GP Super Clinics - radio interview

Now, if these government clinics are to go ahead and offer general practice medical services, then it begs the question: where will they get the doctors? The most likely answer, they'll have to compete with the existing clinics in order to get staff. What is surely required isn't a competitor to existing services, but an adjunct facility with allied health service provision to work in a coordinated way with existing practices.

Now the federal minister, Nicola Roxon, has said that Modbury has high levels of chronic disease and suffers poor access to health infrastructure. When I saw that I thought, hello, why are we reducing services at the Modbury hospital and shunting birthing clients 20 kilometres through a suburban corridor that has no direct public transport?

And the other fact is that the State is ignoring the reality that the extension of defence force work by WRE in that area is attracting a younger cohort of citizens who will need access to acute services, but be denied them at Modbury if they need more than 23 hours admission time.

Because after that time what happens is, whoever's being treated has got to go somewhere else; they've got to be transferred to another hospital that may or may not have capacity to handle a child with appendicitis, severe asthma, infected illness, gastroenteritis, trauma cases.

Now, when doctors transfer patients from Modbury, it is common to spend several hours on the phone ringing various hospitals to have their patient accepted for transfer.

This is daft, potentially dangerous, ill-advised and it's inefficient. Yet the model of care that we're moving to is, allegedly, more efficient. Well then obviously it's not.

Now the health bureaucracy in this State, and this was told to me by Canberra yesterday, was proposed to increase by one per cent a year; it has in fact gone up by ten per cent per annum. We require an injection of support services to existing practices, a re-think about our suburban hospitals that are being robbed of facilities over time.

Putting GP clinics near hospitals may appear to be smart, but the fact is that acute services that hospitals look after cannot be replicated by a GP clinic. Now to explain this in greater detail, let's talk to the federal President of the AMA, Dr Rosanna Capolingua.

Rosanna, what is your view on this?

DR CAPOLINGUA: Well, let me tell you that you've just given an absolutely brilliant description of the situation and where the needs are, and the fact that the current proposals coming from the Government around putting a GP super clinic in Modbury are quite ridiculous, and that in fact you need the support in your hospital.

The Modbury hospital needs to be supported, it probably needs more beds and more capacity. It needs to be able to provide the services that the area requires. You've made the point that there is a younger population moving into the area, and that they are going to need different services and access to acute services.

And, indeed, the description that you've given of acute services - if you're waiting for more than 23 hours to be admitted you have to get deferred to another location - all seems an insanity to me.

And surely the State and Commonwealth Government should be thinking about the patients - those people that are needing the care, that will be diverted off, that can't get access to local care - and focus on delivering those sorts of services rather than plonking a GP super clinic in an area which has already got two very well-established clinics that are providing seven day a week services, bulk-billing services which the Government prefers.

And honestly I think that you and the people in the area could tell the Government what they need, because they don't seem to be listening.

LEON BYNER: All right, well John Hill is. John Hill, good morning.

JOHN HILL: Good morning.

LEON BYNER: What's your response?

JOHN HILL: Well I haven't met Rosanna yet. I have invited her to come and meet with me. And I'd like to be able to do that because I'd like to explain to her what our plans are, because she should talk on the basis of the knowledge of what we're doing in our State, rather than on some bits of information which she may have gathered through the media.

We have two strategies to do with the increasing demand in South Australia. One is the primary healthcare strategy, and one is the acute health service strategy. And in relation to Modbury, of course, the population there is not getting younger, as has been claimed. It's actually getting older and the demand for service is for older people, not for younger people.

In terms of birthing, we're increasing the capacity at Lyell McEwin, which will pick up any of the extra demand that the defence services will put into place. So that's the acute services. In relation to primary healthcare, we have a strategy to have a GP Plus healthcare centre for about every hundred thousand of the population.

They don't necessarily have doctors in them, depending on the supply of doctors in that local community. But what they will have is allied health workers, nurses, dietitians, lifestyle coaches; people who can work with the doctors and the community, identify people who are ill or potentially ill with chronic diseases, and help manage them so they don't end up in the acute services.

This is part of a well-thought through strategy, and Modbury is one of the key areas - there are ten of them in the Adelaide area, and we'll have some in the country as well.

Now, whether or not we have doctors in the GP Plus at Modbury will depend on the needs of that local community, and we work through these issues with the local divisions of general practice. So for example in Marion, where we're building a GP Plus, there won't be GPs in it, because it's next door to a GP clinic, but we'll work with collaboration with them. In Aldinga, where there is a shortage of GPs, we do have GPs after hours, and that was done in collaboration with the local GPs who said that what they wanted were after hours, bulk-billed doctors, and that's what we're supplying.

