President and CEO update October 2022
On 1 October, the urinary tract infection (UTI) prescribing pilot became a permanent fixture of the Queensland health system. On 31 October, the declared public health emergency for COVID-19 expired at midnight and mandatory mask wearing became a thing of the past.
In between, changes to the National Law allowing Ahpra to name and shame doctors under investigation passed the Queensland parliament, the government formally announced its plans for the North Queensland pharmacy prescribing experiment, doctors came under unfounded attacks over alleged Medicare fraud, and the federal budget stripped $2.4 billion from the nation’s public hospitals.
It’s been a busy month but AMA Queensland will continue to work tirelessly for our members and the community for the best health outcomes for all.
Federal budget
The Albanese Government’s first budget delivered little to address the issues affecting Queensland – ambulance ramping, bed access block, elective surgery wait lists and the woeful Medicare rebates for patients to access medical services.
Even worse, the budget cuts $2.4 billion nationally over the next four years from public hospital funding based on state forecasts of fewer hospital services to be delivered in that time.
States have cut their forecasts because they don’t have the staff or the resources to deliver these services. It makes no sense to exacerbate the problem by cutting even more funding and perpetuating a vicious cycle of reduced services.
The federal government will also no longer go 50-50 with the states on COVID-related public hospital costs from the end of this year.
Our hospitals were already under pressure before COVID, but almost three years of pandemic has stretched our healthcare workforce to breaking point.
This pandemic is not over.
We had hoped that having the same party in power federally and in the state would make it easier for both levels of government to resolve these funding issues. We were wrong.
We will continue to campaign fiercely to increase funding for our hospitals, to reform Medicare and to support our rural and regional workforce.
Read more about:
North Queensland pharmacy trial
We remain opposed to the state government’s decision to push ahead with its dangerous plan to allow retail pharmacists in North Queensland to diagnose and prescribe for a range of serious medical conditions.
The government has confirmed the North Queensland pharmacy trial will go ahead. However, our advocacy successfully delayed its commencement by more than 12 months and reduced the number of conditions from the original 23 to 17.
We have not given up. This dangerous experiment shows a blatant disregard for patient safety and will do nothing to reduce the pressure on general practice, hospitals or ambulances.
This trial goes against the independent, unbiased, evidence-based advice from the Therapeutic Goods Administration (TGA) about who can prescribe and access medication, and research into patient safety.
We have met with the Office of the Health Ombudsman (OHO) to raise our concerns about the lack of reporting mechanisms for patients who were harmed by the urinary tract infection (UTI) prescribing pilot that was the basis for the North Queensland trial.
Doctors can be reluctant to report patient harm and have told us they lack understanding about reporting pathways. The OHO acknowledged the importance of providing information on its role in dealing with health service complaints.
Read more about our response to the trial’s announcement.
Medicare
We were disappointed to see three respected media outlets - the ABC, The Sydney Morning Herald and The Age - making unverified claims about alleged Medicare fraud.
Members are rightly upset by this. GPs have been on the frontline of the COVID response for almost three years – treating patients, delivering vaccines and keeping people out of hospital. They’re fatigued and burnt out.
We know that every cent of health funding is precious and if anyone is rorting the system, they should be identified and penalised.
However, we have seen no evidence to back the claims of $8 billion a year in fraud.
Medicare is no longer fit for purpose. The patient rebates go nowhere near the cost of providing quality health care and it is time to overhaul the entire system. That’s why we’ve joined a federal taskforce to reform Medicare.
Read Dr Maria Boulton’s interview with ABC Sunshine Coast
Regional workforce
In October we travelled to Rockhampton and Gladstone to hear firsthand from doctors and patients about the strained medical system in Central Queensland.
The Gladstone Hospital maternity unit has been on bypass for months, meaning that women in labour have to travel to Rockhampton or further to give birth.
The phased reopening of the maternity unit, beginning with elective caesareans from mid-October, is welcome but does not resolve the ongoing issues facing patients, doctors, nurses and midwives in the region.
The patient stories were shocking – a family with a woman in labour who drove from Biloela to Gladstone, only to be told to keep driving to Rockhampton; a new mother who was given the option of a 90-minute ambulance trip without her baby to wait in the Rockhampton ED to be stitched, or wait until 7am when the suturing-qualified midwife came on shift.
The staff stories were just as disturbing – no junior doctors, consultants doing the work of two to three people while also being on call, working 30-hour shifts with a four-hour break, no locums, no respite. Our international medical graduates (IMGs) feel abandoned and Australian-trained doctors warn they will walk away.
We warned back in 2018 when Queensland Health purchased the Mater Private Hospital in Gladstone that it would lead to the end of private obstetrics in the region. Sadly, we were right.
We are facing a global shortfall of 15 million healthcare workers by 2030.
It is clear we need real action in Queensland. We need a real investment in healthcare services and staff. We need to grow our own medical workforce, and we need to treat our international medical graduates better.
Read more:
Voluntary patient enrolment
AMA Queensland and our state and national counterparts have been actively engaging with governments at all levels to drive whole-of-healthcare reform for primary care, particularly Medicare rebate reform to ensure longer, more complex consultations attract rebates that reflect the extra resourcing involved.
We believe this should always be delivered through a fee-for-service Medicare model.
The current Medicare funding model is not fit for purpose. Appropriately indexing the rebates is absolutely essential for general practice. GPs deliver 180 million services each year. Increasing each of those by $10 will cost $1.8 billion.
Implementing voluntary patient enrolment (VPE) is among the reforms recommended in the Australian Government’s Primary Health Care 10-Year Plan 2022-2032.
VPE is not capitation, in which the healthcare provider receives a set payment for every patient attributed to them, regardless of the number of times the patient seeks care. The AMA does not and will not support a move to capitation.
Voluntary patient enrolment with a GP or practice establishes a formal relationship with the patient, providing a basis for shared goals and outcomes. This in turn provides a framework for funding reform that rewards continuity of care. For example, chronic disease management plans and health assessments would be linked to these relationships.
This funding is in addition to, not instead of, Medicare fee for service.
The AMA supports VPE, provided it is designed appropriately, strengthens the position of general practice in our health system, and provides a basis for government to deliver extra investment into general practice.
We will oppose any initiatives that do not increase funding into general practice.
Read our member update.
Ramping
Ambulance ramping continues to be a concern, with Queensland recording the worst statistics in the nation according to figures released in early October.
The figures, from the height of the COVID pandemic in July, showed 73 per cent of patients at Redland Hospital and 66 per cent at Logan Hospital were ramped for more than 30 minutes.
At the time, we had hundreds of COVID patients in hospital and thousands of staff furloughed either with COVID or as close contacts.
However, we have seen little sign of improvement and will continue to pursue our Ramping Roundtable’s five-point action plan to reduce stress on all areas of our hospitals, from emergency departments to other wards and the discharge process.
Read Dr Maria Boulton’s interview on Sunrise.
Women in Medicine
It was a pleasure to attend our sold-out Women in Medicine Breakfast with 240 keen attendees, including babies.
Read Dr Boulton’s speech and check out the photo gallery