Issue 20 / 6 June 2011

IT is a great honour to be elected federal president of the AMA, and somewhat humbling to assume this important position unopposed.

It was also a great privilege and learning experience to serve as vice-president to my friend and colleague, Dr Andrew Pesce. Andrew led the AMA strongly through a period of frenzied attempts at health reform and interesting politics, resulting in a minority federal government and a health reform process that is stalled, to say the least.

There is a lot of unfinished business in health reform and I will use my term as president to bring a lot of this to fruition in a way that provides the greatest benefits to patients, the community and the medical profession.

I have a good working relationship with the government and with the Health Minister Nicola Roxon; likewise, the Opposition and Shadow Health Minister Peter Dutton. Both sides know that I am an honest broker — I will go public in my support for good policy and I will openly criticise bad or ill informed policy.

Both sides know that meaningful discussion with the AMA and the profession — before policy is developed and implemented — is all-important. Everybody knows how badly the government’s diabetes and mental health reforms have been received in medical circles —because it was policy first, talk later. Wrong approach.

A priority, of course, will be primary care. This is where there is so much unfinished business, or business underway that is poorly designed or wrongly targeted. Just look at Medicare Locals, GP super clinics and, more broadly, the messy introduction of the new national registration processes and structures.

There is a lot of new bureaucracy but little evidence of new or improved care getting through to patients and communities. There is confusion, waste and unnecessary competition with existing general practices.

Health reform is “taking away” from general practice at the very time it should be supporting and strengthening it. Patients want access to doctors — simple. It is what they need, expect and deserve.

It is little wonder that morale is low among GPs at the moment. They are the engine room of primary care.

There is unfinished business in the hospital sector as well.

While the AMA has been broadly supportive of the government’s new funding arrangements for public hospitals, which includes more than $16 billion of additional funding to 2020, so far that is about all we have achieved — a new way of financing.

Despite the injection of this significant new funding into public hospitals we are yet to see a dividend from this investment. The most recent hospital statistics show that things are steady, not really improving; not getting worse, but not getting better.

It is time now to see some practical changes on the ground. We need to see some positive patient outcomes from every one of those substantial new health dollars for hospitals.

It is a challenge for all governments to make the Council of Australian Governments (COAG) reforms work. It is my job — the AMA’s job — to keep the community informed about how the reforms are working, and letting people know if they are getting better access to quality hospital services.

Again, the government must keep doctors in leadership roles in both primary care and the hospitals.

Medicare Locals and local hospital networks will fail if doctors are not directly involved in their planning and ongoing management and decision making.

Our hospitals need more doctors and more beds, not new bureaucracies and bureaucrats. Our towns and suburbs need more GPs, not GP “substitutes”.

It is my intention to stay engaged with the government to ensure we get successful business outcomes from health reform — but I do not intend to be a silent business partner if the reforms keep going in the wrong direction.

There is a lot of unfinished business.

Dr Steve Hambleton is the president of the AMA.

Posted 6 June 2011

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