AMA President, Dr Bill Glasson - Speech to RWAV Victorian Rural General Practice Conference, Melbourne, Friday 16 July 2004

It has been a busy week for the AMA and the profession.

This week is, of course, AMA Family Doctor Week.

It is a time when we seek to remind the community how much they love us and need us.

Seriously, we use the week to encourage people to go to the doctor and to build a relationship with their doctor.

We want people to see their doctors as friends, carers and confidants - someone to help them when they are sick and help them to help themselves from getting sick.

This year we put an emphasis on smoking, obesity, men's health, and immunisation.

Not a bad range of issues for families in Family Doctor Week.

This week I also spoke at the National Press Club in Canberra about what the AMA sees as the key issues in health for the election.

In that speech I touched on the topic you have given me today - Medicare Plus.

Is it a plus or minus for doctors, patients and the community?

The truth is we probably don't know the full effect of its changes.

But we do know there had to be some change.

Medicare Plus or Strengthening Medicare or whatever they wish to call it will not work without doctors.

And you can bet we couldn't have Family Doctor Week without doctors.

But the horrible truth is we are a bit short of doctors at the moment, and nobody is really doing anything serious about it.

Anyway, I digress.

Medicare Plus is a patchwork quilt of policy.

Rather than address the shortcomings of Medicare in a uniform way, they treated it like an old Holden.

They stuck bits on it to make it look and go a bit better.

They made it a bit lumpy.

Some good lumps and some bad lumps and some lumps we don't yet know anything about.  We're not sure why they are there.

Things like the allied health initiatives are like having air conditioning in the back of a ute.  Seemed like a good idea at the time, but.....

Anyway, Medicare Plus is better than the Government's previous attempt at modifying Medicare - "A Fairer Medicare".

"A Fairer Medicare" was like a P76 on blocks.  It was a dud going nowhere fast.

AMA's greatest concern about the "Fairer Medicare" proposal was that it included an 'opt-in' scheme for GP practices.

Practices that decided to opt-in had to agree to bulk-bill all concession cardholders.

The AMA will not support any policy that compels GPs to bulk bill.

GPs must be allowed to continue to establish their own billing practices.

GPs automatically take into consideration the socio economic and chronic illness status of their patients when billing.

So the AMA bagged the policy.

Then came Medicare Plus.  An improvement.

A Senate inquiry wanted a closer look at it, and so did we.

Then thanks to the independents in the Senate - who all got a pound of flesh for their troubles - we got what we call Medicare Plus Plus, which is the Government's Medicare policy as we speak.

But for some reason - known only to their pollsters - they are calling Medicare Plus Plus another name now - Strengthening Medicare.

Apparently people thought Plus meant they had to pay more for their Medicare, which is not the message you want out there in an election year.

Strengthening Medicare is better in name and content, but still lumpy.

First of all, the "opt-in" component has been completely removed.

This means all GPs can take up the measures as they see fit and ensure their patients have access to the beneficial aspects of the package.

There are several aspects in Strengthening Medicare the AMA really does think are a plus, but not Medicare Plus.

Funding for the initiatives rose from $917 million to a total of $2.4 billion over four years.

This recognition of the need to spend more on the health of Australians is welcome.

In particular the AMA likes the improvements to the safety net.

The safety net gives all Australians reassurance that their primary heath care costs have a finite limit.

They will know that should they experience an unforeseen health event they won't be subject to undue financial pressure.

The safety net gives comfort to the poorest and the sickest, which is what Medicare is supposed to do anyway.

The AMA still believes that the Medicare Benefits Schedule should be better funded.

The MBS patient rebate should be higher to reflect the cost of the GP service.

That way patients would pay smaller gaps.

That way the safety net would be exactly that - a safety net for the few who fall through the system.

It would be far better and fairer if the safety net involved both MBS and PBS costs.  The AMA will continue pushing for this change.

So what else is good with the package?

Extending the practice nurse grants to all urban areas of workforce shortage was good.

We believe this should be extended to all practices, not limited to just a few.

Streamlining of processes for registration of overseas trained doctors makes sense, but we are concerned that people are entering the system without proper support.

Irrespective of their clinical competencies, some OTDs are not getting proper cultural orientation, and they're not getting up to speed in English.

They need more time and mentoring to understand our system.

The AMA will soon be releasing a discussion paper on OTDs to improve the way we recruit and employ OTDs.

Moving towards electronic claiming is a good move for patients and doctors - and a saving for taxpayers.

Allowing the rebate to go directly to the patient's account, avoiding the Medicare office, is helpful.

We have to be careful that the Government does not try to use the electronic initiatives as a means to make GPs de facto Medicare offices.

There are concerns you will be asked to collect patients' bank account details and pass these on to HIC.

But you won't get paid for it.  Not to mention the privacy and red tape quagmire.

AMA is disappointed with the inadequate financial support for infrastructure associated with HIC Online.

