minor complaints deemed likely to be dismissed anyway.

However, Avant medico-legal consultant Dr Craig Lilienthal said the new measure amounted to “denial of natural justice” as it meant more health professionals were not given the option to state their case, however minor the complaint.

“It’s a huge step backwards... making the complaints process totally unreasonable,” he said.

But Dr Brian Morton, chair of the AMA’s general practice council, supported the measure, saying it would save taxpayer money and take up less of doctors’ time with “frivolous complaints”.

COMMENTS:

 

Gila-mdc
2nd Dec 2011
3:04pm

What a good idea - the HCCC can undertake its independent evaluation and sort of the real ones from the ridiculous, nonsensical complaints.

 

ton doulos
2nd Dec 2011
3:33pm

Finally one of these kangaroo courts is been to be seen for what it really is .
viz.and institution not interested in the nature of any issue rather that the real issue is that there has been a complaint at all

 

DrPhil
2nd Dec 2011
6:14pm

so now you can kick the doctor who can't defend themselves???? we need more details on the difference between Brian's position and Craig's.

 

Babyteeth
2nd Dec 2011
9:18pm

In the NSW Parliament Second Reading (2005) of the new HCCA Act, the HCCC were told not to investigate Minor Complaints anymore. Finally, in 2011, they are now answering that directive. In between times, many Drs have been prosecuted for minor Complaints, and one Dr was de-registered for multiple minor Complaints (new Section 37 of the MPA). This couldn't go on, so the HCCC has finally taken the correct position....Simple airing of Complaints is the best way to go, and there really is no need for Drs to reply, but they can if they want to....hopefully this is a move away from the punitive model.... All Drs need to be investigated all of the time, and that is the end point we should aim for......Also, most minor Complaints are false Complaints, and need to be ignored, and shouldn't be added together to convict the Dr....False minor Complaints brought down our Medical Insurance Industry.

 

Babyteeth
2nd Dec 2011
9:23pm

We have to laugh at Avant Insurance and the AMA who stood around for Thirty years, and allowed innocent Drs to be prosecuted, and pursued relentlessly by the HCCC and the NSWMB. Avant Insurance and the AMA, told the innocent Drs to plead guilty and accept their Medicine. Both the AMA and Avant, also allowed and encouraged the most hideous changes to NSW Legislation from 2005 onwards. Both the AMA and Avant, encouraged the few 'bad Apples' concept of Prosecution as long as the HCCC didn't pursue the Specialists and their mates.... Note, both the AMA and Avant, have changed their core people for decades, and so nothing changes, yet it appears the HCCC may be changing...

 

Dr Anne
2nd Dec 2011
11:29pm

a psychotic relative of a patient once made an unfounded complaint about me, but I could do nothing about it. Why couldn't I complain about him? He was a professional (non-medical)and spent his time writing to the HCCc about various doctors. But nothing was done to stop him.
And, Babyteeth, you don't make sense -if 'all doctors need to be investigated all of the time', but most complaints need to be ignored, where is the logic in that?

 

Babyteeth
3rd Dec 2011
12:07am

Dr Anne, your Complainant was a Psychopath,as they like to destroy people, and the system we had in the past, encouraged these outrageous Complainants.,,, in the past, whether this encouragement of Complaints crossed the line to pre-meditation of Complaints against targeted Drs (a likely evolution), is what I am concerned has not been answered to date. ....... I want a level playing field, a benign system, where all Drs weaknesses are recognised, challenged and improved....yes, my statement contradicts, but we will have to compromise with the Authorities,....and even I have learnt from a vexatious Complainant who pressed my buttons and got me to respond, and even to get angry.... I am trying to find a system, that will satisfy the Authorities, but almost removes totally the punitive component of the system.....I only want Punishment of Drs for totally reckless intoxication, crimes and criminal exploitation of their position....A Dr should not fear the end of their career every time they get a Complaint....... Also, the defence of Complaints can be far too complicated to test in Court, ....for example, 'misdiagnosis', 'botched surgery' and 'failed follow-up' Complaints often accuse the wrong Dr as there may be 6 other Drs involved in the background of the patient's care....and history tells us the 'better and most innocent' Dr of those involved ends up facing the prosecution....

 

DR GEORGE QUITTNER
4th Dec 2011
7:21am

IF ONLY IT WERE THAT SIMPLE. The psychopaths also have access to the courts. The unfettered access by mentally disturbed patients to "due legal process" can convert a conscientious doctor's life into a nightmare. I would caution any doctor who thinks they can manage the narcissist.

SWSLHD and Bowral's Health - 50

Senate inquiry ignores GP role in mental health: AMA

2nd Nov 2011 Byron Kaye   all articles by this author

Medical Observer

THE undermining of GP involvement in mental health care through the slashing of Better Access rebates has been ignored by a key Senate inquiry examining the impact of the government’s cuts to the program, the AMA has claimed.

The claims follow the tabling late yesterday of a report from a Senate committee investigating mental health funding – the same day the controversial changes, which include substantial cuts to GP mental health rebates, took effect.

While the long-awaited report made no specific recommendation on the MBS cuts, it questioned moves to reimburse only 10 visits to psychologists under the Better Access program. Previously, up to 18 visits could be reimbursed.

AMA president Dr Steve Hambleton said the report, including dissenting reports from the Coalition and the Greens, presented a “mishmash of views” that largely overlooked the impact on GP patients of cutting MBS rebates.

“I think GPs are entitled to be disappointed,” he told MO.

“It has missed a lot of issues. I think that the department of health really didn’t assist the committee with the evidence it provided. It seems that the department has listened to the advice of bureaucrats, not doctors.”

The government’s mental health funding overhaul was however broadly attacked from both sides of the political spectrum following the release of the Senate committee report, with the Coalition saying the government had “not fully considered” the impact on patients and the Greens calling for a postponement.

The report questioned whether the alternate Access to Allied Psychological Services (ATAPS) program – which is to receive more funding and be administered through the yet-to-be-operational Medicare Locals – could be expected to service patients previously treated under Better Access straight away.

Greens senator and committee chair Rachel Siewert wrote in the report that she was “greatly troubled” that “there will almost certainly be a substantial period where Medicare Locals and GP divisions will not be fully engaged with the ATAPS program, and consequently will not be able to deliver appropriate mental health care for consumers”.

She added in a statement today that cutting the number of psychology sessions under Better Access “is likely to, in the immediate term, exacerbate existing service gaps for people with severe and persistent mental illness.”

“The current system is not ready for the government’s proposed changes. The government should revise its scheduling for the 2011–12 federal budget changes to ensure continuity of care,” she wrote.

The AMA, along with other general practice groups under the umbrella organisation United General Practice Australia, had called for a one-year moratorium on the MBS rebate cuts for GP mental health visits. Senator Siewert’s remarks did not directly address that demand – one of the key concerns that led to the inquiry in the first place.

Liberal senators also gave no recommendation on the GP rebate cuts in the dissenting report but wrote that any MBS cut “ought to have been discussed and fully canvassed with key provider groups and stakeholders before being arbitrarily inserted into the budget purely as a cost-saving measure”.

Both the Coalition and the Greens said the inquiry aired concerns about problems attracting GPs to work for youth mental health initiative headspace, which told the inquiry its staffing problems would be made worse by the rebate cuts.

Senator Siewert wrote that since headspace was getting more funding, it could “employ GPs directly, ensuring a guaranteed funding base that provides a buffer”.

In its section of the report, Labor repeated its claim that the Better Access changes would “achieve a better balance between the Medicare fee-based model provided through Better Access and the low- to no-cost services directly targeted to hard-to-reach groups through ATAPS”.

 
Tags: Mental health, MBS, Better Access, ATAPS, United General Practice Australia

SWSLHD and Bowral's Health - 44

We’ll fight cuts, GP groups vow

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer


GP LEADERS have vowed to keep fighting the “very dangerous policy” of cutting mental health rebates, after a survey found half of family doctors were dissatisfied with their efforts to stop it.

A survey of 150 GPs nationwide, carried out by Cegedim on behalf of MO, found an overwhelming 95% of respondents did not feel their views and experiences with mental health had been “adequately taken into account by government” in the  push for mental health reform.

