Team care - utopia or pipe dream?

Dr David Rivett

Australian Medicine 5 October 2009

As the federal Government’s august chosen advisory bodies release their findings and recommendations, one can be forgiven for concluding that, given their make-up, their pontifications were utterly predictable and unsurprising. Motherhood statements abound.

Preventive care, long the hallmark of any GPs worth their salt, is given well overdue recognition, and team care in multi-disciplinary polyclinics is commended. E-health, which has been struggling for more than a decade to get genuine government support, is recognised, as is the appalling state of Indigenous health. Nothing too surprising here.

Where the wheels fall off, and an overload of plain stupidity or cloudcuckooland dreaming takes over, is when it comes to how the new medical world is to be financed.

No realistic additional funds are proposed. And, believe me, these changes require many many billions to implement and sustain.

If Australia is to have public hospitals properly financed and thus enabled to provide prompt high quality care for all, it means that many more dollars will have to be spent, not fewer.

GPs, long the poor cousins, deserve MBS rebates which reflect their training and expertise and enable the profession to attract graduates of a high calibre. Yet now it is recommended that the same grossly underfunded and inadequately indexed MBS is additionally to fund wide-ranging allied health, nursing and dental care. Plus, the

Government is to construct thousands of new multi-disciplinary health centres for GPs, psychologists, practice nurses, nurse practitioners, pharmacists, physiotherapists and occupational therapists, etc, to work in teams.

Where will all the dollars for this brave new world come from? And will private doctors, dentists and physios embrace the Government’s plans unless it is a financial honeypot? Experience to date from the Super Clinics suggests not.

Signs are already emerging that the realisation has dawned that the grand design is politically unaffordable, for it would require a substantive tax increase or harsh rationing.

Look around you as the month’s progress, and the plot unfolds.

The MBS razor-gang program that the Government has in train is a clear early sign that, rather than applaud the fact that health care provision is being supplied in a high quality manner on a shoestring by Australia’s GPs, the Government is clearly wrongly going down the path of bureaucratic enlightenment. Here the underlying mistaken principles have remained unchanged for eons:

1. more bureaucrats = greater efficiency,

2. bureacrats can cut the fat out by curtailing/rationing or underfunding services and

3. more red tape improves outcomes.

So we are headed for massive changes, but grossly underfunded. This is nothing short of a disaster waiting to happen.

Let us hope that common sense prevails, Cabinet sniffs the wind, a shuffle occurs and a new Health Minister emerges who has the wisdom to build on the current system’s strengths and the persuasive powers to obtain Treasury’s go-ahead for a vital increase in health care funding directed at coal-face care provision, not at layers of red-tape and bureaucracy.