AMA 16th National Conference 2004 - Presidential Statement AMA Annual General Meeting by AMA President Dr Bill Glasson, Sheraton Brisbane Hotel - 'Confidence, Security, Access and Affordability'

Good morning colleagues, special guests, AMA staff and media.

Delegates, a year ago I was honoured - and shocked, quite frankly - to be elected your President.

As a former State AMA President, I thought the pace and the demands would be similar to my time at AMAQ.

I can tell you today that I was wrong.

Why didn't somebody tell me?

I have just lived one of the busiest and quickest years of my life.

I need to wear a photo ID so my family can recognise me.

The travel, the meetings, the crises, the challenges, the phone calls - the bloody phone calls!

I didn't know we had that many journalists in this country.

And they all seem to start work very early in the morning.  Even earlier in daylight saving time.

My friends, it has been a busy year.

An exciting year.

A stressful year.

And a very successful year.

I wouldn't have missed it for the world. 

It has been a busy year because our work - your work - is important.

Exciting because people want to hear what we have to say.

It has been a stressful year because it is vital that we get the AMA message right.

It is vital that we battle for what is best for patients and the community.

We have to get it right for our members.

We have to get it right for our patients.

We have to get it right for the towns and suburbs and communities that depend on doctors.

And we have to get it right for the health system so it can remain strong to serve future generations of Australians.

It has been a successful year because when it comes to health, the AMA matters.

Our opinions and our views matter - and make a difference.

We influence health policy.

And you should all be proud of that.

Being a member of the AMA gives you a voice.

A voice that fights for the medical profession.

A voice that fights for all our patients, no matter their means and no matter where they live.

A voice for our public hospitals.

A voice for public health.

A voice for the proper balance between the public and private health sectors.

A voice for the health of Indigenous Australians.

A voice that reminds us of why we became doctors in the first place and why we love being doctors today.

It's the same voice that convinced me I really want another year in this job.

Dr Mukesh Haikerwal, my loyal deputy, will join me for another year of leadership and hard work...and a wonderful sense of achievement and fulfilment.

Yes, we have the permission of our families.

There is a lot of important work ahead for our profession and our patients.

Once the smoke settles from the Federal election we will have a better idea of the specific challenges.

But first, a look at the year just gone.

When looking at my first year as President, four words readily spring to mind:

• Confidence
• Security
• Access, and
• Affordability.

These four words have pretty well characterised the last twelve months.

Our priorities have been:

• Achieving a situation where doctors have the confidence and security to continue practising medicine

And

• Ensuring that our patients have access to affordable high quality medical care and services.

Just about everything we have done has revolved around these two goals.

Medical indemnity and medical workforce issues have defined our advocacy.

Our advocacy has worked.  The public welcomes our messages.  The politicians heed them.

Medical Indemnity

You can't have a year in medical politics these days without medical indemnity being a hot topic.

While we had broken the back of it this time last year, there was still a lot to do on confidence, security and affordability.

You will have heard much of the detail from Andrew Pesce yesterday, but I will recap some of the highlights.

Twelve months ago, progress on national tort law reform was slow and uneven.  It still is.

We were working on fixing the 'blue sky' claims problem with Government.

We were trying to inject some security into the death, disablement and retirement concerns.

Despite the Government assurances that all would be OK, the tension and uncertainty among doctors was palpable.

UMP was still in provisional liquidation.

Doctors were ceasing high-risk procedures and retiring prematurely.

Communities were losing specialists.

Then Government was more interested in levying doctors than bedding down reforms.

They were sending the wrong messages in a volatile environment.

Then whammo - the HIC issued IBNR levy contribution notices.

To say it was like a red rag to a bull is an understatement.

It was the proverbial last straw.

It was Monty Python's 'wafer-thin mint'.

There were doctor rallies all over the place.  A big one here in Brisbane, then the monster rally at Randwick Racecourse in Sydney.

More than 4000 doctors sent a message that one day in September that registered on the Richter Scale at Parliament House in Canberra.

