AMA President discusses proposal to adopt fund holding system for general practice.

So, I thought the 2020 Summit was for new ideas and positive ideas to improve the delivery of healthcare in Australia. And this idea has been announced today in the newspapers, and the AMA is very concerned for what it means for Australian patients into the future.

QUESTION: So what exactly are they proposing?

DR CAPOLINGUA: The suggestion is that we go to what is a called a fund holding system, that in fact doctors will be given a budget, an amount of money, and in that amount of money they need to provide and deliver all the care for their patients; similar to what has been in the United Kingdom and has been a service that has actually failed patients in providing them with the care that they need.

Patients will lose choice, they will - you know, if you're talking about waiting lists, wait until you see a fund holding system. You'll have waiting lists to go and see your GP, and the responsibility for holding the budget is in the hand of doctors. They will have to ration care in order to allow the money to last the given time that they're allocated that budget for. And if you're rationing care, it's the patient that's going to miss out.

QUESTION: Just on the issue of overseas trained doctors, we of course saw the case of Dr Patel and then this morning the resignation of Dr Kossmann in Melbourne. Do you have any concerns about the quality of care that Dr Kossmann was providing?

DR CAPOLINGUA: I'm not here to comment on Dr Kossmann or his service or care or his track record by any shape or form. That is under investigation in its own realm. So I'm not making any comments on that question.

QUESTION: Just on that point, it seems to me that the sequence of events with the doctor, with the professor, are out of whack. I mean, here he is resigning. The report, as I understand, has not even gone to the Premier yet. I understand his Health Minister has it but nothing has moved in that area. Yet we have a top surgeon resigning from a leading hospital. It seems a great loss.

DR CAPOLINGUA: The circumstances around this particular surgeon are subject to inquiry and I cannot make any comments.

QUESTION: Just on this fund holding model that you describe, can you just take us through the technicalities of how it actually works?

DR CAPOLINGUA: At the moment we have what we call a fee for service model. If you see a doctor then there is an engagement. My responsibility is direct to the patient; the patient and Medicare are supplying funds for the care that I provide to you.

The fee for service makes me directly accountable to the patient.

When you implement a fund holding model, then the Government abrogates its responsibility for the overall health budget, provides a budget to a doctor or a division perhaps, a network of general practice. And in that budget care has to be delivered to the community. Patients will be registered within that network of doctors, so you don't have a choice. And the rationing means that when I run out of money I can no longer provide you with service. And all the way along I'm thinking about the budget rather than your clinical needs.

Right now, you come and see me, I think about your clinical needs, making sure you get the best care.

This is an old style UK system of delivering primary care. It does not serve patients well.

QUESTION: And what do you think would be the network of GPs motive in pushing for this?

DR CAPOLINGUA: AGPN has come out publicly today and declared that block grant funding or fund holding models, and moving away from fee for service, is the way to go.

AGPN is actually fully funded by Government. Perhaps we need to understand that they're the voice of Government and are not really representing patients or general practice across the board.

Perhaps for them this is a justification for their existence and perhaps for them it enables them to build an empire of fund holding for Government.

QUESTION: And do you think there's any realistic chance that the Government will implement this model that AGPN has proposed?

DR CAPOLINGUA: We have really grave concerns that there are ideologies currently being put to Government around changing primary care that will actually mean a detrimental change to the quality of care to patients.

This ideology has been rumbling around. The fund holding, the UK style of delivering medicine, has been rumbling around for awhile.

And now, with the 2020 Summit, with the proposal of new ideas coming forward, with AGPN committing itself over and over again to this concept, I very much fear that Government will take it up.

QUESTION: And just on the issue of overseas trained doctors, what do you think needs to be done to ensure that, as you say, there's not just any doctor in place in a clinic or a hospital, that it's a high quality doctor regardless of where they come from?

DR CAPOLINGUA: When we're assessing international medical graduates we have to make sure that the processes of assessment are thorough and they are standardised. So the assessments are the same for any doctor applying to this country.

Verification of qualifications is essential, and medical boards currently do that. There are overseas companies that have registers for verification of credentials.

