AMA in the News

Your AMA has been active on policy and in the media on a range of issues crucial to making our health system better. Below is a snapshot of recent media coverage.

Print/Online

Medics to fix ‘fear’ culture, The Daily Telegraph, 4 April 2015

A change in the way doctors and nurses report abuse is needed to buck the scourge of sexual harassment and protect whistleblowers within the medical industry. AMA President A/Professor Brian Owler was committed to bringing about cultural change within the profession.

$8.40 more to see doctor, Herald Sun, 7 April 2015

Patients could be paying up to $8.40 for a visit to the doctor by 2018, more than they would have paid under the GP co-payment. AMA President A/Professor Brian Owler said the lazy policy would mean fewer patients would be offered bulk-billing.

Religious belief saw mum and baby die, The Daily Telegraph, 8 April 2015

The AMA has defended doctors at a top Sydney hospital forced to let a heavily pregnant woman and her unborn child die after the mother refused a blood transfusion because she was a Jehovah’s Witness. AMA Vice President Dr Stephen Parnis said doctors could not force a patient to accept treatment.

Not in the script – chemists selling your data, Sunday Mail Adelaide, 12 April 2015

Some chemists are selling their patients’ prescription information to a global health information company, which sells it on to drug firms, trying to boost their sales. AMA Chair of General Practice Dr Brian Morton called it an amazing invasion of privacy for purely commercial reasons.

Coalition’s ‘no jab, no pay’ policy ties benefits to immunisation, Australian Financial Review, 13 April 2015

Australian parents will lose thousands of dollars’ worth of childcare and welfare benefits if they refuse to vaccinate their children. AMA President A/Professor Brian Owler said the AMA backed the plan and said vaccination remained one of the most effective public health measures that we have.

Hospitals ‘storm’ warning, Adelaide Advertiser, 16 April 2015

The number of public hospital beds across Australia has fallen by more than 200 and no State has met emergency department targets. AMA President A/Professor Brian Owler said hospital performance benchmarks are not being met and things will only get worse as funding declines.

AMA hospital report card gives states fuel for fight, The Australian, 16 April 2015

Tony Abbott will face heightened pressure to reverse cuts of $80 billion to health and education, with a snapshot of public hospital performance handing the states fresh ammunition to press home their case. AMA President A/Professor Brian Owler will use the report to warn the Government that its extreme public hospital cuts are unjustified.

Church no longer exempt for jabs, Hobart Mercury, 20 April 2015

A religious exemption loophole, that allowed parents who opposed vaccinations to continue to receive childcare and family tax payments has been scrapped. AMA President A/Professor Brian Owler praised the move.

AMA warns against continued freeze on rebates, ABC News, 22 April 2015

AMA President A/Professor Brian Owler said at a time when the Government should be increasing its investment in general practice, the Medicare rebate freeze will eat away at the viability of individual practices.

Rape row over new anti-jab campaign, Adelaide Advertiser, 23 April 2015

A Facebook graphic on the Australian Vaccination Network site that compares vaccination to rape has been condemned by doctors, the Rape Crisis Centre, and politicians as abhorrent and insulting. AMA President A/Professor Brian Owler said the post undermines the organisation and shows lack of intelligence and common sense.

Doctors back review of Medicare rebates, West Australian, 23 April 2015

Doctors have backed a sweeping review of the Medicare Benefits Schedule, but warned the Federal Government not use it as an excuse to cut patient services. AMA President A/Professor Brian Owler agreed the MBS was outdated and said any savings from the review should be reinvested into the health system.

Aussie in sick new IS video, Sunday Herald Sun, 26 March 2015

The shocking new public face of Islamic State death cult is an Australian doctor. AMA President A/Professor Brian Owler said he was appalled that any medical professional would want to work for terrorists.

Transparency on dug company payments and trips a step closer, The Age, 28 April 2015

Patients will find out what payments and educational trips their doctors have received from drug companies. AMA Chair of General Practice Dr Brian Morton said it was insulting and naïve to suggest doctors would be unduly influenced by a free meal.

