GLASSON:       Good morning ladies and gentlemen, I'd just like to introduce David Rivett who you would know well, as Chair of the AMA Council of General Practice, and Roger Kilham, who's from Access Economics, who provides most of the grassroots figures out of last night's budget.

I'd just like to make some general comments about the budget per se.  Obviously what was announced last night was known in advance, particularly around the Medicare Plus Package and around medical indemnity.

New initiatives around the Aged Care Package were announced and obviously we commend the money that has gone into aged care.

Just specifically on aged care, I would like to, through, more detailed analysis, find out how this package is going to impact on the ability of our public patients - public hospital patients - to access both transitional and aged care beds, to try and address the issue of exit block from our public hospitals.  Because it remains a huge issue in relation to trying to provide services in our public hospitals in the sense that we can't get patients in because we can't get them out.

On the Medicare Plus initiatives as we said in the past obviously there are elements of that package that are very good.  It's a huge amount of extra funding that's gone into the system but our main concern is about how that funding is being delivered.  And certainly delivering it around bulk billing and delivering it around geographical - or differential geographical rebates - is not the way forward.  And I think that to try and discriminate against patients depending on where they live - whether you live in Tasmania as opposed to the western suburbs of Sydney - is unfair and unjust and unacceptable.

The further initiatives last night announced, first of all, the DVA - there was an increase in funding for DVA patients - we have advocated on that on their behalf.  That funding needs to be recognised, it's a modest increase and obviously will go towards making sure that we treat our DVA patients as citizens who've actually contributed - or put their life on the line for us, and they should be treated as first class citizens and not as second class citizens, as was about to occur.

So I think that we need to do more in that area but obviously we recognise that initiative as a good one.

One particular negative one I'd like to bring up, is around vaccination.  Obviously the vaccination schedule - the Australian Standards Vaccination Schedule which recommends appropriate vaccines for our children and adults - we feel should be funded in full, but particularly the pneumococcal vaccine.  This is a ridiculous situation where we've got a vaccine that can actually prevent diseases, prevent disability, prevent our children actually ending up with severe, often disabling, conditions for the rest of their life, where for an input of about $62 million we could vaccinate all children in Australia.

I think this is very short-sighted of the government and it's an issue that we will take up with the government very strongly, coming to the next election.  Because it's a ridiculous situation where we've got $14 billion in tax cuts and we can't deliver $60 million into an initiative that will have an outcome that will impact positively on every child in this country.

Indigenous health.  There's a token $40 million given towards extra funding in Indigenous health.  Listen, we commend that as a recognition of the issue, but the reality is that Indigenous health remains a disastrous situation in this country, and it's a total embarrassment and it's something that each and every Australian should hang their head in shame when we talk about the health statistics of our Indigenous people.

So it's again another issue that we'll drive, and drive hard, in the forthcoming election, and try and develop strategies that will actually turn around the disastrous health statistics that we face.

In relation to the general practice area there are not much, I suppose, positives beyond what's been in the Medicare Plus budget.   But I'd like to turn it over to David Rivett to address specifics around - particularly around red tape etc that is impacting on general practice.  So over to you, David.

RIVETT:             Some of the solutions we were hoping for didn't evolve, I'm afraid.  We've been shown an empty bucket in general practice, basically, despite the work of the Productivity Commission demonstrating that Federal Government red tape costs each general practitioner around $13,000 a year, no solutions have been provided. These weren't high cost solutions that were needed but they've disappeared into the ether despite much work by the Red Tape Taskforce and contributions by all GP groups.

What we wanted to see was a simplification of the EPC and PIP items and the funding from those rolled into attendance items for all Australians on a solid base, so the MBS was revisited and based around our discussions so all Australian citizens got fair rebates for longer consultations.

Even simplifying something such as the authority system, which ties up huge GP time, getting phone authorities for prescriptions hasn't been addressed and doesn't look as though it will be addressed.  Even a simple measure such as getting repeat authorities on the same authority number for that single patient hasn't been put in place, it's been overruled by Cabinet, apparently.

Veteran's Affairs patients have been neglected again, they're now loss leaders for general practice, and we've been told in writing from the department that Cabinet will only reconsider this if GPs leave the LMO scheme.

This is not the way to treat citizens who've put their lives on the line for Australia, it's a lousy way to go forward - cheap and nasty.  I'm very glad that their specialist fees have been addressed but we need an immediate catch-up in GP rebates for veterans.  They're an extremely elderly group and we're talking about aged care initiatives in this budget, and they've been forgotten once again - average age of 76, and extremely complex with their disease mix.  And not easy going for general practices to look after in a quality manner.

As Bill said, some of the initiatives we welcome.  As a rural doctor I certainly welcome the extending of the benefit to existing rural specialists that now applies to new specialists going to rural Australia, because it will help keep those people coming.

They have been extremely annoyed, the fact that they were overlooked previously.  This is a good initiative that the AMA's been pushing hard for.

With aged care, again, we welcome the initial initiatives the government's put in place to attract GPs back to aged care, through panels, through a comprehensive medical assessment when GPs attend aged care facilities - these are items that we welcome.

