Dr Kerryn Phelps, AMA President, Parliament House, Canberra

QUESTION: Is the Government prepared to talk about increasing the payment to GPs for bulk billing?

PHELPS: There's no question that remuneration has to be considered as part of the solution to general practice. But, also, finding a response to the medical indemnity crisis is involved in that as well. We also need to look at workforce as a major problem because people are turning up to public hospital casualty units in areas where there is a shortage of GPs and that's not only about whether there's bulk billing or not, it's about workforce.

The pleasing thing about the events of the last 24 hours is that we are now seeing that Government understands that there is a link between poor remuneration for general practice, general practice workforce, and medical indemnity and the implications that that has for patients in being able to access quality care.

QUESTION: What did Kay Patterson suggest? Is she going to look at workforce and Medicare rebate levels?

PHELPS: The Government is looking at workforce issues and it's something that they will be working with the AMA on. We're also looking at remuneration issues, and I don't think we can move away from the fact that the reason that GPs are working less in general practice, that we have a shortage, is around a whole lot of issues to do with the pressures on general practice.

Medical indemnity being one of them; remuneration being another; and those are issues that must be addressed urgently.

QUESTION: Has the Minister said she'll look at the relative value study; look at, actually look at doctors' Medicare levels?

PHELPS: Not specifically. I think that the issue around the RVS is that the Relative Value Study provided us with a very good foundation for assessing what real values of providing a medical service are. And, of course, that study was completed in December of 2000. But I think we can use that as a basis for assessing what medical fees ought to be.

And then there's a decision that needs to be made about what gap is affordable for patients to pay, whether that in some cases is zero; in other cases is more than that.

QUESTION: What can be done to increase the spread of doctors, especially those who do bulk bill?

PHELPS: Well, the Government has already put in place some incentives for doctors to train in rural areas and to be retained in rural practice. We do need to see more effective ways of supporting doctors who are working in outer urban areas, particularly areas where there are high numbers of disadvantaged patients. Because we do know that doctors under the current Medicare arrangements cannot afford to bulk bill any longer. That's why we're seeing plummeting bulk billing rates. That's why we're seeing doctors moving out of areas where there is a high rate of bulk billing.

And so we do need to urgently address that particular issue. And I think it's important that the State Ministers do get together with the Federal Government and discuss a range of solutions around this because it is now putting pressure on the public hospitals. But it's a reflection of the pressure that GPs have been feeling for a long time.

QUESTION: Senator Patterson last night made friendly noises about the point that she'd do that - she'd meet or discuss with the State Health Ministers. Did she tell you when she'd do that, or how she'd do that?

PHELPS: That I believe you'd have to ask Senator Patterson, but I'm pleased that Senator Patterson is prepared to meet with the State Health Ministers to discuss the issues around general practice. And, certainly, the AMA would be very happy to have any input that we can because we have a great deal of information arising out of our workforce survey; arising out of the work that we've done around general practice remuneration; and how general practitioners are feeling about the work that they're doing, that we believe would be of assistance to the governments at federal and state level.

QUESTION: Do you think the Government will, in any way, try to tie in an increase in bulk billing with that push to have PBS now changed?

PHELPS: The problem with bulk billing is that doctors have lost their trust in Medicare to the extent that they are not prepared to tie themselves into a bulk billing arrangement if they don't believe that year by year Medicare would keep up with the cost of providing the services that they're providing. And so what we need to really focus on is the gap that patients are paying. And that, to an extent, is between the Government and the electors.

QUESTION: Did Senator Patterson give you any specific undertaking about proposals she would look at in more detail?

PHELPS: We're looking at broad options at the moment and that would be the subject of future discussions. We certainly would welcome the opportunity to work further with the Minister to look at possible solutions because, unless they are solutions that are going to be palatable to general practice and to the community, then they're not going to work.

So I think that the more collaboration that we have, not only between the AMA and the Federal Government, but also with the State Health Ministers, the more likely we are to get practical solutions.

QUESTION: But you'd have to concede, wouldn't you, that if the Government isn't prepared to increase payments for the bulk billing payments, then you know, you're not going to go forward, are you?

PHELPS: Well, the bulk billing slide is inevitable and I believe that once doctors have abandoned bulk billing, they are very unlikely to ever go back. Unless we address - that's what I'm saying - the fundamental issue we need to address is the gap that patients are paying to see their doctor and to make sure that that gap is affordable. Now whether that is zero in some cases; whether it is $10, $20 or more, is really a matter for future discussion.

But the issue is one that I have flagged over the last several years and that is that we don't want to get to a stage where general practice services are unaffordable or inaccessible to people wherever they live.

QUESTION: The Government argues over GPs services, 75% of them are still bulk-billed. That's a fairly large number, isn't it?

PHELPS: Well, we're starting to see the impact on the public hospitals around the country and this is I guess the concern that the State Health Ministers have raised, that it has reached a critical point where people, because of the shortage of GPs and because of the cost to some people who are on low fixed incomes of seeing the doctor and having to pay a gap, because of that combination of factors, we are now seeing that it's having an impact on the community. And it's having an impact on the public hospitals.

So once it has an impact on public hospitals and on patients and we're seeing a GP workforce shortage, then the signals are there that urgent action needs to be taken.

QUESTION: Dr Phelps, I might be going over old ground a little bit here, but can you just clarify what exactly, what commitment she gave to help address workforce concerns? Like, did she say she'd get the Health Department to examine how many GPs are in the bush or to do any specific studies?

