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.

SWSLHD and Bowral's Health - 33

McGorry’s mental health minefield

17th Oct 2011 Jodie Thomson   all articles by this author

Professor Patrick McGorry is fending off a barrage of bitter and very personal dissent over his approach to mental health.

AT THE eye of the stormy debate around mental health funding sits one man: the 2010 Australian of the Year, Professor Patrick McGorry.

While he’s lifted the profile of mental health among the general public – and been referred to as ‘the most powerful psychiatrist in the world’ – many of his peers have showered him with criticism since the 2011–12 federal budget.

That’s when funding was diverted from  the GP-led Better Access program to early intervention youth services, leaving GPs concerned that there would be a gaping hole in primary care services for mental health patients.

Professor McGorry, an adviser to the government on mental health funding and founder of the Early Psychosis Prevention and Intervention Centres (EPPIC) and headspace programs, has been accused of bias towards his early intervention models and conflict of interest over his advisory position to the government.

There is also doubt about the stated benefits of EPPIC and headspace, which have scored almost a quarter of the $2.2 billion mental health package.

And there’s concern around early intervention treatment that involves giving antipsychotic medication to young people merely at risk of psychosis.

“We need to get broader advice to government, we need the right advisers, who truly understand developmental principles and a lifespan approach,” says Professor Louise Newman, director of the Centre for Developmental Psychiatry and Psychology at Monash University.

The criticisms have grown increasingly personal in recent weeks. Professor McGorry was attacked by a prominent American psychiatrist, Professor Allen Frances, chair of the DSM-IV Task Force, who accused him in the Psychiatric Times of having a “messianic blind spot” and being an “unreliable evaluator of scientific evidence”.

Professor McGorry says these kinds of criticisms are “false and baseless” and “those making them have not been able to substantiate them in the face of facts”.

He vehemently refutes suggestions of a conflict of interest over his advisory role with the government.

“It is unclear exactly what improper behaviour I’m being accused of here,” he says.

“It is also unclear what criteria would disqualify my participation in the expert group due to my involvement in non-profit youth mental health organisations that would not also disbar all other members of the expert group on the grounds of their professional or organisational affiliations.”

The government says Professor McGorry was just one member of the Mental Health Expert Working Group, which was made up of experts from a range of health and non-health sectors, plus consumer and carer representatives.

“While these consultations helped to inform the development of the government’s record mental health package, decisions on the specific content... were solely a matter for the government,” said a spokesperson for Mark Butler, Minister for Mental Health.

With regard to claims of bias over the high proportion of funding that youth mental health received in the budget, Professor McGorry said three-quarters of the mental health budget went to areas other than youth.

“I would also note that when the Independent National Health and Hospitals Reform Commission considered this issue, they made early intervention models the first two of their 12 mental health recommendations.”

Most psychiatrists’ criticisms concern whether the benefits of the early intervention programs have been overstated. Nearly two-thirds of pyschiatrists in a recent poll thought the government’s focus on EPPIC was inappropriate.1

Professor Frances has described it as a “massive new experiment in early intervention”. Others question Professor McGorry’s claims that the programs are backed by solid evidence.

“They’ve made a lot of promises and raised a lot of expectations and these have not been borne out in the studies,” says Professor David Castle, head of psychiatry at Melbourne’s St Vincent’s Hospital.

In response, Professor McGorry argues early intervention programs like these have been used in hundreds of centres internationally for many years with great success.

“Consequently, there is very good evidence that early intervention for first-episode psychosis is more humane, effective and cost-effective.”

Adelaide University Associate Professor Jon Jureidini says he is concerned the early intervention programs have been misrepresented.

“I don’t think there’s anything wrong with either EPPIC or headspace as models, but there are other approaches to youth mental health, and these two approaches have not been proven to the extent where they dominate the funding,” Professor Jureidini says.

Concerns about the efficacy of the early intervention approach are not shared by the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which has called them “essential” in a recent Senate submission on mental health funding.

“The government must commit to the full implementation of a national youth primary care service (headspace or similar) and a national network of Early Psychosis Prevention and Intervention Centres,” the RANZCP submission stated.

One controversial issue is whether the EPPIC treatment model involves giving antipsychotic medication to young people at risk of psychosis.

A trial by Professor McGorry of antipsychotic drugs on people aged 15–40 who were “at risk” of psychosis was recently cancelled.