And we also welcome the Aboriginal and Torres Strait Islander health initiative with GPs being able to do a comprehensive medical assessment, which is reasonably funded for this group in the population.  And we hope general practice can make a large contribution towards bettering Aboriginal health in the future.

These are areas the government has addressed, but there's other festering sores that have gone unattended; that don't cost big bikkies to fix; and they need fixing now.

Thank you.

GLASSON:       Just another couple of comments.  One is around the issue of workforce.  As we have said, the biggest, biggest issue that Australia faces relates to workforce - not in, just in doctors, but this is nurses and allied health across the board.

And whatever arena you're looking at - whether it be in aged care, or whether it be in acute care or public hospitals and in whatever form, the workforce situation is getting worse by the day.

And so, whatever these initiatives we are looking at here, we have to look at them in light of how they're going to impact on making sure we retain the workforce we have, but more importantly as well, attract new doctors and nurses into the system.

Now, in the aged care area, obviously the nurses are being underpaid significantly compared to their public hospital counterparts.  And so unless there is a rationalisation of that, then obviously there'll be less and less nurses delivering the services in our aged care facilities.

And the same applies to the doctors on the ground.  We have not got enough specialists out there.  We do not have enough general practitioners out there, and we have this knee-jerk reaction in trying to bring overseas trained doctors in at the moment, which will provide an interim measure, but it does not address the fact that we are not, we do not have enough training positions for either specialists or general practitioners out there to address the needs of the community into the future.

And last comment - there was nothing about smoking last night.  It was all about families.  It's all about what is good for families, about us all getting out there and breeding, having more children, replenishing the youthful stock.  What, with that comes a, the issue about health, about access to affordable and high quality health.  And with that we should be talking about the issue of smoking.  And I note that there was no sort of comments about how that issue was going to be addressed.  Because as you know, the cost to the community, both socially and financially, in smoking is unacceptable.

So I'd like to see more targeted initiatives about trying to, have disincentives for people to, first of all take up smoking, and incentives for them to stop smoking in the longer term.

We'd be happy to take any questions.

QUESTION:      With health likely to be a major issue in this year's election would you have expected more from the budget?

GLASSON:       Look, I think from the point of view of where we started 12 months ago - particularly before Tony Abbott came on board - we have got a huge injection of extra money into the system.  There's no two ways about it.  But that was catch-up money.  That's not new money.  This is catch-up money that we should have had in the system, you know, over the last decade.

So we've come from a low-base up to what we think might be considered now fair and reasonable.  But given the fact that we've an aging population; given the fact that we've got increasing technology, increasing expectations from patients, we have to in reality increase the proportion of GDP going into health.  There's no two ways about it.

And as you said, for the forthcoming election, health and education will still remain the major, I feel, election parameters on which electors will judge both parties.  And therefore it's very important that the profession stands on behalf of their patients and advocates for those particularly who are most in need, to ensure they can have access to the services that they require.

QUESTION:      The medical indemnity issue seems to be dragging on.  What's the problem?

GLASSON:       Look, we got it, it's come round the Melbourne Cup sort of track.  We're coming up the race, and with just about a furlong to go and, but can I suggest to you that, well I've had discussions with the Department and the Minister over the last week, and we'll hope to get it across the line - I'd like to see in this sitting of parliament - and we're advocating hard to have that get across the line this sitting, where we'll get the third element of the package in place, and that's the run-off cover scheme.

And so once that's in place, then we can look at issues such as the long-term care scheme, and importantly as well, making sure that the States put their appropriate tort law changes in place to ensure that these gains for patients can be extrapolated to at a State level.

QUESTION:      When that complete package has gone through will that sort of address the crisis in medical indemnity that [inaudible]?

GLASSON:       I believe it will.  I believe this has gone 99% of the way to addressing a lot of the major concerns that were raised last year.

I think that what we asked from the point of view of the government is, or on behalf of patients, is to give both security and affordability - security to the doctor to make sure that he or she was ensured for the rest of their life, and secondly, that there was affordability from the point of view of the patient, because the patients pay for medical indemnity not doctors.

And, what we were finding was fees were going up to fund this system, and unfortunately patients were missing out.

QUESTION:      Public hospitals seemed to miss out [inaudible]?

GLASSON:       Absolutely.  There was no mention of public hospitals last night.  The current funding arrangements between the Commonwealth and the States is absolutely inadequate.  We cannot fund our public system on the current funding arrangements.  We cannot deliver the services that are required in public hospitals, and as a consequence the situation is arising in a lot of our public hospitals around, particularly New South Wales, but across this whole country, a reflection of fact, the funding is inadequate.

You cannot provide quality, high quality medical services and safe medical services when you ask people to do it on a shoestring.  And so our doctors and nurses out there, who are attempting to provide this, to provide this service at high quality level, are finding they cannot do it because the increasing demands, just in sheer numbers, let alone the fact they haven't got the staff or often the equipment to provide those services that are needed.

QUESTION:      The aged care package, you seem to be pretty happy with that [inaudible]?

GLASSON:       Yes, the government has looked at the Hogan Report and then implemented the initial phases and the medium-term recommendations, I understand.

