27 March 2019

Is the consulting room the right place for politics?

General Practice Political TheHill

You can’t half tell we’re gearing up for a federal election.

Almost every day now we see a new media release or public statement from some representative group trying to put the interests of their members on the agenda in the upcoming political battle for power.

Spokespeople for farmers, teachers, anti-terrorism activists and environmentalists have already put their hand up to say they are worthy of political attention even before the actual date of the election has been announced.

So, it is hardly surprising that the doctor groups have started upping the ante.

Within the space of 24 hours we’ve had a media statement from the President of the AMA, Dr Tony Bartone, calling for an end to the 20-year freeze on Medicare rebates for pathology services (sounds very worthy – I had no idea pathology rebates had remained unchanged for more than 20 years) and then we had the media release from the RACGP calling for bipartisan commitment to properly fund primary healthcare.

There is absolutely no question we need to shore up political support to improve the viability of Australian general practice.

And all the key issues raised by the RACGP – the need for improved technology in primary care, increase in GP rebates, support for mental health care provision and recognition of complex care delivery – are very valid and worthwhile.

I doubt any GP will have an issue with the RACGP’s goal of getting these topics in the spotlight.

The issue will be (and is already) the proposed means of achieving this.

In the accompanying video statement, RACGP president Dr Harry Nespolon urges GPs to talk to patients about the importance of general practice.

“I’m asking you to talk to one of the two million people who will come and visit GPs this week about the importance of general practice.”

We are being urged to use the consultation room to garner support for our cause.

Is this really appropriate?

I’m not sure our specialty’s political agenda really should get a guernsey in our 15-minute focus our the patient’s health.

And where’s the evidence that would be an effective strategy anyway? Similarly, Dr Nespolon also announces in the video yet another ad campaign from the RACGP directed at patients.

Regardless of whether or not you were a fan of the “specialist in life” campaign, seen on the side of buses, in airports and in key advertising time slots on television, surely you’d want to see some evidence that the RACGP’s previous foray into this world of garnering public support was effective.

In an interview with Australian Doctor, Dr Nespolon is quoted as saying: “The reality is that over the last five or six years, we have not been particularly active, and we have seen the result in things like the freeze, PIP payments disappearing.”

Not particularly active? Really? I can imagine that raised a few hackles. Especially among those in the RACGP who set up the office in Canberra for the express purpose of improving political lobbying power and access.

If you think I’m being overly critical, you are probably right. It is very easy to sit back and claim a sense of déjà vu toward all these proposals without offering anything constructive as an alternative. If not ad campaigns and accosting patients – then what?

What I 100% agree with is Dr Nespolon’s aspiration for the RACGP to wield the same political influence as the Pharmacy Guild of Australia.

Codeine rescheduling aside, the Pharmacy Guild is widely recognised as one of the most successful lobby groups in Australia.

It would be just common sense to at least look at how this group operates and what methods it employs to achieve this influence.

Dr Nespolon claims the guild had been “very effective” at mobilising members in its political campaigns.

That may be so, but I’m yet to see their glossy ads extolling the virtues of the all-knowing chemist. And I have never been treated to a lecture on the importance of pharmacy when collecting my prescribed medications.

Cleverer brains than mine have attributed the lobby group’s success to key political connections and alliances.

At last year’s GP18 conference, leader of the Greens, Senator Richard di Natale, described the important five-yearly Community Pharmacy Agreements, that determined funding and conditions for community pharmacists, as “backroom deals” that were “negotiated on the back of an envelope”.

The key point here is not the lack of transparency (which should not be an aspiration) but the fact that the lobbying is very targeted. There are not auditoriums filled with outraged professionals or petitions signed by thousands of geared-up consumers, but rather small, quiet meetings with key individuals who can influence change.

In a Sydney Morning Herald analysis piece back in 2015, the guild’s communications manager, Greg Turnbull, said: “One of the secrets of effective lobbying is not to talk about it too much in public.”

Interesting, don’t you think?

I honestly support all the doctor groups’ efforts in getting primary care on the political agenda for the upcoming federal election. And I honestly believe Dr Nespolon has the best interests of the GPs he represents at heart.

We just need the means to achieve this goal to be justifiable and evidence-based.

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5 Comments on "Is the consulting room the right place for politics?"

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Tatiana Cimpoesu
1 year 4 months ago

We all need to join in to point out the obvious: prevention is better than cure and general practice is the best value for money in health care!

Peter Barry
Peter Barry
1 year 4 months ago
The one thing that terrifies the government is the idea of GPs charging everyone or most patients a gap payment. Once they perceive that the GPs are determined to implement this for the majority of patients they suddenly see a need to negotiate. Otherwise they just see us as patsies they can dump on. The attempt in 2014 to force a gap payment for non-pensioners and to change the level 3 vs 23 definitions was withdrawn hours before it was to be implemented once the health minister and his minions discovered it would lead to a rejection of bulk billing… Read more »
Max Kamien
Max Kamien
1 year 4 months ago

1. Only lobby in marginal seats.
2. Put short notices in the waiting room. If you want, your GP can enlarge on this.
3. Few patients have a clue on what they should expect from their GP or on the politics of funding.
4. With a bit of luck, 1/100 will act on it.

Dr Lou Lewis
Dr Lou Lewis
1 year 4 months ago
Linda, I totally disagree with the president of the RACGP regarding his suggestions for GPs turning their consultation into a political forum. The pharmacists, with the support of their representatives. can lobby customers but they are in the business of selling products not prescribing medications for people who have medical complaints and are very vulnerable during a consultation. As an example I treat a lot of members of the Mormon community yet never has one turned the consultation into a religious debate. They understand that a consultation is not the appropriate setting to discuss their religion and try and convert… Read more »
Dr Evan Ackermann
Dr Evan Ackermann
1 year 4 months ago

Great article Linda – but can I tell you a true story.
Many years ago, when jobs were tight – the AMA (no disclosure where) interviewed a high profile left wing activist for a high profile job at the said AMA.
The applicant was asked why she thought political bodies feared the AMA – her reply was that doctors talk to patients day in day out of every week. Politicians cannot get that sort of access and exposure.
Just a thought.