In no time at all we had a new Health Minister.

And we had action.

Andrew Pesce and I joined Tony Abbott's small medical indemnity review panel and we all got to work.

The Government's Medical Indemnity Rescue Package was announced just before Christmas, but the fine detail is still being attended to.

We have only just seen the Run-off Cover Scheme legislation - known as ROCS - and we're still chasing the Government over portability issues.

And, as we all know, some States and Territories still have a way to go on tort law reform.

We have not given up on the long-term care scheme for the severely injured.  In fact, we've only just begun.

The Government is with us on this in-principle, but we are yet to be knocked over by their enthusiasm.

But what of affordability?

The subsidies will help but we still have to see the actual premiums come down.

You also asked us to preserve the MDO structure, and we have.

We have managed to obtain cover akin to 'claims incurred cover' without affecting affordability.

We have achieved an independent peer review mechanism for disputes between doctors and their insurer.

Greater efficiencies in the industry should see benefits flow to members and, ultimately, this will flow on to patients.

Already we are hearing of possible MDO mergers.

But I think the important thing is for all of us in this room to recognise the enormity of our achievement.

I know there are some doctors out there who still think we should somehow have got more.

That is absolute rubbish.

Senior political commentators have told me that the AMA advocacy on medical indemnity has been an outstanding achievement.  And it has been.

The Government didn't have to come along for the ride.

The AMA made it impossible for them not to.

The grudging reluctance of the former Health Minister was replaced by the boundless energy of Tony Abbott who made it his mission to fix the medical indemnity problem.

With the support of the Prime Minister and Assistant Treasurer, Helen Coonan, Tony Abbott has delivered on his commitment.

And the AMA's Medical Indemnity Task Force has delivered on their commitment, too.

All doctors are indebted to the hard work of this group, especially the effort put in by Andrew Pesce.

They have provided the security - and the indemnity affordability for the long-term should follow.

They have given hope to the access and affordability problems confronting patients and communities.

There is now greater confidence in the system.

I said a couple of weeks ago that the long-running medical indemnity crisis is all but over.  I stand by that statement.

There are still things that must happen in tort reform and long-term care but the settings are in place.

The AMA will participate in the Government's review of the medical indemnity arrangements in 2005.

If it has all gone pear-shaped by then, you can elect a new President!

Medicare

Another feature of the past year has been the punch and counter-punch on Medicare policy.

The Government ditched the Fairer Medicare package when nobody could find the fairness.

It was replaced by Medicare Plus, which is better and fairer - but still not Best and Fairest.

As the election draws nearer, expect more Pluses to be tacked on to Medicare Plus.

We have already seen geography-based incentives and higher rebates for cardholders and kids.

The quantum of these add-ons may have made a significant and enduring difference if they had been made years ago when Medicare started seriously haemorrhaging.

We are seeing catch-up Medicare reform.

We are seeing patch-up Medicare reform.

There is no RVS-style vision.

Labor has said it will Save Medicare, but we are yet to see the detail of this rescue mission.

GP after-hours clinics and GP teams who will pop up all over the country when needed - like Batman and Robin - may work in some areas and in some situations, but the evidence seen so far has not been good.

Rather than improve services, the GP after-hours clinics in Perth are threatening existing after-hours services.

They are limiting access, not expanding it.

Some more thought is needed.

But I have to say this - you cannot question the intellect and the energy of both Tony Abbott and Julia Gillard.

I can't remember a time when both sides of politics had such good listeners on health policy.

You will see them in action later this morning.

The great Medicare policy auction is not over yet.

The final products from the Government and the Opposition are still in the workshop.

It is clear that both sides will commit more money to Medicare and health.

We have just got to make sure it is spent properly and that any investment in health is for many years, not just election years.

The AMA will remind them every step of the way that their policies will have no little or no impact if they do not address the medical workforce shortages in a meaningful way.

Unfunded bonded medical places are not meaningful.  They are counter-productive.

Building a medical workforce must be a national priority.