Terror doctor free to practise, Adelaide Advertiser, 28 April 2015

The Medical Board is refusing to deregister the former Adelaide doctor who left Australia to join the Islamic State terrorist group. AMA Vice President Dr Stephen Parnis said he expected the Medical Board to look closely at the case from legal and professional standards perspectives.

Scientists call for action on disease risks from climate change, Sydney Morning Herald, 30 April 2015

The Australian Academy of Science has released a report which shows a range of tropical diseases becoming more widespread in Australia due to climate change. AMA President A/Professor Brian Owler said the report should be a catalyst for the Abbott government to show leadership on reducing greenhouse gas emissions and mitigating their effects on health.

Radio

A/Professor Brian Owler, 774 ABC Melbourne, 7 April 2015

AMA President A/Professor Brian Owler talked about the decision to axe the proposed $5 Medicare co-payment in favour of an alternative Government plan to freeze the amount received by doctors in rebates.

Dr Stephen Parnis, 6PR Perth, 13 April 2015

AMA Vice President Dr Stephen Parnis discussed the use of the welfare system to boost immunisation rates. Dr Parnis said in the 1990s the Howard Government also linked immunisation to social security, which resulted in a big increase in vaccination rates.

A/Professor Brian Owler, Radio National, 16 April 2015

AMA President A/Professor Brian Owler discussed Federal funding for health. A/Professor Owler said the health system has never been adequately funded and doctors and nurses have done well to meet a rise in demand.

A/Professor Brian Owler, 2SM Radio, 16 April 2015

AMA President A/Professor Brian Owler talked about the use of paw paw for chronic back pain. A/Professor Owler said paw paw is a well-known treatment, but that people do not tend to use it as much nowadays.

A/Professor Brian Owler, 4BC Brisbane, 16 April 2015

AMA President A/Professor Brian Owler talked about the issue of health funding and the AMA Public Hospital Report Card. A/Professor Owler said the issue is capacity and resources, and that he is concerned about the future given reduced Commonwealth funding.

Dr Stephen Parnis, 2GB Sydney, 23 April 2015

AMA Vice President Dr Stephen Parnis talked about the recent Facebook post from the Australian Vaccination Skeptics Network, which compares forced vaccination to rape. Dr Parnis said the campaign shows how disgraceful and unhinged some anti-vaccination campaigners are.

A/Professor Brian Owler, 2UE Sydney, 28 April 2015

AMA President A/Professor Brian Owler talked about the Medical Board’s handling of the case of an Australian-registered doctor who has joined Islamic State. A/Professor Owler said he understands the Medical Board is working with security agencies to ensure that the public is safe, and to prevent any possibility of Dr Kamleh returning to Australia to continue practising medicine.

A/Professor Brian Owler, ABC NewsRadio, 30 April 2015

The Australian Academy of Science is warning of the impacts of global warming predicting food and water shortages, along with extreme weather events. AMA President A/Professor Brian Owler said climate change has been a political battleground and that Australia is not ready to cope with its impacts.

Television

A/Professor Brian Owler, Channel 9, 16 April 2015

AMA President A/Professor Brian Owler talked about the AMA’s Public Hospital Report Card. A/Professor Owler said many hospitals are not reaching targets in the emergency department treatment and elective surgery wait times.

Dr Stephen Parnis, Channel 9, 12 April 2015

AMA Vice President Dr Stephen Parnis talked about the Government’s announcement that childcare rebate payments will be cut for families who do not vaccinate their children. Dr Parnis said the children involved are innocent, and their futures need to be insured.

A/Professor Brian Owler, ABC News 24, 16 April 2015

AMA President A/Professor Brian Owler discussed the crisis in Australia’s public hospitals as Commonwealth funding is wound back. A/Professor Owler said the Commonwealth are not living up to their responsibilities to fund States and Territories properly to run hospitals.

A/Professor Brian Owler, Channel 9, 22 April 2015

AMA President A/Professor Brian Owler discussed welcoming the plans for a major review of the Medicare Benefits Schedule. A/Professor Owler said the review is clinician-led and is not just about finding savings.

A/Professor Brian Owler, Sky News, 29 April 2015

AMA President A/Professor Brian Owler discussed the future of the public hospital system if Federal Government cuts come into effect. A/Professor Owler said state governments lack the capacity to increase revenue to pick up the slack.

