Transcript: Dr Hambleton, Life Matters, ABC Radio National, 23 May 2011
Transcript: AMA President-elect, Dr Steve Hambleton, with Richard Aedy
Life Matters, ABC Radio National
Monday 23 May 2011
Subject: 2011/2012 Federal Budget; Better Access program for mental health
RICHARD AEDY: If you’re from the Federal Government, you’re about to hear a lot about GPs, a lot more. Dr Steve Hambleton’s just been elected unopposed as President of the AMA, the Australian Medical Association.
He gets sworn in at the end of the week and he reckons the Government has a bit to answer for when it comes to general practitioners. Steve is a Brisbane GP and he’s previously been the Vice President of the AMA.
He joins me now. Welcome to Life Matters.
STEVE HAMBLETON: Good morning.
RICHARD AEDY: What’s at the top of your agenda?
STEVE HAMBLETON: Well look, there’s a whole lot of things. I suppose, there’s a lot of unfinished business that’s carried on from the last term. And I think it’s really the respect that the Government has for the clinicians on the frontline. And that is doctors who work in hospitals, and that’s general practitioners at the frontline of the engine room of our health system in this country.
RICHARD AEDY: Well, what about the issue of the GPs’ rebate for mental health plans?
STEVE HAMBLETON: Well look, we heard in the last budget that there was some quite significant changes in the Better Access program for mental health. And we would have liked to have stood up with all the other groups and said, look, we think this focus on mental health is bipartisan, the Government and the Opposition, and we think this is a good thing, in an area that really, very much needs investment.
But the Government chose to actually halve the rebate for patients trying to access their GPs, to get that access to psychologists. And we think that these talking therapies, these non-pharmacological therapies, are very important for this group of patients.
And of course, this significantly devalues the role of GPs in this mental health area. And we’re very concerned about that. There’s certainly a rise in discontent among general practitioners right around the country and ...
RICHARD AEDY: So, there was a criticism, wasn’t there, that some GPs weren’t offering as much as they could to mental health patients? Sort of rushing them, for example and then, claiming the rebate.
STEVE HAMBLETON: Well, of course, there is – always easy to point out the exceptions. But when they did the independent analysis of this – and in fact, the Government’s own independent analysis – it showed that a lot of GPs were using this, which means it’s a popular program with their patients.
Ninety per cent of GPs using it and in fact, 85 per cent of family doctors. So, someone who knew the patient very well over a long period of time, using these item numbers to actually help their patients get access to psychologists.
So, I think the independent research, it overwhelmingly was positive. And when people point to those exceptions, it’s a bit disappointing.
RICHARD AEDY: What about some of the broader health reforms going on? Medicare Locals, for example.
STEVE HAMBLETON: Well again, Medicare Locals in the general practice area, I mean, this is something that was put up by the National Health and Hospitals Reform Commission. And Medicare Locals – local, primary health care organisations, looking at the primary care as a whole, trying to bring everything together under one roof.
You know, this is aged care, GP care, mental health in the community, home visiting. It makes sense to have something there but the AMA’s quite concerned about the way the Government’s gone about setting it up, in that it’s actually really, again, disenfranchised the GPs on the frontline.
They did this in New Zealand a few years ago, with primary health care organisations. And they found that they did exactly that; they disenfranchised the GPs. In fact, those primary health care organisations in New Zealand are now embracing GPs, bringing them back into those organisations and finding they’re getting better outcomes.
RICHARD AEDY: But when you – I mean, isn’t there a cultural issue that’s going to work in the favour of GPs here? Is that people now essentially understand the GP is the gatekeeper to the health system and the person with whom they have the relationship with. That isn’t going to change, is it?
STEVE HAMBLETON: No, it’s not and in fact, I like to position the GP really as the gate opener, rather than the gatekeeper. So, we’re trying to get you into the system and make things work more efficiently for the patients, rather than keep you out of something. So, I’m trying to reposition the GPs where we really do properly sit, as the gate opener.
But there are a whole lot of things in primary health care that are, you know, come from different buckets of money. Trying to move through aged care, community care and even mental health care is really difficult.
RICHARD AEDY: Can I ask you about physician assistants, as in paraprofessionals, who would work essentially, one rung down from doctors and to doctors?
On the Health Report just before on Radio National, Norman Swan was discussing the ending of a course at the University of Queensland. Now, the idea of physician assistants was resisted by the AMA. Why didn’t you want them? I mean, most professionals would welcome more help and especially in areas where doctors are spread thin.
STEVE HAMBLETON: Well certainly, I think that, you know, rather than champagne corks going off around the country, I mean, I think that this is, sort of, an element of a wider problem. And that is where – what are we – how are we using our resources on the ground now, in terms of teaching and training?