Without doctors and nurses and other health professionals in the right numbers in the right places with the right skills, the policies simply will not work.

Medical Indemnity.  Medicare.  Medical Workforce, especially General Practice.

That's a pretty handy trifecta to take to an election if you've got them right.

But if you want to win Government, your health care vision has to be broader than that.

As I have found, the AMA vision is very broad indeed.

Let me take you through just some of the issues and activities that have involved your Executive Councillors, Federal Councillors, Committees and grassroots members this year.

Public Health

On tobacco control, we have pushed for cigarette shock packs, anti-smoking messages in cinemas and, in conjunction with the States, we have sought smokefree workplaces and public places.

The AMA Child and Youth Health Committee - especially Dr Michael Rice - has been at the forefront of the community debate on pneumococcal childhood immunisation.

We have campaigned strongly about the health of Asylum Seekers, with an emphasis on the health of children in detention centres.

An area close to my heart is Indigenous Health.  Why can't we get this right in Australia?

Here we are in the 21^st Century and the health of Aborigines and Torres Strait Islanders is going backwards.  It's getting worse.

It is not good enough for political strategists in an election year to say there are no votes in it.  Well, I'm sorry, but there are lives in it.

Votes or no votes, I will be doing my best to raise Indigenous Health as an election issue this year.

The AMA's Indigenous Health Report Card has become a respected measure of progress or lack of it in this area.

We aren't updating the Report Card this year but in a couple of months the AMA will be issuing another groundbreaking report into Indigenous Health.  Look out for that one.

General Practice

The gateway to health care in this country is General Practice.

Our GPs are the frontline troops and, like all frontline troops, they are suffering the most casualties.

General Practice is a tough old school these days.  The sacrifices are many, but the rewards are few...and getting fewer.

The AMA has been fighting the good fight for GPs and their patients again this year.

Our many successes include:

• Elective, supervised, pre vocational GP terms for junior doctors

• A patient rebate that enables the GP to supervise and direct a practice nurse in the delivery of specific primary care activities

• Removal of compulsion to bulk bill concession cardholders that was a feature of the original Fairer Medicare Package

• Financial infrastructure incentives for hooking up to HIC online available to all practices

• An improved Medicare safety net under Medicare Plus

• The AMA played a major role with other GP Groups in convening the GP Summit in Canberra in August 2003. 

• The AMA has taken the lead role for the medical profession in the development of e-health initiatives. 

• And the AMA has been a leader in getting increasing rebates for patients of non-vocationally recognised (Non VR) doctors.

We will continue to shift the focus away from bulk billing to the more important issues of access and affordability.

We keep telling politicians that bulk billing is not a measure of the success or failure of the health system.

There was a slight rise in GP bulk billing last quarter as a result of the new incentives under Medicare Plus, but it won't last.

We expect further increases for the next two or three quarters before the drop starts again.

Inflation and practice costs will soon gobble up short-term incentives.

Our major push in the year ahead will be implementation of a fully funded and appropriately indexed 7-tier GP consultation item structure as developed by the Attendance Item Restructuring Working Group (AIRWG).

To help fund it, we will seek abolition of the disease specific PIP items.

The AMA will continue to lobby for a more appropriate method of indexation for the MBS.  Expect a major announcement on this soon.

Other major themes will be increased GP workforce and decreased GP red tape.

Medical Practice

We have been very busy on the 'bigger picture' medical practice issues too.

We pushed for the health reform agenda not to be lost in the political bun-fight in the lead -up to the August signing of the Australian Health Care Agreements.

The reform agenda is included in the Agreements and parts of it are being rolled out now. 

For example, there are now GP after-hours clinics in public hospitals in areas where there are no other available services - unlike the mess they have made with it in WA.

There was also the transitional care proposal in the budget, along with other aged care initiatives we had supported. 

There is no stronger advocate for public hospitals than the AMA and you will hear more detail this afternoon.

You will hear also an important announcement about the AMA's commitment to our public hospital system.