But the survey also found the disquiet went further than government with 54% answering “no” when asked: “Are you satisfied with the efforts of the RACGP and AMA in their attempts to convince the government to cancel the cuts?”

The cuts to the Better Access scheme, designed to save about $400 million to fund other mental health services, look set to begin next week unchecked.

From 1 November, existing MBS rebates of $163.35 for a GP mental health plan will be reduced to $85.92 for a plan drawn up in a consultation of 20–29 minutes and $125.43 for one drawn up in a consultation of more than 40 minutes.

The tabling of a mental health Senate inquiry report,  sparked by the cuts, originally due in September and expected to provide advice on their impact, has been delayed. It is understood the report will be released this Friday – just three days before the cuts take effect.

RACGP president Dr Claire Jackson said GPs should be reassured by the quick and cohesive action of both bodies and the AGPN, under the United General Practice Australia banner,  to block the cuts.

“In my presidency it is the most critical issue the profession has faced, and the college was determined to work closely with the AMA and the AGPN,” Dr Jackson said.

“It was very much a team effort to try and bring all our strength to bear on overturning what we think will be a very dangerous policy initiative for the most vulnerable Australians,” she said.

AMA president Dr Steve Hambleton said dissatisfaction with his organisation’s representation came from its inability to prevent the cuts, but he would continue pushing the government to restore them.

The poll also found 31% of GPs would continue to bulk-bill mental health plans despite the cuts, while 39% said they would charge a gap and 13% said they would seek other options.

Tasmanian GP Dr Graeme Alexander said “general practice has been abandoned” by government at state and federal levels but dismissed the AMA and RACGP as “out of touch”.

“We certainly can’t get a political person of any flavour to show leadership and fix [the health system],” he said.
“We have no representative body.”

Tags: Mental Health; MBS; Better Access; AMA; RACGP; Steve Hambleton; Claire Jackson

Comments:

Ross
26th Oct 2011
5:48pm

As a bulk billing GP who derives a considerable part of my income from treating mental health cases my income is set to drop when the new item numbers take effect. This is in addition to rebates not keeping up with inflation. The government continue with their so called reforms to improve General Practice when in fact they are wrecking it.

 

SMS
26th Oct 2011
8:51pm

i am putting a big sign up in my waiting saying gillard and roxon big axe to mental health- so far i have alot of angry patients toward labour government- soon i will have charge a gap payment of $80 for drawing up a mental plan

27th Oct 2011
4:06pm

I very much respect Prof McGorry as a defender of youth mental health. However, in this interview, he seems to narrow the mental health budget debate to youth mental health only. That GPs work with Headspace centers would not be much help to a 32 year old with depression.
That we introduce yet more Medicare item number to differentiate between treating a 20 year old and a 25 year old is only going to give those of us at the front line of service delivery more unnecessary administration issues.
Youth mental health is important but not more important than child mental health or adult mental health. Whilst mental illnesses tend to first manifest in youth, most of the burden of disease is manifested by adults who present to their local GP practices in distress. Surely the government has to appreciate the fact that as an aging society, prevention should be focus, but so too the distribution of resources need to accommodate the current demands in mental health services.

 

Annabel
27th Oct 2011
5:26pm

Well said...Prof McGorry is terrific at championing his cause. Does it need to be at the expense of other mental health needs. Rob Peter to pay Paul. Was there no way of gaining the extra funding for Headspace and EPPIC without alienating the whole General Practice and psychologist Profession? Prof. McGorry is saying that in no other area of health care would one group be pitting itself against another for funding (I doubt this is true) and he seems to be pointing the finger at primary care providers as being the divisive faction.

 

Liz
28th Oct 2011
9:21pm

Having previously worked in Addiction and Mental Health, the Mental Health package available to GPs enabled continuing treatment of this group of patients within the GP environment. The ability to refer these patients to a psychologist also assisted their care significantly because ongoing care was often not available in the public sector. These changes to Medicare are such a retrograde step. Professor McGorry seems to think that transferring funding from GPs who mostly do a good job in supporting mental health patients of all ages, to just one group just doesn't make any sense.

SWSLHD and Bowral's Health - 42

Pride and prejudice: the mentally ill GP

24th Oct 2011 Pamela Wilson   all articles by this author

Medical Observer

Should doctors with mental health issues continue to practise? Pamela Wilson investigates.

Sydney magistrate Brian Vincent Maloney has fought a very public battle with bipolar II disorder – and because of it he very nearly lost his job.

Earlier this month he survived a motion in the NSW Legislative Council to remove him following a string of complaints about inappropriate behaviour in the years before his illness was diagnosed, including that he repeatedly asked a pregnant woman to stand up to show how pregnant she was and showing a screensaver of half-naked women to a female colleague.

In May, a NSW Judicial Commission had deemed him incapable of performing his role as a magistrate, despite his condition now being treated and well controlled. MPs’ debate centred on whether Mr Maloney remained incapacitated for the job – though for him their decision had more important implications.

“Upon your decision, in this case, depends whether a person suffering from a mental illness will dare to seek medical assistance,” Mr Maloney said in an address to the Upper House in June.

He could have been speaking for the one in five GPs with mental illness, many of whom are continuing in their professional role: should a well controlled mental illness be a barrier to employment for those in positions of responsibility?

“We know that even with severe mental illness, doctors can practise safely once it is controlled,” says Brisbane GP Dr Margaret Kay, who works with the Doctors’ Health Advisory Service Queensland.

The only time a doctor’s health status should be called into question – legally and ethically − is when it severely impacts on their ability to perform their job within the accepted standards and puts the public at risk, she says.

“We are not allowed to have untreated depression that is affecting our practice because we can hurt people. But we also know that it’s very rare for that to happen,” Dr Kay says.

The law governing medical practice states that anyone who places the public at risk should not be working, but as Medical Board of Australia (MBA) chair Dr Joanna Flynn points out, conversely this means that anyone not placing the public at risk is well within their rights to practise medicine.

If a doctor’s behaviour is brought to the attention of the board, the conditions or penalties they face are not draconian.

“It’s an extremely rare thing for someone to have their registration taken away because of a health problem. It’s only in circumstances where someone is severely ill and not taking the medical advice they are given that their registration would be taken away,” Dr Flynn says.

“There is a process of assessment and negotiation with the practitioner about the conditions under which they can work safely and what monitoring needs to be put in place.”

Despite the laws mirroring the medical profession’s long-standing philosophy of what constitutes best practice in these situations, national mandatory reporting legislation introduced last year seems to have blurred the lines of perception and reality for many in the medical fraternity.

Because doctors are now bound by law to report ‘notifiable’ behaviour of their colleagues, many doctors with mental illness are not seeking help for fear of putting their livelihoods at risk.

Legal sanctions can be imposed on doctors who fail to report colleagues who place the public at risk of substantial harm because they have an impairment or severely breach professional standards. Practising while intoxicated and sexual misconduct in connection with work are also considered notifiable conduct.

Western Australia is the only state in which treating doctors are exempt from mandatory reporting laws.

Since the introduction of mandatory reporting, there has been a drop in the number of doctors seeking help. While hard data is not available, anecdotal evidence suggests a direct correlation between the two.

Dr Kay says the advisory service reported a marked drop in doctors calling for advice at the same time that mandatory reporting was introduced in Queensland.

“It was very hard for us to not think this sudden precipitous drop in calls was related in some way, and then we started getting a number of calls from people asking about mandatory reporting,” she says.

“It’s not that much different to what we have always been professionally and ethically required to do... It’s the perception that is different.”

Dr Kay says the service’s consultants also report that callers are now admitting they delayed seeking treatment because of mandatory reporting, and that they are seeing an increase in doctors reporting to be suicidal.

AMA president Dr Steve Hambleton says it’s regrettable that doctors don’t feel they can seek the advice of a treating doctor without fear of being reported.

“As it stands, doctors are actually not self-reporting, not going to see their doctor as much as they were because they are concerned their livelihood is going to be put at risk,” he says.

Dr Flynn concedes this perception now exists, but stresses it is an unjustified fear.

“The biggest concern we have is that people misunderstand the situation and don’t seek care when they need it because they’re afraid of being reported,” she says.