The Government will save heaps.  You won't.  You'll pay.

AMA welcomes pre vocational terms for junior doctors in general practice - under supervision, of course.

This will give new doctors access and experience in general practice at a very crucial time in their training.

It will attract some to general practice and keep them there.

We are totally opposed to the unfunded bonding of medical places.

This is wrong and it will not work.

It failed overseas.  It will fail here.

Scholarships are the way to go.

We need incentives, not insults.

The $5 and $7.50 payments for bulk billing concession card holders and children under 16 are neither here nor there.

They offer short-term relief for some, false hope for others.

They are not enough and they go to some, not all, doctors,

They go to some, not all, patients.

The AMA believes this incentive should be extended to all consultations.

There are also concerns about the $7.50 payment being geographically based.

The AMA believes support for patients should be based on need not geography.

Many areas of very low socio economic status in urban and outer urban areas miss out on this higher payment despite having a high bulk billing rate because patients simply cannot afford a co-payment.

For example, patients in Western Sydney, a very low socio economic area with a 97 per cent bulk billing rate, are not eligible for this measure.

And besides, it is all based on the wrong objective - bulk billing.

Bulk billing is not a measure of a good or bad health system.

Bulk billing is a Government tool to control general practice.

The AMA is seeking instead a properly funded and indexed 7-tier general practice item structure.

This structure was recommended by the Attendance Item Restructure Working Group (AIRWG) - which involved the Government and all GP Groups.

Under the current attendance item structure, financial incentives favour shorter consultations - the MBS rebate is the same for a 6 minute consultation and a 19 minute consultation.

AIRWG concluded that longer consultation times are associated with better health outcomes.  No surprise there.

They say the existing item structure is not optimal for the purposes of supporting quality care.

So they designed an alternative item structure that will better reward quality care.  And that's the one we want.

It is a structure designed specifically to meet the needs of a rapidly ageing population, and the associated burden of chronic illness.

And we have to get real about looking after our ageing population.

Two measures in Strengthening Medicare are designed to improve medical care in aged care homes.

A new MBS item will provide a rebate of $150.05 for GPs to undertake comprehensive medical assessments of aged care residents.

And funding has been provided to Divisions of General Practice to establish GP panels for aged care homes.

The AMA supports these initiatives in principle.

However, the funding available for the GP panels is too small to support the national roll-out being planned - with all local divisions, and every aged care home in the country, being encouraged to participate.

The administrative and funding models to be used will not create a climate that is likely to attract substantial numbers of new doctors into providing services in residential aged care.

The AMA believes consideration should be given to alternative funding models.

We need to enable the introduction of a GP Facility Adviser model for geriatricians, other medical specialists, and other health professionals to participate more in the residential aged care environment.

And then we have the allied health items I mentioned earlier.

Nobody is relay clear about the motivation for these.

We didn't ask for them, and we haven't said 'thanks' now they are here.

We must help patients with truly complex and chronic illnesses, but is this the way to go?  Time will probably tell us 'no'.

But this measure had to be introduced in order to get the package through the Senate.

So let's find which independent Senator is stocking up on allied health services and we'll all know the culprit.

The original plan was for GPs to act as brokers - negotiate a fee with the allied health professional (AHP), collect the Medicare rebate and pass this on.

We got that changed to a simple referral system, where the GP refers the patient to the allied health provider.

The referral forms the basis for the patient accessing the Medicare rebate.

Another thing the AMA successfully lobbied for is a HIC "hotline" that GPs can ring to check whether a patient has had an Enhanced Primary Care plan with another doctor and is eligible for the program.

This responds to the angst and anger GPs experienced when they did the work associated with an EPC only to find they would not be paid.

Most of our concerns have been addressed, but linking the initiative to an Enhanced Primary Care (EPC) plan ensures its uptake will be determined by the willingness of doctors to subject themselves to the associated red tape.

There is no doubt this measure will create more red tape for doctors.   And we don't want that.  No way.

GPs will also face pressure from patients for access to allied health services, even if the patients are not eligible for an EPC multidisciplinary care plan.

The Government must educate the public on the eligibility criteria for this measure.

There's a good idea - more ads.

Some allied health groups are implementing a strategy around this measure that will unrealistically raise patient expectations and could in fact have the effect of reducing GP uptake.

Medicare Plus is a move in the right direction, at least insofar as there is more money in the system.

But not enough in the right places as far as we are concerned.

The policy has been rushed and so we see some teething problems.

There is a federal election around the corner.

I am sure we will see lots of new policy from both sides in coming weeks and months.

We expect to be consulted along the way.

When we are, we'll be looking for a comfortable Medicare vehicle for all Australians - nothing too flashy.

We want a Medicare that will suit the families and singles, young and old, the poorest and sickest, the city and the country.

We want a 'fair go' Medicare.

Thank you.