Presidential Statement - Dr Kerryn Phelps, AMA President, AMA Annual General Meeting

Good morning fellow doctors, special guests, AMA staff, and members of the media.

It has been a busy year and, as the video says, 'you 'ain't seen nothin' yet'. There is much more to do.

As AMA President, I have been blessed with one of the most professional, talented and committed leadership teams the AMA has seen.

At the Federal and State levels, the AMA has this year set the standard for professional membership organisations.

And it's all thanks to teamwork.

We have had strong messages to convey to Governments, to the profession, to our members and the public and we have spoken as one voice - always on song and always heard.

The Prime Minister, Premiers, Chief Ministers, Ministers, Shadow Ministers, backbenchers and Government Departments - they have all had direct contact with the AMA and are well aware of our position on key health issues and policies.

If there is a policy or a decision we like, we say so.

If there is a policy or a decision we don't like, we say so.

We don't adopt a position to suit the Liberal Party, the Labor Party, the National Party, the Democrats, the Greens, the Callithumpians or anyone else.

The AMA is not aligned to any political party. Our position is dictated by the concerns of our members and their patients. We comment on policy. We play the ball, not the man or the woman.

We do and say what's in the best interests of our profession.

We get results.

Just look at how we have worked with the Federal Government on the medical indemnity forum and solving the crisis.

Look at how we succeeded in getting the Wilkinson Review of the Trade Practices Act effect on rural doctors.

And look at how everyone is taking notice of our GP workforce survey.

We don't always get all of what we want, but we definitely get access and we get a hearing. We've got the runs on the board.

I'd like to thank my Federal Councillors for their wise deliberations and dedicated committee work to produce the best possible outcomes for our members.

Trevor Mudge, my Vice-President, has led the way on privacy and ethics.

Michael Sedgley has done a wonderful job chairing our medical indemnity taskforce.

Allan Zimet has presided over the sound financial management of the organisation through a difficult period.

Dana Wainwright has led negotiations with the private health funds.

And Rosanna Capolingua has helped redefine AMA policy on the important emerging area of complementary medicine.

Thanks to all of our hardworking policy committees.

The State and Territory Presidents have all worked tirelessly with great results. Their media profile was high, their messages strong and consistent, and they got results.

All the States have made invaluable contributions to the AMA, the medical profession and Australian patients over the last 12 months and more.

Their success, our success as an organisation, is due in no small part to the staff who keep our Secretariats ticking over.

On behalf of all the elected officials and grassroots members of the AMA, I thank them for their efforts.

Their hard work on policy and administration, media, member services, our publications and meetings, and putting this Conference together, and everything else they do for AMA members is high quality and greatly appreciated.

As a team, we have had a very successful and busy year.

I have worked to ensure absolute transparency in our activities.

Every meeting is minuted. Communication at all levels has been timely and detailed.

We have regular Federal-State teleconferences. There is frequent informal discussion between the Federal AMA and the State and Territory Presidents and CEOs.

Our Federal Executive members have travelled to the States extensively.

Let me now take you through some of the major issues and events that have delivered for AMA members and their patients this past year. And I will touch on the challenges ahead…and there are many.

Medical Indemnity

Medical indemnity tops the list for the year just past and the year ahead.

It affects not only doctors, but also our patients and whole communities.

What has happened over the last six months has rolled over the Australian health system like a tidal wave.

The fact that there are still medical services available amid this crisis, especially in NSW and Queensland, is due in no small part to the work of the AMA - Federal and State - over many years.

Over the past 12 months, the Federal AMA and AMA (NSW) worked closely with the NSW Government to achieve substantial tort reforms in NSW.

I congratulate the AMA (NSW) on their success on this difficult issue.

The Federal AMA has built on the NSW initiative. Our focus on medical indemnity reform over many years was accelerated in 2000 when UMP made a 'call' on its members after indicating a few months earlier that a call would not be required.

As a response to questions raised about the call, the AMA asked Ernst & Young to conduct a limited review of the key factors underlying the call.

This was not, and could not be, an audit of UMP. A full audit was well beyond our legal and financial scope.

