AMA National Conference 2010 Presidential Statement

Good afternoon …

Twelve months ago I came to National Conference seeking your trust and support … and your vote … to be your President.

I campaigned on a platform of engagement. I wanted the AMA to be a part of the health reform agenda, not a spanner in the works.  I wanted the AMA to work with the Government to shape the changes that were coming to the health system.  I wanted the AMA to have a say about any changes to the way that doctors and other health professionals would work in that system.

I wanted the AMA’s voice – your voice – to be heard.  I wanted the AMA to have influence.

As you just saw in the video, I wanted the AMA to be engaged fully in the reform process.

I can say with confidence that we have been engaged and we remain engaged.  We are not beholden to the Government – we advise the Government.

This does not mean that we get everything we want, nor does it mean we are ignored or paid lip service.

Engagement has delivered positive outcomes for the AMA, the medical profession, and our patients.  Let me remind you of a few …

The collaborative care amendments to the Midwives and Nurse Practitioners Bill.  A big win for coordinated care.

Changes to Medicare audits.

A recognition by the Government that GPs are and will remain the centre of primary care.

Payment for medical services will still be directed to GPs and Practices, not Primary Health Care Organisations, now to be known as Medicare Locals.  This is a big change from what was anticipated a year ago.

A significant expansion in training places for GPs and specialists.

Infrastructure funding for existing general practices, not just the GP Super Clinics.

Funding for GP practice nurses extended to metropolitan areas.

A commitment – as seen in Government advertising – for clinician engagement in Local Hospital Networks.

Commitment to progress long term disability and care support.

Better conditions for International Medical Graduates.

Government concessions on cataract surgery rebates.

The anti-smoking package.

A key coordinating role in the swine flu vaccine rollout.

National Registration and Accreditation amendments.

The Maternity Services Review.

More hospital beds.

A single funding pool for public hospitals.

Investment in aged care.

Emergency department funding.

The bottom line is that there is now more than $7 billion in new funding in the health system.

These things are not imaginary.  They are real.  They have happened.

Many of them have come from our own AMA policy manifesto – our Priority Investment Plan for Australia’s Health System.  Others have come through consultation.  And others through hard work and persistence.  But all of them through engagement – from being at the table.

However, that does not mean we now sit back and put our feet up.  Far from it.  It is our job to ensure that the $7 billion in new funding directly benefits patients.

In regard to the health reforms, we have to apply the AMA ‘no disadvantage’ test to each and every one of them.

No disadvantage to patients.

No disadvantage to communities, especially rural communities.

No disadvantage to doctors delivering care to patients.

There are obvious areas where this test will apply.

It will apply to GP Super Clinics.

It will apply to the new practice nurse arrangements.

It will most definitely apply to the Government’s diabetes plan.

The diabetes plan is perhaps the biggest test of our policy of engagement with Government.  Solving it is a challenge and an opportunity.

The AMA understands that patients with chronic conditions may not always be as well served under the current MBS arrangements.  The reliance on overly complicated verification requirements and red tape has become a barrier to accessing the services for which Medicare benefits are meant to provide an entitlement.

But the Government’s proposal is vague at best.  It is unclear the extent to which the capped funding made available after enrolment of eligible patients will lead to a withdrawal of Medicare rebate entitlement for necessary medical care.

The AMA alternative is to provide timely access to necessary care, not just for patients with diabetes, but with other chronic conditions.  We believe that a patient’s usual GP is best placed to recognise those patients who require enhanced access to allied health care, pharmaceutical benefits, and aids and appliances.

If the funding under the Government’s proposed scheme were made available to patients upon referral from their GP - without red tape - patients would have improved access to services at a lower cost to taxpayers.

For a long time, there has been an appropriate emphasis on evidence-based medicine.

Proposals for new interventions are subject to appropriate trials before they are introduced into mainstream clinical practice.  This is the only way that doctors can be confident that changes in practice will benefit their patients.

The time has come for evidence-based health administration.  There is no substantial evidence that schemes for capitation of funding for enrolled patients improve outcomes, or saves money.

There is evidence, however, that such arrangements may encourage preferential retention of ‘easy’ patients, and a failure to continue to care for higher need patients.

Doctors are sceptical that top down funding for 12 months of all necessary care is likely to improve outcomes for their patients.

Doctors believe if they were allowed to arrange appropriate care of patients without bureaucratic constraints, they would provide better care for their patients, at a more effective price

The AMA is today calling on the Government to commit to a trial of new funding arrangements for patients with diabetes.

It is interesting to note that the Obama Administration has done as much.  It has enlisted the profession in the US to collect the evidence on how better to treat patients with chronic conditions.

The Government should study the outcomes of patients treated under its proposal with the outcomes of patients treated under the AMA’s proposed Chronic and Complex Care proposal.  This should be in the context of a rigorous, properly conducted trial that will gather evidence to inform all of us as to how we can best meet the needs of our patients into the future.

The Prime Minister will be with us after lunch to open our Conference.

His office is well aware of our position on the diabetes plan.  They are also aware of some of the other AMA goals for the year ahead.

We want to ensure that the principle of collaborative care for which we have worked hard is reflected in the regulations we are yet to see.

We want to see the MBS review process reflect quality and safety as well as cost.

We want to be certain that the engagement of doctors in Local Hospital Networks is genuine and meaningful, not symbolic or token.

We want to see progress in proper training for the increased number of prevocational and vocational Doctors In Training.

And we want to ensure that funding for general practice remains MBS fee-for-service focused.

The MBS rebate system works well for the majority of patients.  Access to a Medicare rebate for services allows patients to choose from a number of providers, for whatever treatment they need.  This principle was recognised by the National health and Hospitals Reform Commission.

I would like to mention some of the other major achievements of the AMA in the past year.

• Good Medical Practice: A Code of Conduct for Doctors in Australia;
• The Indigenous Health report Card;
• The Public Hospitals Report Card;
• The AMA National Survey of Ophthalmologists;
• The AMA Position Statement on climate change and health;
• The AMA Family Doctor Survey and the launch of the Support Family Doctors website and campaign;
• Position Statement on Doctors’ Relationship with Industry;
• Position Statement on Medical Professionalism;
• VR GPs registered as Specialist GPs under NRAS;
• General Practice Pharmacies policy;
• Strong stance on home births;
• AMA Junior Doctor Training, Education and Supervision Survey; and
• The AMA Indigenous Peoples’ Medical Scholarship.