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12 Jun 2018

BY DR RICHARD KIDD, CHAIR, AMA COUNCIL OF GENERAL PRACTICE

Members generally expect the AMA to be leading the charge in the media on issues that matter in the health system and, while our advocacy often makes the headlines, much of our good work goes on in the background. While the latter approach might be low key, it can still make a very big difference to day to day general practice.

One good example was the release of the MBS Review Taskforce recommendations that would have excluded GPs from claiming the cryotherapy MBS item 30202 for the removal of malignant neoplasms in favour of Australian Medical Council recognised dermatologists and plastic surgeons.

When the AMA Council of General Practice (AMACGP) first heard this news, it was met with disbelief. This procedure is most commonly performed by GPs and the published Taskforce recommendations were seen as disrespectful of the skills of GPs and contrary to the interests of patients. 

On closer inspection, the Taskforce recommendations also appeared to go much further than the original recommendations made by the Taskforce’s Dermatology, Allergy and Immunology Clinical Committee.

While the Clinical Committee was concerned that best practice was not being observed regarding confirmation by histopathology, it did not recommend that GPs should no longer access item 30202. To support best practice, it recommended tightening the definition of ‘specialist’ in the item descriptor in so far as it related to confirmation of malignancy, and called on relevant colleges to encourage best-practice use of pathology. It also called for the monitoring of high volume users to ensure appropriate requesting of pathology.

The AMA has good relationships with the Department of Health, allowing us to raise this discrepancy with the Department and to get a timely response. The AMA also has significant expertise in the operation of item numbers, allowing us to challenge the reported recommendations of the Taskforce and highlight the impact on patients.  

Following these representations, the Department ultimately conceded that an error had been made during the publication of the Taskforce’s finding on the Department’s website and that it would make it clear that the Clinical Committee’s recommendation had been adopted in full.

This means that GPs have not been excluded from claiming MBS item 30202.

One wonders whether this error would ever have been picked up, if not for the AMA. What a detrimental impact this could have had on patient care, particularly in rural and remote areas, and what a blow to GPs trying to provide best care, if this had been implemented on 1 November as announced. The anticipated delays in patient treatment this would have caused could have been devastating for the prognosis of patients with malignant lesions.

Effective advocacy is about much more than just complaining or being angry. It is about high-level access, sound arguments, technical expertise, vigilance and a good dose of diligence. Your AMA has many years of experience in Canberra and is uniquely positioned to win these types of arguments with the bureaucrats – something I am very grateful for.


Published: 12 Jun 2018