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Preference: Administration and Health Services

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GPs are tops – ABS latest stats

Australians still love their local doctors.

At least that is the finding of the latest Australian Bureau of Statistics (ABS) data, which shows that patients around the nation are satisfied with their GPs.

The ABS’s latest Patient Experiences in Australia Survey reinforces previous findings that Australia’s dedicated GPs are meeting increasing demand and providing quality services.

GPs attracted a very high satisfaction rating from patients in the survey.

The survey produced positive results for medical specialists and emergency department doctors as well, but GPs are the doctors who have the most frequent contact with patients.

According to the survey, 83 per cent of Australians saw a GP in the last 12 months and around 78 per cent of patients have a preferred usual GP.

AMA President Dr Michael Gannon described the results of the survey as outstanding.

“Importantly, the proportion of people waiting longer than they felt acceptable for a GP appointment decreased from 23 per cent in 2013-14 to 18 per cent in 2016-17,” Dr Gannon said.

“Of those who patients who saw a GP for urgent medical care, 75 per cent were seen within 24 hours of making an appointment.

“The survey shows that cost is not a barrier to accessing GP care, with only 4 per cent of respondents saying that they at least once delayed seeing a GP or did not see a GP when needed due to cost.

“Of those patients who saw a GP in the last 12 months, 92 per cent reported that the GP always or often listened carefully to them, 94 per cent reported that their GP always or often showed them respect, and 90.6 per cent reported that their GP always or often spent enough time with them.

“These results are outstanding when you consider the pressure under which our GPs are working today.”

Dr Gannon said GPs are a critical part of the health system, and they must be valued and supported.

General practice remains under significant funding pressure due to cuts by successive governments, he said, but GPs continue to provide high quality and accessible primary care services across the country.

“When people are sick, they want to see a GP,” Dr Gannon said.

“As the Government looks to shape the future of our health system, it needs to build its investment in general practice, which remains the most cost effective part of the system.”

CHRIS JOHNSON

 

AMA PHN member survey

In response to the recommendations of the Hovarth Review into Medicare Locals (the Hovarth Review), the Government established 31 Primary Health Networks (PHNs) across Australia, commencing in July 2015. These replaced Medicare Locals (MLs) that were established by the previous Labor Government.

The fundamental purpose of PHNs is similar to that of their predecessors “to facilitate improvements in the primary health system, promote coordination and pursue integrated health care.” However, GPs are expected to play a more central role in PHNs than they did in MLs. PHNs are also expected to focus more on improving the linkages between primary and hospital care.[1][2]

In 2013, leading up to the Hovarth Review, the AMA conducted a survey of GP members to gauge their views on the performance of MLs. More than 1,200 GPs participated in that survey, with members particularly critical of  their engagement with GPs and the extent to which many had failed to help improve patient access to primary care services. This survey formed the basis of AMA submission to the Hovarth Review, which recommended significant reforms including a more central role for GPs.

The AMA recently conducted a similar survey to provide members with the opportunity to give us their views on the performance of PHNs to date. Participants were provided with a number of statements and, were asked to select the options (strongly agree, mostly agree, neither agree or disagree, mostly disagree, or strongly disagree) that best reflect their opinion.

A total of 399 GPs participated in the survey, which represents a much smaller sample size than the 2013 survey. Nonetheless, it does provide a snapshot of the views of those members who participated in the survey and the results should be used to provide helpful guidance on areas where PHNs need to increase their focus.  

The survey results are summarised as follows:

Understanding of the role and functions of PHNs:

  • 61.5 per cent of respondents indicated that they have a reasonable understanding of the role and functions of PHNs (comparative data is not available for MLs).
  •  Information about activities and services:
  • 47.9 per cent of GPs surveyed believe they have not been kept informed about the work their PHN is undertaking and the services it supports (48.9 per cent for MLs).
  • GPs access to information and events of relevance:
  • 51.4 per cent indicated that they have not been provided with information and access to events of relevance to day to day practice (57.8 per cent for MLs).
  • PHN engagement with local GPs:
  • 62.6 per cent indicated that their PHN had failed to engage and listen to them about the design of health services needed in the local area (68.8 per cent for MLs).
  • Practice staff access to useful and effective education and resources:
  • 46.3 per cent of GPs surveyed indicated that their practice staff have not been provided with access to useful and effective education and resources (comparative data is not available for MLs).
  • Valuing GP contribution:
  • 52.8 per cent believed that their PHN does not value or recognise the inputs of local GPs (60.8 per cent for MLs).
  • Timing of meetings and information sessions:
  • 46.1 per cent indicated that their PHN was holding meetings and information sessions at times that were not easily attended (52.4 per cent for MLs).
  • Supporting targeted programs for disadvantaged groups:
  • 50.6 per cent indicated that their PHN has not been supporting well targeted programs that could help patients, particularly those who are disadvantaged (comparative data is not available for MLs).
  • Facilitating services that complement existing general practice:
  • 52.8 per cent indicated their PHN is not focused on facilitating services that complement existing general practice services s (comparative data is not available for MLs).
  • Practice support for MyHealth Record:
  • 57.4 per cent indicated that their PHN had not provided effective support for practices to implement the MyHealth Record (56.6 per cent for MLs re PCEHR).
  • Access to psychological services:
  • 48.0 per cent indicated that their PHN had failed to improve patients’ access to psychological services (48.9 per cent for MLs regarding improved Access to Allied Psychological Services (ATAPS)).
  • Accessible mental health services for ATSI patients:
  • 35.5 per cent of GPs surveyed indicated that their PHN had not facilitated appropriately funded and accessible services to meet the mental health care of Aboriginal and Torres Strait Islander (ATSI) patients (comparative data is not available for MLs).
  • Delivery of mental health and suicide prevention services and supports to ATSI patients:
  • 43.3 per cent of GPs surveyed indicated that their PHN had not been able to improve the delivery of mental health and suicide prevention services and support to ATSI patients (comparative data is not available for MLs).
  • Access to services for patients requiring mental health care, but who are not eligible for National Disability Insurance Scheme (NDIS) packages:
  • 52.7 per cent indicated that their PHN had been ineffective in facilitating for the needs of patients requiring mental health care, but who are not eligible for NDIS packages (comparative data is not available for MLs).
  • Psycho-social supports for patients with mental health problems:
  • 55.9 per cent indicated that their PHN had been unable to ensure effective and timely psycho-social supports to patients with mental health problems (comparative data is not available for MLs).
  • Overall PHN performance:
  • 58.0 per cent indicated that their PHN had not improved local access to care for patients (73.0 per cent for MLs).
  • Overall delivery of primary care:
  • 62.6 per cent indicated that their PHN had not improved the capacity to deliver better quality healthcare overall (71.6 per cent for MLs).

PHNs have an important role to play in improving the integration of health services within primary health care, enhancing the interface between primary care and hospitals, and ensuring health services are tailored to the needs of local communities. They have the potential to have a strong impact on aged care services, mental health outcomes, chronic disease management, Indigenous health services, and services for the disadvantaged.  

The AMA believes that for PHNs to be successful they must: have a clear purpose, with clearly defined objectives and performance expectations; be GP-led and locally responsive; focus on supporting GPs in caring for patients and working collaboratively with other health care professionals; have strong skills based Boards; be appropriately funded to support their operations, particularly those that support the provision of clinical services; focus on addressing service gaps, not replicating existing services; not be overburdened with excessive paperwork and policy prescription; and be aligned with Local Hospital Networks (LHNs), with a strong emphasis on improving the primary care/hospital interface. [3]

They should focus on the following areas:

  • Population Health – Identifying community health needs and gaps in service delivery; identifying at-risk groups; supporting existing services to address preventive health needs; and coordinating end of life care.
  • Building General Practice Capacity – Supporting general practice infrastructure to deliver quality primary care through IT support; education and training of practices and staff; supporting quality prescribing; training to support the use of e-Health technology and systems; enhancing practices capacity and capabilities to embrace the principles in being a medical home to their patients, and facilitating the provision of evidence-based multidisciplinary team care.
  • Engaging with Local Hospital Networks (LHNs)/Districts – Identifying high risk groups and developing appropriate models of care to address their specific health issues (e.g. those at high risk of readmissions, including non-insulin-dependent diabetes mellitus, congestive cardiac failure, chronic obstructive pulmonary disease, and other chronic diseases); and improving system integration in conjunction with local health networks.[4]

Given that PHNs are still a relatively new feature on primary care landscape, the jury is still out on the performance of PHNs. The AMA believes that they should be given every chance to succeed and intends conducting the same survey in a couple of years’ time to see how much of a difference they are making for GPs and their patients.

Dr Moe Mahat
Manager Policy
AMA General Practice Section

[1]Ducket et al (2015) Leading change in primary care: Boards of PHNs can improve the Australian health care system.

[2] Prof. John Hovarth AO (2014) Review of Medicare Locals: Report to Minister for Health and Minister for Sport.

[3] AMA Position statement Primary Health Networks 2015  position-statement/primary-health-networks

[4] Op Cit.