A/Professor Brian Owler, ABC News 24, 30 April 2015

AMA President A/Professor Brian Owler called on the Federal Government to show leadership on climate change or risk the health of Australians. A/Professor Owler said there was overwhelming scientific consensus that the climate is changing and there will be consequences for health.

Where are general practitioners when disaster strikes?

GPs, inevitably involved in disasters, should be appropriately engaged in preparedness, response and recovery systems

In the past two decades it is estimated that Australians have experienced 1.5 million disaster exposures to natural disasters alone.1 General practitioners are a widely dispersed, inevitably involved medical resource who have the capacity to deal with both emergency need and long-term disaster-related health concerns. Despite the high likelihood of spontaneous involvement, formal systems of disaster response do not systematically include GPs.

An Australian Government review of the national health sector response to pandemic (H1N1) 2009 influenza suggested: “General practice had a larger role than had been considered in planning”.2 It commented that “structures . . . in place to liaise with, support and provide information to GPs were not well developed”; personal protective equipment provision to GPs was “a significant issue”; and planned administration of vaccinations through mass vaccination clinics was instead administered through GP surgeries.2

GPs are well positioned to help

As of the financial year 2013–14, Australia had 32 401 GPs,3 distributed through rural and urban communities. GPs are onsite with local knowledge when disaster affects their communities. External assistance may be delayed, and the local doctor may be integral in initial community response and feel compelled to act, yet have a poorly defined role.

GPs can identify vulnerable community members, and are situated in local medical infrastructure with medical resources. When other agencies withdraw in the months after disaster, GPs remain, providing continuity of care, which is likely to be important at this time of high distress and medical need (Box 1). Primary health care during extreme events can support preparedness, response and recovery, with the potential to improve health outcomes.4 The challenge lies in linking GPs with the existing medical assistance response.

Australian GPs’ experience of responding to disasters

Australian GPs have a strong sense of responsibility and moral obligation to their patients. They have spontaneously demonstrated willingness and capacity to respond in recent disasters, including the 2011 Australian floods, the 2009 pandemic influenza, and recent bushfires. In interviews with 60 Tasmanian GPs, 100% of GPs surveyed intended to contribute to patient care in the event of a pandemic, with expression of a strong sense that to do otherwise was unethical, although this was dependent on provision of appropriate personal protective equipment.5

What is lacking is consistent support for GPs, their families and their practices. Local GPs may be personally affected and immersed in the disaster, or experience repetitive exposure to their patients’ trauma. Changes in patient presentations, workload, income and working conditions create additional stress, particularly if compounded by personal loss or injury.6 GPs involved in ad hoc spontaneous response may experience uncertainty of their role or efficacy, reluctance to stand down, or may prefer no involvement. GPs interviewed after the 2011 Christchurch earthquake noted experiencing “emotional exhaustion” and physical fatigue; some were aware of the need for personal care at the time, and others only in retrospect.6

Principles of disaster management

The principles of disaster management follow the internationally accepted all-hazards, all-agencies approach through the phases of prevention, preparedness, response and recovery (PPRR).7 Despite the variation in GP roles due to practice locations and context, the GP role in disaster management is most evident across the time frames of PPRR. As shown in Box 1, GPs provide continuity of care across these periods, but with the least consistency in the response phase.

Preparedness

Our discussions with key GP groups and leaders in the field suggest that despite a rapid increase in the number of practices engaging in disaster planning over the past year, most GPs are currently underprepared for disasters (Box 2). Lack of preparedness increases vulnerability. To redress this global problem, the World Medical Association recommends disaster medicine training for medical students and postgraduates. This could include education on existing disaster response systems, mass casualty triage skills, psychological first aid and the epidemiology of disaster morbidity in the first instance.

Response

In the response phase, it is important that GPs are aware of the overarching plan following the incident management system that coordinates multiple disciplines (including fire, police, ambulance and health) to respond to all types of emergencies, from natural disasters to terrorism. With this in mind, roles for GPs have previously included accepting patients from a neighbouring affected practice, assisting at other practices or with surges in hospital emergency department presentations and at GP after-hours services, or keeping patients out of hospitals through “hospital in the home” services. It may involve providing prescriptions and medical treatment in an evacuation centre, being included in medical teams such as St John Ambulance or identifying more vulnerable patients for evacuation assistance. Most importantly, GPs should maintain usual practice activities where possible. These response models are aligned with the range of GP skills and have clear operational requirements.