Melbourne GP Dr Caroline Johnson, a spokesperson on mental health for the RACGP, believes the issue is a complex one that needs more debate to get it right.

“The goal is that health professionals can seek treatment, advice [and] support without fear of being reported. By the same token, we obviously need to make sure there are standards in place and there are safety measures, and I think the legislation hasn’t really addressed that balance.”

The first annual report into mandatory reporting will be released in coming weeks, but Dr Flynn says there has been no major increase in mandatory reports since the change in legislation.

All doctors who come before the medical board are treated individually and sensitively.

“The people who do that role understand they need to look at their public protection role but also need to weigh against that the legitimate interests of the doctor in continuing to work… and their health needs,” she says.

Starting the conversation
TWO years ago federal politician Andrew Robb announced he was stepping down from his duties for three months to seek treatment for a depressive illness.

Openly admitting to having a mental disorder took some strength. Mr Robb says in his memoir, Black Dog Daze, that he knew it could be seen as a weakness and could count against him politically, but  he “couldn’t be cowered by that”.

However speaking up and seeking support for a mental illness can actually preserve professional integrity, explains Dr Caroline Johnson.

“If you put your head in the sand... [it could] increase your risk of being unable to work,” she says.

Usually when it comes to mental illness, most doctors who come before the MBA achieve a good outcome, says Dr Kay.

“Even with severe mental health problems, when people are involved with the medical board most of them get back to work very safely,” she says.

Speaking up also helps reduce the stigma of mental illness in the community, says SANE Australia executive director Barbara Hocking.

“[Doctors] have an important role to demonstrate to the community that in fact there is no shame in having mental health problems, and the earlier you get the support and treatment you need, the better it’s going to be for everyone.”

Under the Australian Medical Council’s code of conduct, any doctor concerned that their health status may adversely affect their judgement, performance or their patient’s health must seek medical advice and not rely on their own assessment of the risk posed to patients.

In its document, Guidelines for Mandatory Notification, the MBA offers advice and questions to help reporting doctors choose the best course of action.

It stresses that the threshold that must be met to trigger a mandatory notification is high.

“The notifiable conduct of the practitioner must have placed the public at risk of harm as well as being a significant departure from accepted professional standards before a notification is required,” it says.

AVANT’s special counsel in professional conduct, Helen Turnbull, says the first step for reporting doctors is to approach their colleague with their concerns and encourage them to seek advice.

It is also vital they take time to consider the facts and seek advice from colleagues, medical defence organisations and/or support services so the burden of reporting is a shared decision.

“As they talk through it, they realise in many cases that it’s more an element of a colleague simply being unwell, i.e. suffering from depression, but there is no actual impact on patient safety,” Ms Turnbull says of many of the doctors who call them for advice.

Dr Johnson says all doctors should try to become involved with a GP support network so they have a forum where they can seek advice in these situations.

GP Super Clinics - Is there ever anything for nothing - 7 ?!

AMA calls for super clinics inquiry

13th Oct 2011 AAP   all articles by this author

HEALTH Minister Nicola Roxon has taken a swipe at the AMA following the association’s call for the auditor-general to investigate the federal government's GP super clinics program.

The move by the AMA comes after Ms Roxon announced the scrapping of a planned clinic in Darwin on Wednesday and the axing of a Tasmanian super clinic last week.

AMA president Dr Steve Hambleton has written to Auditor-General Ian McPhee "urging a thorough audit of the program by the Australian National Audit Office".

Dr Hambleton accused the government of putting political needs ahead of patients.

"There is emerging evidence that the GP super clinics program is a failed initiative in concept, design and implementation," he said in a statement.

"In terms of planning, the location of clinics appears to be largely a political process that is not necessarily linked to community need."

Ms Roxon hit back, accusing the AMA of being unhelpful.

"The AMA is not interested in ways to improve the GP super clinic program," she told AAP in a statement.

"They have never supported it and never accepted the need to find ways to attract doctors to undersupplied areas.

"Those who don't change with the times are often reduced to an ineffective chorus muttering on the edge of the stage about keeping things the way they always were."

It was revealed last week that a $2.5 million clinic in Tasmania was to be abandoned, while on Monday Ms Roxon pledged $3.2 million to bail out a stalled Brisbane clinic.

Dr Hambleton said that if the program was found to be flawed, allocated funds should be redirected to improve existing general practices.

The Coalition's Parliamentary Secretary for Primary Healthcare, Dr Andrew Southcott, said the GP super clinics program was a shambles from the beginning.

The Country Liberals MP for Solomon, Natasha Griggs, said Ms Roxon needed to explain how the $5 million originally allocated for primary healthcare in Darwin was going to be spent.

Ms Roxon said 17 GP super clinics are operational Australia-wide. Another 16 are providing early services or are under construction.

Tags: Nicola Roxon, GP Super Clinic, AMA, Steve Hambleton, National Audit Office

 

SWSLHD and Bowral's Health - 21

Stop cuts to mental health funding: doctors’ plea

29th Sep 2011 Andrew Bracey   all articles by this author

DOCTORS have made a plea to Federal Health Minister Nicola Roxon to place a moratorium on the looming cuts to Better Access funding in order to provide adequate time for the government to consider the outcome of an ongoing Senate inquiry.

With the inquiry due to hand down its final report on the government’s handling of mental health funding by 20 October, AMA President Dr Steve Hambleton said the 1 November deadline for the introduction of the funding cuts was premature.

“This leaves very little time for serious consideration of the Senate committee report,” Dr Hambleton said.

“Ten days is not enough. The Minister must defer the implementation of the changes to the Better Access program until at least 1 November 2012 to allow proper consideration of the compelling evidence against the cuts,” he said.

Dr Hambleton argued the 12-month moratorium on Better Access funding would provide adequate time for the government “to acknowledge the error of its ways and restore the Better Access funding”.

If the government fails to agree to the requested moratorium, the current rebate of $163.35 for a mental health plan for GPs trained in level 1 mental health skills, will be replaced by a rebate based on timed consultations from 1 November.

The new rebates will be $85.92 for a plan written during a consultation of 20–39 minutes, $126.43 for a 40-minute consult for GPs trained in mental health skills, and $67.65 and $99.50 respectively, for GPs without the training.

Tags: Stop cuts to mental health funding: doctors plea

Comments:

sergie
29th Sep 2011
6:20pm

A Mental Health Care Plan after 1st November 2011

Dear Mr... Ms... Um...the patient didn't know your name,

This patient, what's his name? - for the medicare rebate, I didn't have the time to get his either - suffers from depression/ anxiety/bipolar disorder/ delusions/ hallucinations/child abuse/ absent self-esteem/ obsessive-compulsive behaviour/ anti-social tendencies/ addictions to alcohol, gambling and pethidine/ dyslexia/ uncontrollable anger/ suicidal ruminations/ wishes to kill someone/ (cross out whichever does/do not apply), carries/rope/ a knife/ gun/hand grenade/assorted explosives wherever he goes (ditto) and has been prevailed upon by his bullied/battered/abused/neglected wife and children to change his ways.

I look forward to your comprehensive report and continuing management of this man.

With thanks.

 

tvkdas
29th Sep 2011
7:24pm

I almost 100% bulk bill but have drawn the line in the sand. As it takes me time to do a proper care plan, I will charge a fair fee for the plan as a reflection of this as well as my expertise (which, mind you, they insisted on us "upskilling" through the additional training for the higher rebate and then about face with this plan to decimate the rebate) and I will make it abundantly clear to my patient that it is Julia Gillard and her health minister Nicola Roxon who feel that they do not feel it worthy to support my patient's access to a fair rebate and so they will be out of pocket significantly as a result.

 

ondocfarm
1st Oct 2011
6:46am

Typical AMA, asleep at the wheel, too little too late and now trying to shut the stable door long after the horse as bolted!!

SWSLHD and Bowral's Health - 20

GPs to charge gap for Better Access Program

• By Michael Woodhead on  29 September 2011

The AMA has prepared a template letter that GPs can use to tell patients why they will face out of pocket expenses for mental health services under the Better Access Program.

The letter (link) explains that the Federal government reduced Medicare rebates for
GP mental health services by up to 49 per cent in the last budget, and the changes take effect from 1 November 2011.

