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 - 52

Better Access cuts will go back into mental health: Roxon

Byron Kaye   all articles by this author

 

 Medical Observer

HEALTH Minister Nicola Roxon has given GPs a guarantee that every cent saved through the controversial cuts to the Better Access scheme will be reinvested elsewhere in mental health services.

In a robust question and answer session before more than 1000 delegates at the AGPN National Forum in Melbourne this week, Ms Roxon also all but ruled out meeting long-running GP demands that MBS rebates be indexed to match inflation.

Ms Roxon was asked by former AGPN chair Dr Tony Hobbs, one of the architects of the Medicare Locals (ML) program, about the government’s plans for the $580 million it is expected to save by slashing GP Better Access.

Dr Hobbs said there were already concerns that the cuts, since taking effect on 1 November, had led to patients being “quarantined” before being treated by their GP, and demanded a guarantee that all savings go back into the ML-run Access to Allied Psychological Services (ATAPS) program.

“I can absolutely commit that that is going into mental health,” Ms Roxon replied.

“We have a very firm commitment about how that money is going to be spent – in mental health.”

She added that it was “just not possible for us to continue to meet growing demands” without reviewing existing spending, but “money that gets saved in one area… will absolutely flow through to mental health”.

However, Ms Roxon was less amenable to calls for indexed MBS rebates and urged GPs to show what additional services they could deliver before asking for extra funding.

Noting GP pay was “still very generous” and the MBS had so far been spared the cuts other parts of the health system had faced, Ms Roxon said there was “no appetite in government” for a “big jump” in the MBS.

“Big licks of money will only ever be considered by government if you can show us what additional benefits patients will get out of it,” she said.
Byron Kaye reports from the 2011 AGPN National Forum in Melbourne.

Tags: MBS, better access, Nicola Roxon, AGPN, mental health, rebates

Comments:

 

John Miller
18th Nov 2011
3:27pm

There's some odd logic here. Ms Roxon talks of "extra funding" while GPs talk of "maintenance funding" ie, keeping pace with inflation.
It's quite interesting to compare the position of the Medical Board of Australia which recently raised its already exorbitant fees by the CPI, with that of Medicare which never raises its rebates by anything near the CPI. On this basis, given sufficient time, the annual registration fee will eventually exceed the annual income of a GP.
In reality, no logic will work on this or any other politician while BB rates remain high.

 

Sniper
18th Nov 2011
5:35pm

If I could see the sense in the government wasting so much money on outdated and bloated PBS subsidies , heading towards the billions and going into the bloated profits of Pharmacy chains then I might not feel so piqued at her intimation that we are over payed. My understanding is that both her parents are/were pharmacists. She has probably been weaned on anecdotes of "how the noble pharmacist saved the dumb Dr". She is presiding over the over spend of billions yet she quibbles and quips about a GPs worth. There is a whiff of nepotism about Roxon.

 

inkblot
18th Nov 2011
5:36pm

A lot of the funding that is bankrolled from these cuts is going into mental health services, however, these are being aimed mostly at centre-based programs for young people aged 15 to 25. But there are no plans in place for people over 25, despite that the highest rates of suicide for any age bracket is for middle aged and older men (with men aged 40-44 years having the highest suicide rate - over 26 deaths per 100,000 males).

The full impact of the cuts wont hit us yet, because by Jan 2012 people are entitled to another 10 (the count zeros out every year). By about April 2012 though, there are going to be folks who have used up all 10 sessions and still need more treatment, but Medicare will stop funding it. If people cant afford to fund their own treatment, then they will be left in the lurch for 8 months. After that, psychiatrist appointments are going to be more difficult to get as mental health consumers turn to them in droves. Psychologists like myself will still be providing services to the wealthier folks in society who can afford therapy, while those who are struggling get cut short at 10 appointments. We have to set aside the fact that it costs a lot more for Medicare to fund psychiatrist consultations and even one hospital bed day for a mental health patient is around $1500, which is incidentally the total cost of Medicare funding 18 psychologist sessions per year for an individual. But the hardest hit of all will be people in rural Australia, as the focus of the Government turns to building big mental health treatment centres in cities and large towns, which only some people will access due to the stigma and visibility of these places. As one rural mental health advocate put it, these cuts are 'ten kinds of stupid': http://betteraccess.net/images/stupid.jpg

 

Stratmatonman
18th Nov 2011
6:33pm

Hey Ms Roxon, it isn't GP Pay - it's patient rebates ! And guess what - I am now privately billing it where previously I would have bulk-billed it. The sooner you're gone the better - you've done more to devalue GPs than ANY Minister in Australian Government history - you're a disgrace.

