GP Network News, Issue 11, Number 7 - 25 February 2011

Medicare Locals

Medicare Locals could enhance primary care and benefit patients if they are established according to the core guideline that GPs must remain the coordinators of patient care, AMA President, Dr Pesce said in response to the Government’s guidelines for the establishment and initial operation of Medicare Locals.

"Medicare Locals will only work to improve primary care if their main purpose is to support the central role of GPs in caring for patients,” Dr Pesce said. "This means that GPs must be the coordinators of patient care, they must be strongly represented on the Medicare Local Boards, and there must be an absolute minimum of bureaucracy and red tape."

Dr Pesce said that the guidelines contain some positive themes but leave the door open for some arrangements that would be strongly opposed by the medical profession should they proceed. The AMA has some concerns that the guidelines appear to have extended the reach of Medicare Locals without any consultation with the medical profession about increased roles and activities and while the Government may have good intentions it has not yet ruled out the introduction of role substitution, managed care and fundholding. A link to the full press release is here.

The Government’s 21 page guideline for applicants includes information on the role, strategic objectives, governance, funding arrangements, performance and reporting procedures and the application process for Medicare Locals. A link to the guideline is here.

Organisations/individuals interested in tendering must address the requirements of the invitation document that is available by registering on the form on the page here.

Applications for the first round of 15 Medicare Locals are due on 5 April. This group is scheduled to commence operations on 1 July 2011. Applications for those organisations wishing to be considered for the January 2012 start and the July 2012 start are due on 19 July 2011.

GP Referrals

The AMA has received the following advice from Medicare Australia:

• Validity of referrals – referrals from GPs are valid for 12 months, unless the referring practitioner indicates it is for a period more or less, e.g. three, six, or eighteen months or indefinitely. A GP referral written while the doctor has a current provider number remains valid until the expiry date on the referral, regardless of whether the GP retires before that date. If there is no date on the referral it is valid for twelve months from the date it was written.
• Indefinite referrals – can be used when a patient requires continuing specialist care and management of a specific chronic condition. If an indefinite referral already exists a new one should not be requested and the referring practitioner should not issue one. Specialists and consultant physicians should accept the validity of an indefinite referral. The referring GP is not required to issue a new referral if an indefinite referral has already been provided. Should a specialist or consultant physician not accept an indefinite referral for a new patient, the Medicare benefit will be paid at a lower rate as an unreferred service.
• New referrals – are appropriate when a patient develops a new problem. It would then be appropriate to bill an initial attendance item relating to the second condition. The renewal of a referral for the same condition does not indicate the start of a new course of treatment where the specialist can itemise another initial attendance. In the continuing management of the condition, the new referral is to facilitate the payment of benefits at the specialist or consultant physician referred rates rather than the unreferred rates.

Australian Doctor – 2010 How to Treat Yearbook 

The Australian Doctor 2010 How to Treat Yearbook is now available. The hardcover publication is a compilation of the popular How to Treat articles published in Australian Doctor last year. The articles are written by experts in their field and include in depth reviews on a wide range of clinical topics. The 2010 book can be ordered from Australian Doctor online here.

We welcome your comments and suggestions as well.  Please tell us what you think.