The actual doctors' references, et cetera, have to be cross-checked, and the qualifications and the standard and experience of the doctor as far as clinical delivery needs to be understood.

So it's a registration process like a registration process for Australian trained doctors, but for overseas trained doctors there's verification implementations about the validity of what they put forward; their credentials or their training and experience. So those processes have to be put in place.

English language - standard English language tests are also already put in place. And of course the Australian Medical Council and its independent ability to assess an overseas doctor for his safety to practise in Australia are all essential parts of that process.

QUESTION: that process already in place, do you think there needs to be more - you mentioned whistleblower…

DR CAPOLINGUA: That process has been in place and also has been heightened over the last 12 months or so. The standard English language test has been implicated across Australia as a routine assessment for international medical graduates. And the verification processes across Australia have now been implemented. And, similarly, the Australian Medical Council is implementing an offshore test for doctors before they even come into the country. That is a new process.

So all of those things have improved the mechanism for looking at international medical graduates entering this country.

QUESTION: But do you think that's enough, or would you want to see more changes?

DR CAPOLINGUA: We need to make sure then that at all times the application of those processes is about standards and quality and safety, and not perversely influenced by political agendas around workforce.

The examples that have come out in the press where doctors have been labelled the rogue doctors, if you go back to the root of the problem you will see that those doctors have been employed because there was a desperate need to have a doctor. And then in one particular case, in the Patel case, he had restrictions on his registration but he was employed above that level of his restrictions.

In the case of Dr Reeves, he also had conditional registration that indeed he was in breach of in the place of employment because they needed an obstetrician-gynaecologist.

So we have to make sure that the profession is held responsible and maintains the standards of those doctors, and those perverse influences that are political agendas, administrative agendas, health department agendas, government agendas, do not interfere because that's when the patients are put at risk.

QUESTION: And do you think doctors should have - or there should be legislation in place to mandate that doctors report unethical colleagues?

DR CAPOLINGUA: It is our ethical obligation to act to do something when we see a colleague that we believe is harming patients. So we have a professional obligation to do so.

In New South Wales they're looking at legislation which mandates a doctor to report a colleague when they believe the colleague is acting in a grossly negligent way as far as clinical concerns go, or there is gross misconduct around sexual abuse or drug abuse.

This legislation put in place will actually afford protection for the doctor who is the whistleblower. Often it's very difficult to make a complaint. Your own career, your own credibility could be in jeopardy if you're trying to speak about someone else who is often more senior than you, that you're worried about their clinical management.

So whistleblower protection, and of course appropriate justice mechanisms for the doctor that is being complained about, need to be part of that legislation.

QUESTION: So you'd like to see something national along those lines?

DR CAPOLINGUA: I think the New South Wales experience will be an interesting trial and no doubt it will be considered across the country.

QUESTION: Does that cover all standards apart from medical? Like, for instance, billing standards, the way they - business side of medicine?

DR CAPOLINGUA: The New South Wales legislation looks particularly at gross negligence and gross misconduct, which is sexual abuse and drug abuse.

Other issues around the delivery of services and Medicare are monitored by other means. Medicare Australia and the Professional Services Review monitor those mechanisms.

The interesting thing about a 2020 summit is the opportunity to actually talk about new ideas and to engage in a different dialogue than what we've had before.

I guess one of the frustrations that we've actually experienced is that coming up with old ideas; trying to re-craft old ideas is very frustrating, because this is about - supposed to be new ideas, fresh ideas, fresh answers to the problems in Australia.

So the AMA is keen to engage the Government. We were asking before the election for reform of Medicare, looking at different ways of handling it, rather than the old ones recycled. And so the frustration we have is that to think that people are putting on the table just old ideas rehashed is really frustrating.

It should be about new ideas, fresh ideas. Let's engage in a different set of discussions. And, again, the frustration of going over old ground is really disappointing.

So let's look at 2020 with a new vision. Let's engage with the Government, and the AMA is keen to do that.

We look forward to something new, something different, and something new for Australia coming out of this rather than the old ideas rehashed.

Ends