 

SJDoc
18th Nov 2011
7:25pm

Let's face it - this is the old labour chestnut of redistributing wealth. We could not have all this money being earned by doctors, heaven forbid! Let's take it off them and give it to mental health nurses or psychologists or social workers but pray, not doctors.... those uncaring parasites that make their living off the sick. But, colleagues, it is in our hands - after all, the Medicare rebate has been cut, but, I for one, continue to charge the same fee and I am not shy about telling my patients whose fault it is that their rebates have been cut!

 

smart
18th Nov 2011
9:48pm

Obviously she is a powerful and rude actress that refuses to answer the questions directly and plays with words and makes false promises for the future.
GPs need to act and pull her down from the position that she does not deserve to have. Until GPs are a bunch of silent lambs , it goes like this and never ends.
Tomorrow this government and its health minister might pass a legislation asking the GPs to work under supervision of nurses and I am afraid that GPs might obey that because they have no unity or courage to stand and fight for their rights.
I feel really sorry that GPs do not believe in their power if they act together. Look at the nurses , they fight for what they want and get it.

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 - 45

Rebate cuts jeopardise GP role in child mental health

26th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

CHILDREN’S mental health visits to GPs have risen dramatically under the Better Access program and cutting the rebates would leave the profession’s role in child mental health care in doubt, new research suggests.

An analysis of Bettering the Evaluation and Care of Health (BEACH) data by the research project’s own authors also suggests GP involvement in child psychology has become less prescription-focused under Better Access as the family doctor plays a more active ongoing role in the mental health care of young Australians.

The study, published in the latest Australian and New Zealand Journal of Psychiatry, claims to be the first dedicated snapshot on GP treatment of child mental health issues over four decades.

Better Access, which offers rebates for GP mental health plans, was introduced in 2006 but is being scaled back – with some rebates cut by almost half – to save $400 million from next week.

The BEACH paper indicates:

·     The proportion of GP mental health visits by patients younger than 15 jumped from 1.4% in 2000–01 to 2.6% in 2008–09

·     16.8% of child mental health visits to GPs claimed Better Access rebates, compared to 7% of GP mental health visits from patients of all ages in 2006–08

·     The rate of GPs prescribing medication to children in mental health visits fell from 28.8 per 1000 in 2000–01 to 18.3 in 2008–09

·     Child mental health visits to GPs for enuresis, insomnia and “behavioural problems” have fallen dramatically since 1971, while child GP visits for ADHD, anxiety, depression and autism rose.

BEACH director and report co-author Associate Professor Helena Britt said the study confirmed Better Access had led to a massive increase in children being treated by their GPs for mental health issues and predicted the rebate cuts would have an impact.

“With the decreased payments to GPs and the decreased number of [psychologist] visits being covered by the program, I’m sure there will be an effect on the extent to which GPs are involved in children’s psychological problems, as with adults,” she told MO.

Dr Emil Djakic, chair of AGPN – a member of United General Practice Australia (UGPA), which is fighting the rebate cuts – said changes to funding child mental health treatment “need to be done with some caution”.

He said the cuts would fund programs targeting children with more complex psychological problems but lamented “the fact that that’s been done, rather than by building on funding for primary healthcare, by a relative change of funding for the general practice side of the equation”.

Australian and New Zealand Journal of Psychiatry 2011; online 22 October, DOI:10.3109/00048674.2011.610743

 
Related:

Tags: Children, Mental Health, Better Access, BEACH, AGPN

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.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 60

Mediation failure forces divisions to quit ML merger

24th Oct 2011 Byron Kaye   all articles by this author

Medical Observer

DOUBTS about the federal government’s Medicare Local (ML) boundaries have re-emerged after mediation between two Sydney division-led bodies, aimed at forcing them into a single ML, collapsed.

Souring relations between a Bankstown division-led consortium and a group led by Macarthur and Southern Highlands divisions prior to the first ML deadline had previously prompted the AGPN to appoint a mediator so the parties could form an ML by next year.

But mediation has since failed, with Macarthur-Southern Highlands having now lodged its own bid, which could see it handed responsibility for the 35 practices it is locked in a feud with.