“A lot of people are very, very concerned about the potential for over-labelling, over-medicalising and over-treating youngsters,” says Professor Castle.

“In America there’s been a 400% increase in bipolar diagnosis in children, and these kids do not all go on to get bipolar disorder. There’s a danger this sort of stuff will happen here.”

Professor McGorry, however, has repeatedly stated that antipsychotic medication will not be used as a first-line treatment option.

“A key goal of youth mental health models... is to address the over-medication of people with mental ill health in our overstretched and under-resourced mental health system,” he wrote recently on his website.

AMA president and GP Dr Steve Hambleton supports the need for early youth intervention.

“In general we want to intervene early and it doesn’t necessarily mean early use of medication,” he says. “We don’t want to label people too early, but services like headspace are appropriate for young people. We don’t want to put people on medication up front and Professor McGorry doesn’t want to do that either.”

For many GPs, a crucial issue is whether Professor McGorry’s influence has seen funding diverted to early intervention services at the expense of the Better Access program.

“Everyone would applaud his bringing youth mental health issues to the fore, but we have a right to be very angry about the diversion of funding,” says Dr Brian Morton, chair of the AMA Council of General Practice.

While the RANZCP and AMA acknowledge there may have been problems with evaluating Better Access properly, GPs believe the cuts will be devastating.

“The mental health cuts are going to disadvantage patients, in particular those who have more chronic and difficult issues,” says Perth GP Dr Stephen Wilson.

Professor McGorry describes Better Access as an “excellent program” that has been a “building block for mental health reform”.

“While I personally did not advocate the changes made in the recent budget – nor did I have prior knowledge of the changes – now that this has occurred, we need to review what is really required to provide appropriately skilled care for those with more complex mental disorders for which Better Access was designed,” he says.

“In the very next federal budget, the federal government [should] fund a more specialised tier of service which would draw in clinical psychologists – who are clearly required if the problem is more serious and persistent –  psychiatrists in many cases, and other disciplines as well, notably social workers and occupational therapists.”

Some argue the real need is for more independent analysis of all areas of mental health and a more involved discussion on which ones have the greatest need.

“I would implore people like Patrick McGorry to understand they are a part of a much bigger system,” says Dr Wilson.

“They need to take a step-back view of policy and realise it’s not just their area of work that needs a lot more funding.”

Professor McGorry says his core recommendation is that mental health policy should ensure all Australians of all ages have the same access to quality care for mental ill health, as for physical ill health.

“Those criticising the decisions of the government on mental health reform are perfectly entitled to do so, though it would be good to learn what their alternative plans are, if any, especially for the million young people with mental ill health,” he says.  

Reference

1. Psychiatry Update, 6 October 2011, http://enews.psychiatryupdate.com.au/cgi-bin19/DM/t/nMCS0FVx0FM0j7tF0E7

 

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 - 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 = 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 - 17

Are we getting the right primary care policies?

7th Mar 2011

Dr Steve Hambleton all articles by this author

2 comments

JUST about everybody wants to see practical achievable reform in primary healthcare. Things can and should be done better. With the right policies and proper support for GPs, it is achievable.

But are we getting the right policies? Judging by the reaction from health professionals – not only GPs – the Government does not seem to be getting much bang for its primary care reform buck.

In the same way that GP super clinics have failed to spark the imagination of health professionals or patients, it looks like Medicare Locals are getting similarly poor reviews. And I think the criticism for the most part is justified – and not just for the lack of detail or clarity of the proposals.

The Government seems convinced that Medicare Locals will somehow take the pressure off emergency departments (EDs). Wrong. This simply will not happen. The ED problems are there because of bed block, not Category 4 or Category 5 patients. Besides, many of these patients should not be seen by a GP in any case. They are appropriately seen in the ED and often need admission.

The ability of Medicare Locals to help ‘join up’ the health system has been severely compromised by the change in the balance of healthcare funding back to almost the status quo.

There should be a single funder. The previous reform arrangements were not perfect either, but at least the Commonwealth was taking more responsibility.

The fact is that there is no momentum any longer for any parts of our health system to come together because the funding keeps going to separate silos. There is the hospital money silo. There is the community services silo. There is the GP and related primary care silo. The aged care silo. The Indigenous care silo. And so on.

