The AMA has handed the government a list of short-term demands for general practice to settle before the next election, warning GPs have been victims of lip service and policy mistakes for too long.
AMA President Dr Tony Bartone told The Medical Republic that the proposals, submitted in writing to Health Minister Greg Hunt several weeks ago, were simple, straightforward and would not break the budget.
“This is only the entrée,” he said, adding that the response would serve as an indication of the government’s “good faith” in longer-term structural reform of general practice.
Dr Bartone outlined the plan in a televised address at the National Press Club, in which he declared there was “something really crook” about the treatment of GPs by successive governments.
“They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs.”
“We’ve seen too many mistakes. Too many policy errors,” he said in the luncheon address to journalists.
The reform plan, focusing on continuity of care, would require “significant changes” in chronic disease management funding and removing obstacles to GPs referring patients to allied health services.
He emphasised the need for funding to recognise GPs’ non face-to-face work in caring for patients with chronic and complex disease and extra money for coordinating the care of chronic disease patients at risk of unplanned hospital admission.
The AMA’s plan would take the best elements of the “medical home” concept and adapt them to the Australian context, he said.
Dr Bartone delivered a blunt assessment of the government’s floundering Health Care Homes trial, once hailed as a revolutionary reform for managing chronic and complex disease.
“Despite the government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients,” he said.
“Instead of real investment, the trial largely shifted existing buckets of money around.
“It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.
“There is no doubt that the challenge of transforming general practice was severely underestimated by policy makers. At least with this model.”
Speaking to TMR, the Melbourne GP said he expected implementation of the proposals could be finalised by the time of the government’s Mid-Year Economic and Fiscal Outlook.
The budget update is usually delivered in December-January.
Adopting a model for GP-coordinated care of chronic -disease patients at risk of hospitalisation, based on the one operated by the Department of Veterans Affairs, could be done “at flick of a switch”, he said.
Dr Bartone said he was not interested in haggling over the proposals, which he said would pay dividends in savings over the longer term.
“This is an absolute minimum,” he said. “I am not interested in two-bit measures.
“We can do so much more to relieve the bottlenecks in other parts of the system.”
New funding arrangements should also reflect the fact that unpaid non-face-to-face work could account for up to 30% of the time GPs spend on caring for some patients.
The list of demands includes better access to GP care for patients in residential aged care and indexation of block funding to support employment of nurses and allied health professionals in general practice.
A mooted redesign of Medicare to reward GPs for continuity of care did not necessarily need a new MBS item number, Dr Bartone said.
On aged care, he said it was “scary” that new research showed that GPs were being forced to cut visits to patients in residential facilities because of time and cost pressures.
In the longer term, Dr Bartone said general practice would need to embrace a more blended funding model to increase capacity for dealing with chronic disease, while keeping fee-for-service at the core.
“It is about scaling up our GP-led, patient-centred multidisciplinary practice teams…” he said.
“We cannot continue to do things the way we always have.”