The AMA says it supports GPs in charging fees that reflect the cost of providing patients a safe and high quality service, and that this will result in some patients facing an out of pocket expense for the first time for GP mental health services.

The template letter states that the practice unfortunately cannot lower fees to match the significant reduction in Medicare rebates implemented by the Government.

“The fees that this practice charges for our services reflect the cost of providing you with a safe and high quality service and the time that needs to be spent in caring for your health needs,” it says.

It also advises patients that if they wish to let the government know that they are unhappy with its decision, they can contact the Minister for Health and Ageing Nicola Roxon.

A recent survey by the AMA found that up to 50% of GPs would be forced to maintain their current fee and charge patients a gap, and up to 28% of GPs would stop using Medicare GP Mental Health Treatment items.

About six out of ten GPs thought the Budget cuts would lead them to spend less time with patients with mental health problems.

The AMA has meanwhile written to Health Minister Nicola Roxon calling for a moratorium on the Budget cuts to GP mental health services.

AMA president Dr Steve Hambleton said that a Senate Community Affairs Reference Committee – which received more than 1000 submissions – is currently looking into the Government’s handling of mental health services and is not due to report until 20 October.

“This leaves very little time for serious consideration of the Senate Committee report,” Dr Hambleton said.

SWSLHD and Bowral's Health - 16

Psychiatrists back Better Access cuts

• By Michael Woodhead on  21 September 2011

Two leading psychiatrists have told the government it is doing the right thing by scaling the Better Access scheme for mental health.

Professor Ian Hickie told a recent Senate Inquiry (link) into Mental Health Services that the cuts – which will see GP rebates slashed by half – were needed to “correct the balance” and were “extremely welcome”.

He said the scheme had never been intended to cover all psychological care outside of hospital, but it was now being used for ‘higher need‘ patients who would be better managed through the ATAPS program.

He also applauded the move to cut the number of sessions from ten to six, saying it would allow more people to be treated for shorter periods.

“We have people who should not be in that care system receiving long-term care while many other people are excluded,” he said.

Professor Hickie was backed up by Professor Patrick McGorry who said any patient needing more than 10 sessions with a GP required “a serious re-evaluation and they probably need more skilled psychological care ... probably on a team basis.”

However AMA president Dr Steve Hambleton (link) told the inquiry the AMA opposed cuts to a scheme that was helping more than a million patients access GP mental health services each year, including over 130,000 in disadvantaged areas.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 56

AMA sets up GP voice for Medicare Locals

• By Gemma Collins on  20 July 2011

The AMA is creating GP consultation groups in each of the Medicare Local districts to “empower” doctors to have a leading role in how the organisations are run. 

AMA President Dr Steve Hambleton said he would be travelling to each of the first 19 Medicare Local areas to help the groups ensure the AMA primary care message is “spread” throughout the communities.

Speaking in Canberra today, Dr Hambleton said that the organisations needed GPs on their boards in order to work, and he had already written to Health Minister Nicola Roxon and chairs of the Medicare Locals to express his concerns.

“Our view of Medicare Locals is that, if they are implemented correctly and with the right intentions, they can work,” he said.

“But doctors have to be core parts of the process.”

The announcement came as the AMA released the results from its latest online poll in which 760 GPs responded about the planned cuts to Medicare patient rebates.

Around a quarter of GPs said they would stop using Medicare GP Mental Health Treatment items following the cuts.

Around 85% said they believed fewer patients would receive vital care and just over half said they thought the budget cuts will lead to them spending less time with patients with mental health problems. 

Doctors also revealed that the average time taken to prepare a mental health plan during and outside a consultation is 52 minutes, not the 28 minutes suggested by the government.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 48

Work with us on Medicare Locals, Roxon tells AMA

27th May 2011 - Medical Observer

Mark O’Brien   all articles by this author

HEALTH Minister Nicola Roxon has urged incoming AMA president Dr Steve Hambleton to work with the Government on Medicare Locals and defended the “sensible recalibration” of rebates for GP mental health plans, in a speech to the association’s national conference in Brisbane today.

Ms Roxon urged Dr Hambleton to “stay inside the tent” when it came to discussing Medicare Locals, following ongoing criticisms from the AMA of the rollout of the organisations.

The AMA has called for the rollout to be put on hold until the exact functions Medicare Locals will have are made clearer and GP leadership within their governance structures is assured.
“My message to the AMA, and in particular to Steve as your new president, is to work with us on these changes,” Ms Roxon said.
“Ultimately, as a new president, the choice of how we engage is yours. But my suggestion to you is this: if you’re not sure you like what you see, come and talk to us about it.”

In response, outgoing AMA president Dr Andrew Pesce said the remaining “lack of detail” about the Medicare Locals was “disturbing”, and pledged that the association would maintain its pressure on the Government.
“The Government’s proposal to roll out Medicare Locals is the next big challenge of the AMA,” he told the conference, adding that he was “confident the Government will have to revaluate its position”.
Ms Roxon, meanwhile, defended the recently announced rebate cuts for GP mental health plans outlined in the Federal Budget, saying they were “based on good data and sound reasoning”. ('Calls for mental health rebate cuts to be reversed,'MO, 24 May)
“They are a sensible recalibration of the rebates which GPs receive, designed to better reflect time spent by GPs and bring them in line with other time-based Medicare items – while, importantly, maintaining a premium if GPs have undertaken mental health skills training,” she said.

Ms Roxon said the AMA’s pre-Budget request for $20 billion in health spending without proposing any savings was not sustainable.
“There is an endless range of areas where you can invest to do good in health – but not a bottomless bucket of money with which to do that,” she said.

Later, while answering questions from conference delegates, Shadow Health Minister Peter Dutton said a Coalition government would ensure Medicare Locals did not become fund-holding organisations, pledging that their funding would be returned to GPs.

stevekth
27th May 2011
5:05pm

Ms Roxon- your slash-and-burn policy towards the better access / mental health care planning process is both short-sighted and inflammatory to a profession already struggling to meet demand, especially in poorly doctored and often realtively poor, bulk bill-dependent communities. Your slashing of the rebate is not sensible. Maybe for your departmental purse strings, but neither for policy in this area nor for bringing GPs on side with your policies. Recalibration? No. Decimation, maybe. Better reflect time spent? How convenient, when the rebates for the other attendance items are frankly insulting and belong at a standard of living comparative rate in the last millenium. This is also in effect dumbing this vital area of our work down. You require us to undergo training to do this work, and then barely either reward or reasonably renumerate us for having done that work. All that this will do for many GPs is encourage them to charge a significant gap fee, or eschew this work altogether. Most of us are already so overbooked we would do better to see our much briefer level B type consult patients who wouldn't otherwise get an appointment. It is no secret that many GPs could see three level B consults in the time it takes for a Level C consult- and for much better net renumeration. What message are you and the pre-existing pegging of rebates for level B and C consults sending? Patients have a need for your help. You are not helping us to provide that help. Premium being maintained? Or derisory incentive to develop and maintain our skills and provide extra time for relatively less renumeration; derisory uplift when considering the extra paperwork, secretarial time, ink, paper, and often telephone calls and correspondence that goes with doing these plans? I and my colleagues are passionate about our patients. I believe strongly in continuity of care and in holistic services for my patients. But YOU are helping to make that not sustainable for me. YOU are decreasing the reasonable renumeration for my time, skills and experience- and all in a world of endless need, when I must decide how I use my time best for patients, maintain an income, support my family, employ staff and run a business, on a background of ever decreasing relative worth of the Medicare rebate system... how am I supposed to be able either to prioritise this work (which was the whole point of the scheme that you recently lauded as successful) or offer to do it at bulk-billing rates? And how is the local community mental health structure meant to manage the undoubted increase in referrals through to them from GPs unable to do this work now for as many patients as they did before? A depressing move indeed, and one which patients themselves need to be advised of- the Government has slashed funding to support GPs in doing this work for them, and is not willing to support our provision of bulk-billing for these services. This is not our fault, although Ms Roxon would paint it as so- and I say to her, my suggestion to you is this: you can't put lipstick on this particular pig, Ms Roxon. You have revealed what our Profession is worth to you, and how you intend to 'reward' us for our work and incentivise us to go that extra mile and to help the community health system.