We do not have a health system. We have health systems – totally disconnected. We will know that we have real health reform when they have all been re-connected.

At its most recent meeting, the AMA Council of General Practice agreed that there are gaps in Australia’s population health coverage that need to be identified and targeted, but I don’t see that the proposed structure under the COAG Agreement will make it any easier. It is frustrating.

The collection of data by Medicare Locals is also problematic. The ‘monitor and provide feedback’ approach to the performance of primary healthcare providers is also problematic. It does not reflect the reality of private general practice.

Blindly putting your faith into GP Super Clinics being the saviours of primary care cannot be supported either, especially as they are so badly located and so lacking in planning and consultation.

They have the capacity to backfire badly on the Government.

Providing infrastructure grants and supporting the GPs who are already committed to their communities would be a much smarter investment – economically and politically.

Governments seem wedded to Medicare Locals and they are already in the process of being established, but these are not the primary healthcare organisations that were envisaged by the National Health and Hospitals Reform Commission.

Given this political reality, it is up to us – the AMA and the medical profession – to do all we can to shape and influence this policy so it actually delivers tangible benefits to patients and communities and supports hardworking GPs.

The AMA is pushing heavily for medical practitioner involvement in the governance of Medicare Locals to avoid repeating the bureaucratisation of primary care that we saw in public hospital care.

The priority for general practice is to build on the chronic disease management gains that have been made and to promote teaching in general practice to support the next generation of doctors.

The current system is not completely broken. We are getting some of the best health outcomes in the world, but we do need further support and it has to be the right support.

The Government is not helping its cause by using terms such as fund-holding and managed care or by continuing to allow the hint of role substitution to linger in the primary care reform debate.

The Government must heed the profession’s warnings, or Medicare Locals could soon be a distant memory.

Comments:

John Wellness
7th Mar 2011
4:29pm

I agree with many of Dr Hambleton's diagnoses. The original GP Superclinic Policy put out by Kevin Rudd and Nicola Roxon in June 2007 had so much promise. Admittedly reducing ED visits was always unlikely to happen and interestingly no-one seems to understand that good proactive primary health care could reduce the number of Category 1-3 patients (strokes, heart attacks and diabetes for starters) but the preventative angle looked promising. Sadly the bureaucrats failed to bring preventative care into the decision-making process and the superclinics presenting at two national conferences barely mention it. This is simply because existing "illness" funding will not allow multidisciplinary preventative care. The location of the Superclinics too has been inept. At a time when there are lots of areas needing services to help meet population growth needs putting them in established areas was simply woeful. Putting them on hospital grounds will work directly against keeping patients out of hospitals.

The Medicare Locals don't look like being very different. Giving the inside track to divisions of general practice is unlikely to generate new ideas and new ways of delivering care. When nearly 1/3 of the total burden of care is preventable by lifestyle improvement that there is so little attention given to looking at new ways of preventing chronic disease is scandalous. The primary health sector could make a huge difference if its funding system could lead to new forms of practice and program delivery. Just don't hold your breath waiting for proper reform.
John Wellness

Detracter
7th Mar 2011
5:56pm

We have a Health Care System built around Disease Management rather than Disease Prevention so you can get funding and administration set ups for diabetics but nothing for the obese person they were for the last twenty years.
Western medicine is falling apart financially as we keep diseased people alive and dependent upon us for ever increasing decades. Politicians have by nature a three year thinking cycle ,so every bureaucratic strategy they come up with in their Health Care tent, such as Superclinics in marginal seats, is aimed at getting themselves out of that boggy tent onto drier more publicly recognised land such as the environment or climate change.
We doctors are in an elite group of highly intelligent articulate people who are trained primarily to think differently to the rest of the population, and secondarily with technical and practical skills unreachable by the rest of the community.
We have a responsibility to actively change the health agenda away from the money for disease formula, to a health prevention formula. The health agenda is quickly moving away from and diluting our clinical skills, and a doctors hand on the abdomen in the middle of the night in former years is now being replaced by a nurse with a MRI scan request.
Our society is not training enough doctors of our standards as it is easier and cheaper to import them, so we as a group need to actively get into the health care debate and challenge and re-educate the politicians, media and general public. We need to stop being seen as a group always whinging about money and repaint ourselves as the caring intelligent professionals our patients see us as.
We need to take control of the Health Care debate away from the politicians and run it ourselves.
Detracter