PHELPS: The AMA has done that work for Government. We commissioned an Access Economics study which was completed earlier this year. We've provided that information to the Government. We've provided a briefing to the Department and I'm actually on my way to a meeting with Jane Halton now where we're going to discuss workforce issues amongst other things.

There also has been established a workforce liaison group between the Department of Health and the AMA where we're discussing a range of workforce issues around general practice. I've also commissioned Access Economics to conduct a similar survey of other specialities around the country which will be happening over the next 12 to 18 months.

QUESTION: So do you think Senator Patterson's genuine in the attempts to improve the system, or I mean she might just be committing to talk more?

PHELPS: I have faith that the Minister is serious about her concerns about the health system and is prepared to work with us to find a solution. I think Government is aware that health is one of the top of mind issues for the Australian people and they are well aware of the AMA's willingness to work with them to find solutions that will work.

QUESTION: On medical indemnity, do you believe the UMP will still be going in two years?

PHEPS: We don't know what the future of UMP is, yet. I think that there is little alternative but for UMP to survive in one form or another. The consequences of the alternative are almost unspeakable. We do need to ensure that we continue to work towards fundamental solutions to medical indemnity.

Now, this means that the State Governments are all going to have to do their bit. They can't fiddle around the edges. They are going to have to take a deep breath and jump in and do the comprehensive tort law reform that we know is needed. We need a national statute of limitations standard - three years for adults and six to seven years for minors. And we also need to see the fast-tracking of a comprehensive care and rehabilitation scheme which is Government-funded for people who are severely injured.

The other consideration, of course, is that if all of this doesn't work to contain the medical indemnity problem, we will have to move to Plan B which is the one that I outlined at the Press Club a few weeks ago.

QUESTION: Did she give you any indication of how close the Government is to making any announcement on these major reform proposals, given that it all has to be in place by the end of the year?

PHELPS: The proposals are yet to go to Cabinet. We will be having further discussions with the Government in the next few weeks which will involve the relevant Ministers and the Prime Minister's office and the task force. And the AMA will be having those discussions in a few weeks and then we will see what comes up in Cabinet just after that.

QUESTION: And do they have, I mean, do they have firm proposals? Did she give you any idea that they actually know what they want to do? What they plan to do?

PHELPS: Well, there are proposals in a number of different areas, bearing in mind that this is an extremely complex area. We are moving towards solutions in a whole range of different areas. We have yet to hear the Government's final position.

QUESTION: Are you confident that they will have these proposals in place by the end of the year?

PHELPS: I think you'd have to ask the Government that. We've been asking the same question and the bottom line here is that, if the proposals and the policies are not in place by the end of the year, then there is going to have to be an extension of the Government guarantee until those are in place because otherwise UMP members will be left out in the cold.

QUESTION: I mean, it's August now and they're still talking about it. It's not a lot of time, is it?

PHELPS: It's not a lot of time. We're aware of the urgency. We have conveyed that sense of urgency to the Government and we're hoping very much that the solutions are in place by the deadline. In fact, the deadline isn't December because there are a lot of renewals that are up at the end of October. So it's looming very large.

QUESTION: Dr Phelps, aren't falling GP bulk billing rates a good thing for doctors because it leads to higher remuneration for doctors?

PHELPS: Well doctors…

QUESTION: Which is what you've been after.

PHELPS: Well, doctors have had to take matters into their own hands as far as bulk billing is concerned. For years we've been saying that the Medicare Benefits Schedule is inadequate and that unless something is done about that, then bulk billing rates will decline because doctors will have to charge what it takes to run their practices. And that's happening and, I don't think it's a bad thing that patients who can afford it are paying something towards their health care. But I do have concerns about patients who are disadvantaged, and I think that there might need to be special consideration for those people.

QUESTION: …But doctors automatically to needy patients, don't they?

PHELPS: Well, it has been traditional and it has been automatic. But doctors have reached a point where they can no longer afford to subsidise Medicare.

QUESTION: Are you saying that there could be a reduction in the number of health care card holders and things like that who are bulk billed? Is that right?

PHELPS: Well the issue of the number of health care cards that have been issued is something that I have raised with Government on a number of occasions because at the moment I believe the assessment is about 8 million Australians who have access to a health care card.

Now how can doctors have faith in a system that claims that 8 million people in Australia are disadvantaged to the point that doctors need to discount their fees to support those people?

QUESTION: So you'd want a review of the bulk billing and Medicare cards and who gets them?

PHELPS: Yes, I think there needs to be a comprehensive review of general practice remuneration, of patient rebates, of health care card holders because doctors do feel a social conscience to make sure that their patients who are disadvantaged are able to see them without it being unaffordable for them.

Unfortunately, we've reached a point where the health care cards are so widespread that doctors are looking at these and saying, well is this person really disadvantaged or are they not. And it's also a situation where doctors cannot afford to discount the majority of their patients coming into their practices.

QUESTION: Will a doctor routinely make a decision about bulk billing if the patient produces a health care card?

PHELPS: It's not routine.

QUESTION: Not routine, that?

PHELPS: No, it's not routine. There are some practices who will see a health care card and say, 'well, I'll discount my fee for this patient or I'll bulk bill this patient', where they might privately bill the full fee to somebody else. But it's certainly not a routine. It's certainly not automatic and becoming less so.

QUESTION: Has the Government agreed to any of your requests to review the number of health care cards out there in the system?

PHELPS: We haven't had a firm position from Government on that at this stage.

QUESTION: Did you discuss this particular health care card issue with Senator Patterson?

PHELPS: Not today. I've discussed it on other occasions.

Thank you all.

Ends