A Macarthur spokesperson told MO the group would not agree to further mediation until the fate of the ML had been decided.

Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.

“It’s such an enormous area with so many complex needs and organisations,” she said.

Dr Brian Morton, chair of the AMA Council of General Practice, warned divisions to settle their differences or risk having general practice “locked out” of MLs. A department spokesperson said the awarding of tenders took into account the applicants’ “ability to engage with key stakeholders”.


Well, it seems the fickle finger of fate has written on the wall of the Southern Highlands Division of General Practice! Christmas is beginning to look gloomy for the CEO and Board of the local Division. 

The final paragraph of the statement above is pretty clear about what causes a Division like the Macarthur - Southern Highlands consortium being "locked out" of Medicare Locals because they can't settle their differences. Certainly the Department of Health and Aging representative suggesting the criteria of the applicant's "ability to engage with key stakeholders" does not apply to the SHDGP's involvement with local people, public and private health practitioners and NGOs. Telling key stakeholders after the event what the SHDGP has done to apply for Medicare Local funding is hardly consulting or engaging, with them.

The other bit of mis-information the Chair of the SHDGP published in his lengthy column in the Division's last newsletter was that the mediation between the Macarthur-Southern Highlands consortium ended because the Bankstown GP Division put in their own application. However, the report published above suggests that it was the Macarthur-Southern Highlands consortium who withdrew from the mediation to lodge their own submission first. Further, the Macarthur spokesperson stated that they would not engage in any further mediation until after the outcome of the second series of Medicare Local allocations had been resolved. It seems they are hoping to get in and only then use their improved position to hammer away at the Bankstown GP Division.

"Bankstown chair Dr Susan Harnett said if the department of health would not force Macarthur-Southern Highlands into more mediation, it should simply split the ML in two.
“It’s such an enormous area with so many complex needs and organisations,” she said."  

This suggestion by Dr Harnett is Solomon-like in its simplicity. The Medicare Local could be split in two. However, in order for the Bankstown GP Division to achieve the numerical population quota set by DoHA, required for MLs it is likely that they may have to extract from Macarthur-Southern Highlands some of the territory that they acquired prior to the implementation of the Medicare Locals. 

Can I see these empire-building expansionists willing to hand over territory? Not likely!

GP Super Clinics - Is there ever anything for nothing - 8 ?!

Super clinic collapse warning went unheeded

17th Oct 2011 Byron Kaye   all articles by this author

HEALTH Minister Nicola Roxon’s office was warned 14 months ago that the Sorell GP super clinic would collapse without extra funding but promised to “make a priority of sorting this immediately post election”, MO can reveal.

But rather than give a $1.5 million lifeline as requested by its operators, the Department of Health and Ageing asked the clinic owner after the 2010 election to cut costs by substituting curtains for walls between doctors’ rooms, lowering the entire building, and relying on “natural ventilation” instead of toilet exhaust systems.

Edward Gauden, CEO of Sorell Integrated Healthcare (SIH), which was to operate the Sorrel super clinic, refused these requests but, encouraged by Ms Roxon’s office, was holding out for other commonwealth funding when he learned on the evening news this month that the minister had scrapped the project.

Emails between the offices of Ms Roxon and local Labor MP Dick Adams, the department and Mr Gauden, obtained by MO, confirm Mr Gauden’s claims that he had long warned the government that the super clinic – which had support among local doctors – could not be built for the allotted $2.5 million, and that he was repeatedly assured the government would step in to save it.

On 12 August 2010, with the federal election less than two weeks away, Mr Adams’s electorate officer Dee Alty wrote to the minister warning that if a funding solution could not be found that same day, SIH would be “announcing publicly tomorrow that they will not be going ahead as they do not have the funding… It is just insufficient”.

The email also questioned “why the Sorell super clinic is not being seen as a proper super clinic which should like the others attract the $5 million”.

Ms Roxon’s chief of staff Angela Pratt responded that the government was in caretaker mode and could not commit new money, but advised that Mr Adams “should say [to Mr Gauden] that he has spoken to the minister’s office and been given an assurance that we will look at the issue post election if Labor is returned, to get the clinic back on track”.

Ms Alty pressed further, writing the next day that Mr Gauden needed assurance the building would be finished by the end of 2010. Ms Pratt replied: “We will make a priority of sorting this immediately post election… Obviously we don’t want it to fall over either!”

