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Joint Statement - Australian Medical Association (AMA); Australian Divisions of General Practice (ADGP); Royal Australian College of General Practitioners (RACGP); Rural Doctors Association of Australia (RDAA) - Government's Medicare Package

General practice in Australia is in crisis.

There are doctor shortages in communities all around the country - urban, rural and remote.

Many GPs cannot afford to stay in practice. They are retiring, moving to areas where they can make a living, going overseas to work or working part time. The GP participation rate is falling to dangerously low levels.

Patients are finding it harder to find a local family doctor. The poorest and sickest in the community are seeing accessible and affordable health care slip further out of their grasp.

The Government's Medicare Package does not adequately address the issues of access and affordability.

The Government's Package will fail to support quality accessible patient care for Australians. It will bring about a two-tiered system of care.

Those practices that are currently privately billing will still do so and will maintain a high standard of care. Practices that choose to opt-in will continue to struggle, and this could impact on quality of patient care.

The independent arbiter (the Relative Value Study) has calculated that a fair fee for a standard GP service should be $50. Based on this, GPs have been subsidising their patients' care for years, particularly if they bulk bill and receive only $25.05 for a service.

Because of this, doctors have been forced to compromise on the physical features of their infrastructure and on their own health before compromising the quality of their practice for 20 years or more. Many doctors would prefer to move practices, close up and change careers rather than compromise quality.

GP Groups do not believe that the Package will have much positive impact on access or affordability.

The Package is unlikely to benefit the working poor who do not have healthcare cards.

It is unlikely to benefit many concessional patients in areas already experiencing low bulk billing rates.

This is because the level of incentives is unlikely to be sufficient to induce changes in the billing practices of many GPs who have a high concessional patient profile and who are currently charging a co-payment to some or all concession cardholders.

While the GP Groups acknowledge that some aspects of the Package could be steps in the right direction - such as the safety net and workforce measure - the complex nature of the Package will create more red tape and all the positives are tied to other aspects that are unacceptable.

The response of members to the overall Package, particularly the way in which some aspects of the Package will be implemented, has ranged from cautious to negative.

The only strategy most members are willing to accept is increased patient rebates with no restrictions on how GPs bill. This Package does nothing to attract new GPs or stem the steady flow of GPs out of the profession.

However beneficial some individual reforms, they cannot be extricated from the Package.

They are linked via a mechanism that compulsorily binds GPs into participating, such as the requirement to opt-in, bonding of students and the placement of registrars.

While this 'stick and carrot' approach, in theory, provides an incentive-driven pathway to achieve the Government's agenda, the compulsory nature of such schemes is perceived as a major departure from the traditional fee for service, free market framework for general practice.

Loss of independence accompanied by increasing red tape is a major cause of dissatisfaction among GPs and this has the potential to result in undesirable outcomes that will make the shared goals difficult to achieve.

Canberra

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