In fact, the provisional liquidator has said it will take his team of auditors six weeks to ascertain the financial position of UMP/AMIL.

Nevertheless, the study yielded a number of very useful conclusions in terms of key issues facing the company and the medical indemnity industry generally.

We could provide members with much more information than they had in the past, and they had the opportunity to give careful consideration to their choice of medical defence organisations.

UMP responded to the Ernst & Young report by publishing for the first time an estimate of its IBNR, which came in at about $455 million.

This was a very important and significant development.

It gave members the opportunity to compare the IBNR with a net asset position of the company, which was then around $120 million.

The combination of the rapid increase in claims in NSW, the Calandre Simpson $14 million verdict, the aftermath of September 11, and the HIH collapse led to the situation unexpectedly deteriorating.

We consulted the Government every step of the way. The former Health Minister had dismissed our warnings, saying it was a state issue.

So we briefed the Prime Minister directly in mid-2001. Soon after, he announced the Government would host a medical indemnity summit. Structured settlements legislation was fast tracked.

In early 2002, it became clear that, even with the higher premiums, UMP was unlikely to be able to meet the higher capital requirements that the Government was introducing through APRA on 30 June this year.

As our lobbying efforts intensified and media coverage of the problem increased, so too did the Government's interest and motivation to respond.

The AMA was one of a select group of medical organisations to meet with the Prime Minister, Assistant Treasurer, Senator Helen Coonan, and the Health Minister, Senator Kay Patterson, in April.

This meeting led to the Government initially agreeing to the guarantee of $35 million towards UMP's capital requirements up to 30 June.

Bear in mind that this was an issue we had been told was not a Federal issue.

However, the goalposts shifted again, with even greater prudential requirements coming into force.

The Government subsequently refused to increase its capital guarantee to cover UMP's much greater requirement beyond 30 June.

This was the proverbial straw that broke the camel's back and a major factor in the resignation of the UMP Board and the appointment by the courts of the provisional liquidator.

As things started to look grim, the AMA managed to keep a firm hand on the tiller.

More importantly, we provided rapid responses to all the Government's queries about possible solutions.

It the PM's direct interest in this issue that gives us hope of a positive outcome for doctors and patients.

I am in regular contact with the PM's office, Assistant Treasurer, Senator Helen Coonan, and Health Minister, Senator Kay Patterson, and their advisers on developments.

Michael Sedgley and I attended a meeting with Assistant Treasurer Helen Coonan and representatives of Treasury and UMP to thrash out details of the Government's guarantee to UMP including a commitment to a care and rehabilitation scheme for the severely disabled.

And our State AMAs - particularly in NSW and Queensland - have joined the federal AMA in raising the issue responsibly in the public arena.

The wheels are turning. The Government is finally becoming aware of the true gravity of the situation.

Just ten days ago, I attended an extraordinary meeting in Canberra.

Convened by Max Moore-Wilton, Secretary of the PM's Department, and the Prime Minister's handpicked Chair of the Government's Medical Indemnity Task Force, this meeting was attended by the Heads of Treasury, Finance, Health and Attorney-General's.

Our advice - and the impact on our members and their patients - is at the core of the Government's response to the collapse of UMP.

As unexpected scenarios emerge as a result of UMP's assets and cashflow being effectively 'frozen', they are being referred to Government and addressed one by one.

Only last night a breakthrough - the Supreme Court worked into the night to approve the agreement between the Government and UMP to unfreeze funds and settle claims on behalf of doctors.

The sting is still in the 'tail' - the IBNR.

The Prime Minister and his Ministers are mindful of the consequences. They know it is more than a health problem. It is a social problem. It is an electoral problem.

Looking to the weeks and months ahead, a big black cloud of uncertainty hangs over the provision of medical services in this country.

It is important to point out that this crisis is a threat to doctors, not a threat by doctors.

We doctors want to see our patients. But the litigious nature of our society makes it a tough decision because if you are not insured securely it is simply too risky to practise.

Many doctors - including many of us here today - remain uncertain about the situation post-June 30.