skindoc4
27th May 2011
5:41pm

Don't bulk bill!!!!!! Duh!

stevekth
27th May 2011
6:00pm

then not only do we have the pressure of patients not being able to afford appointments (the vast majority locally are HCC holders or pensioners, so we would have to bill them) but then we have the expectation of 'I'm paying, so I need longer than the booked time for my problems which I've saved up' or 'I don't have to pay- it's a follow up'... and my point is that the Govt wants us to bulk bill. I am trying to maintain that. Nixon needs to understand that. Isn't that obvious? Duh! right back atchya

tvkdas
27th May 2011
6:42pm

Fair points by both skindoc4 and stevekth - I do agree with these sentiments, might I suggest a new notice for the patient notice board "As a result of the Federal Government Budget of Julia Gillard and as endorsed by Nicola Roxon, Mental Health Treatment Plans will now incur a fee of $160. Your entitlement to the full rebate has been slashed by the government. We encourage you to voice your concerns to the local member."

stevekth
27th May 2011
6:58pm

I don't think that I have much option. But you understand my motives- it will inevitably come back to accusations of greed, and the fundamental patient misunderstanding about rebate versus recommended fee for a consult. Especially uncomfortable around HCC and Pension holders. I think that I am going to have to go mixed billing for these things, care plans, etc. I already have stopped joint injections and use a bulk-bill local radiology outfit. Ears syringing also has no rebate, and I am advised by Medicare now that (a) removal of sutures placed at hospital but sent to us for removal has already been paid for by Medicare to the hospital, hence we are NOT entitled to claim a 10996 (or where done by another GP, irrespective of the time elapsed), and (b) 16500 can not be used when pregnancy is diagnosed, and where a patient attends for their antenatal related issue, eg. for a scan or bloods or results or BP monitoring, or pregnancy-related issues, the 16500 covers everything, even totally unrelated script requests, a cough or cold, etc- totally unrelated to the pregnancy- and 16500 can't be co-claimed with other attendance items (which I am aware is contrary to what had been thought by many GPs previously)- and, more outrageously, a 36 can't be used if the patient comes in for a pregnancy test or follow-up and other issues and it goes beyond 20mins and is complex- just a 16500! This came direct from e-mailing the Medicare resolution centre, given that the Provider hotline is useless, just reading out what is already on the internet for item descriptors. Also dealt with by them- 16591 apparently can't be claimed by me for pregnancy planning and management beyond 20 weeks as this has already been funded by the State to the local hospital, who doesn't even have formal shared care with me, yet expects me to do the usual care of low risk pregnancies and other care elements of those at higher risk... What is the point in this system (medicare) when it is so obviously broken? The lack of transparency, the complete absence of useful item descriptors and a 'knowledge bank' online to help Q&A in ambiguous areas, and often a feeling of anti-Provider sentiment (beware the audit etc.) is appalling.

stevekth
27th May 2011
7:01pm

(when I said about not being able to claim for a 36 if coming in for a pregnancy test, I meant a planned antenatal follow up for getting a test when already proven pregnant, or the results of that test, plus other matters, 20mins+, with complexity- for the initial consult when pregnancy is proven by a urine or blood test, apparently that falls only under the 23/36 category for VRs, depending on time and complexity)

KarynPsych
27th May 2011
7:18pm

Stevekth is correct yet I guess it all comes back to your rationale in medicine and whether all professionals would be happy for health provision in Australia to be a means based system. Obviously this is not an ethical issue for our erstwhile colleague above.

Polly
27th May 2011
7:59pm

Perhaps we should just bill on a time basis, as do lawyers, electricians, plumbers etc etc.?
Then the patient is free to ramble on - or take as much time as they wish - as long as they are forewarned?

Solidarity
27th May 2011
10:44pm

As Lionel Murphy was to law, so is Nicola Roxon to medicine. She needs to resign now and hand over to a medically qualified politician or at least one who understands what the doctors and patients of Australia need - before we all lose the good points of our current system and are consumed by the cataclysm of what she is proposing.

Stratmatonman
27th May 2011
11:12pm

......Come and talk to us! She's got a hide! When has she ever talked to the profession? Eh Roxon! What about Joint injections, Mental Health rebates, naming Medicare Locals, Costs of practice, Appropriate CPI rises etc etc etc. When have you and your Labor Government consulted US. The nerve of you!

DrBX
28th May 2011
3:19am

If MO is reporting accurately Ms Roxon has yet again revealed her inner self. Has she effectively commanded Dr Hambleton that he should stay within the 'party' lines. That as I work in secrecy so should you. That everything is on a 'need to know' basis and 'you do not need to know'.
Since Ms Roxon became health minister, federal health policy development has felt like a personal attack on GPs. As many other comments have pointed out, there is this gradual trimming of reimbursement of the 'usual' GP services that we are still expected to deliver. I certainly have not seen any politicians take a pay cut for the good of the country.
It seems that all new health policy abuses the altruistic nature of the GP - that we will keep caring for our patients no matter what. She confidently if not arrogantly knows that we will keep providing expensive services at reduced on no reimbursement because our patients come first. Same can't be said for our health minister. She states that she comes from a family with medical backgrounds so is eminently qualified as health minister yet displays no evidence of knowledge of the delivery of health services. She personally preached on the importance of preventative health, the importance of GPs and input to delivering complex services yet is slowly disabling primary health, the frontline of preventative health in Australia.

Let me leave you with two of her election statements:
“GPs are incredibly well trusted within the community so I think, as a policymaker, it is foolish not to look at ways you can engage GPs in a broader health promotion and prevention strategy when they are clearly the best conduit to the community at large,”

“GPs are so busy and so pressed for time and there is such high demand for their services that trying to get more involvement in prevention and long-term health goals of the population is quite difficult. It is obvious we need to address consultations that require more time.”

stevekth
28th May 2011
9:02am

Great points guys, and my feelings pretty much too. The point about 'come and talk to us' was a particularly bitter pill to be offered by the Government 'quack', lol- can I recommend that she 1st gets the wax removed which is totally occluding her ear canals! (Giving the benefit of the doubt that she would actually give a damn about anything that we have to say). The biggest insult for me- the way she talks of renumerating at a premium and in line with the time-based items, as if that is some great act of grace, wisdom and mercy. BUT the premise that there are appropriate rebates against which to benchmark 2710/2712 renumeration is a lie, and she knows it!!!!

stephmed
28th May 2011
1:36pm

Stevekth says it all so well, that I feel redundant making a posting

Funnily enough after completing mental health training bar some final paperwork, I decided not to bother when I discovered (at that time) that there would be no difference in payment. Subsequently when this changed the "Medicare local" thru whom I had done my training, could not assist me in completing it for some reason. So I have bitten the poorer bullet for some years, & churned out many of these plans, done thoroughly over 45 minutes.
Now I really cannot do it any more, which is a shame unless I give up a weekend for one of these rushed training courses that will teach me nothing that I have not garnered the hard way already!
& Yes like Stevekth, I recognize that the most needy have little means to pay, & getting older (I am 62), many of my patients are over 65 with multiple needs & bulk billing expectations
I have worked out that it costs me $100 per hour to run my room based on overheads & am lucky to get $160 before costs. meanwhile at the "take-away" down the road where it is "1" problem & all bulk billed, they see 6-8/hr, & only scratch the surface of patient care
This is not really about mental health rebates, it is all about the demise of General Practitioners & the rise of Nurse Practitioners, who will soon be performing all these complex services & being paid the same rate
I like Stevekth's freudian slip when he spoke of renumerating instead of remunerating, because that is exactly what Nicola has done!
To misquote Shakespeare "A Pox on Roxon!

stevekth
28th May 2011
4:17pm

lol!! I am disgraced- and thoroughly English still, though I try my best to assimilate, in true Borg fashion! Props for seeing my spelling- it wasn't a slip or typo, alas, just ignorance on my part. And I'm the guy who freaks his husband out when he talks of his aegis, elucidating, being cognizant of something, etc, etc. (ie I generally have good English & vocab) LOL

stevekth
28th May 2011
4:19pm

ps For other Trekkies, the phrase "We are Borg. You will be assimilated. Resistance is futile..." seems oddly apposite when considering the Roxon Master Plan...