Ms Roxon announced on 7 October 2011 the clinic would not go ahead. Three days later the government committed another $3.2 million to the troubled Redcliffe super clinic in Queensland, on top of an existing $10 million outlay. A spokesperson for Ms Roxon said the department met with SIH “on numerous occasions to assist them in reworking their proposal but unfortunately we have recently been made aware that they will not proceed on this original basis”.

Mr Adams said his office had pressed for more funds, but Mr Gauden should have been able to build the clinic for $2.5 million.

Tags: Sorell; Super Clinics; Roxon; DOHA

Comments

DrPhil
18th Oct 2011
3:27pm

curtains not walls between consulting rooms???? is this 1948 or what????

Limmie
18th Oct 2011
4:08pm

I wonder if Roxon will be happy to see her doctor if the doctor were consulting in a space that is partitioned off with a curtain rather than sound dampened or sound proof walls? How ridiculous is this Minister? I bet, if MO asked her directly, she will vow that she was not aware of the machinations going on with the SIH. Once again, we see evidence that decisions about superclinics have been political rather than business-based. The waste of tax payers money by this Labor government is the same as the days of Whitlam's largess. This spend-a-thon has to stop. As taxpayers, we are not getting value for money.
I don't know the medical manpower supply for Sorell nor whether there is indeed a need for same. It seems the support of local GPs made no difference to the decisions made by the Minister. I wonder, if the local GPs were vociferous in condemning the superclinic, the Minister might consider the request for further funds for the SIH as worthy of supporting. Hasn't that been the pattern of her behaviour. Anything she can do to get stuck into medical practitioners, she will do. Add this to the insult to the Medicare rebate for non-VR doctors now becoming lower than that of "Noctors", can we call this style of governance fair and equitable?

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 52

First Medicare Locals urged to retain GPs’ central role

10th Jun 2011 - Medical Observer

Byron Kaye   all articles by this author

THE AMA has written to the first 15 Medicare Locals urging them to keep doctors central to governance, rule out holding funds and commit to working closely with GPs at every stage of setting up the new primary health hubs.

The AMA has strongly opposed the $416 million Medicare Locals program, arguing the Federal Government has failed to explain how it will improve GP services and is rushing through the reform with just weeks before the supposed 1 July start date.

Four of the first 19 Medicare Locals – all in Victoria – have not been publicly announced with the Government citing a need to redraw the boundaries as the final stumbling block.
The are expected to be named next week.

Yesterday, AMA president Dr Steve Hambleton wrote to the 15 publicly announced successful tenderers – all currently divisions of general practice – asking them to address concerns that the Medicare Locals structure will dilute the governance input of GPs and weaken patient care.
“We are concerned that the Government is rolling out its Medicare Local policy with desperate haste, despite a lack of detail and genuine consultation with the broader medical profession,” Dr Hambleton wrote in the letter.
“Integrating and coordinating the range of organisations and service providers operating within primary healthcare, and better linking primary healthcare and other sectors, is something that can deliver benefit if it is done well.
“However, there is a significant potential for Medicare Locals to get this wrong if they fail to listen to the views of the medical profession.”

The AMA has asked the Medicare Locals to confirm that local doctors would be represented at all levels and have “strong majority representation” on boards and rule out any fund-holding arrangement for GP and other specialist medical services.

Several divisions chosen among the first 19 Medicare Locals, contacted by MO this week, indicated that they would change their board structures to reflect the broader range of primary health professionals expected to be represented by the new bodies.

Tags: Medicare Locals; AMA; Hambleton; governance

Comments: 

Detracter
10th Jun 2011
3:34pm

This is essentially a Labor governments attempt to centralise power and influence over what used to be a non-government operational area. Labor, and particularly Gillard, are doing this in the industrial relations area and the wider economy with the Carbon tax, Mining tax and Flood tax.
If she wins the next election, I could well anticipate a push for universal bulk-billing across the profession to reflect her central control agenda, dating from thirty years ago.
The AMA move to increase GP representation on these Medicare Locals seems to reflect my thinking on this matter.

Pav
10th Jun 2011
3:46pm

I don't really give a s#%t.