Recovery

GP involvement is imperative in the recovery phase, ensuring continuity of physical and psychosocial health care during the ensuing months to years. While most patients recover with minimal assistance, it is crucial that individuals in need of increased support are recognised, particularly those with pre-existing chronic disease. Some presentations may be related to particular hazards, eg, smoke inhalation after bushfire, but many others are risks regardless of the hazard. These include increased substance use, anxiety, depression, acute or post-traumatic stress disorder, chronic disease deterioration, and the emergence of new conditions, including hypertension, ischaemic heart disease and respiratory conditions.8 Children are particularly vulnerable, and changes in behaviour or school performance may indicate residual problems.

Support from general practice organisations (GPOs)

During the 2009 Victorian bushfires, Divisions of General Practice provided strong support to enable general practices affected by the fires to continue to offer health care, by providing human and material resources, skills training, advocacy and media liaison. During the 2013 New South Wales bushfires, there was strong GP linkage by the Nepean-Blue Mountains Medicare Local to existing systems through the Nepean Blue Mountains Local Health District and the state health emergency operations centre, as well as to GPOs at a state level. Lessons learnt need to be incorporated into systems planning.

The need for unified disaster planning is increasingly recognised at both individual GP and GPO levels. The General Practice Roundtable, with input from all the major GPOs, has diverse GP representation, providing an opportunity for broad input into disaster planning across PPRR. Important recent initiatives by GPOs include position statements for GPs,9 and ongoing development of disaster resources, promotion of general practice disaster planning, and the recent formation of a national Disaster Management Special Interest Group within the Royal Australian College of General Practitioners.

Where to from here?

Disasters are devastating events and by nature are unpredictable. While recognising and acknowledging the critical role of the formal emergency response agencies in the existing system of specialised health response and management, the strength of general practice lies in the provision of comprehensive continuity of care, and this lends itself to greatest involvement in the preparedness and recovery phases. There is a need for a clear definition of roles in the response stage. GPs as local medical providers in disaster-affected communities need to be systematically integrated into the existing stages of PPRR with clear responsibilities, lines of communication, and support from GPOs, avoiding duplication of other responders’ tasks. Valuing and using the expertise and resources that GPs can bring to disasters may improve long-term patient and community health outcomes.

1 Current defined roles for general practitioners in disasters

2 Potential roles for general practitioners and GP-related groups in disasters

Prevention and preparedness — before the disaster

national position on the role of GPs in disasters across PPRR;
clearly defined roles that integrate with other responding agencies;
GPO representation on national, state and local disaster management committees;
unified disaster planning across GPOs through the GPRT;
information for other agencies on GPs’ skills and roles through the GPRT and GPOs;
education and training in core aspects of disaster medicine for GPs and medical students;
involvement of local GPs in local disaster planning and exercises through ML or PHN;
general practice business continuity and disaster response practice planning;
assisting patient preparedness to reduce vulnerability;
GP personal and family preparedness; and
vaccination, infection control measures and surveillance in infectious events.

Response — during the disaster

representation in EOCs for communication and coordination with other responders (including ambulance, mental health, public health, etc);
unified disaster response from GPOs, including information, resources and phone support;
coordination through GP networks for workforce support for affected practices;
clearly defined integrated roles in existing systems for GPs involved in response, such as:
- maintaining usual practice activities where possible to help surge capacity
- expanding practice capacity to treat extra patients if needed
- expanded use of practice infrastructure, medical resources and trained staff as appropriate
- supporting existing medical teams such as St John Ambulance
- assisting at the scene, evacuation centre or local clinic as appropriate;
assistance in identification of potentially vulnerable and at-risk individuals and families;
ongoing communication with and referral between other local primary care health providers;
patient education on hazard-related health matters, eg, asbestos, infectious outbreaks, etc;
preventive vaccination — tetanus (clean-up injuries); and
surveillance for future outbreaks and emerging community disease threats.