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 47

Calls for mental health rebate cuts to be reversed

24th May 2011

Byron Kaye and Andrew Bracey   all articles by this author

FEDERAL Parliament has been urged to seek savings in programs such as the GP super clinics and Medicare Locals in order to save rebates for GP mental health plans which were slashed significantly in the recent Budget.

In a letter to all Federal MPs and senators, the AMA has today requested the rebate cuts be axed, arguing that the decision was made with no prior consultation with the profession and would undermine the Government’s own push to bolster mental health services.

The letter came as Mental Health Minister Mark Butler today repeated his claims that GPs were overpaid for drawing up mental health plans. He was answering questions following a speech at the National Press Club.

Last week Mr Butler pointed to data that showed the average Better Access consultation lasted just 28 minutes and attracted a $163 rebate, while a 40-minute GP consultation attracted a rebate of just $99.
But Associate Professor Helena Britt, head of the Bettering the Evaluation and Care of Health (BEACH) program, said the 28-minute average GP consult for mental health – provided by her and quoted by Mr Butler – was only part of the time practitioners spent on mental health plans.

She said the data included only the face-to-face time between GPs and patients and did not include the time doctors spent outside sessions on related paperwork and liaising with other healthcare workers.
“I don’t know what they’re thinking, but it’s possible that they have not considered these other time issues,” she told MO.
“The 28-minute average… is correct [but] I’ve questioned the interpretation.”

The AMA has similarly questioned the Government’s interpretation of the data in its letter.
“It has always been acknowledged that the justification for the higher rebate was based on additional face-to-face time before or after the service attracting the item, additional non face-to-face time, onerous compliance requirements and the non face-to-face time involved in consulting with other health service providers involved,” reads the letter.

The RACGP last week also seized on the 28-minute figure touted by Mr Butler, with college president Professor Claire Jackson calling for the cuts to be reversed as soon as possible to prevent GPs abandoning the scheme altogether.

The AMA’s letter concludes with a request for Parliamentarians to reconsider the cuts and retain existing rebate levels “to avoid an inevitable campaign of opposition from patients and doctors alike”.
“In our view, patient rebates should be maintained at their current level with the realistic expectation, indeed hope, that the program will become more, not less, available and that Australians will continue to benefit from the GP services involved.”

Under the plans, the current rebate of $163.35 for a mental health plan for GPs will be replaced by a rebate based on timed consultations from 1 November.

Rebates will now be $85.92 for a plan written during a consultation of 20–39 minutes and $126.43 for a 40-minute consult for GPs trained in Level 1 mental health skills.

Those without the training will receive $67.65 and $99.50, respectively.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 46

AGPN seeks accelerated Medicare Local timeline

24th May 2011

A CALL by the AGPN to launch more than 15 Medicare Locals in July has met with fierce resistance from the GP fraternity.

With the Government yet to announce which Medicare Locals will be the first to be established, the AGPN said there were more than 15 that could feasibly be launched now.
 It urged the Government to bring forward their launch, and not wait six months to announce the next tranche as planned.

AGPN chair Dr Emil Djakic said there would be no financial disadvantages in launching an additional 10 Medicare Locals from 1 July.

“The work and commitment is there... Why wait another six months?” Dr Djakic told MO.

“If there are other proposals that came to that original invitation to apply that meet the eligibility criteria and really look like being able to get on and do the job, then we should be allowed to roll our sleeves up and get on with it.”

AMA president-elect Dr Steve Hambleton, however, said too much remained unknown about the organisations, and he reiterated his concern that GP autonomy would be reduced.

“Accelerating the process means there’s going to be more risk, not less,” he said.

RDAA president Dr Paul Mara also urged “slowing down” the rollout, saying GPs had been “hoodwinked” because Medicare Locals were set to take fund-holding from GPs.

Federal Health Minister Nicola Roxon’s office had not responded to MO’s queries at the time of press.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 41

Divided in opinion with Medicare Local

Nursing Review of Australia

02 May 11 | Print this story | Send this story to a friend

Announced as part of the 2010 Health Reform, Medicare Locals will be rolled out as early as in the middle of this year. However, groups in the field are still divided in opinion regarding the plan, writes Jeff Li.

In the closing address of the 11th National Rural Health Conference, the Minister for Health and Ageing Nicola Roxon said that through strong engagement with local health services, Medicare Locals will make it easier for rural patients to use the health system and to reduce mismatch between services provided and services needed.

Jenny May, chairperson of the National Rural Health Alliance, says that Medicare Locals is a chance to bring focus to primary care, but stresses that it is important for it to be aware of the needs of the local community.
“There are some principles, if you like, in terms of Medicare Locals that the Alliance feels very strongly about, and they are the need for them to be local, and the need for them to be genuinely consultative and the need for them to be very multi-disciplinary in their approach and to really model a primary health care approach to prevention to early diagnosis and to support the services,” May says.

“There needs to be collaboration between the local players involved in primary care, that comprises general practices, including GPs, practice nurses and others, including aboriginal medical services, the local government sector and numbers of other private or public allied health commissions, who all currently provide primary healthcare services.”

She also says that primary healthcare organisations can collaborate in terms of planning services, identifying service gaps and providing or supporting a range of services.

“I think practitioners, in collaboration with service providers, have a much better idea at a local level, where the gaps in services are. So I think they have much to bring to the table.”

However, Steven Hambleton, vice-president of the Australian Medical Association says that one of his concerns is that general practices will repeat the process in hospitals where doctors and other health professionals are taken out of management and become disconnected with the needs of the patients.
“The overarching concern is that we don’t want to see primary care goes the same way as hospital care in that a bureaucracy gets in the way between patient and doctor.”

“If there is going to be a body of Medicare Locals, there definitely needs to be GPs in there in the majority to make sure that it remains connected to the patients. The GPs have in this space for a long time and has the expertise.”

Hambleton says another concern is the nature of Medicare Locals as fund holders.
He says it implies that there is a definite fund pool and that when it runs out, there is none left. “[It] basically means that there is a great potential for rationing of healthcare at the Medicare Locals level.”
He also says GPs should be providers of medical care and that working with other primary healthcare providers is the way of the future. But he says that patients need to be educated on what services are available and when to seek healthcare.

“We’ve gone from episodic healthcare to chronic disease managed healthcare and are about to proactive chronic disease management, which must be linked in with health literacy from the patients and a lot of self-management. You can’t do that with just one provider. We do work well with nurses; we do work well with health professionals and all parties that contribute to the healthcare of the patient. I guess the key person in all this is the patient themselves.”
Hambleton also says the fact that funding for primary healthcare and community services coming from different pools of fund will reduce the efficiency of the two systems working together.

“The structural drivers of health reform, which was the Rudd government’s push to have the majority of the funding of primary care all coming from the Commonwealth has been unbound by the current Prime Minister, meaning that it is going to be a lot harder for Medicare Locals to actually achieve to what they originally planned to do in the National Health and Hospitals Reform Commission.”

“We’ve seen Medicare Locals issues accelerated, when at the same time, the structural drivers that pushed the groups in the Medicare Locals’ base together have been lifted. So at the very least, we have to stop the rate of roll out, stand back a bit and do some more planning. With the way things have been rolled out right now, the AMA is not happy with it.”

May agrees that there has been some haste in the process, especially when some of the organisations for Medicare Locals cover a large geographical area with different needs. The NRHA will see with interest on how the applicants for Medicare Locals funding plan to operate and that it has some principles on whether a Medicare Locals bid is successful.

“The important thing from our point of view is to see integration of the best available services in rural areas. Often there is a deficit of any services, and we are keen to see those needs articulated and then met.”

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 38

Health reforms walking a weak and wobbly plank

by Andrew Pesce

16 Apr 05:50am

The Federal Australian Medical Association opposes the Government’s Medicare Locals as currently proposed.

What happens if you take the doctor out of the picture?

There is little detail on structure or funding. There is no explanation of patient benefit. There is plenty of uncertainty.

