TOP STORIES

First talks frank but friendly

AMA President Dr Bill Glasson has come away from his first meeting with Mark Latham saying he's impressed with the new Opposition Leader as 'a straight shooter who tells it like it is'.

In a brief meeting at Parliament House in Canberra, the two leaders exchanged views about Medicare, doctor shortages and public health issues, especially those relating to Indigenous people.

While they did not agree on everything, there was common ground on the concept of social entrepreneurs being central to the effective delivery of services to Indigenous communities.

Teenagers will lose out

In a misguided move, the Federal Government wants to give parents increased access to the medical records of their children, raising the age to which they can see them from 14 years of age to 16.

Health Minister Tony Abbott has been pushing the move strongly, citing the abortion rate as a national tragedy and warning Australians not to sanction 'open-slather sexual activity by 15-year-olds.'

But as AMA President - and ophthalmologist - Dr Bill Glasson has pointed out, he seems to be suffering from tunnel vision on this contentious issue of increasing parental control over teenagers.

Dr Glasson says if implemented, the policy will dissuade teenagers from seeking expert medical and other health-related advice on a wide range of health issues, including drugs, depression and contraception - issues they may not feel comfortable discussing with their parents.

'No' to in-store pharmacies bid

AMA Vice-President Dr Mukesh Haikerwal says a Federal Government move to stop Woolworths and other retail chains from setting up in-store pharmacies will protect patients.

His comments came as Federal Health Minister Tony Abbott committed the Government to protecting community pharmacies.

Dr Haikerwal says the AMA wants to see quality maintained in the pharmacy system: 'The provision of good service requires a good relationship between pharmacists and patients.

'We would be concerned that many of the privacy and confidentiality safeguards that you get in a pharmacy would be even less so in a supermarket.'

INSIDE

AusMed Feature

Broadening the path

The health of our Indigenous people continues to be of grave concern to the AMA as it is to others, as is the fact that there are so few Indigenous medical graduates to take a health leadership role.

The disadvantaged educational status of Indigenous people goes hand-in-hand with their poor health, as starkly brought home in Bob Collins's landmark 1999 report Learning Lessons.

So how do we improve the educational status of our Aboriginal and Torres Strait Islander peoples?

How do we encourage more Aboriginal and Torres Strait Islanders to aim high and become medical practitioners? 

This edition of AusMed looks at the issues as well as at two significant success stories.

FROM THE VICE-PRESIDENT - Dr Mukesh Haikerwal

Rethink needed on hospital GP clinics

The proposal for 10 State Government-funded GP clinics, co-located at major city hospitals, staffed by salaried personnel who would be allowed to 'bulk-bill' was announced in early April.

The Commonwealth's agreement to allow bulk-billing in this set-up was required and it allows for some 'cost recovery' for State-Government expenditure.

Four of these clinics are in Perth alone and we can only wonder why the plans of a State-based organisation have been brought into play to the potential detriment of Perth patients and their GPs.

The Federal Government has put a significant $2.85 billion into the nation's health through the Medicare Plus package.

A major part of this package has been about addressing the general practice workforce crisis. Retention of GPs is at an all-time low, with a participation rate of 64 per cent and a shortfall of about 4,000 doctors nationwide.

If each GP dropped two hours consulting it would be like 1,000 GPs haemorrhaging from the system.  Initiatives for increasing workforce numbers have been around quality of training, quality care and continuity of care.

This scheme for four bulk-billing clinics in metropolitan Perth will not work.  It seriously undermines the Commonwealth's phenomenal efforts to address the macro problems of the system.

This flawed model with the State Divisional organisation is condemned by most of the constituent WA Divisions and their GP members.

It will result in less care as GPs close their doors early in existing practices when they cannot compete with a State-subsidised, Federally-underwritten competitor.  Assuming GPs will be found to staff the clinics, the service provided will be episodic and not the true model of GP care, which is a long-term therapeutic relationship.

Specialists have clearly stated that the load on emergency wards is not from patients looking for a free service but from those who are ill and need of in-patient services that cannot be provided without more beds.

The close location of a free service will attract large numbers of patients who will have to wait, putting a huge burden on the medical and support staff in these clinics, who will be tempted to refer on to the emergency department much more readily.

GPs have been working to provide services at inhospitable hours and participating in numerous successful models for ensuring continuity of care including:

• After-hours co-operatives
• Services from within a practice
• Services from groups of practices
• Extended hours within practices
• Deputising services

The quality agenda is about providing excellent care within hours to reduce the demand for after-hours care.

Rather than set up a competitor with a grossly unfair advantage, perhaps the State Governments would like to subsidise the infrastructure of existing, hard-working practices to secure their future and engage them in conjoint health delivery.

• I recently had an opportunity to meet with key senior HIC personnel.

Over the years, my intrepid colleagues Drs Bills Pring and Bob Brown have had a rather arduous involvement in the Professional Services Review (PSR) process both at the HIC level - and once a case passes through the door from HIC - to the PSR committee of peers stage, directed by Dr John Holmes (DPSR).

Each time we thought we understood the process, some other concern used to pop out of the woodwork.

One of these was that the process was poorly understood.  As the AMA is cited in all the documentation pertaining to the HIC given to practitioners under review, we must not only understand the processes but be comfortable with them.

The HIC professional review process and the PSRC are components of the PSR scheme.  The HIC will identify and examine cases of concern regarding inappropriate service provision.  Should the need for a referral arise to a committee of peers, the case is passed onto the DPSR.

There is work soon to be put in place about the way the HIC and its medical advisers conduct their business of reviewing practice and giving advice around the statistics and work patterns they see.

Much to our approval, the role of the medical adviser is more to the fore, allowing such advisers to use their knowledge and experience to discuss cases under review and to identify and eliminate those who have appropriate practice from further scrutiny.

The modus operandi will be in the form of a handbook demystifying the process.  I believe the new system will be a major improvement, will utilise the medical adviser role more usefully and be more consistent and transparent.

Persistence by the AMA has brought some changes but time will tell how effective these changes will be.

The investigation of fraud is a police matter and does not pass through a peer-review process.  It may not get to a medical adviser at the HIC and the normal system of interviewing and discussing circumstances need not occur. 

Overall, the peer-review system is a system we need to maintain as it allows a committee of doctors who understand the practice of medicine to check on alleged inappropriate practice.

The AMA has to ensure that there is adequate review of that system.

Dr Mukesh Haikerwal is Vice-President of the Federal AMA.