Recovery — after the disaster

inclusion in the review process to improve future PPRR;2
representation on recovery committees to improve interagency referral and communication;
ongoing support from GPOs for affected GPs and staff through regular contact and resources;
GPOs and ML or PHN support for those practices that are more affected;
management of deterioration of pre-existing physical and mental health conditions;
surveillance for new physical and psychological conditions to improve patient outcomes;
surveillance for emerging community disease threats; and
linkage and communication with community groups and allied health on recovery activities.

EOC = emergency operations centre. GPO = general practice organisations. GPRT = General Practice Roundtable. ML = Medicare Locals. PHN = Primary Health Networks. PPRR = prevention, preparedness, response and recovery.

The Sydney siege: courage, compassion and connectedness

To the Editor: Raphael and Burns highlighted the strong police response to the hostage situation in Sydney in 2014.1 Diversionary devices, such as the flash-bang grenades used in Sydney, have been increasingly used to distract and disorientate people in civilian hostage and riot situations internationally. While not intended to cause permanent damage, there are risks associated with their use.

Flash-bang grenades deflagrate using a powdered blend of aluminium, magnesium and ammonium perchlorate, which generates a spontaneous explosion. When initiated, illumination is produced through oxidation of the components, resulting in heat exceeding 38°C, a blast reaching 180 decibels and a brief flash of 1–6 million candela (up to 600 million lux) within a distance of about 1.8 m.2

The intense flash results in temporary bleaching of the photoreceptors in the eye. Ocular injury can occur if the flash-bang grenade explodes at close range, with possible thermal or mechanical damage. Other more powerful devices, producing a similar intensity of unidirectional light, have resulted in vision loss similar to that seen with laser weapons.2

Temporary hearing loss and aural pain results from a single or multiple blast of loud noise between 140 and 170 decibels. Damage to the sensitive structure of the inner and middle ear can result in hearing loss and tinnitus.3 Perilymphatic fistula of the inner ear may occur, necessitating immediate assessment and possible surgical treatment.4

Premature deflagration can also cause injury to the operator.5 As these devices continue to be used in civilian situations, it is important to remain aware of any potential hazards, to both the operator and bystanders.

Mini Cooper S Restoration Part 3

After spending so much time, energy and money on the restoration of the Mini Cooper S, it’s great to see that it’s finally on the home stretch.

With the re-built engine installed and running it’s now time to add some of the finishing touches.

Forty-five years of UV light and wear and tear can take its toll on all of the window and door rubbers, but fortunately they are all still available for purchase at $600 for a full set.

The seats have been re-upholstered, and the cabin is all back in one piece at last.

So, it’s finally time to take the Mini back out on the road.

The engine ticks over nicely and, with the gearbox completely re-conditioned, everything should be as good as new.

But alas, there is a problem.

The gears aren’t changing freely, and it’s necessary to double de-clutch on every change.

That means slightly revving the engine in neutral to try to match the revolutions of the input and output shafts, particularly when down-shifting.

How could this be? After all, the Mini had a brand new clutch.

Further investigation revealed that the culprit was a worn clutch pedal pivot bush.

The movement in the loose bush meant that, even when the clutch pedal was fully depressed, the other end of the shaft just wasn’t moving through its full range of movement and, therefore, the clutch was not fully disengaging.

Once discovered, it was a simple fix for a problem too subtle to spot on the re-build.

So what was the Mini like on the road?

Well, frankly, just a little disappointing!

It is, after all, a 45-year-old design which lacks all of the modern engineering that makes 2015 cars feel so refined and smooth.

There’s no power steering, no air conditioning and the performance is sluggish compared to a modern turbo-powered car.

In the event of an emergency there is no ABS, no airbags or crumple zones and crashing in a Mini was never meant to be injury-free.

So, for a total investment which could have bought a fairly new hot hatch, was the whole job worthwhile?

Well yes, I think so.

Because restoring the Mini was never about making a profit.

It was about restoring a piece of motoring history and bringing the little car back to its full glory, just like it was when it left the factory.

Would my friend tackle the whole job again?

He’d have to think about that.

PS Once completed my friend reluctantly decided to sell the Mini.