Doctors are angry, confused, uncertain about the future, and we need answers.

The Government has come this far. We have to give them the chance to go the full distance. But they must provide a clear indication of their plan for the way forward.

We understand the complexity of the problem facing the Government. It has always been the most complex issue the AMA has had to face.

A workable solution crosses at least four Government Departments and requires the cooperation of the Federal Government and eight separate State and territory governments. No small feat.

But time is running out. Doctors must consider renewing contracts in the next few days.

Every day that passes, more doctors are leaving UMP, leaving fewer to manage the tail.

Every day that passes, another doctor decides whether to retire early, work overseas, or do something less risky and less stressful.

The Government knows the AMA cannot stop individual doctors making individual choices about whether or not to shut their doors.

We need a strong response from Government and we need it now.

ACCC

There are guarantees you can trust, and there are those you can take with a grain of salt.

Guarantees from the ACCC fall into the latter category and, rather than a grain of salt, they are usually accompanied by a truckload of insult.

Once again, as a result of AMA advocacy on this issue we have seen the Prime Minister personally intervene.

He told me he thought the ACCC action on this occasion failed the 'common sense test'.

There are now two inquiries into the ACCC and the Trade Practices Act.

One, the Wilkinson review of the effect of the TPA on the recruitment and retention of rural doctors - which came about as a result of my direct request of the PM - will report soon.

In the meantime, Allan Fels continues his campaign of persecute, prosecute and press release.

The ACCC seeks out defenceless vulnerable targets and intimidates them with outdated and inappropriate legislation.

Over the last few years, their bovver boy attacks on the medical profession can only be described as senseless.

As they go to the media waving another swag of scalps, they leave behind bewildered doctors, stressed spouses and families, and communities stripped of vital medical services.

No public benefit. No common sense. No logic. No justice.

Well I say 'no more'.

The AMA will continue to challenge Allan Fels and the ACCC, and provide advice and support to the ACCC's victims.

We recently challenged them over their treatment of three Rockhampton obstetricians.

The professional and private lives of these doctors were put under enormous strain by the ACCC.

Their reputations have been damaged, their roster destroyed, and Rockhampton is left with an obstetric service in tatters.

Maybe the Government will twig to the fact that the community is sick of these attacks.

They only disadvantage towns and suburbs by leaving them without services and skilled people to help their communities grow and prosper.

The ACCC must not be allowed to continue to prosecute good people whose only crime is to provide important services to other Australians around the clock.

Aged care

One group of Australians deserving of a 'fair go' is our aged - our mums and dads, uncles and aunts, grandparents, friends and mentors.

Australians are getting older but are we getting any wiser about getting older?

As a community, we must realise that the work we put into aged care policy today will set the scene for the system that awaits us when our kids are looking at options for us in our 'twilight' years.

We can't approach aged care policy in the 'third person'.

It's about us, our parents, our loved ones. It's personal.

The AMA has a long history of dealing in aged care issues dating back to the 1960s.

In April 2000, the AMA attended the initial meeting of what is now the National Aged Care Alliance, and we are now a sponsoring member.

It was in this guise that we hosted the National Aged Care Summit just prior to the last Federal election.

Debate at that Summit had a direct impact on the final aged care policies that were presented at the election.

It is our view that it is time now to consider change within the health care system for older people, and it is up to the aged care sector to lead debate and action.

The medical profession must be central to the team providing seamless care that bridges the current gaps between preventive and health maintenance services, family and other carer services, services based in medical practice rooms and surgeries, hospital services, home based services, and residential aged care services.

Ethical and care standards must be established and maintained.

Access to a high standard of clinical care is a right and must never be denied on the basis of age, disability or perceived societal usefulness.

The AMA is continuing to work with other members of the aged care sector and with Government in order to achieve a flexible integrated health care system that allows choice of health care delivery to meet individual care needs.

GPs must have incentives and proper facilities to call on aged care facilities, and incentives to visit the elderly in their homes.

There is a need for humanity and compassion back in the aged care debate. We must try to remove fear from the ageing process.

