President and CEO update - October 2023

There has been intense media interest in the impending closure of private maternity services in Cairns, the opening of the latest urgent care clinics in Queensland, and changes to Medicare benefits from 1 November.

AMA Fees List 

The latest AMA Fees list takes effect from 1 November. You may have seen media coverage around the increase in the Level B (Item 23) GP consultation to $102. This reflects the impact on general practice of long-running COVID, additional costs of PPE and training, increases in time for staff to perform functions, and changed business practices and patient time/complexity. 

The AMA has published the Fees List since 1974 to provide costing assistance and guidance for members. The List took on a greater importance as Medicare rebates stopped keeping pace with the cost of providing medical care. It is a guide only and all members can adapt its recommendations to suit their individual practice needs. 

The Medicare rebate for Item 23 also increases on 1 November – by 20 cents. The tripling of the bulk billing incentive for certain patients also begins then. There has been some confusion in the community as to what this actually means, and some misrepresentations stating that it is the rebate and not the bulk billing incentive that is being tripled.  

We have developed a suite of resources for practices to explain the changes to patients. 

See the bulk-billing resources

Urgent care clinics and satellite hospitals 

The fourth of Queensland’s promised 11 federally-funded urgent care clinics has opened. At the same time, the state government has released initial figures about presentations at its two new satellite hospitals. 

While we welcome all investments into primary care and efforts to ease the pressure on our public hospital emergency departments, we cannot see either of these projects having the desired effect. 

At least two of the urgent care clinics are still not open for the full advertised extended hours, raising questions about workforce availability and whether extra Medicare funds are best spent on a handful of clinics in a few areas or on improving access to GPs for all Queenslanders. 

The satellite hospitals’ openings have seen a drop in Category 4 and 5 presentations to nearby hospitals. However, our ED colleagues tell us that these low acuity presentations are not the reason EDs are overcrowded or ambulance ramping is occurring – it is because there are no ward beds to admit patients to. 

As we head into an election year, we will be working closely with both sides of politics on real solutions to the challenges facing our healthcare system. 

Medicare rebates need boost

GP clinic closures can't continue  

Vaping and liquid nicotine 

We continue to advocate for both levels of government to respond to the rise of vaping, particularly amongst children and adolescents.  

It is important that liquid nicotine prescribing remains under medical oversight. Smoking cessation is one of the conditions listed for pharmacist prescribing under the North Queensland – now statewide – pilot. 

However, no vaping product has been approved for use in Australia as a quit aid, and the federal government has made liquid nicotine a prescription-only medication. 

State governments have the power to allow non-medical practitioners to prescribe certain scheduled medications. We are urging our government to keep this highly addictive substance as one that can only be prescribed by a medical practitioner. 

GPs have no financial incentive to prescribe liquid nicotine, as they do not sell it. However, we have seen Big Tobacco offer lucrative incentives to pharmacists to stock their vaping products and “spotter’s fees” for referring customers to GPs for prescriptions. 

The long-term effect of vaping on the lungs is still unclear and we must do all we can to restrict growth in this new addiction. 

Restrict vape prescribing to doctors  

Vaping crisis needs national approach

Pharmacy prescribing 

GPs may receive a letter from someone purporting to be your trusted pharmacist colleague about 60-day dispensing. 

These letters are part of a campaign from a group called CAPS, which claims to be an independent pharmacy lobby group not associated with the Pharmacy Guild of Australia. 

CAPS remains opposed to 60-day dispensing, while the Guild has shelved its campaign against this new program as it negotiates the eighth community pharmacy agreement with the federal government. 

We encourage you to ignore any correspondence from CAPS. This group does not speak with any authority. Its decision to post photos online of patient prescriptions may be a breach of privacy. These actions have not been endorsed by any recognised pharmacy peak organisations. 

Details of how 60-day prescribing works are available here. 

Letter from CAPS? Ignore it

Telehealth red tape 

The AMA has received assurances from federal Health Minister Mark Butler that his department will address concerns about outdated regulations around patient consent for telehealth services. 

Throughout the pandemic, the Department of Health and Services Australia allowed verbal consent for telehealth consults to be documented in a patient’s clinical notes. However, Services Australia has published fresh advice after concerns this practical approach did not meet the technical requirements of the Health Insurance Act. 

Minister Butler issued the following statement on 6 October following a meeting with AMA Vice President Dr Danielle McMullen. 

“I have asked my department to provide options to address concerns about the assignment of benefit for Medicare bulk billed claims, including legislative amendments. My department has advised me that until these changes are made, there are no plans to pursue any broad punitive actions on this issue unless it relates to fraudulent claims against Medicare.” 

The AMA will keep members informed about work in this area, recognising the potential for the current interpretation to impact on access to care for patients and add unnecessary complexity to the day to day work of doctors. 

AMA receives key assurances on telehealth red tape  

Payroll tax 

We remind members that expressions of interest for the Queensland Revenue Office’s GP payroll tax amnesty are due Friday 10 November 2023. 

The QRO also published an updated payroll tax public ruling for medical centres on 19 September 2023. 

We are continuing to work with our federal and state colleagues as other jurisdictions also begin to implement this new interpretation of tax laws. Queensland was the first state to win an amnesty and a halt to retrospective audits for eligible general practices. 

AMA Queensland hosted a payroll tax webinar on 24 October. If you could not attend, you can watch the recorded webinar. 

All medical practices are urged to seek updated professional advice about how the ruling impacts their business. General practices should also consult their advisors about whether to apply for the amnesty in time to meet the 10 November deadline. 

Find out more about the Queensland Revenue Office's payroll tax amnesty. 

Maternity care 

We have urged Health Minister Shannon Fentiman to urgently intervene to allow private specialists access to care for their patients in public hospitals. 

The Cairns and Hinterland Hospital and Health Service has rebuffed an offer by two private obstetricians to treat public patients in return for being able to birth their private patients in public hospitals when the local private maternity unit closes on 1 November. 

We have welcomed many of the moves Minister Fentiman has made towards resolving regional workforce shortages, including more training places for GP obstetricians and a digital passport to make it easier for doctors to work across different HHSs. 

We have asked her to step in and stop individual HHSs from blocking private specialists from practising in public hospitals. 

Metro North Health has effectively blocked private obstetricians from practising at the Royal Brisbane and Women’s Hospital since early 2022. 

This must be considered as part of Queensland Health’s Women and Girls Health Strategy. Women must be given real choice around birth models. 

Private specialists must have access to public hospitals  

Vale Dr Russell Stitz AM RFD 

It is with much sadness that we advise of the passing of AMA Queensland Past President, friend, and colleague, Dr Russell Stitz AM RFD. 

Dr Stitz was AMA Queensland President from 2002-03 and a member for 52 years. He was farewelled in a private ceremony. 

Renewals 

It has been our honour and privilege to work hard for members over the past year. 

Keep an eye out for your renewal notice, which you should receive via email in coming weeks. 

We cannot do our work without your support and we thank you for your valuable and continuing contribution.