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Grattan Institute ideas detached from reality

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The Grattan Institute report Access all areas: new solutions for GP shortages in rural Australia finds what many other studies have also concluded, that limited access to GP care is leading to worse outcomes for rural Australians.

Well and good, but one wonders just how many such reports have to be produced before much needed meaningful and lasting solutions are enacted by an enlightened Government acting in concert with the profession. The solutions proposed by this report are half-baked, and are likely to only lower standards of care.

Its suggestion that pharmacists could reduce GP workload by taking over some tasks, such as immunisation, is cloud cuckoo land stuff.

GPs invest considerable resources in maintaining a cold chain, and in employing nursing staff to provide vaccinations under supervision. To transfer this service to pharmacists would make the ongoing provision of vaccinations by GPs unviable. Additionally, it would fragment care and record keeping. To justify such a change by arguing that pharmacists need a new source of revenue because of the terms of the PBS agreement re-negotiated by the Federal Government is not a sound reason for putting such theorems forward.

Involving pharmacists in chronic disease management would be a step forward for patients, rural or urban, but only as part of a practice team – not as an independent practitioner. If done in a quality manner, it would likely reduce hospitalisations from both iatrogenic causes and the exacerbation of chronic conditions, and save the Government large sums in PBS expenditure. However, it would require a team approach and increased, not decreased, GP time.

Physicians’ assistants can be a useful adjunct to the practice team, but two major barriers stand to their utilisation. Firstly, the training system is already stretched to capacity coping with the influx of medical students coming through the pipeline. Under current funding restrictions there is just not the room to create a new area of education. Secondly, access to Medicare rebates is restricted to the providing doctor, which militates against the employment of physicians’ assistants.

Furthermore, I have yet to see any evidence that physicians’ assistants would be more cost effective than well-trained rural GPs. I have, however, seen plenty of evidence that independent nurse practitioners are more expensive than GPs.

So, facing reality, these proposals are basically to provide rural Australians with fragmented, lower quality care – most likely at a higher cost.

After all the woeful press about politicians attending the footy, cricket and car racing – as well as the odd wedding – at considerable cost to the public purse, the previous Government’s decision to impose a $2000 cap on tax deductions for self-education expenses seems even a greater nonsense. Its introduction has been delayed until mid-2015, but it must be thrown out. It will, if enacted, hit all rural doctors hard. It is indeed pleasing to see the AMA championing this fight, as well as providing a sound, multifaceted package of workable rural workforce solutions.