I think we've got to look at how this is going to translate across the board as far as the appropriate number of residential aged care beds; the number of community packages that are required out there.

And so I think there's, we look at a bit more of the detail, but maybe David you could comment further from the point of view of your area in general practice and aged care access.

RIVETT:             Certainly as a GP I welcome the increase I community care packages, but if it comes at a cost of residential aged care facility beds, that's also a major concern.  If it's gone by two there, despite the ten increase in the community packages, that's alarming.

And the transitional care beds are coming out of existing beds.  They're not new beds, which is also of concern.

The other neglected group that's really been forgotten is the carers in the community.  Their carer's pensions haven't been addressed.  They do a hell of a lot of work and save the government a mint in providing care for the elderly in society, and they've been unrecognised in this budget.  And they're really a saintly group that does an awful lot of aged care in Australia.  And the dynamics of providing that's getting more and more difficult with both family partners working more and more frequently in this day and age.

So, carers have been forgotten along with veterans, basically.

QUESTION:      On the issue of [inaudible]?

RIVETT:             They've agreed to consult more on a simplification of the EPC and SIP items, which basically isn't a firm commitment to do anything.  A consultation process doesn't ensure any change whatsoever.

QUESTION:      [inaudible] agreed position from GP groups?

RIVETT:             It was [inaudible] consultation with most department heads involved, and great enthusiasm displayed at the onset, and we really thought it was going to go somewhere.  So it's a major disappointment that nothing has come out of it of any note.

QUESTION:      What sort of effect does that have [inaudible] Medicare Plus and the allied health issue overall in terms of [inaudible]?

RIVETT:             Again, it makes general practice less attractive as a profession.  Graduates coming through are going to go onto other career paths when they see the red tape that burdens general practice.  It's a huge cost to general practice in time and dollars as the Productivity Commission has demonstrated, and the fact that it hasn't been lifted at all, with some plain sailing simplifications that would cost the government next to nothing that could bring this in line.

And if they want a real solution, and a real commitment to Medicare, they should be looking at the AIRWG solution and proper indexation in years ahead, so we don't get patients being dudded year by year with shrinking rebates and then a catch-up package by government to bring rebates back to reality.

That's all we see year after year is wage cost index [inaudible] bringing down patients rebates.  And if I was a consumer out there I'd be pretty alarmed about it and making a lot of angry noises about it.

QUESTION:      When you talk about [inaudible] in the AMA's budget submission there was talk of the government's actually made a lot of savings [inaudible] underspend particularly on the Medicare benefits schedule [inaudible].  Do you think that's, that's money turned up somewhere in the budget to make [inaudible]?

GLASSON:       Roger.

KILHAM:            Look, there's always going to be a gap between the expectation of any industry.  I mean it'll happen with the aged care package.  There'll be aged care providers saying there's not enough.  I think the proof is in the pudding.

I mean, if people can't get access to service; if they can't find a doctor when they need one; if they can't get a hospital bed when they need one, then, you know, full stop.  I mean that just tells you all you need to know.  And, you know, at the moment, that's where we're at.  We don't have enough access to GP services for the community as a whole.  We have some groups within a community who are missing out very badly, and we have great pressure on hospital beds.

GLASSON:       It's really about access to affordability, as we keep using those two key words, and whether you talk about residential aged care facility or talking about, you know, acute care facilities, it's all about actually access and affordability, and I suppose that's what we've been saying - that there hasn't been enough money in the system to deliver affordability on behalf of the patients, and with that we've got a huge workforce on, workforce problem on top that is compounding the problem.

And, as I said, the real concern is how do we address this workforce, given the fact it's an international problem.  It's not only in Australia, it's across the whole world.  And so we're in a competitive market, where our doctors are being attracted overseas, and we're going to have to try and attract doctors from elsewhere to try and fill these positions.

But a lot of these strategies around workforce, particularly when you look at our medical students places, and the government is still going down this line of these unfunded bonded medical student places.

Listen, we have made it very clear to them that is the wrong way to go.  There are some discreet strategies out there where you can offer scholarships or offer to pay their HECS towards the end or during their course of their medical career, who, those doctors will then be committed to going to work in areas of need, whether that be rural, outer metropolitan or wherever.

But this strategy whereby you actually lock people in before they actually take a medical school place, with the view that somehow in 12 years time they're going to go out and work at the back of Barcaldine, in a happy environment, that does not work.

And so I think they have to redirect their strategy around medical students to make sure they offer either scholarships or offer sort of to pay part of the HECS or whatever, and offer at the right time, not, not to sort of bribe them as far as, bribe them with a medical school place with the view that somehow they're going to be willing and happy participants to go and work in the back of beyond.

That's not the way forward, and we're going to continue to lobby the government hard, because we do need more medical school places, no two ways about it.  We need our home grown Australian graduates actually treating us as doctors, and we do not have to, want to depend on overseas trained doctors to keep this system sustainable.

But they're going about it the wrong way, and if we get behind scholarships, get behind the proper incentives, then there will be no problem with getting these young doctors out to where we want them to go to.

Okay?  Thank you very much indeed.

Ends