The GPRG held its second meeting for 2004 on the 21st
May in
The GPRG again noted its support for implementation of the 7-tier attendance item restructure, as a means to support high quality general practice care that focuses on the needs of individual patients.
Whilst acknowledging the benefits for
patients of providing incentives for longer consultations, the Minister stated
he is only willing to consider an MBS restructure in a budget-neutral context,
which the GPRG has rejected as unworkable.
The GPRG also sought, and was pleased to
receive, the Minister’s commitment to the ongoing work of AIRWG in reviewing
attendance item structures, including consideration of proposals for indexation,
and rebate structures for aged care and after hours care.
Whilst welcoming the Minister’s statement
concerning implementation of the recommendations of the Red Tape Taskforce for
the PIP and EPC programs, the GPRG requested that the Minister give a firm
timeframe for this process.
The GPRG was pleased with the Minister’s
direction to the Department to finalise arrangements for implementation of
Option 1 (Simplify and Streamline) within six weeks and his commitment to
establish a working group including GP Groups, to develop an implementation
plan by October 2004 to progress reform towards Option 2 (Radical Redesign) as
agreed by all GP Groups at the final Red Tape Steering Group meeting on 27
November 2003.
The GPRG advised the Minister that it
considered the new initiative as currently conceived to be seriously flawed,
with unacceptable levels of red tape for all providers and unrealistic
expectations by the public regarding access to the new items. It considers that
the proposed implementation options are unachievable by 1 July.
In the context that the GPRG considered
implementation of any scheme in the time frame improbable, an alternative model
was suggested.
The GPRG stated that a modified More Allied Health Services (MAHS)
process managed by Divisions, with an agreed timeframe for evaluation of the
initiative to ensure the model is meeting needs of individual practices and patients
may be an acceptable option in the event that other options could not be
achieved by 1 July. It was agreed by the
GPRG that credentialing and registration of allied health professionals under
the program should be administered by the Department of Health & Ageing,
and that indemnity insurance for all participating allied health professionals
was essential.
The Minister agreed to consult the GPRG
regarding the options for implementation to be presented by the Department
within the next week.
Noting concerns about the process
undertaken in WA, the GPRG sought reassurance from the Minister that any
further clinics will have the full and written support of local GPs, through
the local Division.
The Minister confirmed this was the case
and noted that he had advised his State colleagues that agreement with the
Divisions’ State Based Organisations (SBO) in general terms was not sufficient
and that it was up to local GPs through their local Division to work out how
the clinics will operate in their local area. He also stated it was not the
Government’s intention to have junior hospital doctors staffing the clinics.
The GPRG agreed to a set of key principles
related to the establishment of extended hours collocated clinics. The GPRG will write to the Minister advising
these principles, including the need for doctors who work in the clinics to
meet the standards of the RACGP, the need for the clinics to meet the RACGP
standards for general practices, and the need to add value to local general
practice services for the community.
The GPRG sought an update from the
Minister on the arrangements being made for the governance of GPET. The GPRG
advised the Minister that professional responsibility and ownership must be
returned to vocational training for General Practice. The GPRG conveyed to the
Minister the importance of the Chair of GPET being acceptable to the GPRG.
The Minister agreed that GPET should be required
to ensure that functions which interface with the professional colleges and
which are defined by requirements of the AMC are met. The GPRG advised the
Minister that it was keen for the external evaluation of the new general
practice vocational training arrangements to proceed.
The Minister agreed that the profession
would be actively involved in the review of tenders for the external evaluation
of GPET, and that the evaluators would need expertise in medical education. The
GPRG sought appointment of the GPET Board for one year whilst consideration is
given to a new ownership and governance structure for GPET.
The GPRG advised the Minister of the
untenable situation resulting from MedicarePlus that general practice rebates for
veterans’ services had fallen relative to those for standard consultations.
The Minister agreed to look at costings to
restore the differential for DVA rebates in RRMA3-7, but noted that broader
increases would need to be considered as part of next year’s Budget.
The Minister also agreed that the issue of
GP proceduralists warranted consideration in the context of the increased
funding for specialists under the DVA LMO scheme.
The GPRG noted its grave concern, from a
quality and safety perspective, that a trial of pharmacy-based INR testing,
funded under the agreement between the Pharmacy Guild and the federal
government, was going ahead, particularly in light of the significant delays in
rolling out the Point of Care Testing (PoCT) trial in general practice.
The Minister noted the GPRG’s view that
there were significant safety concerns and undertook to seek further
information on the issue.
The GPRG unanimously agreed that the
Australian Government should substantially increase payments for general
practice-based teaching of medical students to a level that encourages GPs and
compensates them for their efforts.
The Minister noted that he had had this
issue raised with him numerous times during a recent tour and he is currently
looking into it.
The GPRG agreed that the allocation for
the GP component of this measure should be commensurate with that amount
provided for other medical specialties, and that relevant colleges should be
directly involved in its implementation.
The Minister noted that the allocation was
an indicative figure for budgeting purposes rather than limit of what could be
spent and some flexibility was possible. If the measure required more resources
to be successful, he would agree to find additional funding. He requested that
the Department look at the issue, and that the relevant Colleges put forward
proposals to develop suitable training packages.
The GPRG requested a list GPPAC projects
and reports and a list of sub-committees and representatives current at the
time of GPPAC de-funding.
The Minister agreed that the Department
should provide this list and that the GPRG should be asked to provide
representatives for any standing committees that have GPPAC representatives.
The AMA agreed to develop guidelines and
schedules for payment of GP representatives on Government and Statutory
Authority committees in consultation with the other GP groups.
The GPRG suggested that the Department
would need to revise its expectations for the program, given the amount of
funding and timeframe for implementation.
The Minister agreed that guidelines for the
program should be as flexible as possible. He also agreed to look at general
practice nurses providing parts of the Comprehensive Health Assessments in aged
care homes, as they do for the current EPC Health Assessments.
The GPRG noted its support for Government funding for
GPRA continuing beyond the current funding term.
The Minister agreed to consider funding the GPRA for
an additional year, on the condition that GPRA develop a plan for generating
income apart from such government support.
Other issues agreed by the
GPRG included:
·
That individual groups would follow up with the Minister on
other key issues arising from the Federal Budget announcements.
·
That members continue to monitor the implementation of the
new arrangements for nationally consistent medical registration and ensure that
doctors’ concerns over privacy are recognised. It also agreed that general
practice should be recognised as a specialty in those jurisdictions that do not
currently do this.
·
That there are a number of complex issues regarding
practice nurse education and support to be addressed, with both short and long
term impact. The GPRG agreed to consider the RACGP/RCNA and ADGP reports and to
discuss a GPRG position at a future meeting.
·
That stakeholders be invited by the GPRG to attend
future GPRG meetings to discuss specific issues only.
·
That the GPRG would continue to support the
implementation of the RDAA’s Viable Models of Rural and Remote Practice
project.
·
That the activity of the Australian Health Care
Alliance be noted and the GPRG continue to monitor its work. An invitation will
be extended to Professor John Dwyer to attend the proposed GP Summit.
CONTACTS:
Kerry Ungerer,
ADGP (02)
6228 0828 / (0412) 424 309
Ronald McCoy, RACGP (0407) 318 911
Patrick Daley,
RDAA (02)
6273 9303 / (0408) 004 890
[1] The General Practice Representative Group (GPRG), consists
of representatives of the Australian Divisions of General Practice (ADGP),
Australian Medical Association (AMA), the