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EVEN though voters consistently place health high on their list of important issues, both sides of the political divide somehow managed to dodge the issue in the recent election campaign.
“Voting for change” and “6-point plans” seemed to grab the media’s attention rather than health.
In the hope that new Prime Minister Tony Abbott and new Health Minister Peter Dutton read MJA InSight, here is my 6-point plan for health change:
1. Change our approach to Indigenous health
Whatever we’re doing now is plainly not good enough. Programs are disjointed, lack penetration and are often bogged down for several reasons, including lack of funds, geography, politics and red tape. Many health professionals lack cultural awareness and experience in Indigenous health and therefore miss opportunities to intervene.
Given Tony Abbott’s zeal to address Indigenous disadvantage, I want to again suggest a free and open model of Medicare for Indigenous people based on the Department of Veterans’ Affairs system. No matter what it costs, the results will be worthwhile.
2. Change our medical schools
There are too many schools and too many students. The quality of training and clinical experience is being diluted as students and junior doctors trip over each other for access to patients and hands-on training.
Politicians have been overly ambitious in hurriedly opening medical schools before knowing if suitable teachers and clinical placements are available. A minimum standard must be enforced for graduates and for international medical practitioners.
It is time to consolidate some medical schools and introduce some common exams with minimum pass marks.
3. Change red tape
We have too much bureaucracy and too many forms to fill out. The compliance costs — in terms of time and money — of being a doctor have reached the point where the good intentions of regulators are being offset by hindrance and inefficiencies in clinical care. We seem to spend 1 minute doing something and 5 minutes writing about it. Patients don’t get better by having a form filled in. Consolidation is needed here too.
4. Change the regulator
One of the greatest failures of the Rudd–Gillard government was the process to streamline national registration by creating the Australian Health Practitioners Regulation Agency (AHPRA), which has increased red tape and considerably raised the cost of registration.
NSW has not adopted the AHPRA complaints system, Queensland has rejected it in parts and Victoria is holding an inquiry into AHPRA. A diverse group of health and allied health professionals has been lumped together under the one organisation, even though the needs and roles of the individual groups are so varied.
It was bound to fail, is failing and needs change.
5. Change Medicare Locals
When he was Opposition health spokesman Peter Dutton promised to scrap them, and then Tony Abbott stated in a live televised debate that he would not close them. Not closing them does not mean not changing them.
Many Medicare Locals still struggle to define themselves and funding seems to be based on projects and timelines, which favour “project officers” and “program co-ordinators”. Many of these programs come from on high, making the “local” a misnomer. There is also a feeling of insufficient leadership and representation by GPs.
The management of after-hours funding remains contentious, especially in rural areas. Medicare Locals should be high on the new government’s agenda for change, as we cannot afford small rural towns to lose their after-hours cover.
6. Change e-health
The profession has not embraced the National E-Health Transition Authority or the personally controlled e-health record. Part of this failure is poor communication from the government and ongoing suspicion about privacy and intellectual property issues.
Another big reason for the lack of engagement is that practices are already overwhelmed with the administrative burden of running a viable e-health-based practice. We need to step back. Many doctors still have not come to terms with electronic prescribing and medical record keeping.
The change of government brings with it an opportunity to listen to health experts — practising doctors — about how to improve medicine for patients and the profession, and to begin a program of positive change.
Dr Aniello Iannuzzi is a GP practising in Coonabarabran, NSW.
The points are well taken. Not only AHPRA but Medical Board of Australia (MBA), its staff, as well as the legislation AHPRA Act 2009 need to be reviewed, to be accountable, represent the patient’s view, where the patient is not vexatious, frivolous, unfounded or misrepresenting issues, and pay compensation to having taken up vexatious claims at great cost to practitioners, financial, professional and emotional. MBA and AHPRA are self serving. Mandatory reporting puts more power into the hands of the regulators who are above accountability. There is conspiracy/collusion/subjective view between the MBA/AHPRA and Tribunals and Courts. There is no justice, something that affects health and which needs to be addressed. Undoubtedly Australia is over regulated by bureaucrats whose job is to design forms. This is not good for health, financial, emotional or creative and needs to be accountable, validated as good for society or not, by introducing “a System of Evaluated Decisions” applicable to all agencies of government, so that what is going on can be critically appraised as in being society’s interests or not, and be dropped or installed, monitored and revised.Myers JB. Is The Future Direction in Health About Bureaucratic Self Interest or Creativity, Professionalism and Wellbeing? Rights and Responsibility Must Replace Quality And Safety In Health Care. RACP Future Directions in Health Congress. Perth, Australia 26-29 May 2013.
Since Peter Dutton has decided not to dismantle MLs, for reasons unclear to me, I would advise him to do some restructuring of the ML Board. As it stands, from my knowledge, GPs cannot constitute >49% of the ML Board.
If GPs are to remain the lynchpins of Primary Health Care, then there needs to be a stipulation that ML Board has to have a minimum of 60% representation. Otherwise, the voice of the GP will remain a voice in the wilderness.
The GP voice was dominant in the Divisions of GPs & I firmly believe that the MLs were formed with the main purpose of stifling the GP voice. The Labor Health Minister did not hide her contempt for GPs.
If Peter Dutton truely believes that GPs ought to be the lynchpins of Primary Health Care, around whom all Allied Health Professionals should revolve, then he will ensure that GPs have a strong Voice in the ML Boards.
Great suggestion for Indigenous Health, Aniello. So much of that red tape seems to be about complicance rather than performance. Let’s try looking more at outcomes than at processes.
Good on you Dr Iannuzzi. Your 6 point plan will resonate with many doctors. Hopefully someone from the AMA will email it to the Federal Minister for Health.
Congratulations on a realistic statement of urgent problems — in particular, the AHPRA mess. Somehow it turned courteous collegial registration matters into expensively negative confrontational nonsense, with little benefit to be seen. It needs a clean-up!
I endorse all of your 6 points and wish that these would reach the eyes and ears of Peter Dutton and the Prime Minister since they are valid with little cost implications overall.The funding for Aboriginal health based on the system used for Veterans Affairs system makes good sense as does the reduction in the number of Medical Schools and the excessive red tape.