It didn’t last long on carsales.com.au, and the new owner really didn’t pay a premium for all the time and effort that had gone into the restoration.

He mentioned that he was thinking about changing a few things on the car, like installing a stereo system.

Expecting that might happen, my friend advised the new owner that he’d pre-wired the car for whatever stereo he might install, but he also warned the new owner that whatever he did from here that changed the car from its original stock build would de-value it.

Proving the point that it’s often better to leave things alone and stick with the original, particularly if it has stood the test of time.

Safe motoring,

Doctor Clive Fraser

1970 Mini Cooper S

Engine: 1275cc 4 cylinder OHV

Power: 45 kW @ 5550 rpm

Torque: 91 Nm @ 3000 rpm

0-100 km/h in 12 seconds

Top speed 148 km/h

7.3 l/100km

Patients face longer delays as ‘perfect storm’ set to hit stressed public hospitals

Patients face increasingly lengthy waits for hospital care as the Federal Government squeezes funding despite rising demand, creating a “perfect storm” for the nation’s hospitals, AMA President Associate Professor Brian Owler has warned.

As Prime Minister Tony Abbott prepares to meet with State and Territory leaders tomorrow, the AMA’s annual Public Hospital Report Card, released today, shows that, despite the best efforts of doctors and other health professionals, who are working increasingly efficiently and effectively, hospitals are struggling to meet the needs of an expanding and ageing population.

In a clear sign of a system under stress, the national median waiting time for elective surgery has remained stuck at historically high levels.

For the fourth year in a row, patients waited an average of 36 days for elective surgery in 2013-14, almost 10 days longer than they were a decade earlier.

Meanwhile, less than 80 per cent of category 2 patients were admitted within the clinically recommended time of 90 days last financial year, well short of the national target.

Evidence of the strain on public hospitals is set to add to the pressure on Mr Abbott when he meets the nation’s premiers and chief ministers at the Council of Australian Governments in Canberra tomorrow.

Treasury has admitted that Commonwealth funding cuts unveiled in last May’s Budget and December’s Budget update will strip $57 billion from public hospitals between 2017-18 and 2024-25.

The cuts have outraged the premiers who, led by NSW Premier Mike Baird, intend to press Mr Abbott at the COAG meeting to restore the funds.

A/Professor Owler said the States and Territories were facing “a huge black hole in public hospital funding after a succession of Commonwealth cuts”.

“The hospital funding blame game is back, and bigger than ever. Public hospitals and their staff will be placed under enormous stress and pressure, and patients will be forced to wait longer for their treatment and care,” he said. “Funding is clearly inadequate to achieve the capacity needed to meet the demands being placed on public hospitals.”

A/Professor Olwer warned that “a perfect storm” was building ahead of new, lower indexation arrangements for Commonwealth public hospital funding due to come into effect from 2017-18 that will reduce funding from its already inadequate levels, further hampering performance and undermining patient care.

“State and Territory Governments, many of which are already under enormous economic pressures, will be left with much greater responsibility for funding public hospital services,” he warned. “Performance against benchmarks will worsen and patients will suffer. Waiting lists will blow out.”

The AMA said the situation in the nation’s public hospitals was already even worse than the data in the Report Card suggested.

It said official figures disguised the true length of delays that elective surgery patients faced because they only started to count waiting time from when the patient saw their specialist, rather than from the time of referral by their GP.

“This means that the publicly available elective surgery waiting list data actually understate the real time people wait for surgery,” the Report said. “Some people wait longer for assessment by a specialist than they do for surgery.”

Much of this is due to an inadequate number of beds and the staff to serve them.

The AMA’s analysis has found that hospitals have proportionately far fewer beds than they did 20 years ago, contributing to lengthy waits in emergency departments and for elective surgery.

The number of beds per 1000 people fell to just 2.57 per cent in 2012-13, down from 2.62 the previous year, and shows no sign of improving.

Among those most likely to need hospital care, the picture is just as bleak. The number of beds for every 1000 Australians aged 65 years and older has reached a record low of 17.5, a massive 56 per cent decline since the early 1990s.

“Public hospital capacity is not keeping pace with population growth, and is not increasing to meet the growing demand for services,” the report said.

