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General practice undervalued

Ever since the Federal Government’s health reform program commenced back in 2007, the AMA has remained engaged with the Government to ensure the best possible outcomes for patients and the community as a whole.

17 Oct 2011

AMA President Dr Steve Hambleton

Ever since the Federal Government’s health reform program commenced back in 2007, the AMA has remained engaged with the Government to ensure the best possible outcomes for patients and the community as a whole.

Our doctors work in every part of the health system – public and private hospitals, general practice, public health, bureaucracy, research, universities, Indigenous communities, aged care, mental health, disability, and on the list goes.

They interact with patients every minute of every day.  They know what works in the health system and what doesn’t work.  Their experience and their knowledge are valuable.  Their advice should inform Government health policy, but that is not always the case.  Primary health care reform is a good example.

The major planks in the primary health care reform are Medicare Locals and GP Super Clinics.  The AMA has been critical of both from the start, and for good reason.

Let’s start with Medicare Locals.  Few people seem to know what they are, and what they are meant to do, certainly not the GPs who live and work on the front line of health care in their catchment areas. 

I have had meetings with the doctors in Medicare Local areas in Victoria, South Australia and Tasmania, and there is a knowledge vacuum.

The AMA is prepared to support initiatives that have some evidence that they will improve patient care or a structure that will give the best chance of delivering outcomes (GP leadership).

So, for now, our position remains that Medicare Locals as currently structured do not represent an attractive reform in primary care.  We know they are here to stay, but we want to know more about them and we want a guarantee that there will be GP leadership in their operations.

We have opposed many GP Super Clinics for similar reasons.  Where there is a genuine need for a Super Clinic, where there is local GP support, and where they do not unfairly compete with existing general practices, the AMA does not have a problem.

Our major concern is having Government-subsidised businesses being located in places where they will compete with hard working long-established local general practitioners who have invested their own capital in their businesses and who are providing comprehensive services.  It does not make sense on any level.

The GP Super Clinics Program appears to be in trouble, and the Minister admitted as much in a recent media release.

The Government has decided not to proceed with Super Clinics in Darwin (NT) and Sorell (Tas).  Nobody wanted to run them.

This comes on top of the much-publicised issues around the Redcliffe GP Super Clinic in Queensland, which ran out of money.

There is emerging evidence that the GP Super Clinics Program is a failed initiative in concept, design and implementation.  In terms of planning, the location of clinics appears to be largely a political process that is not necessarily linked to community need.

The AMA has called for a proper audit of the Program.

A third example of lack of support for GPs is the cutting of funds from the Better Access mental health program, where people with mental illness accessed a range of care and services coordinated by their GP.

The Government savagely cut Better Access in this year’s Budget, effectively diminishing the role of the local GP in providing mental health services in the community and shifting more costs on to patients.

Put these things together and you can understand why GPs have low morale and are left wondering why they are being put under more and more pressure.  And you can understand why the AMA is somewhat disillusioned about primary health care reform.

Health reform should be about improving care for patients.  It is hard to see how adding stresses and pressures to general practice is in the best interests of patients and communities.

Published: 17 Oct 2011