SWSLHD and Bowral's Health - 69

After-hours care falls short

BY ISABELL PETRINIC

17 Apr, 2012 12:00 AM

IF you need a doctor between 11pm and 7am you must go to an emergency room at Blacktown, Hornsby or Hawkesbury public hospital and join the queue.
There's always the phone (nurses and GPs give advice on the National After Hours GP Helpline) or you can visit Norwest Private's emergency department, where fees are not reimbursable — even for those who are privately insured.

There are only 55 general practices open for 10 or more hours a week during the after-hours period but that is across all western Sydney (264 of a total of 303 practices were contacted) — nowhere near enough, according to medical educators WentWest.

WentWest have found through careful analysis of western Sydney's health needs that in Rouse Hill there are no practices open after-hours and in the semi-rural area above Glenorie even a registered home-visiting is not available.

Parramatta's north-east is serviced by only one practice providing after-hours service — at Epping — and Baulkham Hills North could do with chemists that open longer.
But the real problem is finding GPs to work outside normal hours.

The five doctors' rooms at Round Corner Medical Centre in Dural operate at 95 per cent capacity with 12 GPs on rotation, but doctors find it difficult to cope with demand after hours, even turning people away on Sundays.
The centre began operating after hours three years ago with financial assistance from the federal government.

Peter Szekely, the centre's financial officer, said they aim to stay open until 9pm weekdays and 5pm on Saturday and Sunday.
The ideal, he said, would be to stay open till 10pm every night.

"But we don't always have doctors available to do these hours," Mr Szekely said.

"At the moment the only weeknights we can do are Monday and Thursday.

"If we could expand the premises we would, but we can't, so the only thing we can do is expand the hours."

Mr Szekely praised the GP placement program, saying two junior doctors had stayed on at his centre, and saw this as encouraging.

Dural is among the many suburbs in The Hills identified by the Department of Health and Ageing as being in a district of workforce shortage, defined as an area of Australia in which the population's need for healthcare has not been met.

The others are Annangrove, Beaumont Hills, Bella Vista, Kenthurst, Oatlands and Rouse Hill.

Beaumont Hills and Rouse Hill are also among the growth suburbs in The Hills, which is of major concern given The Hills population is expected to rise 1.94 per cent every year until 2031, bringing the total population from 177,245 to 255,270 people - a rise of 44.02 per cent — over the next 19 years.

WentWest will submit its first after-hours plan to the Department of Health and Ageing in May, highlighting these and other service gaps in the Western Sydney Local Health District, which stretches from Auburn in the east to Blacktown in the west and to The Hills in the north.

 

Medicare Local defines after-hours as:

1. before 8am and after 6pm weekdays;
2. before 8am and after noon Saturdays;
3. all day Sundays and public holidays.

After-hours is further divided into:

1. the unsociable after-hours period of 11pm to 7pm; and
2. the sociable after-hours period which is all other after-hours times.
   A map showing the current District of Workforce Shortage areas is available at: http://www.doctorconnect.gov.au/i nternet/otd/Publishing.nsf/Conten t/locator
   
   
   Socrates says: While this article details the issues for the north-west of Sydney it can be replicated even more so for  rural and regional areas like the Southern Highlands.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 65

Is there a future for Medicare Locals Ink?

7th Nov 2011 Melissa Sweet   all articles by this author

Medical Observer 

THE suggestion below may sound unrealistic and more than a little self-serving. Even so, it might be worth considering this potential scenario, set sometime in the 2020s.

Medicare Locals, after some years of painful growing pains, have found their footing.
They have established systems to ensure a timely understanding of the wide range of factors affecting the health of their local populations, and they are working with a range of interests, including health services, to help address these. Some have also taken a step that many perceived as high-risk: employing journalists.

The journalists are not churning out the dull, worthy and generally unread reports, nor are they writing press releases and other marketing material. Rather, they are investigating and telling authentic, sometimes confronting stories about their local communities, taking a broad view of the factors affecting health. These include stories about education, employment, local environmental issues, resource allocation and efforts to make local sense of the tide of data that is being released under Gov2.0 initiatives.

The journalists are helping to inform and engage their audiences as well as to provide a forum for debate and discussion between the community, health services and other sectors.

Their work is also helping to join up the dots in a health system that still struggles with the impact of policy and service silos and fragmentation.

Of course, this may all sound like a desperate job creation scheme from a journalist who is painfully aware of her industry’s uncertain future. But I’m not suggesting that only professional journalists have a role at Medicare Locals Ink.

Enlightened Medicare Locals have recognised the role that citizen journalism can play as a population health intervention in its own right. These innovators were inspired by public health-building projects in Australia and other places that equipped community members with the skills to harness the digital revolution in the investigation and telling of stories.

Indeed, one such recent project, NT Mojos, was funded by the Australian government and gave Indigenous people from remote NT communities the skills and technology to tell their stories using iPhones. You can see some of these stories at http://ntmojos.indigenous.gov.au/.