Federal Council communiqué – meeting of 17 and 18 November

Federal Council met in Canberra on 17/18 November. The meeting came in the midst of the political uncertainty arising from measures to deal with the citizenship status of federal politicians, the voluntary assisted dying debates in the parliaments of Victoria and NSW, and the strong majority poll in favour of same sex marriage reform announced during that week. 

The President reported on his activities over the past three months since the last meeting of Council in August. Among the highlights were his attendance at the meeting of Confederation of Medical Associations in Asia and Oceania (CMAAO) in Tokyo in September and the Council meeting and General Assembly of the World Medical Association (WMA) in Chicago in October. The WMA adopted a modernised version of the Declaration of Geneva which was also adopted by Federal Council at its November meeting.

The Secretary General’s report focused on the breadth of submissions, Parliamentary committee appearances, and inquiries to which the secretariat has responded in the last few months, continuing a trend observed throughout 2017.

These included a submission on the security of Medicare cards; several reviews of training funding arrangements and workforce distribution; improving Medicare compliance; secondary use of Medicare data; coordinated advocacy with State and Territory AMAs to change the requirements for mandatory reporting under the National Law; medical indemnity changes; codeine scheduling changes; and ongoing negotiations with Minister Hunt on several issues including the future funding of after hours GP services.

The AMA’s engagement with the MBS Review process and the Private Health Ministerial Advisory Committee continue. Federal Council noted the release by Minister Hunt during October of the first tranche of reforms to private health insurance. Key reform areas remain under review including the scope of benefit cover in the proposed gold, silver, bronze, and basic policies; insurance cover of private patients in public hospitals; and a process to improve transparency of medical fees and out of pocket costs. This latter subject was a focus for discussion by the Council in one of its two policy sessions.

In considering an approach to improved transparency of medical fees and out of pocket costs, Federal Council noted the Government’s proposal to establish an expert working group to consider the most effective way to communicate medical fees and out of pocket costs. Federal Council also noted that informed financial consent was key but not uniformly practiced. Federal Council reiterated its position statement in support of doctors charging an amount appropriate to the service and the patient, while condemning excessive charging. Federal Council agreed principles to guide AMA input into the expert working group.

Federal Council noted the array of AMA’s public health advocacy including an appearance before a parliamentary inquiry into e-cigarettes and consideration of the AMA’s broader tobacco advocacy. Federal Council approved two public health position statements, one dealing with nutrition and the other, road safety. The Council passed unanimously a motion calling on greater transparency of the conditions under which the asylum seekers and refugees on Manus Island are being held and offering an independent assessment by doctors of the health situation.

Continuing areas of public health policy attention include men’s health, sexual diversity and gender identity, and social determinants of health. A new working group was established to review the AMA position statement on drugs in sport.

Federal Council received a presentation from Scott McNaughton, General Manager of Participation Pathway Design with the National Disability Insurance Agency (NDIA) in the second policy session. Councillors were interested to learn about the role of medical practitioners in providing NDIS assessments; and the processes to access appropriate medical and psychosocial supports for people with mental illness. The presentation provided essential information and highlighted the steps underway by NDIA to fully implement the NDIS.

The Equity, Inclusion and Diversity Committee of Council reported that it proposes to publish an annual report on progress to achieve equity, inclusion, and diversity in the AMA.

Federal Council received a report on the successful forum in October on reducing the risk of suicide in the medical profession which was convened jointly by Federal AMA, AMA NSW and Doctors Health Services Pty Limited. The two key themes that came from the forum were the impact of culture and the need for compassion. A full report will be published in due course.

At the conclusion of the meeting the Secretary General reminded Federal Council that 2018 is an election year for positions on the Council, with a call for nominations to go out to all voting members in February. Federal Council draws its standing from its representative structure, with representation of members from across the country, and all specialties and stages of practice.

Dr Beverley Rowbotham
Chair Federal Council

Fees List finalised

The AMA List of Medical Services and Fees 2017 has been finalised, with a single indexation rate of 1.86 per cent across all fees, to take into account the rising costs of running a practice.

“Practice costs – such as wages for staff, rent, electricity, computers, continual professional development, accreditation, and indemnity insurance – have all increased, and must be met from the fees charged by the medical practitioner,” AMA President Dr Gannon said.

“The Government has frozen its contribution toward the cost of medical care – the patient’s Medicare rebate – since 1 July 2014, but the cost of providing that care has continued to rise.

“As a result, today there is a significant difference between the AMA fees – which reflect the real cost of providing care – and the Medicare rebates.

