Transcript: AMA President, Dr Andrew Pesce, with Alex Sloan, ABC Radio 666 Canberra

ALEX SLOAN:In a city which has a shortage of GPs the call by the Australian Medical Association for the Government to scrap the GP Super Clinics program is of key interest.

The AMA says the clinics are cannibalising existing doctors' practices and questions whether they are being placed in marginal seats for Labor's political gain.

In the 2007 election campaign Labor promised 31 clinics, later adding five, and in the 2010/2011 budget the Government committed funding for a further 23 clinics.

Tony Abbott says if elected he will honour the existing contracts but axe the remainder of the program.

In a moment I'm going to speak to Tony McBride who's Chair of the Australian Healthcare Reform Alliance for their view of this policy, but first to the President of the Australian Medical Association, the AMA, and that's Dr Andrew Pesce.

Dr Andrew Pesce a very good morning to you.

ANDREW PESCE: Good morning. Thanks for inviting me.

ALEX SLOAN: Now you've got problems with the GP Super Clinics?

ANDREW PESCE: Yeah I think it's not quite right to say we’re saying that the whole program should be scrapped but we've said from the very beginning that if there is a place for Government funding of clinics to provide GP services to communities those clinics should be set up in areas where there are not existing general practices, and that there is no way that the existing general practices, if they are there, could meet the needs of the community. And it should be done to complement the existing practices.

The problem that we see is that the Government is spending a lot of money to open up the stand alone clinics which can in fact make it less viable for those independent GPs who invested their own money into practices to provide primary care services now, and it really should be done in consultation with them to fill the gaps rather than to go into competition with them.

ALEX SLOAN:What's an example of where that is happening?

ANDREW PESCE:Well for example in Strathpine in Queensland there are five practices in the area. They probably have been complaining that they don't get adequate support to provide the services that the community needs under the current existing arrangements. The Government has committed $2 million to build a super clinic when for example you could spread that funding amongst the existing practices, say what it is that you want to achieve and see how the existing practices could meet it.

You've got to remember that general practice in this country is provided by General Practitioners. There are 7000 general practices in the country providing services all over the country. Sure the Government can open 20 or 30 super clinics, so that's never going to be a significant impact, and what they should be doing is strategically spending the money that they've got to spend to enhance the ability of our existing family doctors to provide services that they'd probably love to provide but can't afford to.

ALEX SLOAN: How many are operating in Australia at the moment?

ANDREW PESCE: Oh look I think there's three or four or five. I mean there are announcements made all the time and I have trouble keeping track of which ones have actually matured. But still - you can still count them on the fingers of one hand.

ALEX SLOAN: Now Strathpine, that's in a marginal seat in Queensland?

ANDREW PESCE: Well it is, yes.

ALEX SLOAN: Is that significant?

ANDREW PESCE: Look I personally, you know, am not saying that the Government is making these decisions based on marginal seats, but we want to focus on the positives and we want to encourage the Government to say yes there is a place for the super clinic idea.  There are plenty of places in Australia where there is just no way that the existing General Practitioners will be able to provide the services necessary and that you'll never get the workforce out there any other way. And that's where the clinics should be going if there is a place for them.

In areas where there's unmet need the Government should be talking to the existing general practices saying how can we help you deliver us the services that we see aren't being met in the community if we give you some enhanced funding, and build up the existing general practice infrastructure rather than opening up clinics that might actually threaten the viability of the practices in the long run, and then the community may only end up with one super clinic rather than five or six general practices.

ALEX SLOAN: And so you're saying that's what you're seeing in Strathpine?

ANDREW PESCE: Well I think Strathpine is an example where the money could have been better spent when there are existing General Practitioners, who have been saying that they'd like to expand what they do, but the way that they're funded just doesn't allow them to do it.

ALEX SLOAN: Dr Andrew Pesce is with me this morning. President of the AMA. You say you're not against this per se but you're saying look actually there would be a better response, and that is to go back to GPs and say what do you need.

So in effect you are saying you're against this policy?