Just so long as the ML's take full responsibility and are accountable for their own actions when they stuff up - not just turf them back to the GP for patching up their mistakes.

ed
10th Jun 2011
4:39pm

Pav' arguement assumes that GPs who work in the Locals are not responsible and have inferior knowledge and skills. The same arguement was put across when the Corporates had commenced business. Errors are made by any type of a GP. What we have to worry is under GILLARD-ROXON AXIS OF SOCIALISED MEDICINE, SOON WITCH DOCTORS Will be employed . Then there will be trouble.And in the famous word of the bard' there was movement at the station'.

John Wellness
10th Jun 2011
5:01pm

A medical dominance of divisions of general practice has led to a fragmentation of primary health care and probably poorer health outcomes, especially for patients with complex chronic illnesses. We need practices that have multidisciplinary teams with each occupation contributing its own strengths. We also need a more preventative approach embracing behavioural as well as medical perspectives. The Medical Locals need governance systems that will allow us to become a health system - not a bunch of independent doctors and allied health practitioners. Doctors have a leading role to play in clinical governance but a lesser role in business governance.

khanGP
10th Jun 2011
6:19pm

When the concept of ' Super Clinics ' was being mooted, a lot of the GPs were stating - but where will the Govt. get the GPs from to work in these Clinics. At that point in time, I told my Colleagues, that the Govt. has a Master Plan in place - they will not need GPs to run these ' Super Clinics ' - they will run them without GPs - they will have their ' Nurse Practitioners ' running them. What with these NPs being given Prescribing Rights / Radiology & Pathology requesting Rights / Rights to refer these Patients ( sorry, ' Clients ' ! ) to Specialists & to Emergency Depts., GPs will be made redundant.
I was then, told that I am being ' Paranoid '.
My GP Colleagues felt then, that we, GPs would be elevated to a ' Consultant ' Role. Why would a NP refer a Patient to a GP, when he / she could refer to a Specialist or an ED ?? Our Local Divisions still feel that we, GPs would have a Lead Role in these ' Medicare Locals ' !! When there is a Collection of ' Primary Care ' Practitioners, each one of these Groups would want an EQUAL Voice in the Board of such an Organisation. So, the Board of these Medicare Locals, will have a Representative from each of the Groups - i.e. one each of a GP/ NP / Pharmacist / Chiropractor / Herbalist / Physiotherapist / Iridologist / Naturopath , etc.etc. The Voice of the GP would be only a ' Whisper in a crowded room '.
Wake up my dear GP Colleagues.
DR. AHAD KHAN, GP Glenbrook NSW

jadugar dar
11th Jun 2011
1:28pm

Ahad has summarised it beautifully!!!! I have said the same for a long time. Nicola has always regarded that GP's are unnecesary.We have one of two alternatives available to us now. 1. Register as a NP with our Medical Degrees and 2. Qualify and elevate to a Specialist level & register accordingly. And of course the 3rd is quit because GPs will not unite and take Industrial Action. Any alterations in the status of the AWU members would by now resulted in Libya-like turmoil. Good luck to those GPs who are retiring, dying or quitting.

Green Demon
11th Jun 2011
3:33pm

so....The 2010 Intergenerational Report, Australia to 2050: future challenges found that total government spending on health will rise from 4% of GDP in 2009/10 to 7.1% in 2049/50 and the bulk of the increase will be on MBS, hospital services and the Pharmaceutical Benefits Scheme.
Aged care expenditure is also projected to rise significantly from 0.8% of GDP in 2009/10 to 1.8% by 2049/50 with residential aged care recording the highest growth.

It's ok to moan; be chicken little with sky falling in but what will happen we can't afford to pay for health? Having a greater emphasis via MLs on population; prevnetaive health has to be a no brainer! or do we head down a teared system like the US who will be facing 20% of GDP spending for the same period? Some words of actual wisdom may be helpful

Amateur Observer
12th Jun 2011
11:52am

Why does General Practice seem to be the only specialty group singled out for special attention by the Federal Health department in their recurrent trial-and-error attempts at health reform? I'm sensing a bit of gutlessness amongst the Feds when it comes to foisting experimental programs onto other medical specialties.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 39

NZ colleagues offer warning over Medicare Locals impact

21st Apr 2011

Byron Kaye all articles by this author

NEW Zealand’s most influential GP has delivered a stark warning to the Australian Government as it prepares to unleash the first Medicare Locals: Don’t make the same mistake the NZ Government did.

Dr Peter Foley, chair of the New Zealand Medical Association, said Australia must learn from the hugely unpopular introduction of Crown Health Enterprises – similar to Australia’s Medicare Locals (MLs) – which he said had failed to ensure adequate GP leadership.