Now, physicians’ assistants, as you quite rightly pointed out, they’ve been supported by a number of areas because they would actually introduce some benefits to practitioners and leverage the doctors to be able to help them to do more.
But right now in this country, the bigger picture is that we’ve got an enormous number of young people – young doctors – coming through; medical students who need to be trained. And those young doctors, we must make sure they’re trained at the same standards that we have. We all know, looking across the board, there are shortages of doctors in every area.
For some reason governments, for 20 years, didn’t increase the numbers of training in the universities. Right now, we need to stand back, have a look at the big picture, make sure those young doctors are trained. And bringing in a new class of health professionals until we get that stabilised again, I think is probably the wrong timing.
RICHARD AEDY: Right, but because there’s - I mean UQ, as you would know, being a Brisbane GP, have just decided not to continue with their course. So there’s this group of keen young people wanting to take part, wanting to be part of the health system, wanting to help people, and very concerned about their futures now.
STEVE HAMBLETON: Well, quite rightly, and a lot of these people were very well trained medically, anyway. Senior nurses, they were paramedics, and they were quite well trained. And so they may well have had a future role.
But for University of Queensland to go it alone, without looking at the bigger picture, without actually discussing it with the rest of the health system is part of the problem, I guess, we see with health number planning right across the country.
So how it’s started in the first place is actually – we should roll the clock back and say, how can we do this better?
RICHARD AEDY: So, you’re not against this in principle; you’re against the way it was executed, essentially?
STEVE HAMBLETON: Well, the way it was executed and the timing. I mean, we’ve got lots of young doctors next year; 2012, we’re going to have nearly double the number of medical students coming out into our hospitals.
Already, we’ve heard that the State Governments in a lot of areas haven’t got enough training places for that first year job, that pre-registration year. And what a tragedy for Australia if we can’t get our young, locally trained doctors into the system to help us out with the shortages we’ve already got.
RICHARD AEDY: Steve, you also have concerns, I think, about the role of the Pharmaceutical Benefits Scheme.
STEVE HAMBLETON: Well yes, certainly and I think I – having been recently a member of the Pharmaceutical Benefits Advisory Committee, I can tell you that – the intense input that committee has to try and get the decisions right.
They look at the drug to make sure it works; they actually look at, is it cost effective? In other words, how much are we going to spend on this and are we buying an outcome that actually Australia can afford?
So before it actually recommends to the Minister that this drug should be funded, it’s done that hard work. And in fact, it’s probably more rigorous than a lot of areas in the health system. And I guess the big concern is if there’s now another filter above that ...
RICHARD AEDY: Cabinet?
STEVE HAMBLETON: Cabinet. It slows down the funding for these products. It puts Australia in a difficult position internationally, in that we’re only a small population. And will the drug companies actually bring those new, innovative products here into the country? That’s one issue.
Now of course, there are patients out there who need access to these drugs. And the drugs that we’re concerned about have really been rigorously tested by the committee and the recommendation wasn’t made lightly.
RICHARD AEDY: Well, there - I mean, the advisory committee though, is an advisory committee. It always would’ve gone to Cabinet, I think, before if it was going to cost us more than $10 million. Now, I think it’s on everything.
STEVE HAMBLETON: Well, it is on everything and in fact, interestingly in the past, the ministers have taken the view, well, once I get the recommendation, it’s my job to find the money.
And in fact, in every case, bar I think one or two, the Minister’s actually found the money and approved the product, and brought it onto the Australian market. So this is a kind of an unusual change or a significant change in the way medicines get onto the funded system in this country.
RICHARD AEDY: Just briefly on you, Steve – because I’m sure we’ll talk to you again over the next year – you are, in a way, an old-style GP. You’ve been, essentially, in the same place for 22 years. Isn’t that right?
STEVE HAMBLETON: Yes, I am and, in fact, I’m probably a bit of a mix, in the sense that the medical centre I worked in was a 24-hour medical centre, 22 years ago. In fact, it was 24 hours for about 10 or 12 of those 22 years.
But being in one place for a long time, sort of committing to your suburb or your patients, gives you an enormous amount of benefit in terms of seeing those patients and understanding them properly, understanding their families. I mean, I’ve now seen children grow up. I’ve seen children get married and having their own children. And it’s a unique experience for a family doctor to actually be really involved in families like that.
And I guess the other end of life too, I’ve sat on the side of the bed, holding someone’s hand until their last breath. And I can tell you, that’s really a privilege that, yeah, I hope young doctors can share.
RICHARD AEDY: Good to talk to you; good to meet you, Steve. I’m sure we’ll talk to you again.
STEVE HAMBLETON: Thank you very much.
23 May 2011
CONTACT: John Flannery 02 6270 5477 / 0419 494 761
Geraldine Kurukchi 02 6270 5467 / 0427 209 753
Follow the AMA on Twitter: http://twitter.com/amapresident