We continue to support the private health insurance rebate.  Without it, there would be mayhem, bedlam and problem after problem.

Our strong opposition to abolition of the 2nd tier default got results.

We didn't get everything we wanted but we settled on a reasonable compromise whereby independent hospitals of 75 beds or less would continue to be covered by 2nd tier default.

We have achieved a more positive outcome on prostheses. Thanks to the work of the AMA, there will be a full range of no gap prostheses for each MBS item.

We ran an aged care summit in February to show leadership in the industry and to make aged care an election issue.

The Government's $2 billion package in the budget is a good first step. 

We are making steady progress in making it more attractive for GPs to provide medical services in Residential Aged Care.

We have a Comprehensive Medical Assessment item and further items are on the way.

The AMA has defended the Pharmaceutical Benefits Scheme from possible attack under the Australia-US Free Trade Agreement.

We have developed a policy on Overseas Trained Doctors, which will be released later this year.  

Workforce

As always, we have worked tirelessly in the Workforce Policy area.

• We lobbied the Royal Australasian College of Surgeons to reconsider its time expiry policy for Basic Surgical Trainees, which would have ended the surgical careers of 101 trainees

• After a sustained AMA campaign and the withdrawal of around 400 specialists from the Repatriation Private Patient Scheme the 2004/2005 budget saw a $158 million lift in funding for payments to specialists treating veterans under the scheme. From January 2005, Specialists will get a 15 per cent increase for consultations and 20 per cent for procedures

• In November 2003, the AMA Federal Council approved the policy statement "Flexibility in Work and Medical Training Practices for Doctors in Training"

• In May this year, the AMACDT and Committee of Salaried Doctors prepared a detailed list of proposals for the AMA to work on in order to further improve work life flexibility for doctors
  
• We released the "Best Practice Rostering - Training and Resource Kit" in conjunction with the Australian Health Care Association, and

• Working with AMSA, we continue to slam bonded medical places at every opportunity.

Corporate

Our hardworking Treasurer, Allan Zimet, will give a full rundown on the business side of the AMA shortly, but I will make brief mention of an important corporate initiative.

We took a major step forward during 2003 to reinforce our long-term financial position with the establishment of a new subsidiary company - AMA Commercial Pty Ltd.

This company will be instrumental in the years ahead in providing substantial revenue streams to the AMA, while providing a wide range of competitive products and services to members.

AMACOM, as it is known, is vital to our future.

It will provide the necessary financial underpinning that will allow us to grow in numbers and maintain our reputation as THE BEST professional member organisation in the country.

Teamwork

It takes teamwork to build a successful AMA.

Teamwork between the Federal and State and Territory AMAs.

Teamwork between Federal Councillors.

Teamwork between Executive Councillors.

Teamwork between the Executive and the Secretariat.

I have put a lot of time and effort into promoting teamwork in this organization.

We consult regularly.

The key issues are discussed and responses agreed.

I think we are working well as team.

I'd like to thank all the Federal Councillors for their input this year - at Federal Council meetings and through the Committees and in the media.

My special thanks to my Executive.  They are not just a team, they are more like family.

Mukesh Haikerwal, Dana Wainwright, Allan Zimet, Rosanna Capolingua and Choong-Siew Yong have served the AMA membership admirably all year.

My thanks, too, to the AMA Secretariat in Canberra.

Under the leadership of Rob Bain for most of the year, and Robyn Mason more recently, the people in the Secretariat provide us with the material that makes us look good.

They provide the ammunition of strong advocacy.

Special gratitude goes to the more than 28,000 AMA members around Australia who make this job worthwhile.

The grassroots doctors out there who just love being doctors and caring for patients - despite all the pressures and disappointments - are one of this country's great assets.

Last but not least, my thanks to my wife, Claire, and my kids - Gemma, Nicola and William.

These guys have put up with a lot this past year and they have supported me all the way.

It has been my honour and privilege to serve you as AMA President.

I hope I have met your expectations.

Now that I know the ropes, I promise bigger and better things in the year ahead.

Thank you.