Knowing proper health care is always near and appropriate accommodation is available will help.

The AMA has made a major contribution to aged care policy over the past year, and we had influence.

By pointing out deficiencies in the Coalition's aged care policies prior to the last election, we were able to provoke a raft of election promises that were delivered in the May Federal Budget.

Public Hospitals

In the past years, the AMA has been a strong advocate for more funding and better targeted funding for our public hospitals.

In 2001, we commissioned research into the medical profession's perceptions of the public hospital system.

Apart from providing clear evidence of a crisis of confidence in the system, doctors indicated that while more funding is needed, the priority was to address the way the system is managed, so the money would be used most effectively.

This includes the joint Federal/State responsibilities for funding and the need for greater involvement of clinicians in hospital decision making.

Last month we held a high level forum to develop a joint Federal/State/Territory AMA position on public hospital financing.

The forum was particularly successful, with good participation from across the organisation and an eagerness to confront the issues.

Our AMA representatives decided that the focus of future negotiations for health financing should be on outcomes for patients and addressing the perverse incentives created by the current dual funding mechanism.

Since the forum we have actively promoted this message to Federal parliamentarians and State/ Territory Health and Shadow Health Ministers.

So, for the first time, the AMA has positioned itself to influence negotiations over the principal funding agreements for public hospitals.

As a first step in that process, the AMA was recently invited by the Health Ministers to nominate representatives to participate in the work that will inform the next round of Australian Health Care Agreements.

This is a big achievement.

I must welcome also the new commitment from Health Ministers to put health outcomes ahead of funding negotiations in their discussions.

Finally we may be seeing some Commonwealth/State cooperation instead of conflict in improving our public hospitals.

General Practice

On the other hand, nowhere is the impact of long term government neglect more evident than in General Practice.

The AMA fee for a Level B consultation is $48.50. The MBS fee for the same consultation is $28.75 and the rebate is $24.45.

The $24 difference represents the product of governments - Liberal and Labor - sticking their heads in the sand for over 18 years.

It is also the difference between high-quality satisfying general practice and that which many doctors practise today.

There is a certain predictability about the way the Government behaves on these matters. In the beginning, Medicare was attractive enough for GPs to bulk bill nearly 80% of their services.

It looked like a pretty good deal. A fair fee and no worries about fee-collecting or bad debts.

However, the bulk billing figures released this week - and for the previous few quarters - are painting a very different picture.

The cost burdens on GPs today are huge. Medical indemnity, staff costs, GST, superannuation, new technology, computers, and on it goes.

Doctors find they have no alternative now but to charge an appropriate fee-for-service.

Media coverage and editorials this week backed up what the AMA has been saying for some time - a deficient MBS means more doctors charging for their services like any other professionals.

The real value of the RVS has been the realisation by doctors that we cannot look to the Government to solve our problems.

The Government had the chance to adopt the findings of the RVS, but rejected it.

We have put the argument that low Medicare rebates mean more dollars from household budgets, especially for disadvantaged people. They don't want to hear it.

The debate about the level of the patient rebate must now be a matter between the Government and the electorate.

The bad news for the Government is that thanks to the AMA more people now know what the RVS is, and they now know that Government inaction is the reason they are paying more to see their doctors.

The RVS has given doctors the freedom to charge patients the real value of our services. The shackles are off.

It is up to the Government to explain to voters why it is leaving Medicare to wither on the vine.

GP Workforce

Medical workforce issues are gaining prominence.

The orthodox view has been that there is an overall surplus of GPs in Australia - with a supposed maldistribution particularly in rural areas.

This has enabled the Government to criticise and blame doctors for not moving to rural areas and it has been in the Government's interest to perpetuate the myth of oversupply.

It has also allowed the Government to introduce the draconian provider number legislation.

I commissioned Access Economics to conduct the largest ever survey of General Practice to provide the AMA with detailed analysis of the demand for GP services in Australia compared to the actual supply of doctors, now and in the future.

Contrary to conventional wisdom, there is currently an overall shortage of GPs in Australia - as well as a maldistribution.

