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14 May 2018

BY AMA VICE PRESIDENT DR TONY BARTONE

As this is my last column for Australian Medicine in my current role as Vice President, I thought I would take the opportunity to reflect on the past two years, as well as look to some of the challenges ahead for the AMA.

There has been a change in the health narrative over the past two years. This has been on many levels, especially from a Federal Government attempting to become more consultative. We have consistently engaged with Government for the most part. On numerous occasions, it has been happy to acknowledge the role we have played in helping to shape policy.

However, this now needs to ratchet up into a more strategic relationship focussing on outcomes and actions. We must leverage this going forward. They must step up to the plate and deliver.

There have been certain events or areas of advocacy I wish to highlight during the last two years as Vice President. The Medical Workforce and Training Summit was one of them. The need for such a summit was identified early in the work plan of the Medical Workforce Committee. Together with the Council of Doctors in Training and the Secretariat, it was able to bring together key leaders, including many College chairs, jurisdictional representatives and other stakeholders.

The first since 2010, the summit identified areas of consensus, including affirming there was no need for further medical schools, and looked at the thorny issues of workforce distribution and lack of coordination in workforce planning and training between Commonwealth and State governments. It gives impetus to our call for a national medical workforce strategy as a matter of priority.

The elevation and resulting urgency around the issue of mental health and wellbeing of medical professionals was a key pivotal movement. Events such as the Forum on Reducing Risk of Suicide in the Medical Profession as well as the session at last year’s National Conference, which shone a spotlight on doctors’ health and wellbeing, clearly emphasised its critical importance and need for a solution. This issue is clearly very complex and multi-faceted. It is in need of more research, especially around data and greater understanding of the aetiological drivers. It is, however, in need of robust funding to progress various support programs and interventions to support doctors’ wellbeing.

The session on Tackling Obesity at National Conference last year, and the subsequent advocacy and media on the sugar tax later in the year, helped to highlight the enormity of the issue from a behavioural change and public health perspective.

We have also released many other significant public health position statements. The process of reaching these positions served to highlight the strength and depth of the AMA policy machine. The AMA is well served in this regard.  Our people are our greatest asset. The depth of analysis contained in the Public Hospital and Private Health Insurance report cards certainly further exemplifies this factor.

The launch of the Safe Hours campaign and report in 2016 showed how complacency is perhaps setting in, and how extreme and dangerous levels of work hours are still not uncommon in the workplace. The incongruity between rostered excessive work hours (including significant amounts unpaid) and rhetoric about doctors’ wellbeing cannot be greater. Our national voluntary code of practice is a signpost of the change required in the time ahead.

We have also had a very busy time over the past two years with a variety of other issues:  from codeine upscheduling to medicinal cannabis and managing the incessant thirst of media in regards to information. There continues to be a huge workload ahead of us. There always will be. There is much unfinished business.

This includes continuing to wade through the quagmire of private health insurance and associated OOPs (out-of-pocket costs), including the focus on a fees comparison website. The Professional Practice Framework recommendations and implementation will need scrutiny and collaboration during implementation to safeguard rural access, as will concerns regarding practice viability and other unintended consequences.

Securing significant meaningful improvement in GP funding remains imperative. Incentivising for quality; acknowledging prevention along the whole of life journey; as well as recognition for GP facilitated downstream savings across the whole budget, need to be recognised and appropriately remunerated.

Aged care will also remain a key focus, as four additional position statements will be added to the recently released Resourcing  Aged Care Position Statement. With many parliamentary reports and inquiries completing, or about to, this remains an area of key reform for the Government and key concern for the community. How we care for our elderly says a lot about us as a society and remains core business for us going forward.

The release of the Position Statement on Mental Health has forged new potential opportunities for advocacy, especially for step-down access, acute hospital beds, and mental health community support services to help GPs manage patients back in the community and be involved in the discharge planning in a meaningful way.

Of course, there are many other areas where we need to continue our significant advocacy. Closing the Gap, implementing the recommendations of our two previous report cards on Indigenous health is essential.

The MBS review also remains a key area going forward. The promise of modernising the MBS into a fit-for-purpose 21st century framework is perhaps taking significantly longer than Government expected. It remains a key area of concern to ensure transparency and to ensure that any savings are reinvested into new items. The digital health record implementation promises a lot to health outcomes and savings, but it will need to overcome the problems of utility and engaging with all clinicians, as well as perennial concerns about privacy.

The AMA has continuously sought to influence health policy at the highest levels; achieving some excellent outcomes for doctors, patients, and the Australian community. It has been an enormous honour to serve our AMA as your Vice President and I thank you all for your support and assistance over that time.

 


Published: 14 May 2018