“If the [Australian] Government truly regards general practice as central to the delivery of primary healthcare… then this position must not be undermined by any top-down direction of how that might be delivered,” Dr Foley told MO.

Dr Foley’s warning came after the AMA recently wrote to all Australian federal parliamentarians arguing the ML model “does not give adequate recognition to the fundamental role of GPs”, and warned it may repeat the failure of the New Zealand reforms.

“The GP team – doctors and nurses – must be consulted and involved in every step in the design of any new system. Respectful engagement and collaborative development with real clinicians is crucial to achieving the necessary buy-in and subsequent success of any health reforms,” Dr Foley said.

AGPN CEO David Butt agreed the New Zealand reforms had “disempowered” GPs but believed Australia had already “learned from New Zealand”.

“They made mistakes and didn’t realise the central role of GPs, [but] our models are different. All the things that the divisions are doing now with GPs will be continued,” he said.

Tags: Dr Peter Foley, Medicare Locals, New Zealand, David Butt, AGPN

Comments:

Stratmatonman
22nd Apr 2011
1:08am

Good on Peter Foley for coming out and saying this this - listen up Labor your non-consulting and arrogance has been found out even across the Tasman; I DO NOT believe the mistakes of NZ have been learned and AGPN will come to regret its naivete.

SSWAHS = SWSLHN + SLHN and the Medicare Locals - 34

At last, there is something more substantial in the way of the every-growing backlash against the Federal government's Super Clinics and Medicare Locals. Socrates notes that this survey of GPs is of just a small sample, but it does seem to confirm the anecdotal view that there is mass confusion amongst the general practitioners of just what will be the business of the Medicare Locals and of the Super Clinics and how either will in any way change the delivery of health services in the Australian community.

Secondly, it confirms what seems to have been evident in this blog, and elsewhere, that there has been very little information provided to local communities about how the Medicare Locals will operate to improve their local health services. The big exception has been the Bankstown GP Division and their SWS Health Coalition.

Let's hope that the Federal Government budget focusses on what works and what does not when it comes to making cuts in health spending.

GPs: Axe Medicare locals to free up health funding

19th Apr 2011

Byron Kaye all articles by this author

JUST weeks out from what is predicted to be a tight Budget, GPs have pointed the way for the Gillard Government to reach its all-important surplus: freeze the rollout of super clinics and scrap Medicare Locals altogether.

Winding back incentive payments for pharmacists to dispense generic drugs also rated a high mention in MO’s latest national poll of 150 GPs.

Asked where health spending should be cut in the May Budget, 77% of GPs nominated the super clinics program – now $630.4 million deep in promised Commonwealth funding.

Nearly 40% recommended Medicare Locals for the chopping block, freeing up at least some of the $416 million that has so far been committed to their rollout, which begins on 1 July.

“If you took the super clinics money from Canberra, the leverage that you would get would train five times as many students and doctors,” AMA vice-president Dr Steve Hambleton said.

“Nobody can understand anything about whether super clinics are any benefit to the health system at all.”

Health economist Professor Gavin Mooney said the super clinics program was too advanced to be stopped, but “what could be possible and a good thing would be if Medicare Locals were delayed”.

The survey, conducted by Cegedim Strategic Data, also found 45% of GPs wanted to see a reduction in the $1.50 payment that pharmacists receive each time they substitute branded medicines with generic ones.

One area where some GPs and the Government appear to agree is the chronic disease dental scheme, which the Gillard Government claims is costing close to $63 million a month.

Nearly a quarter of those surveyed would be happy to see the scheme axed.

The poll comes as medical researchers held a series of rallies protesting widely tipped budget cuts to the sector of $400 million.

GPs were not short of ideas for where to spend the savings. Two-thirds nominated indexing MBS rebates to inflation as a priority.

Dr Hambleton said the rebates had been “systematically underdone” for years, making out-of-pocket expenses harder for patients to meet.

A quarter of GPs wanted MBS rebates for point-of-care testing (PoCT).

Robert Wells, director of the Menzies Centre for Health Policy at the ANU, said Government support for PoCT was inevitable, but a rebate now could undermine the new funding deal with pathologists. But given PoCT was both safe and convenient, he said, rebates for this should be supported.

This poll was conducted for Medical Observer by Cegedim Strategic Data research company.

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