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21 Sep 2015

The AMA Submission to the Government’s Primary Health Care Review highlights the robustness of the Australian health system, particularly the crucial role of general practice, and stresses the need to build on the proven track record of general practice with significant new investment.

AMA President Professor Brian Owler said that the Review must focus on strengthening the parts of the system that deliver quality, accessible, and affordable care to the community, most notably general practice.

“This is not the time to throw the baby out with the bathwater,” Professor Owler said.

“In terms of both cost and health outcomes, the Australian health system is performing very well by world standards, and general practice delivers outstanding public health outcomes from modest Government investment.

“We must avoid radical change for change’s sake.

“Some of the potential reforms raised in the Primary Health Care Advisory Group's (PHCAG) discussion paper have been tried or are in place in other countries, and there is only very limited evidence about any significant positive impact.

“General practice in the UK, for example, has been the subject of several rounds of funding reforms, and the GP workforce in the UK is now being reported as demoralised and suffering from extreme shortages.

“We do not want or need to repeat the same mistakes here. It is concerning that some of the failed UK experiments are still on the table here for PHCAG consideration.

“For the Review to have genuine credibility, the Government must change its reform language – it must start talking about primary care reform as an investment, not a cost or a saving to the Budget bottom line.

“There is no doubt that extra investment in general practice will deliver long term savings to the Government, and improve the sustainability of the health system.

“The Government needs to take a long term view and make this investment now, in the knowledge of savings in later years, better patient outcomes, and less pressure on our hospital system.

“Significant new investment in general practice and the urgent need to lift the current freeze on the indexation of Medicare patient rebates must be priorities for the Review, or they will be priority issues for voters at the next election,” Professor Owler said.

With the growing burden of chronic disease and the long term impact this will have on the health system, the AMA is encouraging the PHCAG to consider reforms that will better support these patients in accessing high quality GP-led care.

The AMA Submission highlights a number of areas for change, including:

  • provided there is no overall reduction in funding, reform of existing Medicare chronic disease items to strengthen the role of the patients usual GP, cut red tape, streamline access to GP referred allied health care services and reward longitudinal health care;
  • the adoption of pro-active models of care-coordination for patients with higher levels of chronic disease and who are at risk of unplanned hospitalisation - similar to the Coordinated Veterans' Care program that has been established by the Department of Veterans' Affairs;
  • the introduction of an incentive payment through the Practice Incentives Program to support quality improvement, informed by better data collection;
  • the introduction of non-dispensing pharmacists in general practices to help improve medication management, particularly for patients with chronic disease;
  • an enhanced role for private health insurers to fund targeted programs that support general practice in caring for patients with chronic disease;
  • the utilisation of Primary Health Networks to support GPs in providing care for patients, particularly in improving the connection between primary and hospital care; and
  • better use of technology, including the use of point of care testing.

While the AMA Submission promotes a number of reforms, it also emphasises that fee-for-service should remain the primary source of funding for General Practice.

Professor Owler said that the fee-for-service model works well for the majority of patients in the Australian context.

“Fee-for-service provides patients with autonomy and choice, and access to care based on clinical need as opposed to the potential for rationed care that arises under some other funding models,” Professor Owler said.

“It also supports the doctor-patient relationship, with patients receiving a Medicare rebate to support them in accessing GP services.”

The AMA Submission to the Primary Health Care Review is at

John Flannery

Published: 21 Sep 2015