The Year of the GP?
Buoyed by the Coalition’s pre-election commitment that general practice would remain the cornerstone and leader of primary care in Australia, my predecessor Dr Steve Hambleton declared last year that 2014 would be the year of the GP – and, on the evidence at the time, he had every right to say so.
And there was no need to doubt that commitment in the early part of this year.
In March, Health Minister Peter Dutton told GP registrars – the next generation of GPs – that:
I can say unequivocally that general practice will be at the front and centre of our plan. The Australian Government is committed to rebuilding general practice and putting GPs back at the centre of our health care system.
It wasn’t long before things started to unfold, with the Federal Budget in May unleashing a torrent of attacks on general practice.
There had been warning signs just weeks earlier when the Government released the Commission of Audit report, and certain commentators had been promoting GP co-payments since before Christmas 2013 – but nobody expected the massive cuts and changes to primary care in the Budget.
There was the $7 co-payment for GP services.
There were new co-payments for pathology and radiology.
There was permission for States to charge co-payments for emergency departments.
There were higher co-payments for medicines.
There was the $5 cut to Medicare patient rebates.
And MBS patient rebates for specialist services were frozen.
On top of this, there were cuts to Indigenous health services.
The Government is also reducing public hospital funding by $1.8 billion over the next four years, and reneging on the guarantee of $16.4 billion additional funding under the National Health Reform Agreement over the next five years.
All of these acts will have a devastating negative effect on primary care. They will hurt GPs and their patients.
And now, in the past week, we have seen extraordinary mismanagement of the arrangements for GPs to conduct health assessments.
First there was a statement from the Department of Human Services declaring that GPs could no longer count the time spent by their practice nurses in completing health assessments – an accepted practice since 2010.
Then the Department of Health issued a clarification that was not a clarification, with the result that general practices were unsure of what they could do when processing health assessments, practice nurses were left wondering if they would still have jobs, and vulnerable patients such as the elderly, children, and the disabled had their access to quality primary care threatened by bureaucratic bungling.
The AMA stood firm in its calls on the Government and the Department to sort out this mess – and with results. There will be a meeting later this week to produce sound unequivocal advice on health assessments.
But how did we get to this? This is supposed to be the year of the GP. Maybe it is – but for all the wrong reasons. It is GP Apocalypse Now!
There is some light, however.
When I met recently with Prime Minister Tony Abbott, I believe he saw the wisdom of the AMA’s ways in opposing the GP co-payment and other measures as proposed by the Government.
The PM’s political antennae could detect the harm to vulnerable people in the community, especially the elderly, the disadvantaged, the chronically ill, and Indigenous Australians.
Within 48 hours, the Government publicly acknowledged they should revisit the co-payment for people in aged care.
The Prime Minister has asked us to come back to the Government with some other changes – changes that could possibly make some of the Budget reforms palatable to the AMA and the community.
There are no guarantees, but it is a start.
The Government is in no doubt that the AMA is totally opposed to the proposed co-payments as they stand.
We still have six months in 2014 to go. Our aim is to still make this year the Year of the GP, but for all right reasons.