ANDREW PESCE: No, what we are against is where the policy doesn't take into consideration the existing general practices in an area.

And instead of being something where the Government works with the general practices to see how we can best meet the needs of the community, and if it's agreed that the General Practitioners just can't do it, yet put up a super clinic.

But they should be supported first and foremost. These are people who've been working very hard trying to meet the needs of the community, the support that they've been getting and the funding hasn't allowed them many times to deliver the services they'd like. It's not that we haven't said that there's a problem, and rather than sort of pretend that you're just going to build services from the ground up, complement the existing practices, talk to the GPs, see how they can be helped and sure, if you still find that there's no way that you can provide services then go ahead, put in a Government funded service.

ALEX SLOAN: It's reported in The Australian that the AMA does believe these are a political tool by Labor, by putting them in marginal seats rather than areas of greatest need.

ANDREW PESCE: There are certainly some members who have that perception. I don't know, there haven't been enough opened, there have been a whole lot announced, I don't think that that's the issue that I want to focus on, I don't want to make this a party political issue, I want to see this a health policy. And what we should be doing is supporting our family doctors where we can, provide the services that they'd like to provide and only use a Government funded infrastructure where there is no way that the existing general practices can support that.

ALEX SLOAN: So as health policy though, you're rating it as fairly poor?

ANDREW PESCE: I think that if it is done in consultation with the profession it can be the icing on the cake to deliver the services where that's the only way to deliver them.

But surely it's much better to spend less money supporting the existing practices that have been out there, that know the patients, that know the community needs rather than just bringing something in and building it from the ground up which will potentially threaten the diversity and the numbers of General Practitioners that might be able to have successful practices and viable practices in the area.

ALEX SLOAN: Of course there's not one planned for the ACT, there is one in Queanbeyan, but we hear all the time the need to get into a GP, and a lot of practices won't take new patients.

ANDREW PESCE: Well that's right because the way that they're funded at the moment leads them to say this is the service we can provide.

Now if we want to make sure that practices are open extended hours and after hours, well you can give them payments to do that.

At the moment the incentives just don't make it economically viable, but you don't have to spend $2 million building a new clinic to do it and then pay for the service on top of that. If you divided the $2 million up amongst the existing GPs I'm sure you could get a significant improvement in the services they could deliver rather than opening a Government-sponsored clinic in opposition to them.

ALEX SLOAN: Tony Abbott says if elected he will honour the existing contracts but axe the remainder of the program? Do you support that?

ANDREW PESCE: Look we feel that any policy should be done in consultation with the doctors. I think Tony Abbott wants to make sure that good GP services are delivered to all communities. We would encourage him to talk to the doctors to see how if he wants to spend that money that's been allocated to super clinics differently, yes we would like to see it done in consultation with our doctors, the people who are actually providing the service, saying how much do they need to help them provide the services that have been identified as not being met.

And that's what we'd encourage Tony Abbott to do.

ALEX SLOAN: So you say it's clear from the example you gave us, Strathpine, I think there's Ballan in Victoria and Port Stephens in coastal New South Wales and there are another nine offering some services, that it's clear that they are taking or cannibalising the existing GP practices?

ANDREW PESCE: Well it's clear that in certain situations it would have been very much simpler and probably cheaper for the Government to approach the GPs in the area saying look we're thinking of putting in a super clinic because people tell us that they're missing out on services in this area, can we talk to you about those services, is there any way that by giving you some extra funding you will be able to provide those services and meet our community obligation to provide services for the whole community, meet your desire to provide the best service you can and talk with us about how we can do that?

ALEX SLOAN: So a new approach, a re-think is what you're calling for?

ANDREW PESCE: Well I think the first thing, before making a final decision on putting in a super clinic approach the doctors in the area, think about all the money you're thinking about spending on a super clinic and I bet you for half the money you'll be able to get the services that you want provided by the existing family doctors.

ALEX SLOAN: Dr Andrew Pesce thanks for joining me this morning.

ANDREW PESCE: Thank you

 

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3 August 2010

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