These shortages are not confined to rural and remote areas but are increasingly apparent in outer urban areas. Inner urban areas generally have an adequate supply. Very few areas are in surplus.

Looking into the future, there will be a large increase in the demand for GP services as the population ages.

Based on current working patterns and assuming current policy settings are maintained, there will be a yawning gap in numbers that needs to be addressed by changing the policy settings.

The medical profession must grasp this nettle. The coming year will see intense debate on the meaning of this survey and what ought to be done to address its findings.

The Government controls the number of university entries into medical training, the number of GP trainees who are allowed, the supply of overseas trained and temporary resident doctors and remuneration for GPs.

Given there can be a 10 year time lag before a decision to increase university entry and a GP working on the ground, we suggest the Government needs to work with us very soon to talk about solutions.

We have lobbed the medical workforce ball into the Government's court.

Private health insurance

The private health insurance ball is also in the Government's court, which is starting to look a bit like centre court at Wimbledon.

As a result of policies such as Lifetime Health Cover, which the AMA pushed strongly for, private health insurance membership has stabilised at around 45 per cent of the population.

This has been very good news for many of our members with both volumes of services and fees charged rising significantly over the last year.

The AMA's private health insurance task force led by Dana Wainwright - which also includes representatives from the surgical, ophthalmology and anaesthetic groups - has been busy meeting the funds and putting the views of the profession as to the way that Gap Cover schemes should operate.

We have been successful in having both Medibank Private and the Australian Health Service Alliance introduce "known gap" products.

We have also succeeded in getting nearly all the major funds to allow doctors to provide their Gap Cover accounts directly to their patients.

We are seeing an increased use of Gap Cover schemes (now up to 26% of in-hospital services) and a decline in the use of Lawrence contracts.

We will soon be calling for the Government to repeal the increasingly redundant Lawrence legislation, and we will be asking the funds to sign on to a code of conduct.

General Policy

There is still a lot of policy and other important work to report on, but time is short.

I'll briefly touch on some other highlights of the year.

Privacy

The AMA has led the way in assisting private medical practitioners to use the new privacy legislation to enhance, not hinder, good clinical practice.

We distributed a Privacy Kit to all members before the legislation came into effect and followed this up with advice via our website and a telephone hotline.

Complementary Medicine

Our complementary medicine committee, chaired by Rosanna Capolingua, took on the enormous task of revitalising the AMA position on complementary medicine - dragging it into the 21st century.

We released a formal position statement on complementary medicine addressing the key issues for doctors and stressing the importance of taking an evidence-based approach.

The AMA can now be seen as progressive, yet cautious, in this area, and we have established the medical profession as a responsible stakeholder in evidence-based alternative treatments and remedies.

Youth Health

The Commonwealth Bank and AMA Youth Health Advocate Program released the report, Adolescence: An Opportunity for Health, documenting the priorities identified at the National Youth Health Summit held last July.

Our youth health program also convened a Drug Summit this year to canvass concerns with so-called 'party drugs'.

And a new AMA position statement on Body Image and Health was adopted by Federal Council in February.

Indigenous Health

Indigenous Health remains a priority for the AMA. You need look no further than the background paper circulated yesterday to see our work in this important area.

Yesterday we also released a groundbreaking report card on the state of Aboriginal and Torres Strait Islander Health.

Its release comes hot on the heels of the announcement of some welcome indigenous health initiatives in the Northern Territory this week.

The NT Government has announced the creation of 21 new Indigenous health zones across the Territory, each with a Health Board to coordinate all funding for health services targeting Aboriginal people.

The Commonwealth and Northern Territory Governments are to be congratulated for this important step forward.

On the industrial front, we are pursuing fair pay rates for doctors working in Aboriginal Medical Services.

Asylum Seekers/Children In Detention

The AMA has spoken out on the need to provide health services and proper health care for asylum seekers and children in detention while they await the outcomes of their applications.

Last week, Mukesh Haikerwal and I opened the Bula Bula Health Centre in Melbourne.

The warmth and the gratitude flowing to our fellow doctors who are providing voluntary services to asylum seekers in the community was wonderful to witness.