Some Medicare Locals also took the plunge into publishing, having realised they had plenty to learn about public health communications and engagement from the corporate sector.

When McDonald’s launched its own TV channel for customers (as was recently announced in the US), many public health observers were alarmed by the implications. But others saw it as a lesson that in this era of do-it-yourself publishing, there are new opportunities for those with an interest in contributing to a more informed and useful debate about health matters.

As was recently observed by Dr Ivan Oransky, the executive editor of Reuters Health and founder of the blogs Retraction Watch and Embargo Watch, “a better informed public is a healthier public”.

Of course, there are any number of pitfalls between the idea and the execution of Medicare Locals Ink.

To make a difference, Medicare Locals would need to be publishing journalism (perhaps in collaboration with other like-minded organisations) that rocks the boat, challenges the status quo, and seeks accountability.

As Dr Oransky also noted, “in journalism, you’re not there to make friends with your sources, you’re there for your readers”. (His comments were reported in a recent interview with Other Doctors, a new US blog featuring “doctors who ventured outside the hospital”).

Clearly, Medicare Locals Ink would face some rather daunting barriers, especially as the health sector’s approach to communications has often been driven by a debate-suppressing, risk-management focus.

But it may prove to be timely that primary healthcare reform is evolving at a time of innovation and risk-taking in new media more widely.

Melissa Sweet
Freelance health journalist and editor of Crikey’s health blog, Croakey

 

 

Comments:

 

 

 

Dr Amanda, Sydney
7th Nov 2011
4:13pm

As always wonderful commentary. Primary healthcare restructuring (reform not happening yet) has had a wonderful basis for 10 years with Practice Based Research Networks. This has lost funding and there is reduced (near nothing) primary care research funding now in Australia.
Medicare Locals are not filling this research funding gap
Medicare Locals INQ (INQuiry = research) would be fabulous for the hundreds of GP and allied health care professionals involved in this long term research base (proven in Canada and USA) which has been discontinued for no given reason and with no substitute.
We are keen in Australia and have nowhere to go. All GP research depts at all Australian universities are united in working for this.
Dr Manda GP Sydney

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 64

Medicare Locals - Criteria for applicants

Given the apparent failure (again) of the Macarthur - Southern Highlands consortium to gain selection in the second tranche of the successful Medicare Locals announced this week, it is perhaps timely to reproduce here the DoHA selection criteria which the consortium needs to consider for the third tranche to be notified. I suggest to the Boards of the SWSGP Link and the SHDGP that they should consider in particular Criterion 2; and Criterion 4 - 6. 

At present, there are clearly significant gaps in the consultation process with key stakeholders and groups that the consortium has been required to have in the development phase of their application. Perhaps they should take a serious look at the way in which the Bankstown GP Division progressed their community consultation process

The relevant consortium Boards need to beat their collective breasts and admit their failure and then, start again!

2.4 Selection Criteria

There are six (6) selection criteria against which applications for Medicare Local funding will be assessed. These criteria are outlined below:

Criterion 1:

Demonstrated expertise and capacity to address the five Strategic Objectives for Medicare Locals specified above, for the selected catchment area including outlining:

i. Activities currently undertaken and previous achievements which relate to each of the five strategic objectives;

ii. How these activities can be extended and expanded to meet the needs of a modern primary health care system;

iii. Demonstrated knowledge of the population base, health service architecture and infrastructure, utilisation and other demographic characteristics and health priorities in the proposed catchment area (this should indicate the evidence from which this knowledge is drawn);

iv. A strategy for development of a population and health service plan to address need;

v. Infrastructure already in place;

vi. Capacity to collect and manage data as appropriate;

vii. Strategies for ensuring appropriate accountability and transparency to the community; and

viii. Indicative personnel and other resources to be allocated to deliver these activities.

AND

Criterion 2:

Proposed governance and operational arrangements, including:

i. Details of the proposed legal/corporate and organisational structures;

ii. Experience and skills expertise of the proposed Executive;

iii. A structure that recognises the diversity of clinicians, services and health care recipients within the modern primary health care sector;

iv. Structures that encourage and maintain local engagement and responsiveness;

v. A transition plan, including estimates of costs associated with transition activities;

vi. Strategy for ensuring appropriate clinical governance;

vii. Strategy, skills and expertise to manage flexible funding to target services to the local community’s specific needs;

viii. Strategy for establishing effective linkages with other sectors and organisations, including Local Hospital Networks; and

ix. Strategy for ensuring community engagement and accountability.

The assessment panel will have regard for the desired governance attributes, including broad community and health professional representation, as well as business management expertise; and strong clinical leadership.

AND

Criterion 3:

The financial viability of the Medicare Local including:

i. Demonstrated record in efficient and effective use of funds of each organisation covered by the proposal;

ii. The experience and expertise of the organisation’s proposed executive team to manage substantial public funds appropriately; and

iii. Current contractual arrangements.