A/Professor Brian Owler said the results showed that, even before the latest massive Federal Government funding cuts bite, public hospital performance was already being hit by inadequate resources.

In last year’s Budget, the Government announced measures that will rip $20 billion out of hospital funding in coming years, including the renunciation of spending guarantees and cut in funding indexation to the inflation rate plus population growth. These cuts were compounded late last year by a further $941 million reduction in spending over the next four years.

A/Professor Owler warned the funding cutbacks would entrench sub-par hospital performance.

“If it proceeds with its savings measures, the Commonwealth will lock in hospital funding and capacity at the inadequate levels demonstrated by current performance,” the AMA President said. “Without sufficient funding to increase capacity, public hospitals will never meet the targets set by governments, and patients will wait longer for treatment.”

The Government has argued budget cuts are necessary because health spending is growing unsustainably.

But A/Professor Owler said total health expenditure actual shrunk in 2012-13, and Commonwealth support was now “well short of [what is needed] to position public hospitals to meet increasing demand”.

The AMA Public Hospital Report Card 2015 can be viewed at the AMA website: ama.com.au

Adrian Rollins

GP training confusion: call for urgent talks

The AMA has voiced “grave concerns” about the Federal Government’s handling of far-reaching changes to general practitioner training under the shadow of looming doctor shortages.

AMA President Associate Professor Brian Owler has written to Health Minister Sussan Ley seeking an urgent meeting to discuss the implementation of changes to GP training announced in last year’s Budget.

A/Professor Owler warned the Minister that the medical profession was “fast losing confidence in the process, and history shows that the last time GP training was reformed by the Government it took many years to recover”.

In its 2014-15 Budget, the Federal Government abolished General Practice Education and Training (GPET) and the Prevocational General Practice Placements Program (PGPPP), axed funding to the Confederation of Postgraduate Medical Education Councils and absorbed Health Workforce Australia and GPET within the Health Department.

Under the sweeping changes, the Health Department will have responsibility for overseeing GP training.

The changes have stoked warnings that, combined with cuts to valuable programs and fears of massive hikes in student fees, they pose a serious risk to the quality and viability of general practice training, placing the profession at long-term risk.

Concerns have centred on the short time frame to implement the changes, the Department’s lack of experience in managing training programs, and the profession’s loss of supervision over training.

A/Professor Owler said expert AMA representatives who have been consulting with the Government and Health Department on the implementation of the changes have been alarmed by on-going delays and a lack of detail being provided by the Department on crucial matters such as the funding of professional oversight and governance arrangements.

“Unfortunately, we are now in a position where we simply do not know what the structure and delivery of GP training will look like beyond 2015,” the AMA President said in his letter to Ms Ley.

He said briefing papers provided by the Health Department for those attending its stakeholder meetings were “generally scant on detail and do not adequately deal with key issues, such as the future role of the GP Colleges”.

A/Professor Owler said the overwhelming view in the medical profession was that the Colleges should be given responsibility for the governance and management of GP training.

Anxiety about the changes has been heightened by predictions the nation could face a critical shortage of doctors in the next decade.

The ageing of the GP workforce and the struggle to attract students to specialise in general practice has contributed to forecasts of a shortfall of 2700 doctors by 2025 unless there is a major investment in training.

Last month Health Minister Sussan Ley re-announced the allocation of $157 million to extend the life of two medical training programs – the Specialist Training Program and the Emergency Medicine Program – through to the end of 2016.

Ms Ley said the programs were being sustained for an extra year while the Government continued to consult with the medical Colleges and other stakeholders about reforms to come into effect in 2017.

“This consultation will focus on in-depth workforce planning to better match investments in training with identified specialities of potential shortage and areas that may be over-subscribed into the future,” the Minister said. “Workforce planning is something that doctors and health professionals have been raising with me during my country-wide consultations to ensure those areas of expected shortages are addressed sooner rather than later.”

But Shadow Health Minister Catherine King condemned what she described as a “short-term fix”.

Ms King said the Government had thrown the entire field of specialist medical training into chaos by delaying confirmation of contracts just weeks before candidate interviews were due to commence.

Ms King warned that any cut to funding to specialist training would result I fewer specialists working in areas where they are needed most.