Medicare Locals are supposed to be a major plank of the Government’s health reforms. It is a weak and wobbly plank.

We have called on the Government to defer the establishment of any primary health care organisations (PHCOs) until there has been genuine consultation with the medical profession.

The AMA has for some time been calling for consultation and more detail about the governance and operation of Medicare Locals, but those calls have been met with silence.

The AMA and the medical profession cannot support primary care reforms that do not explain how they would benefit patients or communities, and which do not guarantee they would maintain and support the leadership role of GPs in primary care.

There must be meaningful dialogue with the medical profession about a way ahead that is best for patient care.

The AMA is not opposing the concept of a primary health care organisation to coordinate primary care services. When Medicare Locals were first announced, we were cautiously optimistic about the role they might play in improving health care for Australians.

But since that time there has been little detail about governance, funding arrangements, or the envisaged role of doctors in their management. It is a big ask for us to support a concept that is very short on principles, let alone detail.

Some commentators seem concerned that the AMA insists that doctors should be strongly represented on the governance structures of our health systems.

You need only look at the chaos wrought upon our public hospitals when they are administered without appropriate reference to the doctors (and other health workers) who actually deliver the health services in the hospitals.

New Zealand’s initial experience with PHCOs that were run by ‘skills-based’ boards was heading for disaster until the situation was retrieved by an increased presence of doctors on those boards.

The assumption that health care is improved by marginalising the role of doctors in decision making is, to say the least, contestable - and the AMA will certainly continue to argue against it.

Locally, we examined closely how the proposed Medicare Locals were intended to integrate with Local Hospital Networks. Our examination was not too encouraging – hence our concerns.

Medicare Locals will be funded separately, governed separately, and will function separately to the acute hospital system.

The chances of evolving a Medicare Local-inspired integrated health system are just about zero.

The likelihood of continued cost and blame shifting between the Commonwealth and the States is extremely high.

The Prime Minister has also stated that Medicare Locals could be fundholding bodies and, despite our requests, she has not ruled out fundholding for GP services.

Currently, patients decide when they need a GP service, not a distant bureaucracy that works to a fixed budget, and which increasingly emphasises cost control rather than access to quality services.

This is a big change in the way a patient’s visit to a GP is funded. The community needs to understand that this will inevitably lead to the rationing of GP services – in the just the same way as public hospital services are rationed.

Although Medicare rebates have failed to keep up with the costs of providing GP services, patient co-payments, where necessary, have kept general practice viable.

Fundholding arrangements delivered by Medicare Locals could be the final straw that breaks the back of general practice.

Doctors practise according to the principle of ‘first do no harm’. Perhaps the Government should apply the same principle to its currently proposed Medicare Locals.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 36

First Tranche Applications Exceed Expectations

The Australian General Practice Network (AGPN) has stated that the process for application was both “thorough and exhaustive”, whilst at the same time calling on the Federal Government to commence as many Medicare Locals as possible in the first round (see http://www.ergpa.com.au/news/development-of-medicare-locals-on-track-just-waiting-for-the-tick/).

The Australian Medical Association (AMA) is continuing to call for further consultation with the medical profession, and push for deferred establishment, with expanded timelines (see position statement @ http://ama.com.au/node/6500).

The Victorian Healthcare Association (VHA) (see http://www.vha.org.au/positionstatements2010.html) and Statewide Primary Care Partnerships have continue to exercise caution in their approach.

Meanwhile, consumer groups and allied health professionals are starting to knock on the doors and ask some valid questions about their role and position in this change.

As somewhat of a pragmatist I tend to believe this is all an important part of people working out where they stand in relation to the changes afoot, and what the likely impact will be on their patients, their business or service and the overall landscape of health care in Australia. None of which is a bad thing, it all challenges all of us in how we plan for, deliver and receive services, which is ultimately the point of system reform in the first place.

What I think is the real issue right now is how we keep our health care services focussed on the outcomes, rather than the process of change. It’s very easy to be distracted by the minutia of the funding cycles and the many, many reporting requirements, the boundary cut offs, and who gets what from which level of government. It’s easy to forget that ultimately we are there to assist people in need of care and good health. Our job is about finding the best way to do that, in this case under a Medicare Local banner, but still with the same concern for how our communities get the best from their health care system.

So at the end of the day, does it matter what they’re called, or how many start in July and how many start 6 months later? What do you think?

Comments (1)

Bel
18 April 2011

Great blog Kristin,

Not taking away from the importance of being informed and asking questions, as health professionals and consumer groups have every right to seek understanding and further have a voice but I think it’s really important that in light of “reform uncertainty” people are reminded that regardless of what is happening, what could happen or even what should happen, that our focus remains with the patient and our ability to assist them with the best possible health outcome.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 23

Waiting game begins for first Medicare Locals

5th Apr 2011
Medical Observer

THE countdown to the announcement of the first 15 Medicare Locals to begin operation is now on, despite continued opposition from the AMA.

While the Health Department has not released a date for the announcement of successful applications, or the number received, an AGPN spokesperson said the network expected more than 50 tenders to have been submitted by the 5 April deadline.

The first 15 Medicare Locals are due to begin operations from 1 July. The tendering period and process have been marred by public feuds and stoushes between competing GP divisions.

Applicants planning to bid for the next round of Medicare Locals, scheduled to begin operating in January and July next year, have until 19 July to lodge proposals.

The AMA has meanwhile maintained its opposition to the establishment of Medicare Locals, pending further government consultation with the profession.

Comments:

ed
6th Apr 2011
5:03am

The health Minister's divide and conquor rule is seen in everything she does. Not satisfied in reducing us doctors to just filling driving medicals she now wants witch doctors from the jungles of Cameroon to look after Australians. Ask her who does she go to when sick. Doctors in Canberra should boycott her and let her visit a herbalist in Melbourne.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 22

Here is more on the Medicare Local debate: Should we have them, who should run them, what are the benefits and what are the losses for the communities which they will serve? Will they just be another name for the Divisions of General Practice?

If we acknowledge that there are set criteria for their establishment we, in the Southern Highlands, can see that the CEOs and Boards of the Southern Highlands and Macarthur Divisions of General Practice appear to be taking the view that the funding they get will simply extend their Division's power and influence without necessarily improving the health outcomes for their health consumers.

On the other hand, the Bankstown GP Division continues to adhere to the guidelines for the Medicare Locals and has established a coalition of health services and agencies to bring about real change and collaboration in the access to, and delivery of, reformed health services in the SWSLHN area.

A reality check for the AMA’s contrary stance on Medicare Locals

March 21, 2011 – 6:33 pm, by Melissa Sweet

The timing of the AMA’s dummy spit about the new primary health care organisations to be known as Medicare Locals (MLs) was impeccable. The AMA announced last Friday that its Federal Council had voted to oppose MLs.

AMA President Dr Andrew Pesce said the AMA could not support primary care reforms that “do not guarantee they would maintain and support the leadership role of GPs in primary care”, and warned against any moves to fundholding.

The timing was impeccable because it so superbly illustrated the points made by a number of speakers at the national rural health conference in Perth last week – about the need for a more prominent place for the community in health debates, to try and counter the voices of the overly powerful vested interests. (You can see some of these comments in this previous Croakey post, quoting presentations from the Centre for Policy Development’s John Menadue and the University of South Australia’s Professor Robyn McDermott, although they were far from the only presenters making such comments).

Notably, some of the priority resolutions put forward by the 1,000-plus people attending the conference were supporting not only Medicare Locals but also models of care not based upon the AMA’s holy grail of fee-for-service.

The Australian Health Care Reform Alliance (AHCRA) has issued a statement expressing its disappointment with the AMA’s stance on Medicare Locals and fund-holding, and hoping “that the AMA will reconsider it positions to more forward-looking and collaborative ones”. The AHCRA statement also noted that “the future of health care is about teamwork”.

Meanwhile, health policy Jennifer Doggett suggests that perhaps we should read the AMA’s screams of protest as the mark of good health policy. If the AMA isn’t complaining, then presumably the status quo isn’t threatened…

The AMA: not exactly famous for its leadership in health reform

Jennifer Doggett writes:

"The Australian Medical Association (AMA) continued its tradition of opposing key health reforms when its Federal Council voted last week to oppose the establishment of Medicare Locals.