“Medical practices can’t absorb these increasing costs for five years in a row. They have to increase their fees – and without an increase in the Medicare rebate, patients will have to pay more out of their own pockets.”

This year’s 1.86 per cent rise is lower than last year’s average rise of 2.35 per cent.

The Fees List is now available online at: https://feeslist.ama.com.au/

EU driving e-health

Estonia, which is coming to the end of its presidency of the Council of the European Union, has recently sought to bring together EU countries that would be willing to launch a project concerning the cross-border movement of healthcare data.

The Digital Health Society, initiated by the Estonian Presidency of the Council of the European Union and ECHAlliance, have assembled an e-Health Declaration that includes more than 100 European organisations’ proposals for developing e-health in Europe.

The Declaration describes the bottlenecks that hamper the development of e-health, such as the lack of people’s trust in e-services in Europe, the lack of interoperability between different information systems, the lack of a clear legal framework, inadequate training of health-care professionals. Proposing solutions for overcoming these obstacles, the document emphasizes the need for unified approaches to the development of data exchange infrastructure, raising people’s awareness of the use of e-health solutions and implementing the European Union Data Protection Regulation in a way that it does not create unnecessary obstacles to the free flow of data between member states.

At the recent e-health conference held in Estonia, European Commissioner for Health and Food Safety Vytenis Andriukaitis called for a strong partnership within the EU to move towards simplified public e-services and formalities.

This would make interactions between citizens and public administrations easier.

“Let us all work together with governments, health professionals, businesses, and researchers, but above all with the patients to make digital health in Europe a reality,” he said.

Central to the EU’s agenda on digital innovation in healthcare is: the right of citizens to access, manage and control their health data electronically in a convenient and secure manner; to better use health data, in particular for research and innovation purpose; and the better use of health data, in particular for research and innovation purposes.

Clemens Martin Auer, Director General of the Austrian Federal Ministry of Health and Women’s Affairs, said that using the opportunities of information technology in healthcare, or e-health, is one of the most important innovative drivers in the healthcare sector: “Especially for organizing the continuous care in the fragmented world of healthcare services.”

The EU acknowledges that at that level, although health competence remains the responsibility of each member state, there is a goal for a common understanding to be formed into an agreement that fixes common components and common infrastructure that enables the free flow of health data.

A number of European member states have already designed their healthcare system in order to digitalise data. The remaining member states should implement strategies and policies for the creation of electronic health records across their country in order to stimulate the innovation for health and exchanges data with other EU countries.

MEREDITH HORNE

[Comment] Estimating abortion safety: advancements and challenges

In The Lancet, Bela Ganatra and colleagues1 present an innovative and important analysis of global abortion safety, in which they attempt to move beyond the binary understanding (safe or unsafe) of abortion safety. As the availability of misoprostol increases, and abortion telemedicine services reach more women worldwide, fewer women are undergoing abortions with invasive or outdated methods and more women are having abortions outside of formal health-care systems.2 These changes prompt a need for rethinking how we view and measure abortion safety.

What do you want from your CPD?

 

Although continuing professional development (CPD) is a requirement of your medical registration, it’s not always easy to fit it into a busy practice life. At doctorportal Learning, we want to get a clearer idea of how we can best tailor our comprehensive CPD offering to your needs. To do that, we’ve put together a medical education survey that you should have already received in your inbox.

The survey should only take you around 15 minutes to complete. It will help us understand your CPD motivations and preferences in terms of access, pricing, learning interests and other key areas. We’ll use this information to better match our offering to your needs and help you meet your medical education requirements as easily as possible.  An example of how new content responds to feedback is doctorportal Learning’s soon to be launched online CRANA Plus Advanced Life Support course. Requested by members, it’s the only completely online, accredited delivery of ALS certification in Australia and supports time poor and remotely located professionals who need to access this often mandatory piece of learning.

We’d appreciate if you could complete the survey by 10th of January, 2018. If you have any questions, please don’t hesitate to contact our team at memberservices@ama.com.au, or by phone on 1300 133 655.

[Series] Public health information in crisis-affected populations: a review of methods and their use for advocacy and action

Valid and timely information about various domains of public health underpins the effectiveness of humanitarian public health interventions in crises. However, obstacles including insecurity, insufficient resources and skills for data collection and analysis, and absence of validated methods combine to hamper the quantity and quality of public health information available to humanitarian responders. This paper, the second in a Series of four papers, reviews available methods to collect public health data pertaining to different domains of health and health services in crisis settings, including population size and composition, exposure to armed attacks, sexual and gender-based violence, food security and feeding practices, nutritional status, physical and mental health outcomes, public health service availability, coverage and effectiveness, and mortality.