AND

Criterion 4:

Demonstrated evidence of ability to engage with and form productive relationships with key stakeholders, providing supporting evidence of any current partnerships and operational arrangements, and strategies to improve engagement with:

i. Community Organisations;

ii. Aboriginal and Torres Strait Islander Health Organisations;

iii. Workforce Organisations;

iv. General practice;

v. The broader primary health care sector; and

vi. Research Organisations.

AND

Criterion 5:

Strategies and ability to respond to local needs and emerging priorities, including Commonwealth priorities in Aboriginal and Torres Strait Islander health, eHealth and telehealth, mental primary health care, aged care, population health and after hours primary health care.

AND

Criterion 6:

Evidence of ability to build upon a sustained track record of high performance as a Division/s of General Practice or primary health care related organisation, including:

i. Driving improved outcomes and system change in general practice and primary health care through effective practice support;

ii. Improving eHealth and information management infrastructure, including the use of data to improve preventive health and chronic disease management in clinical practice, to measure the effectiveness of health program delivery, and to inform population–based services planning and evaluation;

iii. Effective governance and corporate management;

iv. Demonstrating effective collaborative relationships with other agencies and health service providers to achieved improved referral pathways, health service provision and/ or outcomes, including a demonstrated culture of inclusion across the spectrum of primary health care service provision and local community engagement;

v. Demonstrating compliance with contractual obligations;

vi. Delivering sustained achievement and improvement against national performance indicators for Divisions of General Practice (where relevant) and associated programs; and

vii. Actively sharing expertise and resources with others to promote quality improvement and knowledge transfer across the primary health care sector.

The selection panel will develop a relative merit list from the applications assessed, based on the selection criteria above, and provide recommendations of preferred applicants to the Minister for Health and Ageing.

The selection panel will also have regard to the desirability of achieving a reasonable spread of Medicare Locals across the country and geographic classifications for the first tranche of Medicare Locals.

All applicants should note that, where the assessment process does not identify a preferred applicant within a Medicare Local region, the Department reserves the right to broker an arrangement between funding applicants and/or other interested parties.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 61

Medicare Local 'takeover' dispute

• By Michael Woodhead on  28 October 2011 - 6Minutes

The merger of two GP divisions into a Medicare Local has turned acrimonious, with the Murrumbidgee General Practice Network (MGPN) claiming that it has been subject to a takeover by its neighbouring  Riverina division.

The CEO of the MGPN says the Riverina division, chaired by former AGPN leader Dr Tony Hobbs, “unilaterally negotiated with DoHA without the MGPN's knowledge and exclusively executed the Medicare Local contracts for themselves."

Despite  formal complaints to DoHA and ASIC about the “breach of trust” the Riverina’s conduct was not deemed illegal, the local newspaper (link) reports.

According to The Irrigator, the Murumbidgee Medicare Local was planned to be a merger of the Murrumbidgee General Practice Network and the Riverina Division of General Practice and Primary Health.

However, in the annual report for the Murrumbidgee General Practice Network, CEO Keith McDonald says the Riverina division secured secured a controlling interest of the consortium, without consultation.

"Though MGPN has subesquently pursued serious formal complaints through numerous channels on this breach of trust, there has been no remedy and subsequent arbitration concluded that, technically, the RDGP&PH's conduct was not illegal.

"With DoHA's continued insistence on endorsing RDGP&PH as the lead agent in establishing the Medicare Local, the process has now firmed as a takeover rather than a merger," he writes.

Mr McDonald says the takeover and the loss of Commonwealth funding for the division means there are now doubts about the future of local offices and programs.

Hmmmmm! Something about this does seem to ring alarm bells with another such amalgamation. Perhaps the Southern Highlands Division of General Practice might like to consider their current position with their Macarthur colleagues. It could be a matter of history repeating itself.

SSWAHS = SWSLHD + SLHD and the Medicare Locals - 48

Work with us on Medicare Locals, Roxon tells AMA

27th May 2011 - Medical Observer

Mark O’Brien   all articles by this author

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

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

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

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

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

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

stevekth
27th May 2011
5:05pm

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

skindoc4
27th May 2011
5:41pm

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

stevekth
27th May 2011
6:00pm

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

tvkdas
27th May 2011
6:42pm

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

stevekth
27th May 2011
6:58pm

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

stevekth
27th May 2011
7:01pm

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

KarynPsych
27th May 2011
7:18pm

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

Polly
27th May 2011
7:59pm

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

Solidarity
27th May 2011
10:44pm

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

Stratmatonman
27th May 2011
11:12pm

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

DrBX
28th May 2011
3:19am

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

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

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

stevekth
28th May 2011
9:02am

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

stephmed
28th May 2011
1:36pm

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

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

stevekth
28th May 2011
4:17pm

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

stevekth
28th May 2011
4:19pm

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