AMA campaign to protect and promote general practice

Dr Steve Hambleton, AMA Vice President

Australian Medicine

14 December 2009

The AMA is deadly serious about protecting its general practitioner members and their practices.

I recently chaired the first meeting of the new steering committee charged with this responsibility. Leading GPs from around the country came together to offer their expertise and support to the campaign. Every State and Territory was represented. The steering committee will also draw on the resources and skill sets that exist in each State AMA to ensure that we will have the firepower we need and that we will get a truly united national approach.

It is internationally recognised that an effective and efficient health care system should be based on primary care. Australia’s GP-led primary health care system is the envy of much of the world in terms of life expectancy and population health outcomes.

We have heard a lot about our ageing population and the burden of chronic disease that is before us. We all know about the past history of poor planning and lack of investment in our health system infrastructure, both in buildings and in people. There is a groundswell of anxiety among our colleagues, as evidenced by strong attendance at meetings held recently in New South Wales and Victoria.

We are all suffering from the errors and omissions of previous governments and the lack of coordinated planning. We have had multiple reports commissioned by this Government from learned groups about possible reform of our health system, but we are still living in a relative policy vacuum. The current Government has not yet committed to any of the major recommendations of those bodies and remains in consultation mode.

The current Minister has made a number of recent speeches in several major forums. All have provided encouragement for the audience that she was standing before, but each speech was relatively light on concrete policy directions.

The AMA must ensure that any change in our health system supports what works and fixes what doesn’t.

To inform the campaign, we intend to connect with our members and nonmembers alike, and we will utilise multiple modes of communication both to get our message out and to gather information in.

We know that GP-led primary health maximises health care benefits to our patients – and that is what we need to protect. If the proposed Primary Health Care Organisations are a mechanism to impose outside control, impose funds rationing and interfere in the doctor/patient relationship, they are to be resisted. If they are GP-led and are a mechanism to reduce the Federal-State bureaucratic divide and to focus scarce resources on unmet need, then they could be supported.

We are not afraid to talk to our patients either, and they are likely to be our very best allies. We are prepared to ask them what they want and we are prepared to inform them of any adverse consequences of proposed future change.

The Government well knows that between 80% and 90% of all Australians will present to their GP every year. Our patients are also voters and they deserve the very best – and we all know there is an election looming in 2010. The AMA will be ready.

When Australians are sick, they want to see their doctors. They want the freedom to choose their doctors. They want access to their doctors when they need them. Above all, they want their doctors working in their best interests and not to be distracted by any third party, or external rules, or red tape. GPs are already held in high regard by their patients. The potential reform agenda must build on this and not be allowed to interfere with it.

What we have seen from this Government so far does not fill GPs with much confidence. We have asked for MBS reform and we have been delivered MBS cutbacks. Our elderly and infirm patients have had their rebates for joint injections removed. As our patients’ eyesight diminishes from cataract formation, affordability for a fix has diminished. If our patients need coronary angiography, the same applies. If our patients need a blood test, their access to affordable pathology has also been diminished. If our patients need an MRI for a knee injury or for suspected multiple sclerosis, they will not have access to the MRI rebates approved by the previous Health Minister, despite the AMA showing that it would be a cost saving.

If Grandma’s not happy, it would be fair to say that Grandpa is not happy either.

There are multiple GP Super Clinics springing up all around the country which, in many cases, are more likely to be competing with existing GP practices than enhancing them. In our Priority Investment Plan, the AMA has already called for $830 million over the next three years to enhance GP infrastructure.

This could support more community-based training, more on-site collaborative care, more virtual consolidation and coordination with other services and more practice nurse services.

Nurse practitioner and midwife access to MBS and PBS funding is now a reality. The AMA has already been working hard to ensure that the close collaboration that has always existed between health care professionals is enhanced and that fragmentation of care - which is both cost inefficient and the enemy of quality care - is prevented. Self-interested radical elements cannot be allowed to unpick the fabric of our health system.

Our President Dr Andrew Pesce has heard the message from grassroots GPs and has commissioned the AMA GP strategy. The State and Territory AMAs have provided their leading GP delegates and offers of tangible support. The AMA is united in this campaign and we are getting on with the job.

Watch this space for more detail on the campaign – we should have our web portal up and running before the new year.