"Just as in the early 1980s it opposed the introduction of Medicare and in the 1940′s argued that the proposed Pharmaceutical Benefits Scheme (PBS) represented a dangerous slide into socialism.

"Thanks to these programs, Australians now have access to universal health care and some of the cheapest medicines in the developed world.

"Had the governments of the day bowed to pressure from the AMA and scrapped those planned reforms, we may well have ended up with a health system like the USA’s which costs more than double that of Australia’s and delivers poorer health outcomes.

"Luckily for the Australian community, the Health Ministers at the time were able to resist pressure from the AMA’s scare campaigns and propaganda machine.

"They pushed ahead with the introduction of these health programs which greatly benefited the Australian community and which are the envy of many other countries today.

"Even the AMA eventually agreed that perhaps there were some benefits to publicly subsidised health care. It’s hard to find an AMA spokesperson today who will publicly advocate the abolition of these programs.

"Similarly, the objection to Medicare Locals (MLs) is likely to turn out to be short-term paranoia about doctors losing control over the health agenda rather than substantial objections to the detail of the ML initiative.

"The fact that there is strong support for MLs among many other health groups – including some representing GPs – demonstrates how isolated the AMA is on this issue.

"In fact, the main concerns of other health groups about MLs are precisely the opposite of the AMA’s. They are worried that they will simply entrench the power of the medical profession in the primary care sector and fail in their stated aim to support better integrated and coordinated primary care.

"For example, the Royal College of Nursing Australia recently wrote to all political leaders describing Medicare Locals as ‘a reconfiguration and rebranding of the Divisions of General Practice’ and stating that it was ‘unconvinced that Divisions would be able.. to achieve the organizational cultures and attitudes required…to genuinely and effectively coordinate multidisciplinary health care’

"You don’t have to be Machiavelli to see that this tactfully worded letter is code for ‘don’t let the doctors take over’.

"The fact that the AMA is opposing Medicare Locals for not being doctor-focussed enough and other health professional groups are concerned that they are too doctor-centric, shows how tricky this area of health policy can be. It also is good evidence that the Government has probably made the right judgement about how far to push the reform agenda, at least from a political perspective.

"The political juggling act needed now is to progress the needed changes without getting the AMA offside to the point that it undermines the reform process while also not alienating other health professional groups by bowing to AMA pressure to maintain medical control over primary care budgets.

"It’s a difficult challenge but Nicola Roxon and her colleagues should take heart from the lessons of the past that it is possible – and indeed sometimes necessary – to deliver major health reform in the face of resistance from the AMA.

"In fact, looking at the public support and longevity of both Medicare and the PBS, it could be argued that the AMA’s opposition to a proposed health reform is a good predictor of its success.

"On this basis, it’s likely that one day the AMA will come around to supporting MLs, just as they did with Medicare and the PBS.

"It might just take them a little longer than the rest of the community.

5 Comments

1. Andrew Pesce
   Posted March 22, 2011 at 12:58 am | Permalink

   Before people accept what has been written here, perhaps they might actually
   read the AMA statement which stimulated this piece.

   http://ama.com.au/node/6494

   If they do, they will see that the AMA is not opposing the concept of a PHCO
   to coordinate primary care services.

   They might also note that our initial response to the announcement of
   Medicare Locals was cautiously optimistic about the role they might play in
   improving health care for Australians.

   http://ama.com.au/node/6433

   Many seem concerned that doctors insist they should be adequately
   represented on the governance structures of our health systems, but we only
   need to look at the chaos wrought upon our public hospitals when they are
   administered without appropriate reference to the doctors (and other health
   workers) who actually deliver the health services in the hospitals. Garling in NSW, incidentally, was not an agent of the AMA

   The statement that the Rural Health Alliance “has great hopes for Medicare Locals” is hardly an ringing endorsement of the announced structures, even if they do manage to change the name. And AHCRA’s comments contained as much criticism of the Medicare Local structure and function as it did of the AMA’s position.

   Inconvenient truth 1. New Zealand’s initial experience with PHCOs run by
   “skills based” boards was heading for disaster until the situation was
   retrieved by an increased presence of doctors on those boards.

   Inconvenient truth 2. Medicare Locals will be funded separately, governed
   separately and will function separately to the acute hospital system. Chance
   of evolving a ML inspired integrated health system: just about zero. Likelihood of continued cost and blame shifting between commonwealth and states: extreme
   Like it or not, the assumption that health care is improved by marginalising the role of doctors in decision making is to say the least contestable, and the AMA will certainly continue to argue against it.

   Andrew Pesce
   President, Australian Medical Association

2. Tim Woodruff
   Posted March 22, 2011 at 8:22 am | Permalink

   Whilst the negative response of the AMA is to be expected, it is hard for those interested in genuine health reform to become too excited by Medicare Locals. The vision is limited, the plans are sketchy at best, and it is hard to know whether MLs will be just another white elephant or worse.
   Regional entities could have the capacity to pursue the Federal Government’s rhetoric of ‘central funding, local control’. Unfortunately, the current plan is more likely to result in central funding and control and local blame.
   It is proposed that MLs will be engaged in population health planning. That requires knowledge of health needs which is also flagged. But there is no mention of information on current health spending at a regional level. (Remember how hard it was to get the Government to put in expenditure on the MySchools website). With health expenditure data at a regional and subregional level we would see the very stark inequities which exist in health funding and could plan to address them. That could then form the basis for health planning.
   Governance of MLs remains vague especially with respect to consumer and citizen involvement. This is partly because the Government has no national policy framework for consumer involvement and generally pays lip service to the concept. The transition of MLs from Divisions inevitably means that governance will be biased towards control by general practitioners currently involved in Divisions. Whilst this may work well in some regions, it is hardly the best way to achieve balanced governance with all stakeholders well represented.
   There are no plans for MLs to have sufficient funds at their disposal for them to exert much influence on current models of care. Whilst it will take time for MLs to build the capacity to use funds appropriately, it does not appear to be a significant part of the vision. In addition, they will be relatively powerless in their relationship with the well funded Local Hospital Networks. This is despite the rhetoric that we need a much greater emphasis on primary health care.
   The recent backflip by the Federal Government to abandon its plans to take over all primary health care funding will now mean that MLs will have to work with three levels of government in their co-ordination and integration role. That role would be hard enough with one level of government funding everything. It will now be even harder.
   Adequate data, resources, governance, and needs based funding at a regional level with national standards including for marginalised groups are required for MLs to evolve into anything useful.
   Where is the vision?

   Tim Woodruff
   Vice President
   Doctors Reform Society

3. rechoboam
   Posted March 22, 2011 at 7:12 pm | Permalink

   Could the author please explain in 25 words or less what a Medicare Local is and does?

   After Medicare Gold, the epic COAG reforms that never quite occured, the federal takeover that Rudd threatened, which never occured, I’m very confused by this government’s plans and have not seen a single example of how MLs or anything else will actually relate to human beings and their health requirements.

4. rechoboam
   Posted March 22, 2011 at 7:15 pm | Permalink

   For example I googled Medicare Locals and this is an example of what I found:

   “The South West Sydney Health Coalition has recently been made aware of certain assertions made by the Macarthur and Southern Highlands Divisions of General Practice concerning the formation of a Medicare Local in south west Sydney.

   The purpose of this letter is to inform you that the South West Sydney Health Coalition denies each of these assertions categorically as being completely without basis in fact.

   The Macarthur-Southern Highlands Divisions are not the official bid for the South West Sydney Medicare Local. The Macarthur-Southern Highlands Divisions do not enjoy any exclusive right to lodge a bid for a Medicare Local covering the Bankstown, Fairfield, Liverpool, Campbelltown, Camden, Wollondilly, and Wingecarribee local government areas. “

5. Melissa Sweet
   Posted March 24, 2011 at 11:35 am | Permalink

   Hi Rechoboam

   Take a look at this previous Croakey post which links to a series of posts about Medicare Locals: what they’re intended to do, and debate about how they will work etc.

   http://blogs.crikey.com.au/croakey/2011/03/03/a-comprehensive-analysis-of-the-plans-for-medicare-locals/

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