AMA President Dr Tony Bartone has used an address to the National Press Club to salute Australia’s general practitioners, and to call for significant reform of primary care.

In his first major speech since being elected in May, Dr Bartone said the challenge of transforming general practice was severely underestimated by the nation’s policy makers.

He said the AMA has a plan, but it is one which will require upfront and meaningful new investment, in anticipation of long-term savings in downstream health costs.

Delivering the nationally televised address during Family Doctor Week in July, Dr Bartone said his overarching concern as a GP himself has always been the patient journey and ensuring that people get the right care at the right time in the right place by the right practitioner.

“The priorities for me are always universal access to care, and affordability,” he said.

“GPs of Australia, I salute you. We all salute you. Your hard work and dedication is highly valued. The AMA will always support you and promote you.”

But he described there being “something really crook” about how GPs have been treated by successive Governments.

“They have paid lip service to the critical role GPs play in our health system, often borne out of ignorance and often in a misguided attempt to control costs,” Dr Bartone said.

“General practice has been the target of continual funding cuts over many years. These cuts have systematically eaten away at the capacity of general practice to deliver the highest quality care for our patients. They threaten the viability of many practices.”

The AMA President said Australia has seen too many poor decisions and mistakes in health policy.

General practice must be put front and centre in future health policy development.

“Despite the Government’s best intentions – and lots of goodwill within the profession – the Health Care Homes trial and implementation failed to win the support of GPs or patients,” Dr Bartone said.

“Instead of real investment, the trial largely shifted existing buckets of money around. It has fallen well short of its practice enrolment targets, and it looks like only a small fraction of the targeted 65,000 patients will sign up.

“But general practice still needs transformation and rejuvenation to meet growing patient demand and to keep GPs working in general practice.”

Dr Bartone outlined the AMA’s plan for general practice, which included in the short term: 

• significant changes to chronic disease funding, including a process that strengthens the relationship between a patient and their usual GP, and encourages continuity of care;
• cutting the bureaucracy that makes it difficult for GPs to refer patients to allied health services;
• formal recognition in GP funding arrangements of the significant non-face-to-face workload involved in caring for patients with complex and chronic disease;
• additional funding to support enhanced care coordination for those patients with chronic disease who are at risk of unplanned hospital admission – a similar model to the Coordinated Veterans Care Program funded by the Department of Veterans Affairs;
• a properly funded Quality Improvement Incentive under the Practice Incentive Program – the PIP;
• changes to Medicare that improve access to after-hours GP care through a patient’s usual general practice;
• support for patients with chronic wounds to access best practice wound care through their general practice;
• better access to GP care for patients in residential aged care; and
• annual indexation of current block funding streams that have not changed for many years – including those that provide funding to support the employment of nursing and allied health professionals in general practice.

“In the longer term, we need to look at moving to a more blended model of funding for general practice,” he said.

“While retaining our proven fee-for-service model at its core, the new funding model must have an increased emphasis on other funding streams, which are designed to support a high performing primary care system.

“This will allow for increasing the capability and improving the infrastructure supporting general practice to allow it to become the real engine room of our health system.

“It is about scaling up our GP-led patient-centred multidisciplinary practice teams to better provide the envelope of health care around the patient in their journey through the health system.”

On public hospitals, Dr Bartone said a better plan was needed.

Instead of helping the hospitals improve safety and quality, Governments decided to financially punish hospitals for poor safety events.

“There is no evidence to show that financial penalties work,” he said.

“Public hospitals are a critical part of our health system. They are highly visible. They are greatly loved institutions in the community. They are vote changers.

“The doctors, nurses, and other staff who work in our public hospitals are some of the most skilled in the world…

“Despite their importance, and despite our reliance on our hospitals to save lives and improve quality of life, they have been chronically underfunded for too long.

“Between 2010-11 and 2015-16, average annual real growth in Federal Government recurrent funding for public hospitals has been virtually stagnant – a mere 2.8 per cent.

“The AMA welcomes that, between 2014-15 and 2015-16, the Federal Government boosted its recurrent public hospital expenditure by 8.4 per cent.

“But a one-off modest boost from a very low base is not enough.” 

Dr Bartone called on the major political parties to boost funding for public hospitals beyond that which is outlined in the next agreement.

There must be a plan to lift public hospitals out of their current funding crisis, which is putting doctors and patients at risk.

And Governments must stop penalising hospitals for adverse patient safety events, he said.

The wide-ranging Press Club address also went to aged care, with Dr Bartone describing it as “one of the highest profile segments of the health system – but for all the wrong reasons”.

He added that aged care was now emerging as an area in need of significant reform as the population ages and lives longer.

“An increase in funding for GP visits to aged care facilities would result in many savings, including from reduced ambulance transfers to hospital emergency departments,” he said.

“Changes to after-hours care remuneration must consider services that are currently provided under ‘urgent’ item numbers to patients in aged care facilities.

“We also need to ensure that the critical role that nurses play in caring for older Australians is recognised in those facilities.”

On private health insurance, the President said affordability meant very little without value, and that the Government knows the issue is at crisis point.

“Australians want reasonable and simple things from their insurance,” he said.

“They want coverage. They want a choice of the practitioner, and a choice of the hospital. They want treatment when they need it.

“We can’t have patients finding out they aren’t covered after the event, or when they require treatment and it’s all too late…

“Australians do not support a US-style managed care health system. Neither does the AMA. One area we are disappointed with in the recent announcements is pregnancy cover.

“It does not make sense to us, as clinicians, to have pregnancy cover in a higher level of insurance only.

“Many pregnancies are unplanned – meaning people are caught out underinsured when pregnancy is restricted to high-end policies.

“Pregnancy is a major reason that the younger population considers taking up private health insurance.

“They are less likely to be able to afford the higher-level policies. We need to make sure it is within reach.

“And having female reproductive services at a different level to pregnancy coverage is, to us, problematic, and will leave a lot of people caught out.

“There will be much more to talk about as the private health reforms are finalised and bedded down.”

Dr Bartone’s full address to the National Press Club of Australia can be found at: media/dr-tony-bartone-speech-national-press-club

Whatever it takes to clear up ambiguity over My Health Record privacy concerns

During the Q&A segment of his National Press Club address, AMA President Dr Tony Bartone said promised a face-to-face meeting with Health Minister Greg Hunt to gain assurances the Government will take further steps to ensure the privacy and security of the My Health Record.

Dr Bartone said there had been a groundswell of concern from AMA members, the broader medical profession, and the public about the 2012 legislation framing the My Health Record, particularly Section 70, which deals with the disclosure of health information for law enforcement purposes.

“The priority of the AMA at all times has been to support the My Health Record, and its precursors, for the important clinical benefits it will deliver to doctors, patients, and the health system,” Dr Bartone said.

“The AMA has always been protective and vigilant about the privacy of the doctor-patient relationship, and this should not be affected by the My Health Record.

“Given the public debate, I support calls for the Government to provide solid guarantees about the long-term security of the privacy of the My Health Record.

“I will do whatever it takes to ensure that the security concerns are raised and cleared up as a matter of urgency.

“This may involve examining the legislation.”

Mr Hunt contacted Dr Bartone directly after the Press Club to set up a meeting to discuss all aspects of the rollout of the My Health Record.

CHRIS JOHNSON