In Elizabeth there will be GPs because there's a shortage; so it depends on the circumstances. But this is a strategy about providing primary healthcare, exactly as you said at the beginning of your comments Leon.

And we're working with the Commonwealth to make sure this strategy, their ambitions for GP super clinics, are rolled into our strategy for GP Plus.

LEON BYNER: Rosanna what's your reaction to that?

DR CAPOLINGUA: Well, why call them GP Plus or GP super clinics, if you're actually going to take the patients' right to see a GP away?

JOHN HILL: Okay well let me answer that Rosanna. I'd like to have a talk to you about that because, in the past…

DR CAPOLINGUA: Is that John interrupting me?

JOHN HILL: I'm sorry, I didn't mean to interrupt you, I just want to answer your question. In South Australia, in the past in the '70s, we had community clinics established and you may …

DR CAPOLINGUA: I believe they failed, John. If you're into the habit of interrupting then I will as well. I understand that the community clinics in South Australia failed. We have to remember...

JOHN HILL: Well hang on, let me finish my original interruption. Part of the reason they failed is because they didn't link in with GPs, and the model we're building at the moment is to make sure that the GP is at the centre of it.

That's why we call them GP Plus, because we want to link in with your members, with members of general practice, because we know that primary healthcare won't work if the state is running a separate system to the system that's already run by GPs; a good system, I might add, and we want to work in collaboration with them, not against them.

LEON BYNER: Rosanna?

DR CAPOLINGUA: I would still put to you that the strategy underlying all of this is to ultimately encourage patients to not see a doctor when they need one. And we have to make sure that Australians continue to access the high quality of safe medical care that they have done in the past, and in fact we want even better. And we need to look at issues of how patients are getting to see a doctor.

So in Modbury, I believe, that to provide community transport and assist patients to access the very good services and clinics that are there, would be something of great use to them, something like the Veterans Affairs model of getting patients to the doctor. If you're talking about allied health services, in many arenas allied health services exist and GPs appropriately refer patients to them when the clinical need is evident, and often they are co-located or closely aligned to existing practices.

So let's just be very careful about what it is that is being promised here, what it is that's being sold here to the public, and remember why super clinics were promised in the election in the first place?

They were promised because of the belief that if you put super clinics in then you would stop people from presenting at emergency departments and you would remove the load on the hospitals. And the AMA has claimed that's always been incorrect, that we actually need more hospital beds. Now it seems that argument is disappearing into the ether, and other solutions or answers or reasons are being created for the existence of these clinics.

Why not increase and invest and support existing general practices where they are present, and assist patients in getting access, support the allied health providers? Look at putting super clinics in, if we must have them indeed, to areas where GPs will not necessarily be able to set up, put the capital investment in - you know it's not an area that's going to be easy to have a viable general practice in.

Let the Government put infrastructure and capital support in those areas and attract doctors, when we have more of them hopefully, into those areas and allied health providers, so that patients in those areas will locally be able to access GPs. And let's make sure that the local public hospitals, and public hospitals across Australia, are properly funded, that more beds are open, and that when you need to see a doctor and when you need to go to hospital, you can.

LEON BYNER: John, before I let you respond to what Rosanna has said, there's a point. You I think know of the problems that a lot of patients are having via their specialists at Modbury where they can be on the phone for long periods of time trying to find them a bed after 23 hours. You wouldn't deem that to be satisfactory would you?

JOHN HILL: Well let me say that in relation to Modbury, you're talking about paediatrics not general medicine there, that…

LEON BYNER: Well I've got to say to you that the AMA locally through a number of practitioners have said to me - I said give me some examples of the issues on the 23 hour rule. And they said a child with appendicitis, asthma, infective illness, gastroenteritis, trauma cases.

JOHN HILL: But what I'm saying is that the service to paediatrics is a 23 hours service. So what we…

DR CAPOLINGUA: Hang on a second John. Aren't kids in need, more in need perhaps that adults or general medicine?

JOHN HILL: Look, rather than make some political points why don't you let me explain what we're trying to do, Rosanna, so you can understand where we're coming from? What we're trying to do is to build a health service which provides services to all of our population.

In the past the Lyell McEwin Hospital and Modbury Hospital were both at a sort of - slightly more than a general hospital but not at a tertiary level service. What we're wanting to build up in the north is one hospital which is a tertiary hospital so we're putting more beds in there and more services and a whole range of things at the acute end.

We're building up Modbury as a general hospital which will provide a whole range of services, but not the most acute. So we've said in relation to paediatrics that the kids who will have to stay in for longer than a day will go to either Lyell McEwin or the Women's and Children. If it's a short term, less than 23 hours and that's just a figure that the doctors developed, a one day stay, then of course they can go to Modbury.

So that's - not every hospital can do everything. And I think everybody, including the AMA, would agree with that.