Pharmaceutical Benefits Scheme (PBS)

The PBS will be a big issue for the year ahead.

You all saw the Federal Budget and the AMA's concerns were widely covered in the media.

The AMA has advocated strongly in defence of the disadvantaged and poor families who will be affected by increased co-payments.

We have also strongly defended clinical best practice in prescribing in the face of new bureaucratic obstacles and red tape.

The AMA's position is that it is much better to provide doctors with evidence-based information on prescription drugs and avoid massive consumer focussed advertising.

The Government would rather try to impose impractical and onerous restrictions on doctor prescribing.

We will not let the bureaucrats get away with using doctors as scapegoats.

The PBS cuts are at odds with international trends and research.

Studies and experience in the USA and Canada have shown that increased Government pharmaceutical expenditure results in reduced hospital care expenditure.

It is better to improve patient care and enhance quality of life through a well-managed PBS than to have our hospitals and accident and emergency departments overcrowded and unable to cope further down the track.

We will be talking further with the Minister about our problems with the proposed PBS changes.

Work Life Flexibility

Meanwhile, the AMA's efforts to address work and lifestyle issues affecting doctors will culminate in a Work Life Flexibility Forum later this year.

Safe Hours

The AMA Safe Hours Code is now formally recognised by many health sector agencies.

Our Safe Hours project has been so effective that it won a prestigious national occupational health and safety award.

It is now a role model for other organisations and other professions.

The onus is on State Governments to revise rosters and employ enough qualified staff.

Corporatisation

The march of the corporates has slowed, but the AMA's work in this area has not.

We produced a decision support kit for doctors and negotiated a Code of Conduct with the major corporates.

We also produce a Corporate Medical Practice e-mail newsletter for doctors interested or already working in the corporate environment. Already we have 1000 subscribers.

Repatriation Private Patient Scheme

We launched a major lobbying campaign on fees for specialists under RPPS late last year, which was well received by members.

Negotiations continue with the Minister, the Department of Veterans Affairs and the RSL.

I met last week with three senior members of the DVA.

I was assured that indications are that the DVA accepts the need to move to "market" rates and will soon approach the Minister for funds.

Now that would be good news if it comes off. We'd then want to wrap that into the LMO agreement for GPs.

Other Industrial

Elsewhere on industrial matters, there is plenty happening.

We are updating GP registrar minimum conditions of service.

We have set up a coordinating committee of salaried doctors, which will be constituted for the first time this weekend.

We have established the biggest junior doctor e-mail newsletter in Australia with more than 3500 subscribers.

Well done to our industrial team.

Membership

For those of you concerned about our membership numbers - and I know that some of you have been very interested in them - we are travelling very well indeed.

Between January 2000 and April 2002, total membership increased from 26,185 to 27,456 - a rise of 4.8 per cent.

Over the same period, GP membership rose from 8,460 to 8,580 - up 1.4 per cent.

This is against a background of member organisations, professional associations and unions losing membership.

The best way to keep these members and attract more is to continue to provide strong representation on the issues that matter to them - to Government and through the media.

The AMA remains Australia's largest independent medical organisation and we should all be very proud to be part of it.

Conclusion

In closing, let me thank once again the whole AMA team for a year of remarkable achievement.

It has been an honour to serve as your President these past two tumultuous but rewarding years.

There is much important work to finish and new projects to begin.

Your AMA leadership team has got results.

We went to the government demanding action on medical indemnity. We got it.

We went to the government demanding an inquiry into the ACCC. We got it.

We offered advice on aged care policy. The Government took it.

We released the biggest ever survey on the GP workforce. Everybody noticed it.

We challenge the ACCC at every opportunity. Allan Fels hates it.

The AMA's in town and everybody knows it.

Our work and our name are high in the public consciousness. We may not be universally popular but we are taken seriously.

If you think it's been a ride and a half these last two years, as the song says, 'you ain't seen nothin' yet!'

Thank you.

CONTACT: John Flannery (0419) 494 761

Sarah Crichton (0419) 440 076