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AMA Speech - AMA President A/Prof Brian Owler - Doctor Forum

08 Feb 2015





Welcome to the Sydney AMA GP Forum.

This is one of a number of meetings occurring around the country. As I speak, your colleagues are meeting in Melbourne, in Adelaide, and I will be travelling to Brisbane to speak to more GPs this afternoon.

It takes a lot to get GPs angry. We have heard your dismay and we recognise your anger following the attacks that have been made on general practice in this country.

Every nation knows that, as their population ages, people live longer - but they do so with chronic disease. Managing this burden of chronic disease, keeping people well, keeping people in the community and out of expensive hospital care, is essential. 

The key to a sustainable health care system is general practice.

Rather than sustaining the Australian health care system, the Government’s attacks on general practice, its disinvestment in general practice, threatens the very viability of general practice.

In doing so, the Government has undermined the most important element in sustaining our health care system and jeopardises the future health of all Australians.

We were all shocked when the Government announced the first co-payment proposal in its Budget last May.

A policy that introduced a $7 co-payment for general practice, as well as pathology and diagnostic imaging.

An unfair policy that failed to protect the most vulnerable in our community - children, the elderly, Indigenous patients, those with chronic disease, and the poor.

A policy that jeopardised the hard fought gains in immunization rates and that ignored the importance of prevention.

A policy that attacked the viability of practices, particularly those providing services in disadvantaged communities.

That is why the AMA fought hard against this proposal.

It was poor policy conceived on the basis of personal assertions, assumption, and the anecdotes of political hacks.

It was a fiscal policy. It lacked any notion of being a health policy. The sole aim of the Government was to take $3.5 billion out of general practice.

It was based on ideology. It is important to believe in ideas but, when policy is based on ideology alone, when it ignores data and evidence, that’s when policy fails to have intellectual integrity - and ideology becomes the natural enemy of common sense, of logic, and of moderation.

I went to the Prime Minister. He asked me to come up with an alternative proposal. If we were to have a co-payment, it had to protect vulnerable patients, it had to invest in general practice, and it had to fair. We worked hard and presented a proposal that did just that.

What we didn’t do was propose taking money out of general practice. That is the key. The Government wasn’t interested in sustainability, only savings.

What was the response? Nothing but silence from the Prime Minister, and Minister Dutton describing it as a cash grab by greedy doctors.

In December, the Prime Minister along with Minister Dutton announced a new co-payment proposal. Another set of measures aimed at cutting funding to general practice.

The proposal included a change to the level A and B rebate. That would have seen your skills, your experience, being valued at just $16.95, and from 1st July just $11.95, for a consultation lasting less than 10 minutes.

What a slap in the face to general practice.

This measure alone ripped $1.3 billion out of general practice. It’s no wonder that you are angry. It’s no wonder that GPs feel undervalued, and no wonder you are here today.

The AMA lobbied hard. In January alone, the AMA and its opposition to this policy was quoted in over 600 media items. We mobilised our members with more than 7000 emails sent to MPs. The AMA provided material for your practices. I know many of you galvanised your patients and that those patients also acted to tell their MPs that they valued general practice.

I wrote to the Prime Minister, pleading with him to reconsider the change.

Finally, the weight of public pressure won through. The scrapping of the proposed changes to level A and B consultations was a win for general practice. It was a win for patients.

The AMA is not satisfied with that change alone. There are two elements of the Prime Minister’s December announcement that remain – the $5 cut to the rebate for non-concession patients over 16 years, and the freeze to indexation across the board until 2018.

The AMA does not support any proposal that cuts the Medicare rebate. This proposal, which has a so-called ‘optional $5 co-payment’, is purely a cut to the rebate. It is a cut to general practice. Whatever happened to ‘no cuts to health’?

GPs will have to pass the rebate reduction on to patients. You will have to charge them a fee. As you know, that is not always possible.

Where patients can afford to make a contribution, it is not unreasonable to ask them to do so. We know that a patient rebate of $37 for level B is not sufficient for the quality care GPs provide.  That has always been the AMA’s position.

However, a further cut to rebates undermines both private billing and bulk billing practices.  It makes it harder to bulk bill those patients who need that support, and compromises those patients who do make the $30-40 contribution to their own health care costs.

The $5 cut to the patient’s Medicare rebate is supposed to be a price signal. A price signal is a financial deterrent. Why should we deter people from accessing general practice? The irony is that the price signal only applies to those that can afford to pay.

So is it really a price signal? Or is it just a direct transfer of costs from the Government to the patient’s pocket with the GP acting as the middle man? This ideological spin just doesn’t have the intellectual rigour we require in our health policies.

The freeze to the Medicare rebates represent the dismantling of Medicare. Our rebate has been falling in real terms for decades. Propped up by bulk billing incentives, ironically by the Prime Minister in 2005, and other initiatives.

A freeze in GP rebates will make it six years of rebate freezes. The Medicare rebates will no longer be any reflection of the cost, let alone the value, of the quality services that you provide.

And this is not just an issue for non-concession patients. This extends right across the board for all patients. Your ability to bulk bill even the vulnerable patients will be an issue and I fear for the viability of general practices, particularly those serving disadvantaged communities.

This is a challenge for both the Government and the Opposition. Scrap the freeze. Don’t punish general practice, don’t penalise those that are already contributing to the cost of their health care. Most of all, don’t punish the disadvantaged.

This Government is in a bit of trouble at the moment. Tomorrow there will be a vote on a leadership spill. There is no doubt that the Government’s continued attacks on Medicare are a major contributing factor to their current woes.

Now I have tried to work with the Prime Minister. I have tried to work with this Government. Whoever the Prime Minister is tomorrow, the Government must not only change its policies but also its process.

For the past nine months, we have done nothing but argue to protect our patients from the Government’s attacks on general practice. We have missed almost a year of real health policy development. The Government has missed the opportunity to harness your ideas and your passion for making this country healthier.

What the Government does not understand is that this is NOT about politics. This is about the future of our health care system and the AMA will NOT be held to ultimatums or support policies, of any Government, that undermine the Australian health care system.

Success should not be measured by the ability of the Government to wrangle unpopular policies through the Senate.

Success should be formulating policies that are based on evidence and expert opinion; that can be argued convincingly, and that win support based on the intellectual integrity of those policies.

Those are the policies that will enhance our health care system.

There are some signs of change from the new health Minister. I am pleased that Minister Ley is consulting. She appears to have an open and constructive approach.

I am glad that she will hear from you; your ideas for a better health care system, and she can help you, general practice, get the best outcomes for your patients.

That is one of the reasons that we are here today. The other reason we are here today is to say that general practice needs rebuilding. We want to get these current proposals off the table now so we can start the real discussion about how general practice should be funded to provide the comprehensive quality care our patients need. 

I have said many times, Australia has an excellent health care system. We are efficient and we deliver a high standard of care.

Can we improve? Of course we can, and all of us are prepared to make the system better. It is something that we do every day.

As I said, general practice is the key to sustaining Medicare, to sustaining our health care system.

Expenditure in health care is an investment. Investment in general practice is an investment in the future of all Australians. The AMA has fought hard to protect that future.

The AMA will continue to stand up for general practice and for our patients. To be successful, your support is essential and thank you for providing it here today

8 February 2015

CONTACT:         John Flannery                     02 6270 5477 / 0419 494 761

                            Kirsty Waterford                02 6270 5464 / 0427 209 753


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Published: 08 Feb 2015