But to go back to your point about trying to get away from the model where people see doctors, that's absolutely the opposite of what we intend. For example in the GP Plus in Aldinga where there is a shortage of doctors after hours the GP Plus has a private provider of services who provide services after hours and bulk-bill. And in the 12 months or so that it's been there eight or 9,000 people have used - gone to see those doctors.

And we know by looking at the stats that the percentage of people attending Noarlunga Hospital from that community in the same period has declined by about 16 per cent.

DR CAPOLINGUA: That must have been an area of need.

JOHN HILL: Oh exactly true.

DR CAPOLINGUA: That makes sense.

JOHN HILL: Yeah well, and so in areas where there's a shortage of doctors - and as I say this was done in collaboration with the local…

DR CAPOLINGUA: That's not Modbury.

JOHN HILL: …in collaboration with the local doctors, that was the service we built there. But in Modbury there'll be a different model of service because of the needs. The needs will be different. It's an older population. Chronic disease is on the increase and we want to use the GP clinic to work with local doctors and the community to deal with those issues. Not to compete with doctors.

And I just say this for the AMA, and I've said it many times at a State level, we don't want these centres to compete with existing surgical practice. We want to work in collaboration with them. GPs are not our enemy…

DR CAPOLINGUA: And all that we're interested in as doctors, and all that we are interested in as GPs is to make sure that our patients can get to see the doctors that they need to, when they need to. That they can easily get there.

In other words that the location of super clinic won't mean that a more local general practice will have to close down so that it's more difficult - and usually for people that are disabled or elderly or frail, or mums with lots of kids, it's very difficult to get to a practice. It makes the whole thing much harder for them so…

LEON BYNER: John, what are you going to do about the doctors spending hours on the phone trying to get places for kids that are there for more than 23 hours? Are you going to be able to fix that?

JOHN HILL: Well what I'd suggest to - I'm not sure who that doctor is but I'd suggest they…

LEON BYNER: It's more than one doctor, I can tell you that.

JOHN HILL: Well what I was…

LEON BYNER: Are you saying you didn't know this?

JOHN HILL: Well I wasn't aware of that particular issue, no. What I'm saying is…

LEON BYNER: AMA reckon you do. I spoke to Peter Ford this morning.

JOHN HILL: Well Peter Ford has said that there's been difficulties at times to get access but I wasn't aware of it in relation to a paediatric case. But I'll have a talk to Peter about the examples that he is raising. I mean there is some - there is movement from the current - what is the system until January - to a new system.

And obviously as you introduce a new system sometimes communications aren't as good as they ought to be, but we're working to make it effective.

I understand it's working pretty well. In fact Peter Ford said in one other program I think that the birthing service for example at Lyell McEwin is working pretty well. And we want to make sure all of the services work very well.

It's a complex thing trying to run and change a health system at the same time but it has to be done. And we're building up service, we are putting more beds in a Lyell McEwin and at other hospitals, and we're making sure that Modbury focuses on needs of that local community which is an ageing population.

LEON BYNER: Would you say - you see the Tea Tree Gully Council have got some information about the fabric of the community and their age and what they do, and I mentioned this in the beginning. It didn't come from a media report. There are people now who are employed by WRE and that's one example, where these people are in their 30s. So they're going to have kids.

JOHN HILL: Sure, but they're not the general rule.

LEON BYNER: Well, but nevertheless though, we shouldn't be using that as an excuse to make life more difficult for people who have children.

JOHN HILL: It's not an excuse and it's not to make life more difficult. It's to make life work for all of the people in the community. We have an excellent birthing service at Lyell McEwin in the north and one at the Women's and Children's in the centre and one at Flinders in the south. That's how we run birthing in Adelaide. They're the three places where women have children. One for each part of our community.

The other hospitals will take on the role of looking after the growing ageing population. The number of people over the age of 65 is going to increase dramatically over the next five to ten years. And people over the age of 65 are twice as likely to be hospitalised as those under the age of 65. So we need to make capacity for them.

DR CAPOLINGUA: In that case - in that case if they're twice as likely to be hospitalised, we need more beds.

JOHN HILL: Well we're building more beds, but Rosanna, we're building more beds in our State.

DR CAPOLINGUA: …the federal minister as well that we need more beds. The ageing population and the incidence of chronic disease actually means that the need for beds is increasing as well. You know the AMA supports preventative medicine and the idea of beefing up primary care, beefing up general practice to make sure that we can help people to stay well, but there is no doubt - and you have quite easily declared it today again - that we need more beds across the country in order to look after the increasing number of people who are increasing in age.

It is an absolute inevitability and the accountability of the government to open beds, to look after patients is the bottom line here.

LEON BYNER: Okay. Well John Hill and Dr Rosanna Capolingua from the AMA thank you.

Ends